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Kines Quiz #5
TMJ
| Question | Answer |
|---|---|
| Where is the mandibular condyle? | Fits within the mandibular fossa of the temporal bone and can be palpated just anterior to the external auditory meatus |
| What is the external auditory meatus? | the opening into the ear |
| Temporal fossa | slightly concave region of the skull |
| Which 5 bones contribute to the temporal fossa? | temporal parietal frontal sphenoid zygomatic |
| The mastoid process is on which bone? | temporal |
| The zygomatic arch is formed by what? | union of the sygomatic process of the temporal bone and the temporal process of zygomatic bone |
| Which 6 bones are related to the structure of the TMJ? | 1.mandible 2. maxilla 3. temporal 4. zygomatic 5. sphenoid 6. hyoid |
| Which bone is the largest of the facial bones? | mandible & it is very mobile |
| Name the 8 relevant bony features of the mandible | 1. body 2. ramus 3. angle 4. coronoid process 5. condyle 6. notch 7. neck 8. pterygoid fossa |
| Two main parts of the mandible | 1. body 2. rami |
| what are the 6 relevant bony features of the temporal bone? | 1. mandibular fossa 2. dome 3. articular eminence 4. postglenoid tubercle 5. styloid process 6. zygomatic process |
| What are the 3 relevant bony features of the sphenoid bone? | 1. greater wing 2. medial pterygoid plate 3. lateral pterygoid plate |
| In the mandibular fossa, the posterior region of the articular disc attaches to what 2 sites? | 1. collagen rich inf. retrodiscal lamina, which attaches to periphery of superior neck of mandible & capsule of TMJ 2. Elastin rich superior restrodiscal lamina |
| What does the rich superior retrodiscal lamina attach to? | tympatnic plate of the temporal bone just posterior to the mandibular fossa |
| What 3 things attach to the anterior region of the articular disc of the mandibular fossa? | 1. periphery of sup. neck of mandible and ant capsule of TMJ 2. tendon of sup head of lateral pterygoid M 3. temporal B ant. to articular eminence |
| What are the 5 supporting connective tissues within the temporomandibular joint? | 1. articular disc 2. fibrous capsule 3. lateral ligament 4. sphenomandibular ligament 5. stylomandibular ligament |
| What is the coronoid process? | triangular projection of thin bone on mandible |
| What is the attachment site for the lateral pterygoid muscle? | anterior-medial surface of manibular neck within pterygoid fossa |
| Is the maxilla fixed or moveable? | fixed |
| The maxilla forms | floor of the nasal cavity and the orbit of eyes |
| What forms the bony concavity of the TMJ? | the mandibular fossa |
| The highest point of the mandibular fossa is called | the dome |
| The mandibular fossa is bound anteriorly to the _________and posteriorly to the ___________. | anteriorly to articular eminence posteriorly to postglenoid tubercle & tympanic part of temporal bone |
| What happens with full opening of the mouth? | the condyles of the mandible slide anteriorly and inferiorly across the pair of sloped articular eminences |
| What CN is responsible for innervation in the face? What muscles does it innervate? | CN 5 - trigeminal nerve muscles of innervation - tensor tympani, tensor velli palatini, mylohyoid, and digastric |
| What nerve innervates muscles of the head? | vagus nerve |
| The ramus of the jaw includes what 2 structures? | coronoid process angle |
| What muscle attaches to the coronoid process? | temporalis M |
| How many teeth in an adult mouth? | 32 |
| What are the poles of the mandibular condyle? | lateral pole medial pole |
| What is the site of attachment for the hyoid muscle? | mandible medial |
| What muscle attaches to the angle of the mandible between the angle and the mandibular foramen? | medial pterygoid M |
| The hyoid consists of what three parts? | 1. greater horn 2. lesser horn 3. body |
| Where is the hyoid palpable? | just below the throat |
| What is the significance of the hyoid? | it is the site of attachment for the muscles that control swallowing |
| Name the 7 muscles of the suprahyoid and the infrahyoid | 1. mylohyoid 2. stylohyoid 3. omohyoid 4. sternohyoid 5. digastric 6. sternothyroid 7. scalenius anterior and medius |
| Name the 3 muscles of mastication | 1. masseter 2. temporalis 3. pterygoids (medial and lateral) |
| What are the three branches of the trigeminal nerve and where do they go? | V1 --> forehead V2 --> maxilla V3 --> mandible |
| The three branches of the trigeminal innervate what area? | masseter |
