Craniofacial Pain Neuromusculoskeletal Assessment Treatment and Management

Index 685 vertebrobasilar lateroflexion of occiput–C2 to craniofacial morphology insufficiency, 122 right in sitting, 130, 130 and, 369–70 contributory factors, 156–7 lateroflexion of occiput–C2 to instability and, 125 definitions, 120, 121 right in supine, 130–1, 131 juvenile headache, case ‘delayed’, 124 functional, 120, 121, 141 vagal neurodynamics, 529, 530 study, 665 movement diagrams, 126–7, Cervical lordosis lordosis, 104, 125 mouth breathing and, 627–9, 127 biomechanics, 104 physical examination, 125–41 cervical instability and, 125 642–3 Cervical physiological neutral position control, 327 active movements, 125–7, normal variation in, 104 143 movements, 172 peripheral neurogenic pain, Cervical physiological occlusion case report, 143–4 111, 111 guidelines, 125 (spatula technique), 171–2, vertical occlusion hypothesis/planning, 143 172 inspection, 125, 143 Cervical plexus dimension and, 323–4 linear movements see Linear cervical instability and, 122 see also Head/neck posture hypoglossal nerve connections, proprioception, 122 stress tests 122, 123 rehabilitation in mouth movement diagrams, 126, Cervical slump test see Slump test breathing children, 649 Cervical spine stability, 119–20, 120 126–7, 150, 150 biomechanics, 100, 100, 119–20, active subsystem, 120–1 muscle control see Muscle 120–1 definitions, 120 compression, head posture muscle control, 138–9 tests and, 628 passive subsystem, 119–20 PAIVMS, 138, 144 craniomandibular dysfunction regulating subsystem, 120–1 PPIVMS, 127, 129, 143 differentiation, 171–6 see also Cervical instability see also specific tests craniomandibular effects on, trauma, 112 structural, 120, 127, 152 62, 109–13, 295–308, 369–70 craniomandibular pain and, substitution strategies, 140 dynamic direction/through therapy see Cervical instability range control, 329–30, 330 65, 66, 98–109, 105–9 management hyoid effects on, 320 instability and, 120, 124–5 X-rays, false negatives, 124 hypermobility see Cervical surgery and craniofacial Cervical instability management, hypermobility 149–57 instability see Cervical pain/dysfunction, 72 contributory factors, 156–7 instability see also Whiplash/whiplash- joint dysfunction, 150–2 movement effects, 101, 101–2, automobilization, 152 102 associated disorders hypomobile adjacent joints, muscle control, 138–9 (WAD) primary mobilizers, 139 trigger point pathophysiology, 150–2 primary stabilizers, 138–9 257 hypomobile painful joints, trigger points and, 263 trismus, 249 nervous system adaptation, see also Craniocervical region 150, 150, 151 598 Cervical stabilization exercises, unstable painful joints, 152, oculomotor neurodynamic 144, 154, 154–6 tests, 505 ‘Cervical syndrome’ pilot study, 152 passive movements 104, 104–5 muscular stability exercises, C0-C2, Eagle’s syndrome, Cervical trigger points, 104 Cervicogenic juvenile headache, 154–6 528 594–6 basic exercise, 154, 154–5 C0-C3, accessory nerve migraine vs., 600, 601 deep cervical flexors, 155 research reports, 603–4 examples, 156 assessment, 486, 486 Cervicothoracic junction, extensor muscles, 155 cervical instability, 127, 138 hypomobility, 151, 151, 156 functional stability, 155–6 mouth breathing in C-fibres, 13 progression, 154, 155 Cheek bone see Zygomatic arch/ neural structures, 152–4 children, 644 bone (cheek bone) lateral glides, 153, 153 vasomotor headaches, 536 Chewing validity of therapeutic posture overbite and, 287–8 adaptations, 111–12, 112 skull deformation during, approaches, 153–4 craniofacial/ 409–10 neuromuscular dysfunction, unilateral, craniomandibular craniomandibular pain dysfunction/pain, 66 149–50 and, 314, 314 treatment planning, 144, 149 Cervical lateroflexion glossopharyngeal nerve neurodynamics, 523, 523

