Читать книгу Temporomandibular Disorders - Robin J. M. Gray - Страница 71

This muscle is inaccessible to manual palpation so palpation for tenderness lacks validity and reliability and is difficult if not impossible to perform.

A more reliable technique is to examine the response to resistance. The patient is asked to open the mouth. The examiner's hand is placed under the patient's chin and pressure is applied to try to close the mouth while the patient tries to resist (Figure 3.10a). This results in a more reliable test because the muscle is fixed. If there is tenderness in the lateral pterygoid muscle, this test will produce pain in the preauricular region. The same can be done by resisting lateral mandibular movement (Figure 3.10b).

Figure 3.10 (a) Examination of lateral pterygoid muscle against vertical resisted movement; (b) Examination of lateral pterygoid muscle against lateral resistance.

(M. Ziad Al‐Ani, Robin J.M. Gray.)

If the patient were, for instance to move the mandible to the right and this movement were resisted, left preauricular pain would arise if there was lateral pterygoid tenderness on the left.