1
Q
TMJ observation: contours of face
A
- divide face into 3rd
- hair line to bipupital line
- bipupital line to nose line
- nose line to crinoline
- not asymmetry
2
Q
TMJ muscle testing
A
- left medial and lateral pterygoids–jaw lateral and forward to R
- right medial and lateral pterygoid–jaw lateral and forward to left
- have patient depress jaw against mild resistance–digastric and supra hyoid muscles
3
Q
TMJ palpation
A
- palpate all muscles of the face for spasm
- use glove to feel medial pterygoid (runs vertically–fell lateral to molars)
4
Q
TMJ active motion
A
- palpate anterior to tragus with the patient supine
- have patient slowly open mouth fully
- note deviations: C and S shaped
- have patient move mandible laterally and medially
- have patient retract and protrude mandible
5
Q
C-shaped deviation
A
- unilateral problem, deviates toward side of dysfunction
- if jaw 1st deviates to R then L it is a dysfunction of the R muscle (it is tight and pulling it towards R)
6
Q
S shaped deviation
A
-bilateral muscular imbalance
7
Q
Muscle energy for C shaped deviation and all muscles that move TMJ
A
- patient supine
- have patient open mouth slightly
- doc contacts the body of mandible not the same side of deviation with palm of hand
- apply a force toward the opposite side of the chin deviation
- have patient provide an activating lateral force with mandible (in direction of deviation) against your force)
- hold for 3-5 seconds, relax, and establish new barrier, repeat until no new barriers
- these principles can be applied to any of the muscles of mastication
8
Q
Isometric exercises for “S” shaped deviations and muscular spasm/weakness
A
- have patient place warm towels over TMJ for 10-15 minutes
- have patient resist their own motion
- mandibular depression and closure
- lateral deviation, in both directions
- retraction and protrusion
- have patient hold resistance for 20-30 seconds
- sets of 10, twice a day
9
Q
TMJ bilateral stretch
A
- patient supine
- doc contacts both angles of mandible
- stretch caudally
- may be modified to treat tissue tension in all planes
10
Q
TMJ unilateral stretch
A
- patient supine with head turned away from side of dysfunction
- doc at head of table
- one hand stabilizes the head while other grasps the mandible
- apply a caudad stretch
- this may be modified as needed to address other motion barriers
11
Q
Pterygoid fascial stretch
A
- patient supine with doc standing or sitting at head of table
- with a gloved hand, place the little finger along the upper molars, sliding the finger posteriorly until you engage the pterygoid fascia
- induce a force superior and lateral and wait for a tissue release
- this can cause some discomfort in your patients, therefore be as gently as possible
- may see some tearing in ipsilateral eye due to indirect stimulation of the sphenopalatine ganglion
12
Q
Counterstain for TMD Masseter point
A
- tender point just inferior to zygoma in the belly of the masseter muscle
- treatment position: patient supine
- have patient depress the mandible slightly to disengage TMJS
- place hand on mandible and translate toward side of tender point until pain decreased 70%
13
Q
Counterstain for TMJ tender point
A
- tender point on posterior aspect of angle of mandible, on side opposite of the mandibular deviation
- patient supine
- rotate head to the opposite side of tender point
14
Q
Reduction of an anterior disc
A
- patient supine
- grasp mandible on the involved side
- place 4th and 5th fingers on the posterior aspect of the rams
- place the 2nd and 3rd fingers on the body of mandible
- use other hand to contact the body of the mandible on opposite side
- 4th and 5th fingers lift mandible anteriorly
- 2nd and 3rd fingers lift the mandible cephalad
- opposite hand applies force to mandible, pushing medially, gliding the mandible around towards the dysfunctional side
- this attempts to pin the condyle on the side of the disc and reduce it with the motion of the mandible
- this may be a temporary fix until tissues have healed or patient has surgery
