part 2

Question 1

What functions does the medial pterygoid have?

Answer 1

1. works synergistically with the masseter and temporalis to suspend and elevate the mandible
2. protrusion of the mandible with teeth slightly apart is it most active state
3. unilateral action creates lateral devation and works synergistically with the ipsalateral lateral pterygoid
4. inhibited with active mandibular depression

Question 2

What are the attachments of the medial pterygoid?

Answer 2

1. lateral pterygoid plate of the sphenoid, pyramidal process of palatine bone, tuberosity of the maxilla
2. inserts inferior and posterior part of medial ramus and angle of the mandible

Question 3

What are the attachments of the lateral pterygoid?

Answer 3

Two heads

1. upper- infratemporal crest and the interior lateral surface of the greater wing of the sphenoid TO the disc
2. lower- lateral pterygoid plate of the sphenoid TO condylar neck and ramus of the mandible

Question 4

What is the function of the lateral pterygoid?

Answer 4

1. laterally deviation the mandible to the contralateral side
2. eccentrically control position of the disc with mandibular elevation

Question 5

How does shortening of the lateral pterygoid effect occlusion pattern?

Answer 5

1. Premature contact anterior opposite

2. premature contract posterior same side

Question 6

What muscle was once thought to be part of the temporalis muscle?

Answer 6

shenomandibularis

Question 7

What are the attachments and innervation of the sphenomandibularis muscle?

Answer 7

1. greater wing of the sphenoid
2. temporal crest of the mandible
3. branches of the buccal nerve off the mandibular nerve off of CN V

Question 8

What TMJ muscle is theorized to contribute to cluster headaches and why?

Answer 8

1. sphenomandibularis

2. it is thought spasm will compress the maxillary nerve against the posterior maxillary wall

Question 9

What are the attachments of the masseter?

Answer 9

1. Deep- posterior 1/3 of the inferior border of zygomatic bone and from the entire zygomatic arch TO superior half of the mandibular ramus and lateral surface of the coronoid process
2. Superficial- lower surface of the zygomatic arch TO the mandibular angel and lower part of the ramus

Question 10

What innervates the masseter?

Answer 10

Masseteric nerve from the anterior branch of the mandibular branch of CN V

Question 11

What are the attachments of the digastric muscle?

Answer 11

ORIGIN- Two bellies
1.posterior- mastoid notch of the temporal bone and sometimes the styloid process of the of the sphenoid bone
2.anterior- digastric fossa of the lower border of the mandible close to the symphasis
INSERTs- the two bellies joint together passing through a tendonis loop that that perforates the stylohyoid muscle at the hyoid bone

Question 12

What is the innervation of the styloid muscle?

Answer 12

1. anterior belly- mylohoid branch of inferior alveolar of CNV
2. posterior belly- facial nerve (CN VII)

Question 13

What is the function of the digastric muscle?

Answer 13

1. raises the hyoid bone

2. open the jaw when the hyoid is stabilized from below

Question 14

What are the attachments of the stylohyoid muscle?

Answer 14

styloid process TO hyoid bone posterior superior

Question 15

What innervates the stylohyoid?

Answer 15

CN VII facial nerve

Question 16

What are the attachments of the omohyoid?

Answer 16

1. upper margin of the scapular near suprascapular ligament (sometimes on the ligament) TO the hyoid bone
2. TWO bellies meet at a central tendon held down by the SCM

Question 17

What is the innervation of the omohyoid?

Answer 17

ansa cervicalis C1-3

Question 18

What function does the omohyoid serve?

Answer 18

the omohyoid assists in swallowing, vomiting, respiration, and some scapulo-clavicular actions

Question 19

What impact does thumb sucking having on the hyoid muscles and what other pathology causes similar changes?

Answer 19

1. it elevates the hyoid so that the suprahyoids shorten and the infrahyoids lengthen
2. forward head position has a similar impact

Question 20

What are the attachments of the styologlossus muscle?

Answer 20

anteriorlateral surface of styloid process of the temporal bone and styolmandibular ligament TO tongue and hypoglossus muscle

Question 21

What type of symptoms or patients might have styloglossus disfunction?

Answer 21

1. people with difficulty swallowing because the styoglossus assists in tongue muscle move the bolus back and up
2. mouth breathers might have shortening of the styologlossus

Question 22

What are the attachments of tensor veli palatini

Answer 22

FROM sphenoid bone
-base of the scaphoid fossa at the bottom of the pterygoid plate
-angular spine of the sphenoid
-lateral wall of eustachian tube
TO palatine aponerurosis and horizontal plate

Question 23

What is the function of tensor veli palatini

Answer 23

1. tense and raise the soft palate during swallowing allow room for the bolus
2. works with levator veli palatini to to open and close the eustachian tube during yawing, swallowing, and sneezing

Question 24

What muscles can contribute to hypobaroacusia?

Answer 24

tonic contraction of the medial pterygoid can increase tension on tensor veli palatini leading to closure of the eustachian tube

Question 25

What are the four main ligaments of the TMJ?

Answer 25

1. lateral or temporomandibular 2. internal lateral or sphenomandibular 3. stylomandibular 4. mandibular-malleolar or ligament of Pinto

Question 26

Describe the shape and attachments of the temporomandibular or lateral ligament?

