Manual therapy of the mandibular accessory ligaments for the management of temporomandibular joint disorders

Temporomandibular joint disorders are characterized by chronic or acute musculoskeletal or myofascial pain with dysfunction of the masticatory system. Treatment modalities include occlusal splints, patient education, activity modification, muscle and joint exercises, myofascial therapy, acupuncture, and manipulative therapy. In the physiology of the temporomandibular joint, accessory ligaments limit the movement of the mandible. A thorough knowledge of the anatomy of accessory ligaments is necessary for good clinical management of temporomandibular joint disorders. Although general principles regarding the anatomy of the ligaments are relatively clear, very little substantiated information on the dimension, orientation, and function of the ligaments has been published, to the authors' knowledge. The authors review the literature concerning the accessory ligaments of the temporomandibular joint and describe treatment options, including manual techniques for mobilizing the accessory ligaments

The arterial blood supply of the temporomandibular joint: an anatomical study and clinical implications.

Purpose: The aim of this study was to analyze three-dimensional images of the arterial supply to the temporomandibular joint. Materials and Methods: Ten patients (five men and five women, mean age 36 years) without signs or symptoms of temporomandibular disorders, who underwent contrast-enhanced computed tomographic (CT) scanning with intravenous contrast, were studied. The direct volume rendering technique of CT images was used, and a data set of images to visualize the vasculature of the human temporomandibular joint in three dimensions was created. After elaboration of the data through post-processing, the arterial supply of the temporomandibular joint was studied. Results: The analysis revealed the superficial temporal artery, the anterior tympanic artery, the deep temporal artery, the auricular posterior artery, the transverse facial artery, the middle meningeal artery, and the maxillary artery with their branches as the main arterial sources for the lateral and medial temporomandibular joint. Conclusion: The direct volume rendering technique was found to be successful in the assessment of the arterial supply to the temporomandibular joint. The superficial temporal artery and maxillary artery ran along the lateral and medial sides of the condylar neck, suggesting that these arteries are at increased risk during soft-tissue procedures such as an elective arthroplasty of the temporomandibular joint

Relationships between stomatognathic and oculomotor systems in the postural determinism

Objectives To establish if oculomotor apparatus, stomatognathic apparatus and postural system are someway related. Materials and methods Ocular deficit, postural stabilization, head inclination and rotation, shoulder position and dental class were assessed by convergence test, cover test, postural and stomatognathic examination in a sample of 22 patients with ocular disease (convergence deficit, strabismus and heterophoria) aged from 10 to 18 years. Results In patients with convergence's deficit, body axis deviated to left (65%) and head inclination to right (65%), right shoulder was higher (68%) and I dental class was observed (49%); in patients with strabismus, body axis deviated to left (54%) and head inclination to left (53%), right shoulder was higher (61%) and II dental class was observed (33%); patients with heterophoria showed head inclination to left (98%), body axis and higher shoulder deviated to left (78%) and I-II dental class (33%). Conclusions This study suggests that head inclination on the left side in patients with convergence's deficit or strabismus and head inclination on the right side in patients with heterophoria compensate ocular deficit

Oral breathing and head posture

Abstract Objective: To determine the head posture and cephalometric characteristics in oral breathing children. Materials and Methods: Lateral cephalograms taken in natural head posture of 35 oral breathing patients (OB) (mean age 8.8 ± 2.2 years SD; range 5–13 years) and of 35 patients with varied malocclusions and physiological breathing (PB) (mean age 9.7 ± 1.6 years SD; range 7–13 years) were examined. Results: A Student's t-test showed that an increase in angles NSL/OPT (P = .000), NSL/CVT (P = .001), FH/OPT (P = .000), FH/CVT (P = .005), and NSL/VER (P = .000); a decrease in the distance MGP-CV1p (P = .0001); and a decrease in the angles MGP/OP (P = .000) and OPT/ CVT (P = .036) were found in the OB group. A low position of the hyoid bone (H-MP, P = .009), a major skeletal divergence (ANS-PNS/Go-Me, P = .000), and an increased value of the ANB angle (P = .023) were present in OB patients. To ascertain if the changes in posture were connected with posterior obstruction of the upper respiratory airways, the OB group was divided into two subgroups based on the distance Ad2-PNS being greater than or less than 15 mm. No significant differences were found between these two groups. Conclusions: Our data suggest that OB children show greater extension of the head related to the cervical spine, reduced cervical lordosis, and more skeletal divergence, compared with PB subjects