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The temporomandibular joint (TMJ) is the area right in front of the ear on either side of the head where the upper jaw (maxilla) and lower jaw (mandible) meet. The temporomandibular joints are very complex and are made up of muscles, tendons, a disc and bones.You have a temperomandibular joint on each side of your jaw (right and left side). Micro trauma is considered internal, such as grinding the teeth (bruxism) and clenching (jaw tightening).
TMJ pain can usually occur because of unbalanced activity, spasm, or overuse of the jaw muscles. Most patients are quite successful with conventional conservative therapy (such as resting the jaw or night guard). We are a full service dental practice that specializes in relaxation and cosmetic dentistry services, dental implants, TMJ disorder treatment, periodontal disease treatment, teeth whitening, porcelain crowns and porcelain veneers, and other restorative dental care. Find a doctor at The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center or Johns Hopkins Community Physicians. Hay fever, also known as seasonal allergic rhinitis, is an allergy-related inflammation of the nasal passages, throat and eye membrane (conjunctiva), caused by sensitivity to airborne pollens and molds. Hay fever and its sister ailment, perennial allergic rhinitis (a year-round sensitivity to animal dander, dust mites or cockroaches), are most common in people who have a family history of allergies or a personal history of allergy-related conditions, such as eczema and childhood asthma.
The congested nose can lead to mouth breathing, and the dripping mucus can cause persistent cough and sore throat.
Your doctor will ask you about your symptoms, especially about when you have them and whether they occur outdoors or indoors. Your doctor will make the diagnosis of hay fever based on your allergy history, the timing and appearance of your symptoms and the results of your physical examination. To identify the specific allergen (allergy-triggering substance) that is triggering your hay fever, your doctor may refer you to an allergist, who can do skin testing. Blood tests also can be done to measure eosinophils (a type of white blood cell that increases in number during allergy seasons) or levels of IgE, an allergy-inducing antibody.
Although hay fever symptoms can reappear each year when the offending plant begins to bloom, they tend to diminish as you get older. You can help prevent attacks of hay fever by reducing your exposure to the suspected allergens.
Stay indoors as much as possible during months when you know that your hay fever symptoms will flare. While traveling in your car, you should drive with your external vents closed and air conditioning on. When planning your garden, choose flowers that are bright and colorful, because these colors usually signal that the plant is pollinated by insects rather than by wind. Take a shower or wash your hair before going to bed at night to remove pollen that accumulated during the day.
Although the best way to treat hay fever is to minimize exposure to the allergens, it is almost impossible to completely avoid airborne allergens such as pollen. Another nonprescription nasal spray, cromolyn sodium, prevents allergy symptoms by blocking the release of an irritating substance called histamine. Corticosteroid nasal sprays, such as beclomethasone (Beconase, Vancenase), budesonide (Nasonex) and fluticasone (Flonase), are probably the most effective treatment for hay fever and perennial allergic rhinitis.
Montelukast (Singular) can be used alone or in combination with other medications to treat allergic rhinitis.
If steroid sprays and antihistamines fail, or if you have perennial symptoms, your doctor may recommend trying allergy shots (immunotherapy), a treatment aimed at desensitizing your body's immune reaction to a particular allergen.
Call your doctor if you think you might have hay fever and the symptoms interfere with your normal everyday activities or make you feel generally miserable, or if you have hay fever and your symptoms are not controlled by your current medications. In most cases, hay fever can be managed successfully by minimizing exposure to the allergens and treating with one or more medications. Disclaimer: This content should not be considered complete and should not be used in place of a call or visit to a health professional. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. It is very important to visually project deep structures onto the surface of a person or patient when making educated clinical diagnoses.
The carotid artery pulse can be felt by pushing lateral to the upper border of the thyroid cartilage just under the anterior edge of the sternomastoid muscle. Starting above the hyoid bone in the anterior triangle, we have two small triangles: submental and submandibular (or digastric). Once the skin over the mandible and upper neck is removed, you can identify the submandibular triangle and its boundaries. Notice that the lingual nerve and submandibular duct pass through a gap between the hypoglossal (hg) and mylohyoid (mh) muscles and the lingual artery passes deep to the hyoglossus muscle. Starting from the most superficial aspects of the carotid triangle, we will point out the items that are related to it. The first layer, under the skin and superficial fascia includes the platysma, which forms the roof of the carotid triangle. When the strap muscles are reflected, you are able to see the thyroid gland (tg) with its arteries (superior thyroid artery from the external carotid (sta) and the inferior thyroid artery from the thyrohyoid trunk from the subclavian (ita). The thyroid gland is hidden under the sternohyoid and sternothyroid muscles and consists of two lobes and an isthmus.
The thyroid is supplied by superior (sta) and inferior (ita) thyroid arteries derived from the external carotid and thyrocervical trunk respectively. Four small reddish-brown pea-sized glands may be seen on the deep surface of the thyroid gland. The cricothyroid ligament and membrane are frequently pierced in emergency situations to open the airway. You will now disarticulate the sternoclavicular joint and identify the structures located at the root of the neck.
