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EDS Awareness in the TMJ Patient
EDS Awareness in the TMJ Patient TMJ and CCI with the EDS Patient “The 50/50” Myofascial Pain Syndrome EDNF, Baltimore, MD August 14,15, 2015 Generation, Diagnosis and Treatment of Head Pain of Musculoskeletal Origin Head pain generated by: • Temporomandibular joint dysfunction • Cervicocranial Instability • Mandibular deviation • Deflection of the Pharyngeal Constrictor Structures Parameters & Observations . The Myofascial Pain Syndrome (MPS) is a description of pain tracking in 200 Ehlers-Danlos patients. Of the 200 patients, 195 were afflicted with this pain referral syndrome pattern. The MPS is in direct association and correlation to Temporomandibular Joint dysfunction and Cervico- Cranial Instability syndromes. Both syndromes are virtually and always correlated. Evaluation of this syndrome was completed after testing was done to rule out complex or life threatening conditions. The Temporomandibular Joint TMJ Dysfunction Symptoms: Deceptively Simple, with Complex Origins 1) Mouth opening, closing with deviation of mandibular condyles. -Menisci that maybe subluxated causing mandibular elevation. -Jaw locking “open” or “closed”. -Inability to “chew”. 2) “Headaches”/”Muscles spasms” (due to decreased vertical height)generated in the temporalis muscle, cheeks areas, under the angle of the jaw. 3) Osseous distortion Pain can be generated in the cheeks, floor of the orbits and/or sinuses due to osseous distortion associated with “bruxism”. TMJ dysfunction cont. (Any of the following motions may produce pain) Pain With: . Limited opening(closed lock): . Less than 33 mm of rotation in either or both joints . Translation- or lack of . Deviations – motion of the mandible to the affected side or none when both joints are affected . Over joint pain with or without motion around or . -
Upper Lid Orbicularis Oculi Muscle Strip and Sequential Brow Suspension with Autologous Fascia Lata Is Beneficial for Selected P
Eye (2009) 23, 1549–1553 & 2009 Macmillan Publishers Limited All rights reserved 0950-222X/09 $32.00 www.nature.com/eye Upper lid orbicularis B Patil and AJE Foss CLINICAL STUDY oculi muscle strip and sequential brow suspension with autologous fascia lata is beneficial for selected patients with essential blepharospasm Abstract Introduction Purpose Severe cases of blepharospasm Patients with severe blepharospasm, whose resistant to botulinum toxin represent a symptoms are not controlled by botulinum challenging clinical problem. Over the toxin injections, are a difficult management last 10 years, we have adopted a staged problem for whom a number of surgical options surgical management of these cases have been tried. with an initial upper lid orbicularis Two operations, in particular, have been tried; myectomy (combined with myectomy the orbicularis myectomy (or strip) and brow of procerus and corrugator supercilius as suspension. The choice of the procedure appropriate) and then 4–6 months later classically depends upon the clinical a brow suspension with autologous fascia presentation, with all types being offered the Department of lata. The aim of this study was to orbicularis myectomy except for the apraxic (also Ophthalmology, assess the outcome of this staged surgical called the pre-tarsal) type. The proposed Queen’s Medical Centre, approach. aetiology of the apraxic type is considered to Nottingham University, Materials and methods A questionnaire differ and to represent a failure of eyelid opening Nottingham, UK was sent to all patients who had undergone and is clinically characterized by the eyebrows Correspondence: AJE Foss, the procedure and the clinical records going up and not down with the spasms. -
The Myloglossus in a Human Cadaver Study: Common Or Uncommon Anatomical Structure? B
