Yatreyu at 09:52, 18 April 2026

2026-04-18T09:52:01Z

← Older revision		Revision as of 02:52, 18 April 2026
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	"wiki_page": "Muscle:Masseter/Superficial",		"wiki_page": "Muscle:Masseter/Superficial",
	"chapter_ref": "Travell & Simons Vol.1 — Ch.8 Masseter",		"chapter_ref": "Travell & Simons Vol.1 — Ch.8 Masseter",
	"notes": "Refers to cheek, lower jaw, upper and lower molar teeth, and ~~eyebrow~~. Chewing pain without restriction of opening.",		"notes": "Refers to cheek, lower jaw, upper and lower molar teeth, maxilla (often described as sinusitis), eyebrow, and temple. Tooth hypersensitivity to pressure, percussion, heat, and cold is a common associated feature. Chewing pain without significant restriction of opening.",
	"treatment_hint": "Spray and stretch, intraoral massage, correct parafunctional habits (clenching, bruxism)",		"treatment_hint": "Pincer palpation with one digit inside mouth and one outside. Spray and stretch, intraoral massage, correct parafunctional habits (clenching, bruxism). Check SCM and upper trapezius as key TrPs first.",
			"confirmatory": [
			"Tooth hypersensitivity to all stimuli (pressure, percussion, heat, cold) without dental pathology — confirms myofascial referral",
			"Sinusitis-like maxillary pain without fever, discharge, or radiographic changes — confirms anterior-superior TrP referral",
			"Gonial angle tenderness on flat palpation — associated with bruxism (enthesopathy, not primary TrP)",
			"Observe for mandibular deviation toward affected side on slow opening — more apparent than with deep head TrPs"
			],
	"less_likely": [		"less_likely": [
	{ "muscle": "Masseter — Deep Head", "reason": "Opening not restricted — deep head more associated with end-range restriction and tinnitus" },		{ "muscle": "Masseter — Deep Head", "reason": "Opening not restricted — deep head more associated with end-range restriction and tinnitus" },
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	"wiki_page": "Muscle:Masseter/Deep",		"wiki_page": "Muscle:Masseter/Deep",
	"chapter_ref": "Travell & Simons Vol.1 — Ch.8 Masseter",		"chapter_ref": "Travell & Simons Vol.1 — Ch.8 Masseter",
	"notes": "Refers deep into the ear ~~and~~ TMJ area. Tinnitus is a strongly associated feature of ~~deep head involvement~~.",		"notes": "Refers deep into the ear, TMJ area, and diffuse midcheek. Tinnitus (low roaring quality, not associated with hearing loss or vertigo) is a strongly associated feature. Puffiness beneath the eye on the affected side and narrowing of the palpebral fissure may result from venous entrapment of the maxillary vein.",
	"treatment_hint": "~~Deep pressure release, spray~~ and stretch over TMJ, address bruxism",		"treatment_hint": "External flat palpation against posterior ramus and zygomatic buttress. Spray and stretch over TMJ, deep pressure release, address bruxism. Check SCM and upper trapezius as key TrPs first.",
			"confirmatory": [
			"Tinnitus provocation test — pressure on TrP in upper posterior deep layer may activate or reproduce ipsilateral tinnitus",
			"Tinnitus is low roaring quality, not associated with hearing loss or vertigo — distinguishes from vestibular tinnitus",
			"Infraorbital puffiness and palpebral fissure narrowing on affected side — venous entrapment of maxillary vein",
			"Bilateral tinnitus suggests systemic cause rather than myofascial — however bilateral deep masseter involvement can produce bilateral tinnitus with unilateral fluctuation"
			],
	"less_likely": [		"less_likely": [
	{ "muscle": "Lateral Pterygoid", "reason": "No resisted jaw closure pain or jaw deviation identified" },		{ "muscle": "Lateral Pterygoid", "reason": "No resisted jaw closure pain or jaw deviation identified" },
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	"wiki_page": "Muscle:Medial_Pterygoid",		"wiki_page": "Muscle:Medial_Pterygoid",
	"chapter_ref": "Travell & Simons Vol.1 — Ch.9 Pterygoids",		"chapter_ref": "Travell & Simons Vol.1 — Ch.9 Pterygoids",
	"notes": "Refers to ~~inside~~ the ~~mouth~~, hard palate, ~~throat, posterior~~ TMJ, and ear. ~~Dysphagia~~ is ~~a key distinguishing feature~~. ~~Intraoral palpation required~~.",		"notes": "Refers diffusely to the tongue, pharynx, hard palate, below and behind the TMJ, and deep in the ear. Pain is NOT referred to the teeth — this distinguishes it from masseter and temporalis. Ear stuffiness (barohypoacusis) may be present due to TrP bands blocking the tensor veli palatini from opening the eustachian tube. Dysphagia with characteristic compensatory pattern: patient extends neck and pushes tongue forward when swallowing.",
