TMJ Ax Flashcards
TMJ disorders affect how much of the population?
approx 25%
70% of TMJ disorders involve mal positioning of the disc
What is the primary pathology of TMJ disorders?
osteoarthritis/osteoarthrosis
Study found that with patient presenting with unilateral TMJ pain through function and assisted or unassisted mandibular opening, 54.2% of those had OA
What is the anatomy of the TMJ?
Modified Ball and socket
involves the temporal bone and the condyles of the mandible
Loosened capsule for movement
Has a disc (meniscus) attached more to mandible
What is the middle meningeal artery?
artery that runs behind the TMJ, blood supply to dura
What are the muscles of the TMJ?
temporalis: covers lateral area like fan. powerful for biting
masseter: main chewing muscle
lateral pterygoid: when both sides working ==> push chin out and/or depress chin. Unilat produce side to side chin motion
Medial pterygoid: helps elevate and close jaw. Working together they protrude mandible. Unilat produces a grinding motion
hyoid
SCM
Platysma
What are the TMJ biomechanics?
Opening: anterior roll and anterior glide
Closing: posterior roll, posterior glide
DOES NOT FOLLOW CONVEX/CONCAVE RULE
What is the normal opening of the mouth and what is the requirement for daily use?
Normal opening is 35-55mm (2-3 fingers in mouth)
Normal daily use requires 25-35mm
What are history questions that are specific to the TMJ?
Grinding of teeth
Clicking, locking, popping
Pain with functional movement of jaw
Recent dental work
Surgeries
Medical conditions (lymph nodes swelling, tonsillitis, sinus infections
Hearing and balance issues
Headaches
What is the profile of a mouth breather?
Tired eyes
Restless sleep and snoring
Set back jaw
Leaning forward
Poor head posture
Narrow palate
Lower CO2 and oxygenation
Higher BP
Stress activation
What are Wilkes Stages of Internal Derangement?
Normal: normal anatomical position of disc with respect to condyle and articulating surface
ID-Reducing: anteriorly displaced disc returning to normal anatomical position upon max opening (Wilkes stage 2-early stage 3)
ID-Non-Reducing: Anteriorly displaced disc during closed and max opening positions with disc thickening present (Wilkes late stage 3-Stage 4)
What are Wilkes 5 stages to classifying ID?
Stage 1: painless clicking in early opening and late closing with unrestricted motion
Stage 2: occasional pain with clicking, intermittent locking, orofacial pain
Stage 3: frequent orofacial pain, as locking becomes more frequent and mandible becomes restricted
Stage 4: contours begin to change, chronic pain and restricted mandibular opening
Stage 5: similar to stage 4 but with more severe symptoms
What are the 6 types of headaches?
TMJ: pain is at temples, in front of ears
Sinus: pain is behind browbone and/or cheekbones
Cluster: pain is in and around one eye
Tension: Pain is like a band squeezing the head
Migraine: pain, nausea and visual changes are typical of classic form
Neck: pain is at top and/or back of head
What is Bell’s Palsy?
Damage or inflammation of the CNVII (Fascial)
Sudden paralysis of one side of your face, causing it to droop
S/S:
drooling
eye problems
loss of ability to taste
pain in or behind ear
numbness in affected side of face
increased sensitivity to sound
How would you feel the ROM of the TMJ?
Patient supine place index lightly on external auditory meatus, ask patient to open and close jaw, feel for smooth, equal movement
Click: condyle slips over disc and self reduces
What could crepitus of the TMJ indicate?
Possible OA
Possible disc displacement