Folia Morphol. Vol. 76, No. 1, pp. 74–81 DOI: 10.5603/FM.a2016.0044 O R I G I N A L A R T I C L E Copyright © 2017 Via Medica ISSN 0015–5659 www.fm.viamedica.pl The myloglossus in a human cadaver study: common or uncommon anatomical structure? B. Buffoli*, M. Ferrari*, F. Belotti, D. Lancini, M.A. Cocchi, M. Labanca, M. Tschabitscher, R. Rezzani, L.F. Rodella Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy [Received: 1 June 2016; Accepted: 18 July 2016] Background: Additional extrinsic muscles of the tongue are reported in literature and one of them is the myloglossus muscle (MGM). Since MGM is nowadays considered as anatomical variant, the aim of this study is to clarify some open questions by evaluating and describing the myloglossal anatomy (including both MGM and its ligamentous counterpart) during human cadaver dissections. Materials and methods: Twenty-one regions (including masticator space, sublin- gual space and adjacent areas) were dissected and the presence and appearance of myloglossus were considered, together with its proximal and distal insertions, vascularisation and innervation. Results: The myloglossus was present in 61.9% of cases with muscular, ligamen- tous or mixed appearance and either bony or muscular insertion. Facial artery pro- vided myloglossal vascularisation in the 84.62% and lingual artery in the 15.38%; innervation was granted by the trigeminal system (buccal nerve and mylohyoid nerve), sometimes (46.15%) with hypoglossal component. Conclusions: These data suggest us to not consider myloglossus as a rare ana- tomical variant. -
Case Report and Osteopathic Treatment
Journal name: International Medical Case Reports Journal Article Designation: Case Report Year: 2016 Volume: 9 International Medical Case Reports Journal Dovepress Running head verso: Bordoni et al Running head recto: The tongue after whiplash open access to scientific and medical research DOI: http://dx.doi.org/10.2147/IMCRJ.S111147 Open Access Full Text Article CASE REPORT The tongue after whiplash: case report and osteopathic treatment Bruno Bordoni1–3 Abstract: The tongue plays a fundamental role in several bodily functions; in the case of a Fabiola Marelli2,3 dysfunction, an exhaustive knowledge of manual techniques to treat the tongue is useful in Bruno Morabito2–4 order to help patients on their path toward recovery. A 30-year-old male patient with a recent history of whiplash, with increasing cervical pain during swallowing and reduced ability to open 1Department of Cardiology, Santa Maria Nascente IRCCS, the mouth, was treated with osteopathic techniques addressed to the tongue. The osteopathic Don Carlo Gnocchi Foundation, techniques led to a disappearance of pain and the complete recovery of the normal functions of Institute of Hospitalization and the tongue, such as swallowing and mouth opening. The manual osteopathic approach consists Care with Scientific Address, Milan, 2CRESO, School of Osteopathic of applying a low load, in order to produce a long-lasting stretching of the myofascial complex, Centre for Research and Studies, with the aim of restoring the optimal length of this continuum, decreasing pain, and improving Castellanza,3CRESO, School of functionality. According to the authors’ knowledge, this is the first article reporting a case of Osteopathic Centre for Research and Studies, Falconara Marittima, Ancona, resolution of a post whiplash disorder through osteopathic treatment of the tongue. -
Ear Pain in Patients with Oropharynx Carcinoma: Karlt.Beer Peter Vock How MRI Contributes to the Explanation Richard H
Eur Radiol (2004) 14:2206–2211 DOI 10.1007/s00330-004-2340-2 HEAD AND NECK Harriet C. Thoeny Ear pain in patients with oropharynx carcinoma: KarlT.Beer Peter Vock how MRI contributes to the explanation Richard H. Greiner of a prognostic and predictive symptom Received: 22 October 2003 Abstract Reflex otalgia is a predic- glossus muscle, stylopharyngeus Revised: 11 March 2004 tive and prognostic parameter for lo- muscle, hyoglossus muscle and pre- Accepted: 5 April 2004 cal control in patients with orophar- epiglottic space. No difference was Published online: 1 May 2004 ynx carcinoma. Can a morphologic found for the muscles of mastication, © Springer-Verlag 2004 correlate of this important symptom levator and tensor veli palatini mus- be detected by MRI? Thirty-six pa- cles, styloglossus muscle, genioglos- tients were prospectively evaluated sus muscle, intrinsic muscles of the by MRI before radical radiotherapy. tongue, digastric muscles, mucosal Sixteen patients had reflex otalgia; surface of the lateral and posterior 20 did not. The oropharynx and adja- pharyngeal wall, uvula, valleculae, cent regions were analyzed. Alter- parapharyngeal space and larynx. An ation was defined as effacement of alteration of structures innervated by