TMJ

Myofascial pain dysfunction (MPD) syndrome

Increased pain at the TMJ due to muscle tension and spasm. physical manifestation of psychologic stress No primary disorder of the joint itself is present.

During mastication, the power stroke, when the teeth crunch the food, involves a movement from

a laterally deviated position back to the midline. (think of a cow)

The power stroke will return the mandible to the center, so the movement is to the left and involves

a retraction of the left side. At the same time, all the closing jaw muscles on the right side contract to crush the food.

subluxation

acute episode in which both joints become dislocated, often due to excessive mandibular protrusion and depression head of each condyle moves too far anteriorly on the articular eminence.

The ______ muscles are involved in depressing the mandible when they bilaterally contract during opening of the jaws with the hyoid bone stabilized by the other hyoid muscles.

anterior suprahyoid

The ____________consists of a rounded protuberance on the inferior aspect of the zygomatic process.

articular eminence

The squamous area of temporal bone has the _____ and the ____ articulating to the mandible

articular eminence and articular fossa.

symptoms of TMD

chronic joint tenderness, swelling, and painful muscle spasms. difficulties of joint movement such as a limited or deviated mandibular opening.

The rotational movement of the TMJ occurs mainly between the

disc and the mandibular condyle in the lower synovial cavity.

The articular fossa, which is also known as the _________ , is posterior to the articular eminence.

glenoid or mandibular fossa

What are two basic types of movement performed by the TMJ and its associated muscles:

gliding (or sliding) -Back and forth rotational (or hinge) movements.

Most cases of TMD improve over time with

inexpensive and reversible conservative treatments, including patient-based or prescription pain control, relaxation therapy, stress management, habit control, moderate muscle exercises, and orofacial myology.

Lateral deviation of the mandible

involving shifting the lower jaw to one side.

Stylomandibular ligament of TMJ

is a variable ligament formed from thickened cervical fascia in the area. It also becomes taut when the mandible is protruded.

The sphenomandibular ligament

is not strictly considered part of the TMJ but is located on the medial side of the mandible, at some distance from the joint.

A fibrous _____ completely encloses the TMJ.

joint capsule

Contraction of the contralateral lateral pterygoid muscles, the one on the protruding side, is involved during_____

lateral deviation.

The ______ muscles are primarily involved in the protrusion that accompanies opening. Because the protruded condyle articulates with the articular eminence rather than the articular fossa, a slight depression is associated with protrusion.

lateral pterygoid

A _____ is a band of fibrous tissue that connects bones.

ligament

The mandible is joined to the cranium by _____ of the TMJ.

ligaments

Depression of the mandible is the __________ of the lower jaw

lowering

The TMJ allows for the______ during speech and mastication by way of each muscle attached to the cranium and mandible..

movement of the mandible

what is posterior to the articular fossa is a sharper ridge

postglenoid process.

Elevation of the mandible is the _________ of the lower jaw.

raising

If the food is on the right, the mandible will be deviated to the _____ by the ____ muscle

right by the left lateral pterygoid muscle.

The muscles of mastication involved in elevating the mandible during closing of the jaws include

the bilateral contractions of the masseter, temporalis medial pterygoid muscles.

The rotational movement of the TMJ occurs mainly between what?

the disc and the mandibular condyle in the lower synovial cavity

The TMJ ligament prevents what?

the excessive retraction or moving backward of the mandible

Mandibular condyle

the head expending from the mandibular ramus (the head is what articulates)

mandibular ramus with the TMJ

the joint disc working with the knuckle-shaped posterosuperior process of the mandibular ramus

Although it is not part of the TMJ, the _______ becomes accentuated and taut when the mandible is protruded.

the sphenomandibular ligament

The resting position of the TMJ is not with

the teeth biting together.

the reduced opening of the jaw

trismus When the patient tries to close and elevate the mandible, the condylar heads cannot move posteriorly because the muscles of mastication have become spastic. (TMD)

can overbite impact TMD

yes, it can add to the issues

Blood supply to the TMJ

-from branches of the external carotid artery, predominantly the superficial temporal branch. -venous return is by the superficial temporal, maxillary, and pterygoid plexus of veins -lymph from the TMJ is drained deeply into the superior deep cervical nodes

At what position does a displaced joint disc of the temporomandibular joint usually lie? A. Anterior to its usual position B. Posterior to its usual position C. Within the articular fossa D. Within the mandibular notch

A. Anterior to its usual position

Which of the following situations occurs when there is subluxation of the temporomandibular joint? A. Head of condyle moves too far anteriorly on the articular eminence. B. Neck of condyle moves too far posteriorly on the articular eminence. C. Coronoid process moves too far anteriorly on the articular eminence. D. Coronoid process moves too far posteriorly on the articular eminence.

