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

?
Palpation Method of determining muscle tenderness and pain by digital palpation.

[Okeson, 2008)

?
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.thefreedictionary.com]

?
Palpation
Difficult to be done or uncomfortable for the patient

Functional Manipulation

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

FUNCTIONAL MANIPULATION Part 1 : Introduction

?
The Objects

The Objects
A. Lateral Pterygoid Muscle B. Medial Pterygoid Muscle

(Okeson, 2008)

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

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

The Objects
A. Lateral Pterygoid Muscle

The Objects
A. Lateral Pterygoid Muscle

External Pterygoid

The Objects
Lateral Pterygoid
Superior Inferior

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

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

The Objects
B. Medial Pterygoid Muscle

The Objects
B. Medial Pterygoid Muscle

Internal Pterygoid

The Objects
Medial Pterygoid Superficial Head Deep Head

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

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

Physiology

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

Physiology

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

Physiology

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

Physiology

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

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.

www.biology.org

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

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

69%

27%

Getting To Know

In this case the implication was that when palpation was used, lateral pterygoid might be blamed when it was not actually the source

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

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

Lateral Pterygoid Stretching

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

Medial Pterygoid Stretching

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

The Anatomy
Arises from the lateral surface of the lateral pterygoid plate and inserts onto the neck of condyle of the mandible.

(www.wikipedia.com)

The Anatomy

FUNCTIONAL MANIPULATION OF THE INFERIOR LATERAL PTERYGOID Part 1 : Contraction

The Anatomy
The Physiology Clinical examination

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

FUNCTIONAL MANIPULATION OF THE INFERIOR LATERAL PTERYGOID Part 1 : Contraction

The Anatomy
The Physiology Clinical examination

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

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

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

?
Definition straighten or extend ones body or a part of ones body to its full length, typically so as to tighten ones muscles or in order to reach something

(oxforddictionaries.com)

?
inferior lateral pterygoid muscle stretches when the teeth are in maximum intercuspation

(okeson, 2008)

Functional Manipulation Of The Inferior Lateral Pterygoid Part 2 : Stretching

?
The importance Clinical examination

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

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
Dont 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

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.

(wikipedia.com)

The Anatomy

FUNCTIONAL MANIPULATION OF SUPERIOR LATERAL PTERYGOID Part 1 : Contraction

The Anatomy
The Physiology Clinical Examination

The Physiology
Superior lateral pterygoid together with the inferior lateral pterygoid protrude and depress mandible. Individually, they move the mandible side to side.

(getbodysmart.com)

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

(Okeson, 2008)

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.