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PE I TMJ 2007 Slides

This document provides information about examining the temporomandibular joints, muscles of mastication, and occlusion. It describes the anatomy of these structures and how to assess their function through range of motion tests and palpation. Common disorders like myalgia, myofascial pain, disc displacement, and arthritis are discussed. The goals are to recognize abnormal findings, record examination findings, and diagnose common temporomandibular disorders.

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Amit Kumar
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76 views69 pages

PE I TMJ 2007 Slides

This document provides information about examining the temporomandibular joints, muscles of mastication, and occlusion. It describes the anatomy of these structures and how to assess their function through range of motion tests and palpation. Common disorders like myalgia, myofascial pain, disc displacement, and arthritis are discussed. The goals are to recognize abnormal findings, record examination findings, and diagnose common temporomandibular disorders.

Uploaded by

Amit Kumar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PHYSICAL EVALUATION I

(Dent 5121)
Extra-oral Examination
TMJ, Muscles of Mastication &
Occlusion

Lecture Objectives
After todays lecture, the student will be able to:
Describe the anatomy and function of the
temporomandibular joints, muscles of mastication
and occlusion.
Describe how to examine the function of the
temporomandibular joints, muscles of mastication,
and occlusion and how to record the findings in the
dental record.
Describe some common abnormal findings and disorders
associated with the temporomandibular joints,
muscles of mastication, and occlusion.

Temporomandibular Joint Anatomy

Mandibular condyle
Glenoid fossa and
articular eminence of
temporal bone

Temporomandibular Joint Anatomy


Articular disc
Posterior attachment
Superior head of
lateral pterygoid
muscle
TMJ capsule

Normal TMJ

Temporomandibular Disorders functional


disturbances of the masticatory system
Muscles of mastication
Temporomandibular joints
Both

Temporomandibular Disorders

Diagnoses involving the muscles of


mastication
Myalgia
Myofascial pain

Temporomandibular Disorders

Diagnoses involving the temporomandibular


joints
Disc displacement (with and without reduction)
Deviation in form
Capsulitis/arthritis
Subluxation/dislocation

Screening Questions

Pain in jaw/temples/ears
Fatigue/stiffness in jaw
Difficulty opening
Locking open/closed
TMJ noise
Trauma to jaw/face
Change in occlusion
Oral habits

Screening Examination
Range of mandibular
motion
Vertical
Limitation
Deviation/deflection

Lateral

TMJ noise
Pain to palpation
TMJ
Masticatory muscles

Limitation

Protrusion
Limitation
Deviation/deflection

Occlusion

Active Range of Motion

Active Range of Motion

Normal Active ROM


40-60 mm
Adjusted for vertical overlap
of incisors
Males>Females

Pattern of Opening

Deviation in Opening

Deviation in Opening

Deviation in Opening

Which TMJ is involved?


What may be happening?

Deflection in Opening

Deflection in Opening

Which TMJ is involved?


What may be happening?

Protrusion

Protrusion

Protrusion

Normal Protrusion
>6 mm
Adjusted for horizontal overlap
of incisors
Males>Females

Pattern of Protrusion

Deviation in Protrusion

Deviation in Protrusion

Deviation to right

Which TMJ is involved?


What may be happening?

Deflection in Protrusion

Deflection to right

Which TMJ is involved?


What may be happening?

Lateral Range of Motion

Lateral Range of Motion

Lateral Range of Motion

Normal Lateral ROM


>7 mm
Adjusted for deviation in midlines
Males>Females

Tempormandibular Joint

Locate the TMJ by palpating while patient opens and closes


mouth

Tempormandibular Joint

Palpate TMJ for joint noises

Tempormandibular Joint

Auscultate TMJ noises (not routinely done)

Tempormandibular Joint Sounds

Anterior Disc Displacement


Anterior disc
displacement with
reduction
TMJ sound:
Reciprocal click
or
Reproducible
opening click

Anterior Disc Displacement


Anterior disc
displacement
without reduction
TMJ sound:
No click
Possibly crepitus

Deviation in Form of TMJ


Alteration in surface of:
Articular surface of mandibular condyle
Articular surface of articular eminence of
temporal bone
Superior or inferior surface of articular disc

TMJ sound:
Reproducible opening click
Reproducible closing click
Reproducible opening and closing click

