Download OMM-PPC Lecture 08 – TMJ Evaluation and Treatment – Block 7

OMM-PPC Lecture 08 – TMJ Evaluation and Treatment – Block 7
TMJ anatomy – Capsule
 Synovial joint
 Differs from other joints:
o Covered by fibrocartilage rather than hyaline cartilage
o Joint cavity is divided into two separate compartments by an articular disc or meniscus
 More like 2 joints instead of one
 Talking/gentle chewing  confined to 1st compartment
 Eating/yawning (high-opening) involves the 2nd compartment
(between the disc and the temporal fossa)
o MOST DYSFUNCTION OCCURS HERE!!!
Jaw Opening  40 -50 mm
Facial nerve in front of, auriculotemporal nerve behind
Otalgia in children  may be TMJ
Palpation of TMJ:
1. Preauricular area, just anterior to tragus
2. Within the external auditory canal
3. Orally along the last molar
TMJ motions
 Depression (opening of the mouth from rest)
 Suprahyoid and infrahyoid muscles contract, moving the head of the mandible and the
articular disc anteriorly
 Elevation (closing of the mouth to rest)
 Temporalis (vertical fibers), masseter and medial pterygoid muscles contract, pulling the
head of the mandible and the articular disc posteriorly; very powerful movement
 Protrusion (carrying the mandible forward from rest)
 Masseter, lateral pterygoid and medial pterygoids contract, causing the head of the
mandible to glide anteriorly but the articular disc to slide posteriorly
 Retraction (carrying the mandible back to rest)
 Temporalis (horizontal fibers) and masseter contract to pull the head of the mandible
posteriorly and slide the articular disc anteriorly
Anteriorly displaced mandible  can’t close (more common)
Posteriorly displaced mandible  can’t open
Tenderpoints
- Masseter – in belly of muscle, push posterior
o Jaw towards
- Medial Pterygoid – posterior part of jaw 2 cm above angle, push anterior
o Jaw away
- Lateral Pterygoid – right in front of top part of mandible, push medial/posterior
o Jaw away
- Temporalis – anywhere in the muscle (sides of forehead)
o Jaw towards
OMM-PPC Lecture 08 – TMJ Evaluation and Treatment – Block 7