The following description of the root of the neck starts with the most anteriorly placed structures and proceeds to the most posteriorly placed ones.
The posterior part of the root of the neck is made up of the anterior surface of the body of the 1st thoracic vertebra with its anterior longitudinal ligament (in gray).
Muscles attached to and surrounding the jaw joint control the position and movement of the jaw.


Patients may complain that it is difficult to find a  comfortable bite or that the way their teeth fit together has changed.  Chewing on only one side of the jaw can lead to or be a result of TMJ  problems. This continuous pounding on the temporomandibular joint can change the alignment of the teeth.
This trauma can fracture the jawbone, cause dislocation of the TMJ, or cause damage to the cartilage disc of the joint. It is very common for people under stress to release this nervous energy by either consciously or unconsciously grinding  and clenching their teeth. About 80% of patients with a TMJ disorder complain of headache and about 40% report facial pain, and ear pain.
About one half of patients with a TMJ disorder notice ear pain and do not have any signs of ear infection. Grinding, crunching, clicking, or popping sounds (medical term = crepitus) are common for patients with a TMJ disorder.
If your symptoms persist, your doctor may recommend medications or a night guard to help keep you from grinding your teeth at night.
Dentist or doctor will recommend over the counter medications (like Aleve or Motrin), or prescription medications such as Dolobid are a first option to relieve pain.
Antidepressants prescribed to be taken at bedtime have been successful in relieving TMJ pain in some patients. These types of drugs are sometimes used for a few days or weeks to help relieve pain caused by TMJ disorders. Injecting botulinum toxin (example Botox) into the jaw muscles may give relief to pain associated with TMJ disorders.
For patients who grind their teeth patients may gain from wearing a  firm custom made appliance. For patients whose main symptom is from stress or anxiety they may benefit from a visit to a psychotherapist. The success of treatment depends on how severe the symptoms are and how well you comply with treatment.
Marielaina Perrone's advanced training and years of experience translate into greater confidence and convenience for your entire family. Margaret Skinner performs a nasal endoscopy on her patient to examine his nose.Nasal obstruction refers to some blockage of the nose or nasal cavity and can be caused by a wide variety of problems. These airborne pollens come from various species of trees, grasses, weeds and other plants whose pollens are carried by the wind rather than by insects. Currently, about 20% of people in the United States suffer from either seasonal or perennial allergic rhinitis. Because hay fever also causes swelling in the sinuses and near the opening of the Eustachian tube (passage that connects the throat to the middle ear), sufferers can develop additional symptoms of secondary sinus infections or ear infections. Your doctor also will ask about your family history of allergies and your personal history of allergy-related conditions, including eczema, hives and asthma. During your physical examination, your doctor will check for signs of inflammation in your eyes, nose and throat. In skin testing, a small amount of a specific allergen is scratched, pricked or injected into the skin. An elevated eosinophil count or IgE level tells the doctor that there is an allergic response, while skin tests provide more specific information about what the person it allergic to. There are many medicines, both prescription and nonprescription, to treat hay fever and its symptoms.
People with seasonal allergies should start the nasal corticosteroid spray a week or two before an expected rise in pollen counts. It is a leukotriene receptor antagonist, which decreases the allergic response in a different way than either antihistamines or corticosteroids.
In immunotherapy, increasing concentrations of the allergen are injected under your skin either weekly or biweekly.
Without medical treatment, most people with hay fever find that their symptoms gradually diminish as they grow older. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. The first thing you will usually do during a physical examination is to palpate any superficial structure that you can so that you can tell if abnormal changes have occurred. The thyroid gland is closely associated with the cricoid cartilage and the tracheal rings and should always be palpated in a general physical examination of the neck. We will start this study by looking at the submandibular triangle first then the submental. Structures found here are the submental lymph node(s) (ln) that drain the floor of the mouth.
The muscles, at this level, are the middle and lower pharyngeal constrictors (mpc and ipc).
The inferior thyroid artery is closely associated with the recurrent laryngeal nerve (rln). You should be able to palpate this space on yourself or a friend, just to appreciate where it is.
The root of the neck is bounded by the manubrium of the sternum anteriorly, the first rib laterally and the first thoracic vertebra posteriorly.
This is clinically important for anyone entering this region surgically since the lung can be punctured if the surgeon isn't careful. When the muscles are relaxed and in balance and both jaw joints open and close comfortably, we are able to talk, chew, or yawn without discomfort or pain.
A problem with either one can lead to stiffness, headaches, ear pain, bite problems ( also called a malocclusion), clicking sounds, or locked jaws. Teeth grinding as a habit can result in muscle spasm and inflammatory reactions, thus causing the initial pain.
Pain in the TMJ can also occur following dental treatment whereby the joint is stretched open for extended periods of time. 50% of those patients will have resolution of their tinnitus after successful treatment of their TMJ disorder. Your dentist will conduct a careful patient history, dental examination, and take necessary x-rays to determine the cause of your symptoms.


