TMJ Dysfunction OSCE

Question 1

C shaped deviation

Answer 1

unilateral problem, deviates toward side of dysfunction

-if jaw first deviates to the R then L it is a dysfunction of the R muscle

Question 2

S shaped deviation

Answer 2

bilateral muscular imbalance

Question 3

isometric exercises for S shaped deviations and musclular spasm/weakness

Answer 3

have pt place warm towels over TMJs for 10-15 minutes
have pt resist own motion (all directions of jaw)
sets of 10 twice a day

Question 4

myofascial stretching

Answer 4

bilateral stretch
pt supine
doc contacts both angles of mandible and stretch caudally

unilateral: have pt lay supine and turn head away from side of dysfunction
doc applies caudad stretch

pterygoid fasical stretch
-doc with glove slides figner to pterygoid fasica
induce force sup and lateral and wait for tissue release
-may see tearing in ipsilateral eye

Question 5

reduction of an anterior disc

Answer 5

pt supine
grasp mandible involved side
place 4-5 finger on posterior aspect of ramus
place 2-3 finger on body of mandible
other hand to contact body of mandible on opp side
4-5 fingers lift mandible anterior
2-3 fingers lift mandible cephalad
opp hand apllies force to mandible pushing medial, gliding mentum around towards dysfuncitonal side

-attempts to pin condyle on disc and reduce it with the motion of the mandible

Question 6

mandible condyle is ___

Answer 6

bi-convex

Question 7

meniscus function

Answer 7

translates anteriorly during dperession of mandible
innervated at periph
anerual and avascular at force bearing zones

Question 8

lateral pterygoid and disc function

Answer 8

when contracts, pulls disc forward and allows it to slide

allows anterior movement of jaw

Question 9

depression of jaw

Answer 9

suprahyoid and digastric

Question 10

left lateral and medial pterygoids

Answer 10

move mandible lateral and forward to the right

Question 11

what muscles close jaw

Answer 11

medial pterygoid, masseter, temporalis

Question 12

muscle that approximates lips and compresses cheeks (blowing)

Answer 12

buccinator

Question 13

muscle that protrudes lower lip (pouting)

Answer 13

depressor labii inferior

Question 14

depressor anguli oris and platysma

Answer 14

draw corner of mouth down

Question 15

what draws tip of chin upward

Answer 15

mentalis

Question 16

orbicularis oris

Answer 16

approximates and compresses lips

Question 17

zygomatic minor

Answer 17

protrudes upper lip

Question 18

levator anguli oris

Answer 18

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

Question 19

intracapsular TMJ problems

Answer 19

RA
OA
infection
gout
metastatic CA
articular disc displacements

Question 20

extracapsular TMJ problems

Answer 20

myofascial pain of masticatory muscles

Question 21

in over bite the 1st molar on bottom is ___ to ___

Answer 21

posterior to upper mandibular retrusion

Question 22

epidemiology of TMJ disorder

Answer 22

more common in young women

Question 23

symptoms of TMJ unilateral

Answer 23

cephalgia
otalgia
neck pain eye pain shoulder and back pain

CONES

Question 24

symptoms continued in order from least to most comon

Answer 24

TMJ discomfort
headaches
ear discomfort
pain

Question 25

jaw click usually present with disc displacement, by itself is or is not diagnositc

Answer 25

is not

Question 26

causes of click

Answer 26

almost always due to disc displacement
adhesions
uncoordinated m action of pterygoids
tear or perforation of disc
OA

Question 27

evalutation

Answer 27

palpate joints for clicks
palpate muscles of mastication (2-3 lbs of pressure)
range of motion (look for jaw deviation)
note facial asymmetry
pasive rom
feel m inside mouth

Question 28

what is the normal functional opening range

Answer 28

35 to 55 mm

less than 25 in TMD pts and have pain

Question 29

radiologic exam

Answer 29

not usually hepful
use when suspect dental problesm or pt with severe problems that doesn’t get better with conservitive tx

MRI is procedure of choice to see position and shape of disc

MRI finding alone not sig unless TMJ mvmt restricted or clinically suspect disc out

Question 30

differential diagnosis of TMD

Answer 30

inflammatory diseases (infection, RA, arteritis)

dental problems

lymphoproliferative disorders

migraine related disorders (carotodynia)

eagles syndrome (stylohyoid syndrome, long styloid process)

neuralgias like CN V and IX

parotid gland disorders

Question 31

TREATMENT

Answer 31

pt education
self care 
heat for spasms
jaw exercises
decrease stress
dental work
oral devices
(avoid in pts with sleep apnea)

Question 32

treatment (drugs)

Answer 32

m relaxants TCAs
intraarticular steroids (once)
botulinum toxin injections