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TMJ Flashcards

1
Q

TMJ joins it a ___ going

A

Gliding

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2
Q

Describe the TMJ joint

A

Convex articular condyle of the mandible

Concave articular fossa on the squamous portion of temporal bone

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3
Q

The TMJ joint is separated by a what

A

Fibrocartilaginous articular disc (meniscus)

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4
Q

What are the three parts of the fibrocartilaginous articular disc

A

Thick anterior band
Thin intermediate zone
Thick posterior band

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5
Q

Meniscus of TMJ with mouth closed

A

The condyle is separated form the articular fossa Kd the temporal bone by the thick posterior band

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6
Q

Meniscus with mouth open

A

The condyle is separated from the articular eminence of the temporal bone by the thin intermediate zone

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7
Q

Muscles of mastication

A

Digastric, suprahyoid, left lateral and medial pterygoids, temporalis, masseter

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8
Q

What do digastric, suprahyoid do

A

Depress mandible (infrahyoid stabilizes hyoid bone) initially, then pterygoids depress jaw

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9
Q

What do left lateral and medial teratoid do

A

Move mandible lateral and forward to the right

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10
Q

What do temporalis, masseter, medial pterygoids do

A

Close jaw tightly

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11
Q

What does buccinator do

A

Approximates lips and compresses cheeks (blowing)

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12
Q

What does depressor labii inferior do

A

Protrudes lower lip (pouting)

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13
Q

What does depressor anguli oris and platysma do

A

Draw corner of mouth down

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14
Q

What does mentalis do

A

Draws tip of chin upward

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15
Q

What does orbicularis oris do

A

Approximates and compresses lips

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16
Q

What does zygomatic minor do

A

Protrudes upper lip

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17
Q

What does levator anguli oris do

A

Lifts upper border of lip on one side without raising lateral angle (snarl)

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18
Q

What does zygomaticus major do

A

Raises lateral angle of mouth to smile

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19
Q

What does risorius do

A

Approximates lips and draws lips and draws corners lateral

Grimace

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20
Q

Frontal belly of occipitofrontalis

A

Wrinkle forehead, raise eyebrows

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21
Q

Platysma

A

Tense skin of neck

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22
Q

Signs symptoms

A

Cpehalgia-misdiagnosed as migraines

Otalgia

Neck pain

Eye pain

Shoulder and back pain

Tinutis

Dull ache worse with chewing

Difficulty opening mouth

Click crepitans(jaw click usually present with disc displacement, but by itself non diagnostic)

Lateral deviation of jaw

Spasm within facial muscles

Onset of TMJ symptoms may correspond with onset of stress or added stressors

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23
Q

1 retrospective study of 4528 patients with TMD with pain, ear discomfort, headache, TMJ discomfort or dysfunction

A

Other symptoms
Neck pain
Eye pain

Arm back pain
Dizziness

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24
Q

TMJ and nocturnal bruxism

A

Controversial

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25
Q

Jaw clenching

A

Anxiety and psychosocial stress

Does not interfere with treatment in most cases
-although a severely distributed capacity for interpersonal relationships is associated with poor prognosis

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26
Q

Types of TMJ dysfunction

A

Opening click
Closing click (reciprocal clicking)
Inability to fully open jaw (close locked)
Inability to close if TMJ symptoms are bilateral
Crepitus and grating
Fusion of joint (ankylosis)

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27
Q

What causes jaw click

A

*Disc displacement after disc thins or is stretched

Adhesions

Uncoordinated muscle action of pterygoid

Tear or perforation of disc
Osteoarthritis(more likely to have crepitus)
Occlusion imbalance (less likely

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28
Q

Where will we be interfering for TMJ dysfunctions

A

Pterygoids, masseter, temporalis

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29
Q

Trauma to cause TMJ dysfunction

A

Direct, whiplash, third molar extraction, intubation

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30
Q

Left deviation

A

Right medial and lateral pterygoid dysfunction

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31
Q

Right deviation jaw

A

Left medial and lateral pterygoid

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32
Q

A direct blow with closed mouth

A

Posterior capsule injury

33
Q

Malocclusions

A

Deviation from nl contact of maxillary and mandibular teeth

34
Q

Class 1 malocclusions

A

1st molars nl, problem elsewhere

35
Q

Class 2a malocclusions

A

Lower 1st mo;at post to upper to greater degree (larger overbite)

