TMJ and extraocccular muscles Flashcards
TMJ anatomy
- articulation
- mandibular condyle
- with mandibular fossa of temporal joint
Lateral pterygoid
Origin:
- maxilla and lateral pterygoid plate
insertion:
- capsule of TMJ and neck of mandible
Action:
- unilateral = mandibular lateral deviation
- bilateral= mandibular protrusion
Insertion:
- trigeminal nerve
Medial pterygoid
Origin:
- maxila
- lateral pterygoid plate
Insertion:
- angle of mandible
Action:
- Unilateral = mandibular lateral deviation
- Bilateral = mandibular protrusion and elevation
Innervation:
- trigeminal
Masseter
Origin:
- zygomatic arch
Insertion:
- ramus of mandible
Action:
- mandibular elevation
- retraction
innervation:
- trigeminal nerve
temporalis
origin:
- temporal fossa
insertion:
- coronoid process of mandible
Action:
- mandibular elevation
- retraction
Innervation:
- trigeminal nerve
accessory muscles for the TMJ
suprahyoids
- diagastric
- stylohyoid
- mylohyoid
- geniohyoid
- assist with mandible depression and hyoid mobility
infrahyoids
- sternohyoid
- omohyoid
- sternothyroid
- thyrohyoid
- hyoid mobility and stability
Clinical presentation of TMJ dysfunction
- joint sounds: may be assoicated with pain
- TTP over joint
- pt c/o of locking: disc prevents translation during opening and closing
- limitation of jaw movement
- hypermobility
TMJ
refered pain
- head/temporal region
- face
- ear
- mandible
- neck
- eye
Innervation for referred pain of TMJ
- retrodiscal tissues
- joint capsule
- ligaments: disc alterations
- can be related to the TMJ myofascial trigger points of SCM, masseter, medial and lateral pterygoid
Postures affect on the TMJ
- forward head and rounded shoulders
- retraction of pterygoid musculature
- compresses TMJ/restricts motion
- protruded/depressed mandible
- tight infra/suprahyoid muscules
TMJ
PT diagnostic tools/interventions
- therabite: norms = 35-50 opening/12 mm lateral shift
- tongue depression: ispilateral side pain => masseter problem/contralaterl side pain = joint dysfunction
TMJ education
- mouth guard
- gum and ice chewing
TMJ
exercises
- chin tucks
- cervical mobility
- scapular retractions
Eye rectus muscles
- superior rectus: elevation of eye
- inferior rectus: depression of eye
- lateral rectus: abduction of eye
- medial rectus: adduction of eye
Superior oblique eye muscles vs inferior oblique eye muscle
- superior oblique: depression and abduction of the eye
- inferior oblique: elevation and abduction of the ey
Lateral palpebrae
- attaches to the posterior portion of the orbit uppper eyelid
- raises upper eyelide
Trochlear nerve
- superior oblique muscle
abducens
- lateral rectus muscles
oculomotor
- superior rectus
- inferior rectus
- medial rectus
- inferior oblique
- levator palpebrae superioris
Clinical exam of eye muscles and innervation
- crnaial nerve testing 3,4,6
smooth pursuits
- horizontal direction: medial and lateral rectus
- lateral vertical direction: superior rectus and inferior rectus
- medial vertical direction: inferior oblique and superior oblique
Masseter Trigger points
what is it and PT interventions
- point tenderness located over the masseter
- trigger point massage
- education: gum chewing, ice crunching, mouth guard
Internuclear Opthalmoplegia
PT intervention
- damage/lesion to medial longitudinal fasciculus (interneuron to cranial Nerves III and VI
- ipsilateral adduction deficit, contralateral abduction nystagmus
- visual tracking, walking with head turns, saccades
Jaw differential diagnosis
- possibel cardiac issues
- dental problem
- determine what the cause is
- recent dental appointment/hygiene
Eye dysfunction
- macular degeneration
- vestibular dysfunction