| 3 descriptions of masseter M | 1. thick strong muscle 2. easily palpable 3. superficial and deep heads |
| Function of the Masseter M | grind and crush food |
| What does the temporalis look like and what is its function? | flat and fan shaped It retracts the jaw |
| Where is temporalis located? | temporalis fossa and attaches to the coronoid process of the mandible |
| Describe the medial heads of the pterygoid M | two medial heads: 1. superficial head of ptergoid m 2. deep head of pterygoid M |
| Which medial head of the pterygoid is larger? | the deep head |
| Which muscle goes through your palate? | levator velli palatini |
| Which muscle is medial to the levator veli palatini? | the tensor veli palatini |
| Describe the lateral pterygoid M | bipenate with 2 distinct heads |
| Name the two head of the pterygoid M | 1. lateral pterygoid inferior head 2. lateral pterygoid superior head |
| which laterior pterygoid head is larger? | inferior head |
| Two types of fibers in the lateral ligament of the TMJ | deep horizontal fibers superficial oblique fibers |
| 3 ligaments of the TMJ | 1. Temporomandibular ligament (TML) (lateral ligament) 2. Stylomandibular ligament (SML) 3. Sphenomandibular ligament (SphML) |
| two portions of the TML | oblique portion and horizontal inner portion |
| 3 Motions limited by the oblique portion of the TML | 1. downward and posterior motion of the mandible 2. condyle rotation in the opening 3. lateral translation |
| 2 Motions limited by the horizontal inner portion. What does it protect? | 1. limits posterior translation 2. limits lateral translation 3. protects the retrodiscal pad |
| Where does the stylomandibular ligament (SML) attach? | posterior border of the ramus of the mandible between the masseter and medial terygoid |
| What is the function of the SML and SphML? | not really sure what they do |
| What is the name of the capsule in the TMJ? | capsule of the temporomandibular joint |
| Is the mandibular condyle concave or convex? | convex |
| Does the temporal fossa have a non articulating area or an articulating area? | both |
| In the TMJ you have what kind of cartilage on either side | articular fibrocartilage |
| Degrees of the angle of the articular eminence | 55 degrees |
| describe retrodiscal ligament | does not articulate, but is still considered part of the bone |
| 4 things to descibe the capsule | 1. 2 portions 2. strong laterally 3. weak AP and medially 4. highly vascularized and innervated |
| what are the two portions of the capsule in the TMJ? | 1. condyle to the disc 2. disc to the articular eminence |
| Describe the disc in the TMJ capsule (3) | 1. disc is slightly, loosely attached and sometimes gets displaced 2. very strong laterally 3. weak anteriorly, posteriorly and mediall |
| When you dislocate your jaw it goes | forward |
| Describe the articular disc (2) | 1. it is biconcave (both superiorly and inferiorly) 2. firmly attached to medial and lateral poles of condyle of mandible, and to the periphery of the capsule |
| what are the 5 osteokinematics of the mandibular | 1. Depression 2. Elevation 3. Protrusion 4. Retrusion 5. Lateral excursion |
| What is normal and functional in mandibular depression? | normal = 3 PIP joints between teeth functional - 2 PIP joints between teeth |
| Describe arthrokinematics of early phase of mandibular depression | 1. convex mandibular condyle rotates inferiorly on concave disc |
| early phase of mandibular depression is up to what? | 1st 50% |
| What happens if you keep your tongue on the roof of your tongue during mandibular depression? | Disc is not moving if you keep the tongue against the roof of your mouth you can only open it so far |
| What is the late phase of manibular depression? | last 50% |
| Describe late phase of mandibular depression | 1. Lateral TMJ ligament oblique fibers pulled taut and cause translation: 2. Disc-condyle complex (DCC) translates forward onto articular eminence of mandibular fossa. 3. The superior retrodiscal lamina gets tight and limits anterior translation |
| What limits anterior translation during mandibular depression? | superior retrodiscal lamina |
| what is mandibular elevation? | reverse of depression |
| What are the arthrokinematics of mandibular elevation? (describe both early and late phase) | 1. Early phase: Superior retrodiscal lamina retracts disc Posterior translations of Disc-Condyle Complex 2. Late phase: Rotation superiorly of condyle on disc. |
| Describe mandibular protrusion | Translate anteriorly without significant rotation |
| What is retrusion? | return from protrusion |