36
Q

Class 3 malocclusions

A

Lower 1st molar ant to upper get mandibular protrusion (underbite)

37
Q

Why get malocclusions

A

Muscle strain (oral habits, postural/work, sports)
MSK problems
SD TMJ
Compensatory changes
Developmental abnormalities (condylar hypoplasia/agenesis)
Mood disorders (anxiety, depression, PTSD, history of abuse)
Endocrine
Hypocalcemia (chvostesks and trosseau)

38
Q

Intracapsular

A 
Infection RA
OA
Gout
Metastatic CA
Articular disc displacement
39
Q

Extracapusular

A

Myofascial pain of mastication muscles

  • TMJ myofascial pain syndrome
  • TMJ dysfunction syndrome
  • TMJ syndrome

NIH preferred terminology
-TMJD-temporaomandibular muscle and joint disorder

40
Q

Possible risk factors TMK

A

Contradictory association with hyperlaxity

Neck trauma(severe TMD symptoms in 89% of patients c/o whiplash associated symptoms compared to 18% of controls

Female hormones

Bruxism and clenching

Contradictory evidence about associated with occlusion

Up to 75% of TMD may suffer from psychogical abnormalities

41
Q

Factors not associated with risk of TMJ

A

Genetics, orthodontics

42
Q

Epidemiology TMJ

A

Affect 20% of Americans
Women
#2 cause of facial pain (HA is 1)

43
Q

What population gets TMJ more

A

RA

53094%

44
Q

Osteopathic evaluation for TMJ

A

Cranial
C spine
Scoliosis
Leg length (innominate, sacrum, SI joint)

45
Q

Palpate joitns for ___

A

Crepe tans/clicks

46
Q

Palpate mastication muscles

A

1 side may be tender

47
Q

Ranges of motion

A

Active-patient opens mouth 3-6 cm, laterally 1-2 cm, and then retracts and protrudes mandible

Observe jaw movements for deviation

48
Q

Passive ROM

A

Gloves-move pots jaw medially and laterally(compare ROM on both sides)

49
Q

Observation TMJ

A

Cavities, suspicious lesions in mouth, teeth alignment (tongue blade for bite)

Facial asymmetry

50
Q

LOOK FOR SYMMETRY

A

Ok

51
Q

When should you suspect TMJ

A

Abnormal mandibular movements

Decreased ROM of TMJ
(Normal functional opening is 35-55 mm. Functional opening on TMD puts usually <25 mm and very often associated with pain)

Muscles of mastication tenderness

Pain with dynamic loading

Bruxism(look for signs of tooth wear)

Postural asymmetry (observe posture, assessing for slouching or a preference to lean to one side)

Neck and shoulder muscle tenderness

Normal cranial nerve examination

52
Q

Differential diagnosis TMJ

A

Migraine related disorders (Carotodynia)
Inflammatory diseases (infection, RA, giant cell arteritis)
Dental problems (posterior teeth support loss)
Neuralgia (trigeminal , glossopharyngeal)
Parotid gland disorders
Lymphoproliferative

53
Q

Microbiology and pathology TMJ

A 
C tetani-lock jaw
Odontogenic cysts
Sclerosing osteomyelitis of garre
Monocystic fibrous dysplasia
Acromegaly-enlarged jaw-prognatism
54
Q

Medical side effects TMJ

A

Steroids-avascular necrosis

Bisphosphonates-osteonecrosis of the jaw

55
Q

Eagles syndrome(stylohyoid syndrome)

A

Elongated styloid process

56
Q

MOTHRR

A 
Medication 
OMM
Testing
Holistic/humanistic
Referrals
Return visit
57
Q

Radiology for TMJ

A 
Not helpful really 
But do if suspect dental problems 
Patient with severe symptoms that don’t improve with conservative treatment tactics
Concern for alternative cause
Recent, severe trauma
58
Q