Answer 26

1. fan shaped 2. lateral surface of the zygomatic arch and articular eminence TO 3. postero-lateral aspect of the neck of the mandible

Question 27

What are the functions of the lateral or temporomandibular ligament?

Answer 27

1. strengthens the TMJ | 2. prevent excessive retrusion and compression of posterior structures

Question 28

How can you isolate lateral temporomandibular or lateral ligament pain?

Answer 28

1. passive retrusion of the mandible will tension the ligament and posterior structures 2. passive opening of the mouth will decrease the posterior pressure and keep the tension on the lateral ligament

Question 29

How would you differentiate between tempromandibular and sphenomandibular ligaments?

Answer 29

1. initial opening of the mouth is the lateral ligament | 2. terminal opening is resisted by sphenomandibular and stylomandibular

Question 30

What is the function of the sphenomandibular ligament?

Answer 30

1. its considered an accessory ligament and the function is not clear 2. may act to provide a restraining force to maintain opposition of condyle, disc and temporal bone

Question 31

Describe the attachments of the sphenomandibular ligament

Answer 31

1angular spine of the sphenoid | 2.lingula of the mandible at the mandibular foramen

Question 32

How would you incriminate the sphenomandibular ligament?

Answer 32

protrusion, jaw opening, contralateral lateral deviation

Question 33

Describe the attachments of the stylomandibular ligament

Answer 33

1. styloid process of the temporal bone | 2. medial angle of the ramus

Question 34

What motion does the stylomandibular ligament resist?

Answer 34

anterior translation of the mandible

Question 35

How would you incriminate stylomandibular ligament?

Answer 35

passive opening with protrusion

Question 36

What are the attachments of the ligament of Pinto

Answer 36

the mandibular-malleolar ligament attaches to the neck of the malleus and tympanic membrane TO medio-posterior-superior capsule or meniscus of TMJ

Question 37

How does the TMJ directly effect the ossicles of the ear?

Answer 37

The Mandibular-malleolar ligaments run directly from the TMJ capsule or disc to the malleus bone there for movement of the the capsule or disc changes the orientation of the ossicles

Question 38

What is the function of the TMJ disc and how it accomplishes its function

Answer 38

1. To fill the constantly changing space between the tow bones of the condyle and the fossa 2. it is somewhat mobile allowing for many minute movements to accommodate for the changing space 3. fibrocatilagenous nature allow for increased flexibility 4. the thin intermediate zone also allows for pliability and adaptation to the changing surgfaces

Question 39

How is the TMJ capsule different than other joint capsules

Answer 39

1. From the disc down it is taut 2. from the disc up it is loose 3. the lateral aspect is kept tight by the temporomandibular ligament while the rest of the capsule is unsupported and loose

Question 40

Describe the articular innervation of the TMJ

Answer 40

1. there are both primary and accessroy articular nerves 2. primary from the auriculotemporal nerve 3. accessory from the massetric, deep temporal and lateral pterygoid nerves

Question 41

Describe the neural pathway of the primary articular nerves of the TMJ

Answer 41

trigeminal nerve > mandibular branch > auriculotemporal posterior and lateral

Question 42

Describe the neural pathway of the the accessory articular nerves of the TMJ

Answer 42

1. deep temporal innervates the anterior and medial joint 2. lateral pterygoid of the mandibular nerve innervates anterior medial capsule 3. anterior auricular arises from masseteric nerve to innervate anterior lateral capsule

Question 43

Describe the behavior of type I mechanoreceptors with TMJ

Answer 43

1. slow adapting 2. long latencies (.8 to 2.5 seconds) 3. adapt within 20 seconds 4. demonstrate a range of thresholds 5. constant afferent contributions to control mandibular musculature

Question 44

Describe the behavior of type II mechanorecptors with TMJ

Answer 44

1. rapidly adapting (within seconds) 2. act as on-off receptors 3. entirely reflexogenic 4. very short latencies 5. respond briefly at the onset of jaw movement

Question 45

Describe the behavior of type III mechanorecptors in the TMJ

Answer 45

1. slow adapting | 2. provide powerful refelxogenic response

Question 46

How does the condyle of the TMJ move during mouth opening?

Answer 46

1. during the first 6-10mm of opening the condylar heads spin around a horizontal axis within the mandibular fossa 2. as the mouth opens further they continue to rotate and an anterior translation takes the condylar heads into the articular eminences 3. the rotation is thought to take place in the lower joint while the translation is thought to take place in the upper part of the joint

Question 47

Describe the movement of the TMJ disc with mouth opening and closing

Answer 47

1. during opening the superior stratum pulls the disc posteriorly to keep in properly oriented on the head of the condyle 2. during closing the lateral pterygoid contracts to reorient the disc on the head of the condyle to counter act the tension of the superior stratum

Question 48

The primary pathology of the TMJ is associated with what factors?

Answer 48

disturbances in occulsion couple with microtrauma

Question 49

What are some signs and symptoms of otomandibular syndrome?

Answer 49

1. ear pain 2. congestion 3. tinnitus 4. loss of equilibrium 5. ear pressure 6. conductive hearing loss 7. abnormal sounds in the ear

Question 50

What muscles does CN V innervate

Answer 50

1. muscles of massitication 2. mylohyoid 3. anterior belly of digastric 4. tensor tympani 5. tensor veli palatini