| Arthrokinematics of protrusion? | DCC translates anteriorly |
| Arthrokinematics of retrusion? | DCC translates posteriorly |
| What is lateral excursion? | Side to side translation of the disc of the condyle and disc within the fossa |
| Lateral excursion consists of (3 ) | 1. slight multiplanar rotations 2. Comes anterior rotates medially and laterally, posteriorly and back 3. Pivot point is the left fossa |
| Arthrokinematics of lateral excursion | DCC lateral translation AND rotation Occurs in same direction Eg: LEFT lateral excursion: DCC translates left Rotation left |
| What is the muscle action of mandibular depression | 1. suprahyoid Ms 2. Inferior head of lateral pterygoid 3. gravity |
| What muscles assist in mandibular depression? | Dygastric (lower red arrow) Anterior belly and posterior belly of the dygastric muscle (labeled suprahyoid) Lateral portion of pterygoid helps with motion |
| 3 muscles involved in mandibular elevation? | masseter medial peterygoid temporalis |
| What controls the motion of mandibular elevation? | motion controlled by eccentric contraction of- superior head of lateral pterygoid |
| What is the functional sling of the mandible? | Sling holding the jaw |
| 3 parts of the functional sling of the mandible | 1. masseter muscle from the zygomatic arch to the angle of mandible 2. medial pterygoid M from the angle of mandible to the sphenoid bone 3. Temporalis M from the angle of mandible to the sphenoid bone |
| Both head of the lateral pterygoid are ________ & _________ to the medial pterygoid muscle | superior and lateral to the medial pterygoid muscle |
| Protrustion/Retrusion of the TMJ = what kind of activation of the masseter? | bilateral activation of the masseter |
| What muscles help with protrusion and retrusion of the TMJ | Medial & lateral pterygoids also help with this motion |
| What is protrusion? | Protrusion is bilateral activation of the temporalis with assist from digastric and superhyoid muscles. |
| In lateral excursion, what 2 muscles are involved in contralateral motion? | 1. lateral pterygoid 2. medial pterygoid |
| What 2 muscles are involved in ipsilateral motion during lateral excursion? | Temporalis M Masseter |
| Which nerve innervates the muscles of lateral excursion? | CN 9 Glossopharyngeal |
| What is the relationship of the TMJ to the cervical spine? | Muscles that attach to the TMJ attach to the head, hyoid bone, clavicle thus may act on mandible, O/C1 joint and the C/S. |
| Many times TMJ presents with issues actually attributed to the | C/S |
| What is resting position btn the teeth is ___? | anywhere from 1-1.5 cm between the teeth |
| What are the 5 dysfunctions of TMJ? | 1. Bruxism: grinding the teeth 2. Reciprocal Click: Opening = Relocation 3. Closing = Dislocation 4. Early opening/Late closing Click = limited dislocation 5. Late opening/Early Closing Click = more severe dislocation |
| Some dysfunctino of the TMJ may be due to | May be due to trauma or poor oral habits, postural habits |
| What population has TMJ OA changes? | 80-90% of the population greater than 60 years of age have some TMJ OA changes. |
| How does OA of TMJ occur? | Typically occurs unilaterally secondary to repeated minor trauma creating impact between the articular surfaces Often a loss of posterior teeth results in accelerated OA changes due to the increased occlusion which = increased TMJ articular surface impac |
| What is the typical symptom of TMJ? | pain with translation/gliding, NOT WITH ROLLING |
| The styloid process serves as an attachment for what four things? | 1. stylomandibular ligament 2. 3 small muscles (styloglossus, stylohyoid, and stylopharyngeus) |
| muscles innervated by CN 5 | masseter temporalis medial petrygoid lateral pterygoid digastric (division of CN 5) mylohyoid (division of CN 5) |
| 4 Primary muscles of mastication | 1. masseter 2. temporalis 3. medial pterygoid 4. lateral pterygoid |
| 8 secondary muscles | 1. digastric 2. geniohyoid 3. mylohyoid 4. stylohyoid 5. omohyoid 6. sternohyoid 7. sternothyroid 8. thyrohyoid |
| The central part of the articular disc lacks what? | sensory innervation |
| The sensory from the TMJ is carried through two branches of the mandibular N called... | 1. auriculotemporal 2. masseteric |
| Bilateral actionof masseters causes mandible to ______ | protrude |
| unilateral contraction of the masseter causes slight_____of mandible | ipsilateral excursion |
| simultaneous contraction of the R medial pterygoid & L masseter produces what action? | Left lateral deviation and verfy effective synergistic shear force |
Created by:
jnorthcutt