A. Head of condyle moves too far anteriorly on the articular eminence.

Which of the following is located posterior to the articular fossa within the region of the temporomandibular joint? A. Postglenoid process B. Articular eminence C. Bony separation of the nasal septum D. Zygomatic process of the temporal bone

A. Postglenoid process

Which of the following temporomandibular joint ligaments has the inferior alveolar nerve descending nearby in order to gain access to the mandibular foramen? A. Sphenomandibular ligament only B. Stylomandibular ligament only C. Temporomandibular ligament only D. Sphenomandibular and sytlomandibular ligaments E. Stylomandibular and temoprormandibular ligaments

A. Sphenomandibular ligament only

Which of the following landmarks is located upon the temporal bone? A. Condyle B. Articular fossa C. Coronoid notch D. External oblique line

B. Articular fossa

Which of the following landmarks associated with the temporomandibular joint is located DIRECTLY on the mandible? A. Articular eminence B. Condyle C. Articular fossa D. Postglenoid process

B. Condyle

Which of the following statements about the temporomandibular joint disc is INCORRECT? A. Disc separates the TMJ into synovial cavities B. Disc is attached anteriorly and posteriorly to the condyle C. Gliding movements take place between the disc and the temporal bone D. Inferior surface of the disc is concave

B. Disc is attached anteriorly and posteriorly to the condyle

Which of the following provides arterial branches for the MOST direct blood supply to the temporomandibular joint? A. Internal carotid artery B. External carotid artery C. Common carotid artery D. Aorta alone

B. External carotid artery

retraction of the mandible. What is involved?

Bringing the lower jaw backward The contraction of the posterior parts of both temporalis muscles are involved during retraction of the mandible.

protrusion of the mandible. What does this involve?

Bringing the lower jaw forward involves Protrusion involves the bilateral contraction of both of the lateral pterygoid muscles.

Which list is in order of location from the MOST anterior structure to the MOST posterior structure as found within the termporomandibular joint? A. Articular fossa, postglenoid process, articular eminence B. Condyle, coronoid process, mandibular notch C. Articular eminence, articular fossa, postglenoid process D. Coronoid process, condyle, mandibular notch

C. Articular eminence, articular fossa, postglenoid process

Which of the following is an overall description of the basic movement performed by the temporomandibular joint? A. Gliding movement only B. Rotational movement only C. Gliding and rotational movement D. No movement is involved

C. Gliding and rotational movement

Which structure of the temporomandibular joint secretes synovial fluid? A. Mandibular condyle B. Joint Disc C. Inner capsule lining membranes D. Lateral pterygoid muscle

C. Inner capsule lining membranes

Which of the following muscles is involved in the lateral deviation of the mandible? A. Masseter muscle B. Medial ptergyoid muscle C. Lateral ptergyoid muscle D. No movement is involved

C. Lateral ptergyoid muscle

The joint capsule of the temporomandibular joint wrap around which structure? A. Coronoid process B. Mandibular notch C. Mandibular condyle D. Zygomatic arch

C. Mandibular condyle

Which of the following situations can possibly happen to the joint disc of the temporomandibular joint as a person ages? A. Increased blood supply B. Fewer calcifications C. Perforations of structure D. Thickening of structure

C. Perforations of structure

Which of the following ligaments associated with the temporomandibular joint serves to reinforce the joint capsule? A. Styloid B. Stylomandibular C. Temporomandibular D. Sphenomandibular

C. Temporomandibular

Protrusion of the mandible is an action that primarily involves A. opening the jaws. B. closing the jaws. C. bringing the lower jaw forward. D. bringing the lower jaw backward. E. shifting the lower jaw to one side.

C. bringing the lower jaw forward.

During both mandibular protrusion and retraction, the rotation of the articulating surface of the mandible against the disc in the lower synovial cavity is prevented by the A. facial muscles. B. infrahyoid muscles. C. muscles of mastication. D. ligaments of the temporomandibular joint.