686 Index see also Malocclusion Classification systems, 4–8 motor responses and, 237 Children American Academy of pain and, 348–9, 572 Orofacial Pain (AAOP), 4, 5 passive movements in balance/equilibrium anatomical regions, 19, 23 assessment, 601, 601–4, Angle malocclusion dystonia, 445 602 classification, 286–9 tinnitus and, 475–6, 476 clinical aspects, 10, 10 ‘Collaborative clinical reasoning’, craniocervical diagnosis compatibility, 6–8 arthrokinematics, adults vs., differences between systems, 6 juvenile headache, 579, 608 596 dysgnathia, positional Colour analogue scale (CAS), pain anomalies, 286–90 craniofacial dysfunction/pain functional see International assessment in children, 590, incidence, 3 Classification of Function 590, 665 (ICF) Colour vision, assessment, 498 craniofacial palpation, 48–51 International Association for Coman’s five D’s, 73 cranium, adult vs., 48–51, 50 the Study of Pain (IASP), 6, Communication, 83–96 6 assumptions for favourable extra bones, 49, 51 International Classification of conditions, 85–6 extra sutures, 49 Headache Disorders-II attention and, 85–6 suture closures, 34–5 (ICHD-II), 575–7, 576 body language and, 86 facial asymmetry, case study, International Headache Society contact, 86 657–60, 659 (IHS), 4, 5 imagination, 92–3, 95 facial pain, undiagnosed, pain-influencing factors, 86–9, 413–14 Cleft lip/palate, 419–20 87 headaches see Juvenile Clicks see Crepitations pattern of adjustment, 94–6 headache Clinical Dysfunction Index, 66, 68 during physical examination, mouth breathing/abnormal Clinical presentations, 655–68 193 breathing patterns see prerequisites for, 83 Mouth breathing in see also Case studies question scheme, 95 children Clinical reasoning, 8, 9–11, 24, resistance to, 85 nervous system, 598–601 speaker’s role, 85 orthopaedics, adult vs., 629 24–6 strategy, selection of, 84–5 pain best available technique, 25 treatment agreement, 89–91 assessment, 589–91 ‘collaborative’ in juvenile goals, 89–90 experience of, 572–3, 573 trismus effects, 249 see also Pain assessment/ headache, 579, 608 verbal intervention methods, definitions, 11 91–2 measurement hypotheses, 11, 12 virtual mirroring, 86 pathobiological mechanisms, scientific understanding, 24 Compression techniques therapeutic relationship with degenerative disc disease, interpretation, 15–16 223–4 physiotherapy, 8 patient, 24–5 frontal deformations, 377 plagiocephaly symptoms, treatment algorithms, 25, 26 ischaemic, trigger point ‘wise action’, 24, 25–6 treatment, 262 374–5 Clonus, mandibular nerve occipital region, 365, 366 posture occipitofrontal region, 363–5 conduction tests, 457 angulation, 363–4 mouth breathing and see Closing click, 218, 218 combinations, 364–5 Mouth breathing in Cluster headache, classification, 5 rotational movements, 364, children diagnosis compatibility, 6 365 palate and, 421 Cochlea, 478, 478 starting position and security, 16 Cochlear nerve, brainstem nuclei, temporomandibular joint method, 363 36, 37 transverse movements, dysfunction, 637 Cognitive–behavioural strategies see also Adolescents; Growth/ 364 juvenile headache, 592, 592, 604 orbital region, 403, 403 development; Neonates tinnitus management, 476 Chin Cognitive–evaluative pain frontomaxillary, 406 palatomaxillary region, 417 inspection/measurement, 164 dimension, 572 parietal region, 366, 367 numb, skull base tumours, 62 Cognitive processes parietoparietal region, 390–1 palpation, 58 temporoparietal region, 380 see also Mandible juvenile headache, 572, 573, Computed tomography (CT) Chondrocranium (basicranium), 578–9 growth/development and, 32, 36, 383 593 Chorda tympani, 39, 42 influence, 581, 581 tinnitus and, 473 Chronic facial pain see Atypical facial pain (AFP)

Index 687 lateral/medial disc Continuous neuropathic pain, 74 resistance, 360, 361, 361 displacement, 222 Continuum model of juvenile pain classification, 361 pilot treatment, 367 lateral pterygoid in headache, 591–2, 592 recording, 673 symptomatic TMJs, 319 Contract–relax technique, trismus, notations/abbreviations for, local muscle dysfunction, 311 251–2, 252 361–2, 362 neurodynamic studies, 440–1 Contracture, 233 occipital condyl fracture, 371 Convergence, eye(s), 507 responses to, 401–2 skull deformation during Conversation, 86 rhythm of examination, 361 Coordination ‘screening tests’, 362 chewing, 409–10 specific techniques, 367–94 Concentration problems excessive protrusion, 254 reduction in myogenic frontal bone, 386–9 parietal region dysfunction, general methodology, 367 392 disorders, 237 mouth breathing in static (isometric) muscle tests, plagiocephaly and, 375 children, 644 Conduction tests 189–90, 190 occipital region, 368–75 trigger point identification, 261 parietal