Head OMT

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The OMT Head Dysfunction provides High Yield information that is needed for the COMLEX Level 1, 2, and 3 during Medical School.

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Indications for OMT Head Dysfunction

ENT sequence (10 steps)

Facial Effleurage

• Use:
  • a. Start central work outward (neck before face)
    
    • i. Neck
      
    • ii. Frontal
      
    • iii. Maxillary
      
    • iv. Mandibular

Upper Respiratory Infection

• Treatment:
  • a. Trigeminal stimulation (forehead)
    
  • b. Sphenopalatine ganglion stimulation (finger in mouth)

Headaches

• Red Flags (10)
  • a. First/worst headache of a patient’s life
  • b. Headache beginning after 50 years of age and before 5 years of age
  • c. Occipital headaches in children
  • d. Headache with signs of systemic illness (fever, rash, stiff neck)
  • e. Abnormal neurologic exam
  • f. Headache subsequent to head trauma, including loss of consciousness
  • g. Headache triggered by exertion, Valsalva maneuver, or sexual activity
  • h. New or severe hypertension
  • i. New headaches in patients with cancer, immunosuppression, or pregnancy
  • j. Different than the normal pattern

Migraine Cephalgias

• Unilateral, usually frontotemporal
  
• often pulsating
  
• moderate to severe
  
• 4-72 hours
  
• Triggers vary
  
• Nausea, vomiting, photophobia, phonophobia
  
• *may have auras or prodromes (something the patient experiences before the headache sets in)

Tension-type cephalgias

• Bilateral
  
• Tightening pressure
  
• Mild to moderate
  
• Lasts from 30 minutes to 1 week
  
• Triggered by anxiety, stress, and poor posture
  
• May have phonophobia or photophobia, but not both

Trigeminal autonomic (cluster headaches)

• Strictly unilateral
• Severe to very severe
• 15 minutes to 3 hours or longer
• Triggers: possibly alcohol, histamine, or nitroglycerine during a cluster period
• Occur in series or clusters
• Ipsilateral facial symptoms, such as edema, congestion, lacrimation, sweating, miosis, as well as agitation

Temporomandibular junction disorder

• Path:
  • a. Acute or chronic
    
  • b. Clicking or grating within the joint, mechanical restriction, jaw/ear/facial pain, headache, neck pain, stiffness
    
  • c. Most common non-dental cause of facial pain, multifactorial etiology
• Anatomy:
  • i. The synovial joint between the condyle of the mandible and the mandibular fossa of the temporal bone
    
  • ii. The fibrocartilaginous disc between the two bones
    
  • iii. Complex motion
    
    • 1. Hinge (open and closed)
      
    • 2. Lateral glide
      
    • 3. Protraction/retraction
• Presentation:
  • i. NOTE: the jaw deviates to the side of the TMJ restriction
  • ii. Chronic pain in the muscles of mastication, usually unilateral
  • iii. Pain may radiate to the ear and jaw, worsened with chewing
  • iv. Bruxism (teeth clenching)
  • v. Locking of the jaw or asymmetrical movement when attempting to open the mouth
  • vi. Clicking or popping, usually with a displacement of articular disk
  • vii. Headache, neck, shoulder, or back pain
  • viii. Increasing pain over the course of the day
  • ix. History of the jaw or facial trauma
• Imaging:
  • i. Ultrasound
    
  • ii. X-rays are sufficient to prove the fracture of bony erosion
    
  • iii. CT with contrast (arthrogram)
    
  • iv. MRI is the study of choice with uncomplicated identification of TMJ*****
    
    • 1. But two-capsular arthrography should be done when capsular adhesions or perforations were suspected but not seen on the MRI
• Treatment of Acute TMJ:
  • 1. OMT
    
  • 2. Joint capsule stretching
    
  • 3. NSAIDs and muscle relaxants
• Treatment of Chronic TMJ:
  • a. Manual treatment
    
  • b. Dental (occlusal splints, night guards, orthodontics)
    
  • c. Pharm
    
  • d. Behavioral/psych (stress management, CBT, relaxation)
    
  • e. Other (Acupuncture, biofeedback, iontophoresis – electrical current to drive medication through the skin, surgery)
• OMT Techniques for TMJ:
  • i. Suboccipital inhibition
    
  • ii**C1 treatment (AC1 counterstrain or AA MFR/ME)
    • – anterior c1 can mimic TMJ pain***
      
  • iii. Temporalis MFR
    
  • iv. Masseter inhibition
    
  • v. AC7 and AC8 counterstrain on the SCM
    
  • vi. Temporal balancing