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PEDODONTIC SEMINAR Thursday, November 17th 2011

TOPIC : FUNCTIONAL MANIPULATION

PURPOSE
Give you important information about functional manipulation for some muscles and how to deal with it in the clinic.

Supervisor I : Jakobus Runkat, drg., Sp. KGA (K) Supervisors II : Rabiah, drg Dian, drg Tifa, drg Denta, drg Lusi, drg

Speakers : Adilah, Raissa, Brinets, Tiara, Annisa and Asri

SPEAKER #1 Adilah FUNCTIONAL MANIPULATION Part 1 : Introduction .

FUNCTIONAL MANIPULATION Part 1 : Introduction ? The Objects .

? Palpation Functional Manipulation .

2008) . [Okeson.? Palpation Method of determining muscle tenderness and pain by digital palpation.

? Palpation The act of feeling with the hand. the application of the fingers with light pressure to the surface of the body for the purpose of determining the condition of the parts beneath in physical diagnosis. [www.com] .thefreedictionary.

? Palpation Difficult to be done or uncomfortable for the patient Functional Manipulation .

and medial pterygoid. 2008) . superior lateral pterygoid. (Okeson.? Functional manipulation A technique for evaluation of three muscles that are difficult to reliably palpate: inferior lateral pterygoid.

FUNCTIONAL MANIPULATION Part 1 : Introduction ? The Objects .

Lateral Pterygoid Muscle B. Medial Pterygoid Muscle (Okeson.The Objects A. 2008) .

com] . Lateral Pterygoid Muscle Definition: A muscle whose inferior head has origin from the pterygoid process.thefreedictionary. [www. and whose action brings the jaw forward and opens it. and whose superior head has origin from the sphenoid bone. with insertion into the mandible and the articular disk.The Objects A.

Lateral Pterygoid Muscle Functions: • Depression of the mandible • Side to side movement (lateral movement) • Protrusion of movement .The Objects A.

The Objects A. Lateral Pterygoid Muscle .

Lateral Pterygoid Muscle External Pterygoid .The Objects A.

The Objects Lateral Pterygoid Superior Inferior .

[www. Medial Pterygoid Muscle Definition: A muscle with origin from the pterygoid fossa of the sphenoid bone and the tuberosity of the maxilla. and whose action raises the mandible and closes the jaw. with insertion into the medial surface of the mandible.com] .thefreedictionary.The Objects B.

Medial Pterygoid Muscle Functions: • Elevates and protrudes the mandible • Side to side movement .The Objects B.

The Objects B. Medial Pterygoid Muscle .

Medial Pterygoid Muscle Internal Pterygoid .The Objects B.

The Objects Medial Pterygoid Superficial Head Deep Head .

Practice Palpation in The Lateral Pterygoid Muscle 1. Search for what feels like a little pocket between the upper teeth and the condyle of the mandible. Press posteriorly and superiorly from the back molars 3. . Placing your palpating finger inside the vestibule of the patient's mouth to locate the lateral pterygoid 2.

Practice Palpation in The Lateral Pterygoid Muscle .

Conclusion Please be aware to make functional manipulation if the muscle impossible or nearly impossible to palpate manually. .

SPEAKER #2 Raissa FUNCTIONAL MANIPULATION Part 2 : Mechanism .

FUNCTIONAL MANIPULATION Part 2 : Mechanism Physiology Technique Purpose .

Medial pterygoid . Superior lateral pterygoid 3.Physiology 1. Inferior lateral pterygoid 2.

Superior lateral pterygoid 3.Physiology 1. Medial pterygoid . Inferior lateral pterygoid is the primary protruding muscle 2.

Superior lateral pterygoid contracts with elevator muscles 3. Medial pterygoid .Physiology 1. Inferior lateral pterygoid 2.

Medial pterygoid is an elevator muscle and therefore contracts as the teeth are coming together . Superior lateral pterygoid 3.Physiology 1. Inferior lateral pterygoid 2.

FUNCTIONAL MANIPULATION Part 2 : Mechanism Physiology Technique Purpose .

Technique Functional manipulation was developed based on the principle that as a muscle becomes fatigued and symptomatic further function only elicits pain Okeson. 2008 .

Technique Functional manipulation achieved by two activities : Contraction Stretching .

Technique Contraction A process leading to shortening or development of tension in muscle tissue.biology.org . www.

Technique

Contraction

Technique

A process to lengthen, widen, or distend of a muscle

Stretching

www.freedictionary.com

Technique

Stretching

FUNCTIONAL MANIPULATION Part 2 : Mechanism

Physiology Technique Purpose

Purpose To know the real condition of these muscles to its abnormalities Contraction Stretching No pain : Normal Pain : Abnormal .

Important Point As a clinician we should know how to do the functional manipulation .

SPEAKER #3 Brinets FUNCTIONAL MANIPULATION Part 3 : Clinical Implementation .

FUNCTIONAL MANIPULATION Part 3 : Clinical Implementation Getting to Know What Should Be Done .

Getting To Know 27% of a control group had tenderness to intraoral palpation. but none had symptoms after functional manipulation FALSE-POSITIVE RESULT .

