TMJ

Question 1

TMJ is what type of joint?

Answer 1

Synovial

Bi-convex mandible with saddle shaped temporal bone and meniscus to help stabilize

Question 2

TMJ movement?

Answer 2

> 1 plane

inferior and anterior

Question 3

LEFT lateral and medial pterygoid action at mandible

vice versa for right

Answer 3

Moves mandible lateral and forwards to the RIGHT

Question 4

Is TMJD an intracapsular or extracapsular disease/dysfunction

Answer 4

Extracapsular

Question 5

What muscles depressmendible?

Answer 5

Digastric and suprahyoid (initally)

Then pterygoids take over

Question 6

Malocclusions - 1st molars

Class 1, 2, 3

Answer 6

Clas 1 - 1st molars normal, irregularities elsewhere
Class 2 - lower 1st molar post to upper (overbite)
Class 3 - lower 1st molar ant to upper (underbite)

Question 7

Muscles that close jaw (3)

Answer 7

temporalis, masseter, medial pterygoid

Question 8

Active motion - deviation types
Normal - mouth fully open (cm)
Normal - mandible lateral movement (cm)

Answer 8

C and S
Vertical - 3-6cm
Lateral - 1-2cm

Question 9

Is a C shaped deviation is a uni or bilateral problem?

If jaw first deviates to the R and then to the L, what side is the dysfunction on?

Answer 9

Unilateral

Right muscle dysfunction - its tightness pulls it woards the R

Question 10

Is a S shaped deviated a bilateral or unilateral muscular imbalance?

Answer 10

Bilateral

Question 11

ME for C shaped deviation
Patient - body and mouth position
Doc contacts what bone on what side?

Answer 11

Patient supine with mouth slightly open.

Doc’s palm contacts mandible on deviated side.

Question 12

Isometric Excercises for S Shaped Deviations

Answer 12

1. Warm towels for 10-15 min over TMJ
2. Pt resists own motion - mandible depression, closures, lateral deviation, protrusion
   - 20-30 sec of resistance
   - Sets of 10, 2x/day

Question 13

Myofascial stretch - types (4)

Answer 13

B/L stretch
Unilateral stretch
Accessory motion stretch
Pterygoid fascial stretch

Question 14

Bilateral Stretch - 
Patient position
Doc contacts what
Force is what direction
Modified to treat what?

Answer 14

Patient supine.
Doc contacts mandible bilaterally.
Force of stretch is CAUDAD.
Tissue tension in all planes

Question 15

Unilateral Stretch - 
Patient body and head position
Doc position and hand contacts what
Direction of stertch
Modified as needed to address what?

Answer 15

Patient supine with head turned away from dysfunction side (dysfunction side up).
Stretch is in CAUDAD.
Other motion barriers.

Question 16

Accessory motion stretches

Answer 16

direct MFR for each accessory motion.

Question 17

Pterygoid Fascial Stretch
Patient position
Doc does what?
Force in what direction and until what?

Answer 17

Patient is supine with doc sitting or standing at head of table WEARING GLOVES.
Doc places little finger along upper molars, sliding posteriorly until pterygoid fascia is engaged.
Force is LATERAL and SUPERIOR.

Question 18

Reduction of anterior disc.
patient position
Doc grasps what bone on what side? 4th and 5th fingers go where, 2nd and 3rd fingers PLACED WHERE and WHAT ACTION?
What’s the goal?

Answer 18

Patient is supine.
Doc grasps mandible on dysfunctional side.
- 4th and 5th fingers on POSTERIOR aspect of the ramus and they lift mandible ANTERIORLY
- 2nd and 3rd fingers on BODY of the mandible and life CEPHALAD.
- opposite hand pushes non-dysfunctional side of mandible medially
- GOAL - to pin the condyle on the disc and reduce it with the motion of the mandible.

Question 19

What type of radiological examination is most helpful and why?

Answer 19

MRI - used to see position and shape of disc

Question 20

Treatment

Answer 20

oral devices/occlusal splints

Last resort - surgery (total meniscectomy, partial meiscectomy c-disk repair, arthroscopic lysis of adhesions c-lavage)

Question 21

Are narcotics indicates?

Answer 21

NO - it’s not an acute problem