	"treatment_hint": "Intraoral spray and stretch, ~~ischemic~~ compression~~. Refer to dental/oral medicine if needed.~~",		"treatment_hint": "Intraoral ischemic compression and spray and stretch. Resisted jaw opening for reciprocal inhibition of all elevator muscles. Address lateral pterygoid and masseter concurrently — medial pterygoid rarely has TrPs in isolation.",
			"confirmatory": [
			"Pain is NOT referred to teeth — absence of tooth hypersensitivity distinguishes from masseter and temporalis",
			"Ear stuffiness (barohypoacusis) — tensor veli palatini blocked by tense TrP bands from opening eustachian tube",
			"Compensatory swallowing pattern — patient extends neck and pushes tongue forward when swallowing",
			"Mandibular deviation on opening is most marked to the contralateral side at maximum opening",
			"Chorda tympani entrapment — bitter metallic taste may indicate lingual nerve compression between medial pterygoid and mandible"
			],
	"less_likely": [		"less_likely": [
	{ "muscle": "Lateral Pterygoid", "reason": "Dysphagia present — more consistent with medial pterygoid" },		{ "muscle": "Lateral Pterygoid", "reason": "Dysphagia and throat tightness present — more consistent with medial pterygoid" },
	{ "muscle": "Masseter — Deep Head", "reason": "Throat ~~tightness argues~~ for medial pterygoid" },		{ "muscle": "Masseter — Deep Head", "reason": "Throat pain and ear stuffiness argue for medial pterygoid; no tooth hypersensitivity" },
	{ "muscle": "SCM", "reason": "Jaw movement and restricted opening present, not neck rotation" }		{ "muscle": "SCM", "reason": "Jaw movement and restricted opening present, not neck rotation" }
	]		]
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	"confidence": "high",		"confidence": "high",
	"wiki_page": "Muscle:Lateral_Pterygoid",		"wiki_page": "Muscle:Lateral_Pterygoid",
	"chapter_ref": "Travell & Simons Vol.1 — Ch.9 Pterygoids",		"chapter_ref": "Travell & Simons Vol.1 — Ch.11 Pterygoids",
	"notes": "Refers to TMJ ~~area~~ and maxillary sinus. Pain ~~on resisted jaw CLOSING~~ is ~~pathognomonic~~. ~~Often associated with jaw deviation and clicking~~.",		"notes": "Chief myofascial source of TMJ area pain. Refers deep into the TMJ and to the maxillary sinus region (may be described as sinusitis). Pain is NOT referred to the teeth. Tinnitus may be present. Clicking in the TMJ area may result from lateral pterygoid dysfunction. Inferior division shortening displaces condyle anteriorly causing altered occlusion — premature anterior tooth contact on opposite side.",
	"treatment_hint": "~~Intraoral spray~~ and stretch, ~~address jaw deviation~~. ~~Refer~~ to ~~dental/oral medicine~~ for ~~occlusal assessment~~.",		"treatment_hint": "Tongue-tip-to-palate test to isolate lateral pterygoid. Tongue blade test on painful side confirms inferior division. Spray and stretch, intraoral ischemic compression. Treat masseter and temporalis TrPs first to allow adequate mouth opening for examination. Address forward head posture and parafunctional habits. Consider vitamin B1, B6, B12, folic acid if recalcitrant.",
			"confirmatory": [
			"Tongue-tip-to-palate test — slide tongue tip to posterior border of hard palate and observe if incisal path straightens on opening; if yes, lateral pterygoid is chief cause",
			"Tongue blade test — insert between molars on painful side; pain eliminated on vigorous clenching strongly implicates inferior division on that side",
			"Resisted jaw protrusion — pain on resisted protrusion is a specific confirmatory test; more reliable than palpation alone",
			"Lateral excursion reduced toward the SAME side as involved muscle",
			"Pain NOT referred to teeth — distinguishes from masseter and temporalis",
			"Buccal nerve entrapment — weird tingling or numbness of the cheek with buccinator weakness indicates lateral pterygoid compressing the buccal nerve"
			],
	"less_likely": [		"less_likely": [
	{ "muscle": "Medial Pterygoid", "reason": "Resisted jaw closure pain is more specific to lateral pterygoid" },		{ "muscle": "Medial Pterygoid", "reason": "Resisted jaw closure pain is more specific to lateral pterygoid; medial pterygoid pain is more diffuse involving throat and palate" },
	{ "muscle": "Masseter — Deep Head", "reason": "Resisted jaw closure pattern argues against masseter" },		{ "muscle": "Masseter — Deep Head", "reason": "Resisted jaw closure and condylar displacement pattern argues against masseter" },
	{ "muscle": "SCM", "reason": "Jaw movement is primary aggravator, not neck rotation" }		{ "muscle": "SCM", "reason": "Jaw movement is primary aggravator, not neck rotation" }
	]		]

