TMJ, face and cranial nerves notes

Question 1

What are the differential diagnosis for the TMD

Answer 1

• myocardial infarction
• cardiac angina (pain with exercise)
• screen for cardiovascular impairment in patients that pain varies with physical activity (pain described as “throbbing” and decreases quickly with rest)
• headaches
• vertigo/dizziness
• anxiety, depression, or chronic pain
• cranial nerve attachments (trigeminal neuralgia, swallowing/speech difficulty, ear ache/s symptoms)
• common in college students

Question 2

What are questions you ask the patient with TMJ?

Answer 2

• any crepitus and clicking (if pain crepitus usually indicative of degenerative joint disease or a perforation in the disc)
• pain with eating
• any habits that involve the jaw (smoking, gum chewing, biting nails)
• difficulty swallowing (CN VII or V)
• sleep position

Question 3

What observations so you make with a patient with suspected TMJ?

Answer 3

• posture
• facial symmetry (look horizontally and vertically)
• look at eyebrows, eyes, nose, ears, and corners of mouth
• restricted opening or closing mouth
• lateral deviation of jaw
• loss of teeth
• ptosis
• underbite
• overbite
• overjet
• facial profile

Question 4

What is ptosis?

Answer 4

drooping of one side of face (bell’s palsy)

Question 5

what are the components of an underbite?

Answer 5

mandibular teeth are anterior to the maxillary teeth

Question 6

What are the components of an overbite?

Answer 6

anterior maxillary incisors extend below the anterior mandibular incisors

Question 7

What are the components of an overjet?

Answer 7

distance the maxillary incisors close over the mandibular incisors when the mouth is closed

Question 8

what are the 3 facial profiles?

Answer 8

• retrognathic (chin back)
• orthognathic (neutral)
• prognathic (chin forward)

Question 9

When you look at the TMJ what do you also look at?

Answer 9

• joints above and below
• assess the cervical spine
• upper cervical spine plays a significant role in the normal function of TMJ
• may need to assess thoracic spine (postural origin)

Question 10

what is the functional opening ROM needed in the TMJ to eat and speak without difficulty?

Answer 10

35mm

Question 11

ROM for opening of mouth

Answer 11

40-55mm

Question 12

On the rotation phase of opening how many mm are gained from the rotation of the disc?

Answer 12

11-25mm

Question 13

What is the primary movement in the early phase of opening?

Answer 13

rotation phase

Question 14

What is the primary movement in the late phase of opening?

Answer 14

translation phase

Question 15

What is the end feel of the TMJ?

Answer 15

tissue stretch with opening and bone to bone with closing