Getting To Know FALSE-POSITIVE RESULT Is a result that is incorrect or erroneously positive when a situation is normal .

Palpation Pain Functional Manipulation Pain 69% 27% .Getting To Know When the area posterior to the maxillary tuberosity is palpated. a high incidence of pain occurs.

lateral pterygoid might be blamed when it was not actually the source .Getting To Know In this case the implication was that when palpation was used.

FUNCTIONAL MANIPULATION Part 3 : Clinical Implementation Getting to Know What Should Be Done .

What Should Be Done Palpation The muscle is palpated by placing the finger (forefinger) .

What Should Be Done Functional Manipulation The muscles are compromise by contraction and stretching .

Lateral Pterygoid Stretching .Practice Use your hand to laterally deviate the jaw to the right (same) side.

Medial Pterygoid Stretching .Practice Use your hand to depress and slightly deviate the jaw laterally to the same side.

Bottom Line Functional manipulation merely suggests that the pain is not from the lateral pterygoids but that other structures are likely responsible .

SPEAKER #4 Tiara FUNCTIONAL MANIPULATION OF THE INFERIOR LATERAL PTERYGOID Part 1 : Contraction .

FUNCTIONAL MANIPULATION OF THE INFERIOR LATERAL PTERYGOID Part 1 : Contraction The Anatomy The Physiology Clinical examination .

wikipedia. (www.com) .The Anatomy Arises from the lateral surface of the lateral pterygoid plate and inserts onto the neck of condyle of the mandible.

The Anatomy .

FUNCTIONAL MANIPULATION OF THE INFERIOR LATERAL PTERYGOID Part 1 : Contraction The Anatomy The Physiology Clinical examination .

the mouth is opened. or both.2008) . (Okeson. Protuding against resistance will increase the pain.The Physiology When the inferior lateral pterygoid contracts. the mandible is protruded.

FUNCTIONAL MANIPULATION OF THE INFERIOR LATERAL PTERYGOID Part 1 : Contraction The Anatomy The Physiology Clinical examination .

3. 2. 4.Clinical Examination Practice 1. Sit up straight Find a friend beside you as your patient The patient is instructed to relax Hold your patient’s chin with your thumb .

How does your patient feel? No pain : healthy Pain : unhealty . Asked your patient to protrude againts resistance provided 6.Clinical Examination Practice 5.

.Highlight Please do this technique in the clinic.

SPEAKER #5 ANNISA Functional Manipulation Of The Inferior Lateral Pterygoid Part 2 : Stretching .

Functional Manipulation Of The Inferior Lateral Pterygoid Part 2 : Stretching ? The importance Clinical examination .

com) . typically so as to tighten one’s muscles or in order to reach something (oxforddictionaries.? Definition straighten or extend one’s body or a part of one’s body to its full length.

2008) .? inferior lateral pterygoid muscle stretches when the teeth are in maximum intercuspation (okeson.

Functional Manipulation Of The Inferior Lateral Pterygoid Part 2 : Stretching ? The importance Clinical examination .

2008) .The Importance if inferior lateral pterygoid muscle is the source of pain when the teeth are clenched. the pain will increase (Okeson.

Functional Manipulation Of The Inferior Lateral Pterygoid Part 2 : Stretching ? The importance Clinical examination .

CLINICAL EXAMINATION Practice • Ask the patient open the mouth • Put a tongue blade between the posterior teeth. So the intercuspal position (ICP) cannot be reached. therefore the inferior lateral pterygoid does not stretch • Ask the patient about the pain .

CLINICAL EXAMINATION • If the pain increase : not source of pain • If the pain decrease : source of pain .

IMPORTANT POINT Don’t forget to do this technique to your patient .

SPEAKER #6 Asri FUNCTIONAL MANIPULATION OF SUPERIOR LATERAL PTERYGOID Part 1 : Contraction .

FUNCTIONAL MANIPULATION OF SUPERIOR LATERAL PTERYGOID Part 1 : Contraction The Anatomy The Physiology Clinical Examination .

(wikipedia.com) .The Anatomy Originates from infratemporal surface and infratemporal crest of the greater wing of the sphenoid bone and inserts onto the articular disc and fibrous capsule of Temporomandibular Joint.

The Anatomy .

FUNCTIONAL MANIPULATION OF SUPERIOR LATERAL PTERYGOID Part 1 : Contraction The Anatomy The Physiology Clinical Examination .

Individually.com) . they move the mandible side to side.The Physiology Superior lateral pterygoid together with the inferior lateral pterygoid protrude and depress mandible. (getbodysmart.

2008) .The Physiology Superior lateral pterygoid contracts with the elevator muscle. especially during a power stroke like clenching. (Okeson. Clenching on teeth and the separator will increase the pain.

FUNCTIONAL MANIPULATION OF SUPERIOR LATERAL PTERYGOID Part 1 : Contraction The Anatomy The Physiology Clinical Examination .

Clinical Examination Functional Manipulation of the Superior Lateral Pterygoid Muscle achieved by asking the patient to bite on a tongue blade between the posterior teeth bilaterally .

Bottom Line Please be aware if your patient feels pain when the teeth are clenched. .