This night guard prevents your teeth from coming together in contact, and repositions teeth to decompress the jaw joint. This would allow the patient to become self aware of stress triggers as well learning relaxation techniques to relieve stress. As always, it is best to maintain regular appointments to see your dentist and let them know if there any TMJ issues developing.
You’ll find complete dental expertise, utilizing the latest advancements in dentistry, all here under one roof.
There are several common causes of nasal obstruction:Inferior turbinate hypertrophy On the inside of the nose there are normal bony structures called turbinates. Because different types of pollen trigger symptoms in different people, each person's specific hay fever "season" is fairly predictable and is related to times when their allergy-triggering plant is in bloom. Although seasonal allergic rhinitis can affect people in all age groups, its symptoms generally peak during childhood and adolescence.
Typically, the lining of the nose is swollen and pale pink or bluish, though it can be red. Blood tests are most helpful when skin testing cannot be done, such as when someone has severe eczema. Nonprescription decongestant pills, such as pseudoephedrine (Sudafed, Afrin and other brand names), can be used to relieve nasal congestion.
Some can make you drowsy, but newer antihistamines, such as fexofenadine (Allegra) and loratadine (Claritin), usually are less sedating. If immunotherapy is effective, allergy symptoms usually subside within six months to a year.
The mylohyoid muscle (mh) arise from the body of the hyoid bone and insert into the mylohyoid line of the inside of the mandible.
Also note the close relationship of the recurrent laryngeal nerves to the thyroid gland and inferior thyroid artery (rln, ita).
It has been known that an empty ball-point pen or a hollow stem has been used in the field to save lives, where an air passage has been closed above this region. All structures passing from the head through the neck to lower regions pass through this area as well as structures arising in the thoracic cavity and passing out through this region.
The temporomandibular joint functions to move the jaw, especially in biting and chewing, talking, and yawning. We can also feel the joint motion if we put a little finger against the inside front part of the ear canal.
Changes in the normal stimuli or height of the teeth, misalignment of the teeth, and changes in the chewing muscles may cause temporomandibular joint changes.
Teeth grinding and clenching are habits that may be diagnosed in people who complain of pain in the temporomandibular joint or have facial pain that includes the muscles involved in chewing. Massage and heat application following your dental appointment can help relive the discomfort. These symptoms are usually caused by Eustachian-tube dysfunction (structure responsible for the regulation of pressure in the middle ear).
Conventional treatment consists of a diet of soft foods along with warm compresses to settle down the tension of the muscles. For example, for people who are allergic to tree pollens and who live in temperate North America, symptoms usually are worst from March through May, when trees are blossoming. The doctor often looks for other signs of allergic rhinitis, such as dark circles under the eyes (called allergic shiners), resulting from chronic sinus congestion, wrinkles under the eyes as a result of chronic puffiness around the eyes, and a crease across the nose from frequently wiping it and pushing it upward.
Decongestant nasal sprays can give relief for a few days but they can cause congestion to get worse if they are used for more than three days.
You may need to work with your doctor to find the specific antihistamine that best relieves your symptoms with the fewest side effects. If a patient is experiencing TMJ difficulty the simple act of opening and closing your mouth can cause considerable pain. Opening your mouth allows the rounded ends of the lower jaw (condyles) to glide along the joint socket of the temporal bone.
These can include arthritis, trauma to the jaw, or muscle fatigue from clenching or grinding your teeth.
Ear specialists are routinely called on to make the definitive diagnosis of a TMJ disorder. It is believed that patients with TMJ syndromes have hyperactivity (muscle spasms) of the muscles responsible for regulating the opening and closing of the Eustachian tube. June and July are peak months for people allergic to grasses, while people with ragweed allergies suffer the worst symptoms from mid-August through October. TMJ disorders most commonly occur in women between the ages of 30 and 50, but can occur in teens after braces, and in both men and women at any age.
If they become swollen, it can be difficult to breathe through the nose.Deviated nasal septum The septum is the structure separating the nostrils inside the nose. Since molds depend on damp, dark conditions, people who are allergic to molds tend to have the least predictable allergy season. Symptoms may include difficulty breathing through the nose (especially on one side), and a runny nose.
At Johns Hopkins, our experts perform nasal examination with lighted scopes and may use imaging, including CT scans and MRIs, when necessary. We may recommend an allergy evaluation.TreatmentNasal obstruction is often initially treated with medications, some of which may address underlying allergy or other reversible causes of nasal swelling. Your doctor may prescribe a nasal steroid spray to decrease inflammation of the nose and turbinates. Surgery to shrink the turbinates may be required if there is no improvement with medications. There are several new surgical techniques that can be used to shrink turbinates, including use of radiofrequency energy or a small tissue-shaving device.Your doctor may recommend having your adenoids removed surgically if they are the cause of the nasal obstruction.



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31.12.2015 admin



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