H. C. Thoeny (✉) · P. Vock anatomical structures, signal alter- the glossopharyngeal nerve was vi- Department of Diagnostic Radiology, ation or enhancement after contrast sualized on MRI significantly more Inselspital, χ2 University of Bern, medium administration. The -test often when reflex otalgia was pres- Freiburgstrasse 10, 3010 Bern, Switzerland was used to compare categorical pa- ent. Involvement of structures inner- e-mail: [email protected], rameters. In patients with reflex vated by other cranial nerves did not [email protected] otalgia, alteration of the following show the same association with ear Tel.: +41-31-6322939 structures innervated by the glosso- pain. -
Volume 1: the Upper Extremity
Volume 1: The Upper Extremity 1.1 The Shoulder 01.00 - 38.20 (37.20) 1.1.1 Introduction to shoulder section 0.01.00 0.01.28 0.28 1.1.2 Bones, joints, and ligaments 1 Clavicle, scapula 0.01.29 0.05.40 4.11 1.1.3 Bones, joints, and ligaments 2 Movements of scapula 0.05.41 0.06.37 0.56 1.1.4 Bones, joints, and ligaments 3 Proximal humerus 0.06.38 0.08.19 1.41 Shoulder joint (glenohumeral joint) Movements of shoulder joint 1.1.5 Review of bones, joints, and ligaments 0.08.20 0.09.41 1.21 1.1.6 Introduction to muscles 0.09.42 0.10.03 0.21 1.1.7 Muscles 1 Long tendons of biceps, triceps 0.10.04 0.13.52 3.48 Rotator cuff muscles Subscapularis Supraspinatus Infraspinatus Teres minor Teres major Coracobrachialis 1.1.8 Muscles 2 Serratus anterior 0.13.53 0.17.49 3.56 Levator scapulae Rhomboid minor and major Trapezius Pectoralis minor Subclavius, omohyoid 1.1.9 Muscles 3 Pectoralis major 0.17.50 0.20.35 2.45 Latissimus dorsi Deltoid 1.1.10 Review of muscles 0.20.36 0.21.51 1.15 1.1.11 Vessels and nerves: key structures First rib 0.22.09 0.24.38 2.29 Cervical vertebrae Scalene muscles 1.1.12 Blood vessels 1 Veins of the shoulder region 0.24.39 0.27.47 3.08 1.1.13 Blood vessels 2 Arteries of the shoulder region 0.27.48 0.30.22 2.34 1.1.14 Nerves The brachial plexus and its branches 0.30.23 0.35.55 5.32 1.1.15 Review of vessels and nerves 0.35.56 0.38.20 2.24 1.2. -
FACE and SCALP, MUSCLES of FACIAL EXPRESSION, and PAROTID GLAND (Grant's Dissector [16Th Ed.] Pp
FACE AND SCALP, MUSCLES OF FACIAL EXPRESSION, AND PAROTID GLAND (Grant's Dissector [16th Ed.] pp. 244-252; 254-256; 252-254) TODAY’S GOALS: 1. Identify the parotid gland and parotid duct 2. Identify the 5 terminal branches of the facial nerve (CN VII) emerging from the parotid gland 3. Identify muscles of facial expression 4. Identify principal cutaneous branches of the trigeminal nerve (CN V) 5. Identify the 5 layers of the scalp 6. Identify the facial nerve, retromandibular vein, and external carotid artery within the parotid gland 7. Identify the auriculotemporal nerve and superficial temporal vessels DISSECTION NOTES: General comments: Productive and effective study of the remaining lab sessions on regions of the head requires your attention to and study of the osteology of the skull. The opening pages of this section in Grant’s Dissector contains images and labels of the skull and parts thereof. Utilize atlases as additional resources to learn the osteology. Couple viewing of these images with an actual skull in hand (available in the lab) to achieve mastery of this material. Incorporate the relevant osteology to a synthesis of the area being covered. This lab session introduces you to the face and scalp, the major cutaneous nerves (branches of the trigeminal nerve [CN V]) that supply the skin of the face and scalp, and important muscles of facial expression. Some helpful overview comments to consider as you begin this study include: • The skin of the face is quite thin and mobile except where it is firmly attached to the nose and -
Blepharoplasty
