DiagnosticTree/CheekJaw

{

 "tree_id": "cheek-and-jaw-demo",
 "region": "Cheek and Jaw Pain — Multi-Option Demo",
 "start": "agg-1",

 "nodes": {

   "agg-1": {
     "type": "choice",
     "question": "What is the PRIMARY activity that aggravates or reproduces the cheek or jaw pain?",
     "clinical_rationale": "Identifying the primary aggravator at the first step routes directly to the correct muscle group, skipping 2–3 binary questions.",
     "options": [
       {
         "label": "Jaw movement",
         "sublabel": "Chewing, clenching, biting, or wide opening",
         "next": "agg-jaw-1"
       },
       {
         "label": "Neck movement or posture",
         "sublabel": "Rotation, sustained postures, or carrying weight on the shoulder",
         "next": "agg-neck-1"
       },
       {
         "label": "Neither — pain is present at rest or with facial movement",
         "sublabel": "No clear jaw or neck aggravator",
         "next": "symptom-local-1"
       }
     ]
   },

   "agg-jaw-1": {
     "type": "choice",
     "question": "Which teeth — if any — are painful or hypersensitive?",
     "clinical_rationale": "Tooth referral pattern is the fastest split within the masticatory group. Masseter superficial and temporalis refer to upper teeth; digastric anterior refers to lower incisors only; lateral pterygoid, medial pterygoid, and masseter deep do not refer to teeth at all.",
     "options": [
       {
         "label": "Upper teeth",
         "sublabel": "Premolars, molars, or maxilla — sensitive to heat, cold, or biting",
         "next": "exam-masseter-superficial-1"
       },
       {
         "label": "Lower front teeth only",
         "sublabel": "Lower incisors — bilateral or nearly midline",
         "next": "exam-digastric-anterior-1"
       },
       {
         "label": "No tooth pain",
         "sublabel": "Pain is in the TMJ, cheek, throat, or ear",
         "next": "agg-jaw-2"
       }
     ]
   },

   "agg-jaw-2": {
     "type": "choice",
     "question": "Where is the pain focused, and what jaw movement most aggravates it?",
     "clinical_rationale": "Within the no-tooth-pain masticatory group, the location of pain and the direction of aggravating movement separates the three remaining muscles cleanly.",
     "options": [
       {
         "label": "TMJ area — worse on jaw CLOSING or clenching",
         "sublabel": "Pain just anterior to the ear, aggravated by closing or biting down",
         "next": "symptom-protrusion-1"
       },
       {
         "label": "Throat, palate, or ear — worse on wide opening or chewing",
         "sublabel": "Diffuse deep pain; may include ear stuffiness or swallowing difficulty",
         "next": "exam-medial-pterygoid-1"
       },
       {
         "label": "Deep cheek or TMJ — with tinnitus",
         "sublabel": "Low roaring ear noise on the same side",
         "next": "exam-masseter-deep-1"
       }
     ]
   },

   "agg-neck-1": {
     "type": "choice",
     "question": "Which neck or shoulder feature best matches?",
     "clinical_rationale": "Within the neck-aggravated group, the character of associated symptoms separates SCM sternal (autonomic features), trapezius TrP₁ (shoulder loading), and platysma (prickling quality) without needing sequential binary questions.",
     "options": [
       {
         "label": "Autonomic features present",
         "sublabel": "Ipsilateral tearing, eye redness, runny nose, or apparent eyelid drooping",
         "next": "exam-scm-sternal-1"
       },
       {
         "label": "Shoulder or arm loading aggravates",
         "sublabel": "Carrying a bag, elevated arm, or shoulder strap pressure",
         "next": "exam-trapezius-1"
       },
       {
         "label": "Pain quality is prickling — like multiple pinpricks",
         "sublabel": "Not aching, not electric tingling — specifically a pinprick sensation over the jaw skin",
         "next": "exam-platysma-1"
       }
     ]
   },

   "symptom-local-1": {
     "type": "choice",
     "question": "Where exactly is the pain, and does it have any distinctive feature?",
     "clinical_rationale": "Within the non-jaw, non-neck group, location and associated features separate the four remaining muscles — buccinator (mid-cheek + perceived swallowing difficulty), zygomaticus major (nasal arc + jaw restriction), orbicularis oculi (periorbital + jumpy print), and digastric posterior (pseudo-SCM — only apparent after SCM is cleared).",
     "options": [
       {
         "label": "Mid-cheek — with perceived swallowing difficulty",
         "sublabel": "Pain halfway between mouth corner and jaw ramus; patient feels they cannot swallow normally",
         "next": "exam-buccinator-1"
       },
       {
         "label": "Cheek arcing up along the nose toward the forehead",
         "sublabel": "Pain follows a curve from the cheek along the side of the nose; jaw may feel restricted",
         "next": "exam-zygomaticus-1"
       },
       {
         "label": "Periorbital — cheek near the nose or upper lip",
         "sublabel": "Pain near or around the eye socket; letters may appear to jump when reading",
         "next": "exam-orbicularis-1"
       },
       {
         "label": "Upper SCM region tender — but SCM already cleared",
         "sublabel": "Tenderness persists in the SCM area after SCM TrPs have been inactivated; no taut bands in SCM",
         "next": "exam-digastric-posterior-1"
       }
     ]
   }

 }

}