region, 389–94 accessory nerve, 486–7, 487, 489 Coping strategies petrosal bone, 383–6 in craniomandibular juvenile headache and, 578–9, sphenoid bone, 375–8 starting position, 367 dysfunction, 196 580, 592, 593 temporal bone, 378–83 facial nerve and branches, pain, 348–9 symptoms/signs following, 360 Cork and spatula exercise, vasomotor headaches, 536 465–6, 465–7, 467 see also individual techniques; glossopharyngeal nerve, 524, trismus, 253 specific bones/regions Corneal reflex, 455 Cranial blood flow, migraine and, 524, 531–2, 532 Coronal suture, 49, 51, 53, 54, 387 72 hypoglossal nerve, 492 Cranial bones see Neurocranium; oculomotor system, 505 cranial synostosis, neurological specific bones complications, 393 Cranial dystonia Maddox tests and, 512 classification/incidence, 444 olfactory nerve, 495, 496 neonatal cranium, 50 see also Craniocervical dystonia optic nerve, 498, 498, 499 palpation, 48, 53 (CCD) recording, 675, 676, 677 Coronoid process, 51, 57 Cranial ganglia, 429 trigeminal nerve and branches, Cortical motor control, 346–8 abnormal impulse generating Cost–benefit analysis, 90, 90 sites, 73 458 Costen syndrome see Cranial growth, clinical mandibular nerve, 455–7 reasoning, 24 vagus nerve, 531–2, 532 Craniomandibular Cranial nerve injury vestibulocochlear nerve and dysfunction/pain abducens nerve dysfunction, branches, 479–81, 484 Cover bite, 289, 289 521 see also specific tests Cover test, 506, 512 accessory nerve dysfunction, Condyle(s) Cranial accessory movements, 487–8 mandible, 51, 57 357–400, 358 craniofacial neuropathy, 76 disc–condyle relationship, direction, 358–9, 359 facial nerve dysfunction, 560 facial vs., 401–2 oculomotor nerve dysfunction, 316 general techniques, 362–7, 363 518 palpation, 58 frontal distraction, 366 olfactory nerve dysfunction, occipital, 55 mouth breathing in 495–6 fracture, craniofacial pain optic nerve dysfunction, 500 children, 644 trochlear nerve dysfunction, and, 371 occipital compression, 365, 519–20 Condyle canal, 55 vertigo, 476 Congenital defects see 366 whiplash injury, 107 occipitofrontal compression, see also Neuralgia; Developmental Neuropathies abnormalities 363–5 Cranial nerve palpation, 196 Connective tissue, 34, 35, 36 parietal compression/ accessory nerve, 484, 486, 486, cranial nervous system, 410–11, 489 426, 426 distraction, 366, 367 adhesions, 559–60 steps following, 367 innervation, 427 types, 362–3 palpation, 559–60 grades, 358, 359–60, 360 vasomotor headaches, 533 juvenile headache, 597, 597 protective mechanisms and, maxillary adenocystic 344 carcinoma, 664 Contact, communication, 86 normal responses, 360–1 Conti Anamnestic Questionnaire, local pain, 361–2 104, 104 range of motion, 361

688 Index facial nerve and branches, assessment/treatment, 76–7, 77, key cranial nerves, 36, 37–43, 463–5, 464, 467, 528 439–50, 439–550 38–9, 440 categories, 439–40, 440 examination, 446–93 glossopharyngeal nerve, 523–4, clinical decisions, 494 524 conduction tests see movement, 429–30, 551 Conduction tests adaptations to, 429–30 hypoglossal nerve, 490, 491, differentiation tests see blood vessels and, 428 492 Differentiation tests position/localization, 429 first category, 440–6, 674 see also Cranial oculomotor system, 505, 505 inspection, 674 neuromobilization; therapeutic juvenile headache, 600–1 Neurodynamics neurodynamics see passive influence, 552 Neurodynamic neural pathodynamics, 430–1 treatment guidelines, 551–70 techniques neuromusculoskeletal see also Cranial neuromobilization therapy see Cranial structures, 22 neuromobilization neuromobilization palate and, 420 trigeminal nerve and branches, observation, 162–4 particular cranial nerves, 36–7, palpation see Cranial nerve 458, 528 palpation 43, 43–6, 440 mandibular nerve, 454, physical, 195–6, 439–550 examination, 494–536 recording, 674–6 pathophysiology, 431 454–5 second category, 446–93, pain see Pain maxillary nerve, 449, 450 675–6 plasma, 427 ophthalmic nerve, 448, 448 subjective, 73–7 as source of dysfunction, 19, ‘twanging’, 463, 470, 528, 531, theory, 425–38 110–11 560 third category, 494–536, see also individual nerves/ unpalpable nerves 676–8 branches olfactory nerve, 496 treatment guidelines, 551–70 Cranial neuralgia see Neuralgia optic nerve, 497 Cranial