Yatreyu at 06:26, 14 April 2026

2026-04-14T06:26:11Z

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Yatreyu at 08:11, 12 April 2026

2026-04-12T08:11:01Z

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Yatreyu at 08:09, 12 April 2026

2026-04-12T08:09:16Z

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Yatreyu at 08:06, 12 April 2026

2026-04-12T08:06:21Z

← Older revision		Revision as of 01:06, 12 April 2026
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	overlap: { color:'#78716c', icon:'🔍', label:'Inconclusive' },		overlap: { color:'#78716c', icon:'🔍', label:'Inconclusive' },
	neuro_referral: { color:'#b91c1c', icon:'🧠', label:'Neurological Referral' }		neuro_referral: { color:'#b91c1c', icon:'🧠', label:'Neurological Referral' }
	};		}

Yatreyu at 08:05, 12 April 2026

2026-04-12T08:05:58Z

← Older revision		Revision as of 01:05, 12 April 2026
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	~~/* ══════════════════════════════════════════════════════~~		{
	~~TREE DATA~~
	~~══════════════════════════════════════════════════════ */~~
	~~var TREE_DATA =~~ {
	tree_id: "ear-tmj", region: "Ear & Temporomandibular Joint Pain", start: "rom-1",		tree_id: "ear-tmj", region: "Ear & Temporomandibular Joint Pain", start: "rom-1",
	nodes: {		nodes: {

Yatreyu at 08:04, 12 April 2026

2026-04-12T08:04:59Z

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Yatreyu at 06:13, 12 April 2026

2026-04-12T06:13:16Z

← Older revision		Revision as of 23:13, 11 April 2026
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	}		}
	}		}

			[[Category:DiagnosticTree\|EarTMJ]]

Yatreyu at 05:05, 12 April 2026

2026-04-12T05:05:24Z

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Yatreyu at 02:01, 12 April 2026

2026-04-12T02:01:52Z

← Older revision		Revision as of 19:01, 11 April 2026
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	}		}
	}		}


	~~<nowiki>[[Category:DiagnosticTree\|EarTMJ]]</nowiki>~~

DiagnosticTree/EarTMJ - Revision history

Yatreyu at 09:52, 18 April 2026

Yatreyu at 06:26, 14 April 2026

Yatreyu at 08:11, 12 April 2026

Yatreyu at 08:09, 12 April 2026

Yatreyu at 08:06, 12 April 2026

Yatreyu at 08:05, 12 April 2026

Yatreyu at 08:04, 12 April 2026

Yatreyu at 06:13, 12 April 2026

Yatreyu at 05:05, 12 April 2026

Yatreyu at 02:01, 12 April 2026