Normal TMJ

Severe TMJ Arthritis

TMJ Arthritis
Arthritis of TMJ
Mild articular changes
Severe articular changes

TMJ sound:
Fine crepitus
Coarse crepitus

TMJ Subluxation
Condylar head
moves too far
beyond the articular
eminence
TMJ sound:
Eminence pop

Palpation of TMJ
After mandibular
range of motion
assessment
Locate TMJ
Teeth slightly apart
Not clenching
Not opening and
closing

X
X

Muscles of
Mastication

Temporalis Muscle
Origin:
Temporal fossa

Insertion:
Coronoid process,
anterior border of
ramus

Function:
Elevates and retracts
mandible, clenches
teeth

Temporalis Muscle
Anterior, middle and
posterior part of
temporalis muscle

Temporalis Muscle

Temporalis Muscle

Anterior part of temporalis muscle

Temporalis Muscle

Middle part of temporalis muscle

Temporalis Muscle

Posterior part of temporalis muscle

Masseter Muscle
Origin:
Superficial portion anterior
2/3 of lower border of
zygomatic arch
Deep portion medial
surface of zygomatic arch

Insertion:
Lateral surface of ramus,
coronoid process, and angle
of mandible

Function:
Elevates mandible, clenches
teeth

Masseter Muscle
Multiple areas of
masster muscle

Masseter Muscle

Anterior superior part of masseter muscle

Masseter Muscle

Posterior inferior part of masseter muscle

Medial Pterygoid Muscle


Origin:
Medial surface of lateral
pterygoid plate

Insertion:
Posterior and lower part of
medial surface of ramus,
angle of mandible

Function:
Elevates, protrudes and
laterotrudes the mandible,
clenches teeth

Medial Pterygoid Muscle

Lateral Pterygoid Muscle


Origin:
Superior head infratemporal
surface of greater wing of
sphenoid bone
Inferior head lateral surface
of lateral pterygoid plate

Insertion:
Anterior portion of condylar
neck and articular disc

Function:
Protrudes and laterotrudes the
mandible, pulls articular disc
forward

Temporomandibular Disorders
Muscles of Mastication
Myalgia
Symptoms
Pain in localized area of one masticatory muscle
(usually masseter or temporalis)
Fatigue with chewing

Signs
Tender muscles upon palpation
Sometimes limited active vertical range of mandibular
motion

Temporomandibular Disorders
Muscles of Mastication
Myofascial pain
Symptoms

Regional pain in area of masseter or temporalis muscles


Tinnitus, vertigo, toothache, tension-type headache
Fatigue with chewing
May have limited mandibular function secondary to pain

Signs
Multiple tender areas in several masticatory muscles upon
palpation
Tender areas may refer pain to other locations in face
Sometimes limited active vertical range of mandibular
motion

Temporomandibular Disorders
Temporomandibular joints
Disc displacement with reduction
Symptoms
Clicking or popping noise in TMJ
May feel catching in TMJ

Signs
Reciprocal click
May have deviation in active vertical mandibular range of
motion and/or in protrusion
No restriction in active vertical mandibular range motion

Temporomandibular Disorders
Temporomandibular joints
Disc displacement without reduction (Closed
lock)
Symptoms
History of clicking or popping noise in TMJ
Limited mandibular range of motion

Signs
No TMJ sounds
Restriction in active vertical mandibular range motion and
laterotrusion
May have deflection in active vertical mandibular range of
motion and/or in protrusion

Temporomandibular Disorders
Temporomandibular joints
Capsulitis/arthritis
Symptoms
Pain in TMJ or in front of ear
Pain exacerbated by jaw function
May have limited mandibular function secondary to pain

Signs
TMJ tender to palpation
TMJ pain worsened upon clenching
Limited active mandibular range of motion, laterotrusion,
protrusion

Temporomandibular Disorders
Temporomandibular joints
Subluxation/dislocation (Open lock)
Symptoms
Jaw catches open when yawning or opening mouth wide (if
gets stuck open then dislocation)
Pain in TMJ when jaw gets stuck
Loud pop when opening wide

Signs
Excessive active mandibular vertical range of motion
Eminence pop
Residual tenderness in TMJ upon palpation if recent episode

Diagnosis of Temporomandibular
Disorders
Temporomandibular Disorders Muscles of Mastication
Temporomandibular joints
Both

TMJ arthritis and myofascial pain


TMJ disc displacement with reduction, TMJ
capsulitis, and myalgia

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