Peripheral radiographs can r/o _ problems

A

Tooth

59
Q

MRI

A

See position and shape of disc

MRI alone not significant unless TMJ movement is restricted or there is clinical suspicion for a disc out

MRI not for evaluation of muscle pain

-disc commonly displaced in asymptomatic patients

60
Q

Disc displacement Sx

A

MRI showed

61
Q

No Sx of TMJD

A

33% had displaced discs

62
Q

Level 1 TMJ interventions

A

Cognitive behavioral therapy for chronic TMJ reduces activity interference, pain and depression at 1 year

63
Q

TMJ level 2 interventions

A

OMT, exercise emitriptyline, glucosamine sulfate for OA of tmj, benzodiazepine, Botox, acupuncture, OMT, NSAIDS, hypnorelaxation, oral habit reversal treatment, cognitive behavioral skills training plus biofeedback,, physical self regulation, therapeutic exercise

64
Q

Level 3 TMJ intervention

A 
OMT 
Biofeedback alone 
Surgery
Occlusal splints
Occlusal adjustment 
Intra articular corticosteroid inj
PT
65
Q

OMT help TMJ

A

Didn’t improve it

But OMT associated with less NSADIS and muscle relaxant use

66
Q

How can we holistically fix

A

Change head posture, sleeping position , aggravating parafunctional oral behaviors (nail biting, pen chewing)

67
Q

THE MINIMUMGOAL FOR OPENING THE JAW IS TO BE ABLE TO FIT THE KNUCKLES OF THE INDEX AND MIDDLE FINGER BETWEEN THE ___

A

TEETH

68
Q

Retraining

A

Place the pads of your fingers over your chin
Open your mouth comfortable and slid your jaw forward as far as it will comfortable go
Press your jaw into your finger pads with a gentle pressure
Hold this as you inhale deeply
Upon exhalation allow your mouth to close comfortable
Repeat 3-5 times and do it at least 3 times a day

69
Q

Retraining lateral deviation

A

Place hand on mandible on side toward which the jaw deviates
Place the other hand on the opposite cheek bone
Apply enough pressure on these areas to illicit a gentle stretch as you open your mouth
Then close your mouth maintaining the same pressure
Do daily until full relief is obtained, then perform it 2-3 times a week

70
Q

Acupressure

A

Insert your clear pinky finger into your mouth between your cheek and gum
Slide your finger along your gum line, above your teeth, until your finger falls into a deeper recess behind your teeth, but in line your gums
Lean your head upon your finger until you experience a sligh discomfort
This discomfort will subside and you will be able to lean more and more into your finger
Do this 2-3 times a day until the symptoms have gone

71
Q

Deep presssure

A

Sometimes you may find very sensitive tender points in the cheek muscles
By applying a deep and steady pressure these points will disappear
You don’t haven’t massacre yourself to be successful just press on the point to illicit the feathers adage of pain and follow that edge until it disappears

72
Q

Self massage

A

Use the pads of your fingers to feel around your cheeks above the engles of your jaw with a kneading, circular motion
Any tension or Robey sensation that you feel you should massage away

73
Q

Temporalis self treatment

A

Use hot packs or a scarf to warm area for 12-30 minutes
Stretch with pinky finger pads placed firmly just behind the hairline and the rest of the fingers in the hair around the ears, apply traction towards the sky
Open and close the mouth slowly while maintaining the traction 5 times
Repeat 2-5 times

74
Q

Acupressure

A

Apply pressure to the feathers edge of discomfort

75
Q

Temporalis retraining

A

Open your jaw maximally
Press your index finger pads down against your jaw in an effort to open it more
Close your mouth gently against your fingers for 5 sec
Upon relaxing allow your fingers to draw your jaw open more
Repeat 3-5 times

76
Q

How can adjust diet for TMJ

A

Decrease chewing with different foods

77
Q

Referred

A

Dental surgeon
Oral devices
Surgery

78
Q

Surgery /arthroscopy indication

A

Significant pain and dysfunction

Exhausted all conservative measures

79
Q

Poor prognosis

A

Psychiatric factors

-have prolonged use of opiates, benzodiazepines, alcohol, other drugs

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