3. Mr. Abu Jad : A male aged 45-year old, smoker, he works a taxi driver,
presented with the chief complaint of pain in the anterior of his right ear
and in the zygoma.
Medical history: He has CHD and takes Aspirin, Hypoprusre(Beta blocker,
Metoprolol), and plavex( Clopidogrel).
3 months ago he went to Dentist with an acute pain in this region and the
dentist extracted 18 & 48 but he mentioned that he had a severe pain during
anesthesia.
Now he suffers from a difficulty in mouth opening in the early morning and
the pain in the same region.
Quiz 1
4. A female aged 55-year old, nonsmoker, presented with the chief
complaint of a headache & pain in the posterior of her left ear and
sometimes in the chin.
Medical history: She has osteoarthritis in her knees joints and takes
Indomethacin.
6 months ago she went to the hospital and the neurologist refers her to
the dentist.
Now she suffers from the pain in the same region.
Quiz 2
8. Examination with tissue-specific stress
describes the direction of any load that is responsible for
an area of tissue damage within the joint and provides a
better understanding of malfunctions of the system. A
determination of the specific loading vector is important
if one is to follow an effective procedure for arriving at a
diagnosis and treatment plan.
A nonphysiological load of a certain amount in a certain
direction
loading vector
12. Functional Unit
Removable Structures
limitation of movement
Structures
Motor Structures
Lateral ligament
Stylomandibular ligament
Sphenomandibular ligament
Condyle
Articular disk
Bilaminar Zone
Muscles
Nerves
14. Patient History
1- “What are the Complaints that Brought You to Me?”
2- “Rank Your Problems in Order of Severity?”
3- “What Exactly Do You Expect from Me?"
32. Isometric contraction of the elevator (jaw- closing) muscles.
The duration of the contraction should be between 20 and 80 seconds.
According to EMG studies, correct positioning of cotton rolls between the second premolars
and first molars results in maximal loading of the elevator muscles.
Isometric contraction of the elevator muscles
34. Monitoring contraction of the medial
pterygoid muscles: Testing for
contraction of the medial pterygoid
muscles. Following the contraction the
patient is asked if, and exactly where,
any pain was felt. The examiner must
also ask if the pain is similar to that
reported in the patient history or if it is an
unfamiliar pain was evoked only by the
examination.
Isometric contraction of the elevator muscles
36. Differential diagnosis
Painfull lesion at elevator muscles
painfull lesion at joint (Acute
arthritis,Osteoarthritis, non
inflammatory lesion)
Anterior disk displacement
Limitation the translation movement
without
Limitation the rotational movement
Isometric contraction of the elevator muscles
37. There is painful response
centric and eccentric position
of the condyle in the fossa
Differential diagnosis
Anterior disk displacement
Isometric contraction of the elevator muscles
38. There is a painfull lesion
at elevator muscles
Muscle Palpa+on
Masseter muscle
Temopral muscle
Differential diagnosis
Isometric contraction of the elevator muscles
39. Determine the mayofacial
painful point
Isometric contraction of
the depressor muscles
Differential diagnosis
Isometric contraction of the elevator muscles
40. Specific palpation is usually accomplished by laying the palpating
finger parallel with the muscle fibers to be tested. The actual palpating
movements then take place at right angles to the direction of the fibers.
In this way even lesions in different layers of a muscle, such as the
pars profunda and pars superficialis of the masseter, can be reliably
differentiated (Goulet et al. 1998).
A force of approximately 40 N/cm2 should be used during specific
palpation. This procedure results in greater discrimination than do a
number of quantitative methods for detecting painful areas (Wolfe et
al. 1990).
41. Temopral muscle palpation
Palpation of the pars anterior of the temporal
muscle
Palpation of the pars media and pars
posterior of the temporal muscle
Isometric contraction of the elevator muscles
42. Palpation of the masseter muscle
Isometric contraction of the elevator muscles
43. Palpation of the masseter muscle
Palpation of the pars superficialis of the masseter muscle
Isometric contraction of the elevator muscles
44. Palpation of the masseter muscle
Palpation of the pars profunda of the masseter muscle
Isometric contraction of the elevator muscles
48. Isometric contraction of the depressor muscles
Differential diagnosis
Painfull lesion at depressor
muscles
painfull lesion at joint (Acute
arthritis,Osteoarthritis, non
inflammatory lesion)
Anterior disk displacement
Limitation the translation movement
without
Limitation the rotational movement
53. Passive movements
1- Excitated pain
myofacial pain of lateral
pterygoid muscle
2-No excitated pain
myofacial pain of supra
hyoid muscles
Isometric contraction of the depressor muscles
Differential diagnosis
Supra hyoid muscles
palpation at position of
the pain
57. Affected anatomical structures
- posterior belly of digastric muscle
- pars posterior of the temporal muscle
- Superior belly of the lateral pterygoid
muscle
Isometric contraction
1-Elevator muscles
3- Mediotractors muscles
4- posteriotractor muscles
2-Depressor muscles
58. Examination base points
✤ Excited pain
✤ development of the
power
Innervation
Muscles condision
(Pain,Harmony,…)
Isometric contraction
59. There are no problems in the
Nerves of the elevator muscles
There is no deficiency
of power
Isometric contraction of the elevator muscles
Isometric contraction of the
depressor muscles
Differential diagnosis
60. or difficulties in active
movements
There is deficiency of
power There are problems in the
Nerves of the elevator muscles
Referral the patient to
neurologist
Differential diagnosis
Isometric contraction of the elevator muscles
61. Mr. Abu Jad : A male aged 45-year old, smoker, he works a taxi driver,
presented with the chief complaint of pain in the anterior of his right ear
and in the zygoma.
Medical history: He has CHD and takes Aspirin, Hypoprusre(Beta blocker,
Metoprolol), and plavex( Clopidogrel).
3 months ago he went to Dentist with an acute pain in this region and the
dentist extracted 18 & 48 but he mentioned that he had a severe pain during
anesthesia.
Now he suffers from a difficulty in mouth opening in the early morning and
the pain in the same region.
Quiz 1
63. A female aged 55-year old, nonsmoker, presented with the chief
complaint of a headache & pain in the posterior of her left ear and
sometimes in the chin.
Medical history: She has osteoarthritis in her knees joints and takes
Indomethacin.
6 months ago she went to the hospital and the neurologist refers her to
the dentist.
Now she suffers from the pain in the same region.
Quiz 2
