TMJ Dysfunction syndrome

Question 1

Which muscles move mandible lateral and forward to the right?

Answer 1

Left lateral and medial pterygoids

Question 2

Which muscles closes the jaw?

Answer 2

Temporalis, masseter, and medial pterygoid

Question 3

Which muscles depresses mandible initially, then pterygoids depress the jaw

Answer 3

Digastric, suprahyoid

Question 4

what are some intracapsular causes of TMJ dysfunction?

Answer 4

• infection
• RA
• OA
• Gout
• Metastatic Cancer
• Articular disc displacement

Question 5

What are some extracapsular causes of TMJ dysfunction?

Answer 5

• MF pain of masticatory muscle

Question 6

What is malocclusions?

Answer 6

Deviation from normal contact of maxillary and mandibular teeth

Question 7

Classify maloccusions

Answer 7

Class I: 1st molar normal, problem elsewhere
Class 2a: lower 1st molar posterior to upper mandibular retrusion (overbite)
Class 2b: lower 1st molar posterior, to upper to greater degree (larger overbite)
Class 3: lower 1st molar anterior to upper mandibular protrusion (underbite)

Question 8

According to study, pts with what concurrent disease is most likely to develop TMD?

Answer 8

Rheumatoid arthritis. ranges from 53-94%

Question 9

What are some signs and symptoms of TMD?

Answer 9

Unilateral pain: cephalgia - diadiagnosed as migraines; otalgia; neck pain; eye pain; shoulder and back pain

Question 10

what is the most likely symptoms TMD pt present with?

Answer 10

Pain (96.1%); Ear discomfort (82.4%); headache (79.3)

Question 11

what is nocturnal bruxism and how does it relate to TMJ?

Answer 11

tooth grinding. 1 study found 78% of pts had tooth grinding.

Question 12

what’s the best radiographic modality for examining TMJ dysfunctions

Answer 12

MRI

Question 13

To have pt clench their jaw closed, what muscles are involved?

Answer 13

Temporalis, masseter, and medial petrygoid

Question 14

If you wanted pt to move their jaw laterally and forward to the right, what muscles are they activating?

Answer 14

left lateral and medial pterygoid

Question 15

If you wanted your pt to depress their jaw against your resistance, what muscles are being activated?

Answer 15

Digastric and suprahyoid

Question 16

To check of contours of the face, what anatomical lines are you comparing?

Answer 16

Hair line to bipupital line
Bipupital line to nose line
Nose line to chin line

Question 17

Using your pinky finger, you run along lateral aspect of the molar and palpate a uscle that runs vertically. what muscle are palpating?

Answer 17

Medial pterygoid

Question 18

When evaluating the mandible for somatic dysfunciton, you notice there is a deviation that forms a C shape.
A. is this a unilateral or bilateral problem?
B. Which side is the dysfunctional side?
C. If Jaw 1st deviates to the right and then to the left, which side is the dysfunction on?

Answer 18

A. Unilateral
B. Side of the deviation is the dysfunctional side.
C. Dysfunction is on the right (muscles on the right are tight and thus pulling it toward the right)

Question 19

A mandibular dysfunction that forms an S shape is an unilateral or bilateral dysfunction?

Answer 19

Bilateral

Question 20

Upon evaluation, you ask your patient to open their mouth fully and you notice the mentum moves to the right side and then comes back to the midline. When treating this dysfunction with muscle energy, in what direction is the patient’s activating force?

Answer 20

To the right. Doc’s hand is on the right side of the mandible and force is to the left.

Question 21

You treat your pt for S shaped deviation with muscle energy and you tell the pt to continue to this treatment at home. What instruction do you give the patient to continue the isometric exercise regularly at home.

Answer 21

• place warm towels over TMJ’s for 10-15 mins
• hold resistance for 20-30 sec
• Sets of 10, twice a day

Question 22

When performing TMJ myofascial release treatment technique for muscular spasm, what is the hand placement of the doc and in what direction is the force?

Answer 22

If unilateral: Turn pts head away from side of dysfunction. Doc contacts temporal side of the TMJ to stabilize the head while the other contacts the angle of the mandible.
If bilateral: doc contacts angles of mandible with palm of both hands.

In both cases, the force is direct myofascial stretch to the mandible in a caudal direction and wait for muscle creep.

Question 23

when treating intraoral pterygoid muscle with MF, in what direction does doc apply the force?

Answer 23

Superior and lateral direction

Question 24

you are treating pts intraoral pterygoid muscle with MF release and you notice that pt starts tearing. Pt explains that he’s not in pain, but not sure why his eyes are tearing. You explain to the pt that he’s tearing because

Answer 24

The muscle you’re treating is is causing indirect parasympathetic nerve stimulation through the sphenopalatine ganglion

Question 25

Where is the masseter tender point located?

Answer 25

Just inferior to the zygoma, in the belly of the masseter muscle.

Question 26

Describe how counterstrain treatment technique for the masseter tender point is performed.

Answer 26

• pt supine, doc at head of table
• have pt depress mandible slightly to disengage
• place one hand on the body of the mandible opposite of the tender point and translate the mandible toward side of the tender point until pain decrease by 70%
• Hold for 90 sec and slowly release

Question 27

Where is the TMJ tender point located?

Answer 27

On posterior aspect of angle of mandible, generally on side opposite of the mandibular deviation.

Question 28

Explain how TMJ tender point counterstrain treatment is performed

Answer 28

Pt supine, doc at the head of table monitoring tender point. Rotate pts head and neck to the opposite side of the tender point until pain is decreased by 70%. Hold for 90 sec and release

Question 29

What is the purpose of the TMJ anterior disc reduction technique?

Answer 29

To reduce a TMJ disc that has been dislocated anteriorly, most often due to trauma that disrupted the anchoring filaments of the disc.

Question 30

Pt presents to your office complaining that they can’t seem to fully open their mouth and then they try to it hurts “really bad”. In order to treat this and evaluate for other dysfunction, what must be done first? In what position is the pts jaw in?

Answer 30

Pt’s jaw is in Closed locked position thus it hurts to open. This can be due to disruption of the posterior anchoring fascia; due to trauma or chronic tissues. Need to reduce the disk first before evaluating for other dysfunctions. To reduce the disk TMJ anterior disc reduction technique can be applied.

Question 31

A) what is the doc’s hand position; and B) What are the sequential steps taken to perform TMJ anterior disc reduction?

Answer 31

A. Doc’s ipsilateral 4th and 5th fingers are on the posterior aspect of the mandibular ramus; 2nd and 3rd fingers are on the body of the mandible.
B) Pt’s 4th and 5th fingers induce a force to the mandible anteriorly. 2nd and 3rd induce a force to the mandible in a cephalad direction while anterior force is maintained.

Opposite hand then applies force to the mandible, pushing toward involved side, gliding the mandible around towards dysfunctional side as the patient closes the mouth.