C. muscles of mastication.

describe the shape of the disk of the TMJ

Concave- inferior Convex- superior

Which are of the mandible listed below articulates the temporal bone at the temporomandibular joint? A. Lingula B. Mandibular notch C. Coronoid process D. Condyle

D. Condyle

Which of the following nerves innervates the temporomandibular joint? A. Facial nerve B. Hypoglossal nerve C. Vagus nerve D. Trigeminal nerve E. Glossopharyngeal nerve

D. Trigeminal nerve

Which of the following movements of the lower jaw is assisted through contraction by the temporalis muscle? A. Mandibular depression only B. Mandibular elevation only C. Mandibular retraction only D. Mandibular depression and elevation E. Mandibular elevation and retraction

E. Mandibular elevation and retraction

How do you examine the TMJ intraorally

Intraoral palpation of the tendon of the temporalis muscle. The tendon of the temporalis is palpated by placing the finger of one hand intraorally on the anterior border of the ramus and the finger of the other hand extra orally on the same area. The intraoral finger is moved up the anterior border of the ramus until the coronoid process and tendon are palpated.

The fibrous _______ is located between the temporal bone and mandibular condyle on each side, allowing articulation between the two bones.

Joint disc or meniscusis

The temporal bone is a cranial bone that articulates with the facial bone of the mandible at the TMJ by way of the ______

Joint disk or meniscus

Trismus

Reduced opening of the jaws locked jaw

The TMJ has its sensory innervation by the _______ and ____ branches of the mandibular nerve (or third division) of the _____ cranial or ______nerve; motor function is by the muscles of mastication

The TMJ has its sensory innervation by the auriculotemporal and masseteric branches of the mandibular nerve (or third division) of the fifth cranial or trigeminal nerve; motor function is by the muscles of mastication

The articulating surface of the condyle is strongly _______ in the anteroposterior direction and only slightly ______ mediolaterally.

The articulating surface of the condyle is strongly convex in the anteroposterior direction and only slightly convex mediolaterally.

Most symptoms of TMD seem to originate from the ___

muscles supporting the joint.

does the TMJ disk have a blood and nerve supply

no

is malocclusion related to TMD

no it is not involved in most cases, but a lack of an overbite can effect this.

are joint sounds an indicator of of TMD (Popping, grinding, clicking)

no its not, 40%-60% of ppl without TMD will experience these sounds

Do recent studies show the role of TMD in causing headaches, or neck or back pain or instability;

no.headaches are usually caused by muscle tension or vascular changes. Cyclic episodes of TMD and other incidents of chronic body pain are commonly encountered in the TMD population, with smoking now shown to increase pain levels.

Trismus can also occur with

odontogenic infections.

An acute episode of TMD can occur when a patient

opens the mouth too wide, causing maximal depression and protrusion of the mandible, as when yawning or receiving prolonged dental care. causes subluxation

Articular Fossa

oval-shaped depression on the temporal bone, located posterior to the articular eminence, and posterior and medial to the zygomatic process of the temporal bone.

The articulating area on the temporal bone of the joint is located on the bone's inferior aspect, involving its ______ part.

squamous

The TMJ disc completely divides the TMJ into two compartments or ________.

synovial cavities: the upper and lower synovial cavities.

The membranes lining the inside of the joint capsule secrete ______ that helps lubricate the joint and fills the synovial cavities.

synovial fluid

The TMJ is the articulation of the _____ bone and the _________ on each side of the head, the bones of which give the joint its name.

temporal bone and the mandible

The ______ ligament is located on the lateral side of each joint forming a reinforcement of the lateral part of the joint capsule of the TMJ.

temporomandibular

Three paired ligaments are associated with the TMJ, what are they?

temporomandibular stylomandibular sphenomandibular ligaments.

A patient may have pathology associated with one or both of the TMJs, what is this called?

temporomandibular disorder (TMD).

The sphenomandibular ligament is involved in what

troubleshooting the inferior alveolar block due to its location The ligament may actually act as an outer barrier to the diffusion of the local anesthetic agent if the medial surface of the mandible is not contacted with the needle at the deeper mandibular foramen with the inferior alveolar nerve.

true or false Not all patients with TMD have abnormalities in the joint disc or the joint itself.

true