TMJ Dysfunction OSCE Flashcards
C shaped deviation
unilateral problem, deviates toward side of dysfunction
-if jaw first deviates to the R then L it is a dysfunction of the R muscle
S shaped deviation
bilateral muscular imbalance
isometric exercises for S shaped deviations and musclular spasm/weakness
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
myofascial stretching
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
reduction of an anterior disc
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
mandible condyle is ___
bi-convex
meniscus function
translates anteriorly during dperession of mandible
innervated at periph
anerual and avascular at force bearing zones
lateral pterygoid and disc function
when contracts, pulls disc forward and allows it to slide
allows anterior movement of jaw
depression of jaw
suprahyoid and digastric
left lateral and medial pterygoids
move mandible lateral and forward to the right
what muscles close jaw
medial pterygoid, masseter, temporalis
muscle that approximates lips and compresses cheeks (blowing)
buccinator
muscle that protrudes lower lip (pouting)
depressor labii inferior
depressor anguli oris and platysma
draw corner of mouth down
what draws tip of chin upward
mentalis
orbicularis oris
approximates and compresses lips
zygomatic minor
protrudes upper lip
levator anguli oris
lifts upper border of lip on one side without raising lateral angle (snarl)
intracapsular TMJ problems
RA OA infection gout metastatic CA articular disc displacements
extracapsular TMJ problems
myofascial pain of masticatory muscles
in over bite the 1st molar on bottom is ___ to ___
posterior to upper mandibular retrusion
epidemiology of TMJ disorder
more common in young women
symptoms of TMJ unilateral
cephalgia
otalgia
neck pain eye pain shoulder and back pain
CONES
symptoms continued in order from least to most comon
TMJ discomfort
headaches
ear discomfort
pain
jaw click usually present with disc displacement, by itself is or is not diagnositc
is not
causes of click
almost always due to disc displacement adhesions uncoordinated m action of pterygoids tear or perforation of disc OA
evalutation
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
what is the normal functional opening range
35 to 55 mm
less than 25 in TMD pts and have pain
radiologic exam
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
differential diagnosis of TMD
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
TREATMENT
pt education self care heat for spasms jaw exercises decrease stress dental work oral devices (avoid in pts with sleep apnea)
treatment (drugs)
m relaxants TCAs
intraarticular steroids (once)
botulinum toxin injections