Blepharoplasty Bobby Tajudeen Brow position • medial brow as having its medial origin at the level of a vertical line drawn to the nasal alar-facial junction • lateral extent of the brow should reach a point on a line drawn from the nasal alar-facial junction through the lateral canthus of the eye • brow should arch superiorly, well above the supraorbital rim, with the highest point lying at the lateral limbus • Less arched in men • midpupillary line and the inferior brow border should be approximately 2.5 cm. The distance from the superior border of the brow to the anterior hairline should be 5 cm Eyelid aesthetics • The highest point of the upper eyelid is at the medial limbus, and the lowest point of the lower eyelid is at the lateral limbus. • Sharp canthal angles should exist, especially at the lateral canthus. • The upper eyelid orbicularis muscle should be smooth and flat, and the upper eyelid crease should be crisp. The upper lid crease should lie between 8 and 12 mm from the lid margin in the Caucasian patient. • The upper lid margin should cover 1 to 2 mm of the superior limbus, and the lower lid margin should lie at the inferior limbus or 1 mm below the inferior limbus • The lower eyelid should closely appose the globe without any drooping of the lid away from the globe (ectropion) or in toward the globe (entropion) Lid laxity and excess • A pinch test helps determine the degree of excess lid skin that is present. The snap test helps determine the degree of lower lid laxity and is useful in preoperative planning Evaluation • -
Functional Anatomy of the Soft Palate Applied to Wind Playing
Review Functional Anatomy of the Soft Palate Applied to Wind Playing Alison Evans, MMus, Bronwen Ackermann, PhD, and Tim Driscoll, PhD Wind players must be able to sustain high intraoral pressures in dition occurs because of a structural deformity, such as with order to play their instruments. Prolonged exposure to these high cleft palate. It is also associated with some other speech dis- pressures may lead to the performance-related disorder velopharyn- orders. VPI occurs when the soft palate fails to completely geal insufficiency (VPI). This disorder occurs when the soft palate fails to completely close the air passage between the oral and nasal close the oronasal cavity while attempting to blow air through cavities in the upper respiratory cavity during blowing tasks, this clo- the mouth, resulting in air escaping from the nose.5 Without sure being necessary for optimum performance on a wind instru- a tight air seal, the air passes into the nasal cavity and can ment. VPI is potentially career threatening. Improving music teach- then escape out the nose. This has a disastrous effect on wind ers’ and students’ knowledge of the mechanism of velopharyngeal playing, as the power behind the wind musicians’ sound closure may assist in avoiding potentially catastrophic performance- related disorders arising from dysfunction of the soft palate. In the relies on enough controlled expired air through the mouth. functional anatomy of the soft palate as applied to wind playing, Understandably, this disorder may potentially end the musi- seven muscles of the soft palate involved in the velopharyngeal clo- cian’s career.6 sure mechanism are reviewed. -
Atlas of the Facial Nerve and Related Structures
Rhoton Yoshioka Atlas of the Facial Nerve Unique Atlas Opens Window and Related Structures Into Facial Nerve Anatomy… Atlas of the Facial Nerve and Related Structures and Related Nerve Facial of the Atlas “His meticulous methods of anatomical dissection and microsurgical techniques helped transform the primitive specialty of neurosurgery into the magnificent surgical discipline that it is today.”— Nobutaka Yoshioka American Association of Neurological Surgeons. Albert L. Rhoton, Jr. Nobutaka Yoshioka, MD, PhD and Albert L. Rhoton, Jr., MD have created an anatomical atlas of astounding precision. An unparalleled teaching tool, this atlas opens a unique window into the anatomical intricacies of complex facial nerves and related structures. An internationally renowned author, educator, brain anatomist, and neurosurgeon, Dr. Rhoton is regarded by colleagues as one of the fathers of modern microscopic neurosurgery. Dr. Yoshioka, an esteemed craniofacial reconstructive surgeon in Japan, mastered this precise dissection technique while undertaking a fellowship at Dr. Rhoton’s microanatomy lab, writing in the preface that within such precision images lies potential for surgical innovation. Special Features • Exquisite color photographs, prepared from carefully dissected latex injected cadavers, reveal anatomy layer by layer with remarkable detail and clarity • An added highlight, 3-D versions of these extraordinary images, are available online in the Thieme MediaCenter • Major sections include intracranial region and skull, upper facial and midfacial region, and lower facial and posterolateral neck region Organized by region, each layered dissection elucidates specific nerves and structures with pinpoint accuracy, providing the clinician with in-depth anatomical insights. Precise clinical explanations accompany each photograph. In tandem, the images and text provide an excellent foundation for understanding the nerves and structures impacted by neurosurgical-related pathologies as well as other conditions and injuries. -
Appendix B: Muscles of the Speech Production Mechanism
Appendix B: Muscles of the Speech Production Mechanism I. MUSCLES OF RESPIRATION A. MUSCLES OF INHALATION (muscles that enlarge the thoracic cavity) 1. Diaphragm Attachments: The diaphragm originates in a number of places: the lower tip of the sternum; the first 3 or 4 lumbar vertebrae and the lower borders and inner surfaces of the cartilages of ribs 7 - 12. All fibers insert into a central tendon (aponeurosis of the diaphragm). Function: Contraction of the diaphragm draws the central tendon down and forward, which enlarges the thoracic cavity vertically. It can also elevate to some extent the lower ribs. The diaphragm separates the thoracic and the abdominal cavities. 2. External Intercostals Attachments: The external intercostals run from the lip on the lower border of each rib inferiorly and medially to the upper border of the rib immediately below. Function: These muscles may have several functions. They serve to strengthen the thoracic wall so that it doesn't bulge between the ribs. They provide a checking action to counteract relaxation pressure. Because of the direction of attachment of their fibers, the external intercostals can raise the thoracic cage for inhalation. 3. Pectoralis Major Attachments: This muscle attaches on the anterior surface of the medial half of the clavicle, the sternum and costal cartilages 1-6 or 7. All fibers come together and insert at the greater tubercle of the humerus. Function: Pectoralis major is primarily an abductor of the arm. It can, however, serve as a supplemental (or compensatory) muscle of inhalation, raising the rib cage and sternum. (In other words, breathing by raising and lowering the arms!) It is mentioned here chiefly because it is encountered in the dissection. -
MBB Lab 5: Anatomy of the Face and Ear
MBB Lab 5: Anatomy of the Face and Ear PowerPoint Handout Review ”The Basics” and ”The Details” for the following cranial nerves in the Cranial Nerve PowerPoint Handout. • Mandibular division trigeminal (CN V3) • Facial nerve (CN VII) Slide Title Slide Number Slide Title Slide Number Blood Supply to Neck, Face, and Scalp: External Carotid Artery Slide3 Parotid Gland Slide 22 Scalp: Layers Slide4 Scalp and Face: Sensory Innervation Slide 23 Scalp: Blood Supply Slide 5 Scalp and Face: Sensory Innervation (Continued) Slide 24 Regions of the Ear Slide 6 Temporomandibular joint Slide 25 External Ear Slide 7 Temporal and Infratemporal Fossae: Introduction Slide 26 Temporal and Infratemporal Fossae: Muscles of Tympanic Membrane Slide 8 Slide 27 Mastication Tympanic Membrane (Continued) Slide 9 Temporal and Infratemporal Fossae: Muscles of Sensory Innervation: Auricle, EAC, and Tympanic Membrane Slide 10 Slide 28 Mastication (Continued) Middle Ear Cavity Slide 11 Summary of Muscles of Mastication Actions Slide 29 Middle Ear Cavity (Continued) Slide 12 Infratemporal Fossae: Mandibular Nerve Slide 30 Mastoid Antrum Slide 13 Inferior Alveolar Nerve Block Slide 31 Eustachian (Pharyngotympanic or Auditory) Tube Slide 14 Palatine Nerve Block Slide 32 Otitis Media Slide 15 Infratemporal Fossae: Maxillary Artery & Pterygoid Plexus Auditory Ossicles Slide 16 Slide 33 Chorda Tympani Nerve and Middle Ear Slide 17 Infratemporal Fossa: Maxillary Artery Slide 34 Superficial Facial Muscles: Muscles of Facial Expression Slide 18 Infratemporal Fossa: Pterygoid Plexus Slide 35 Superficial Facial Muscles: Muscles of Facial Expression Slide 19 Infratemporal Fossa: Otic Ganglion Slide 36 (Continued) Superficial Facial Muscles: Innervation Slide 20 Infratemporal Fossa: Chorda Tympani Nerve Slide 37 Superficial Facial Muscles: Innervation (Continued) Slide 21 Blood Supply to Neck, Face, and Scalp: External Carotid Artery The common carotid artery branches into the internal and external carotid arteries at the level of the superior edge of the thyroid cartilage.