neuromobilization vestibulocochlear nerve classification of cranial nerves, abducens nerve, 557 36, 439–40 accessory nerve, 560–1, 561 (VIII), 479 active influence (movements), vagus nerve, 528, 531, 531 dysfunction 552–5 Cranial nerve palsies atlas fractures, 371 continuous physiological, abducens nerve, 521–2 axoplasmic transport facial nerve, 111, 112, 469–70, dysfunction, 427, 428, 431 552–5 compression and, 431, 432, pain management and, 555 553, 563–6, 564 433 sequence of movements, hypoglossal nerve, 493 degeneration see oculomotor nerve, 518 Neuropathies 554, 567 trochlear nerve, 519 double crush hypothesis, target tissue rehabilitation, see also Neuropathies 76–7 Cranial nervous system, 35–48, hearing loss, 480 552–4, 565, 568 indicators of, 163 trick movements, 554, 555, 424–37 infections, 482, 518, 521 anatomical/physical features, juvenile headache, 600–1 607 migraine and, 72 variations of active 426, 426–9 paresis see Cranial nerve axoplasmic transport, 427–8, palsies movements, 554 pathobiology, 431–2, 432, active vs. passive influence, 552 428 433 assessment and treatment blood supply, 428, 428–9 petrosal bone and, 386 brainstem nuclei, 35–6, 37 temporal bone and, 382 techniques, 560–2 cerebrospinal fluid, 427 trauma and see Cranial advantages/disadvantages, connection to other tissues, nerve injury vascular dysfunction, 429, 562 430 429, 431 choice of, 556, 558, 560, 563 connective tissue, 410–11, see also Neuralgia; Pain; direct vs. indirect, 563 specific nerves integration into overall 426, 426, 427 dura see Dura mater management, 551–2, 554, fibre types, 35 558 fluids, 427 intensity/duration, 560, 563, ganglia, 429, 432 565, 567–8 innervation, 426–7, 467 location/order, 563 innervation of, 40, 103, 234, passive vs. active, 563 previous history, 563, 566 426–7, 467 reassessment, 552, 556 intrinsic vs. extrinsic results, 564, 565–6, 568, 569 innervation, 427 plasma, 427 styloid process and, 525–6

Index 689 starting position, 560, 563, advantages/disadvantages, contribution to 564, 566 562 craniomandibular dysfunction see under treatment guidelines, 551–70 case studies, 565, 568 Craniomandibular types, 552–62 contexts, 558–9 dysfunction/pain see also specific techniques examples, 560–1 auricular nerve, 565 intensity of stimulation, craniocervical tinnitus, 474 auriculotemporal nerve, 558, craniomandibular region 561 560 buccal nerve, 561, 565 neural container/connective contribution to, 62, 109–13, case studies, 563–9 286, 295–308 facial paresis after salivary tissue changes, 559–60, assessment see 561 gland surgery, 563–6, pathobiology of peripheral Craniomandibular 564 cranial nerves, 559–60 assessment in pain after acoustic neuroma passive influence (movements), craniocervical pain removal, 566–9, 567, 568 552, 553, 554 biomechanics, 110 efficacy studies, 560 case study, 564 bite taking, 296, 298 facial nerve, 467, 468, 533, 557, palpation, 552, 558 clinical/functional effects, 566, 568 physiological movements, 111–12, 112 glossopharyngeal nerve, 565 552 differentiating which came home exercises, 565, 568–9 treatment guidelines, 551–70 first, 296 hypoglossal nerve, 353, 353, trigeminal nerve, 565, 566, 568 malocclusion and, 296, 296, 557, 558, 561, 565, 568 vagus nerve, 561, 565 297, 298 mandibular nerve, 552, 553, vestibulocochlear nerve, 568 mechanisms, 296 557, 557 Cranial synostosis neurodynamics, 110–11, 111, movement diagrams, 553 brachycephaly, 71 112 neural container (indirect case studies, 70–1, 72, 392–3 neurophysiology, 110 influence), 555 craniofacial dysfunction/pain, nociceptive input, 110 advantages/disadvantages, 70–1 pain projection, 110 562 juvenile headache, 596 post-operative dizziness, case study, 566 lambdoid suture, 391–2, 393 case study, 306–7 neurodynamics (direct manual therapy, 70 posture, 110, 112 influence), 555–8 neurological complications, epidemiology, 2–3 advantages/disadvantages, 392–4 children/adolescents, 3 556, 562 plagiocephaly see gender, 2–3, 17 case studies, 564–5, 566–8 Plagiocephaly literature reviews, 2 choice of technique, 556, 558 scaphocephaly, 391–2, 394 mandibular position and, 98–9, combined techniques, 567 trigonocephaly, 70, 71 303–4 distal techniques, 556, 565 Cranial vault see Calvaria parietoparietal dysfunction dosage, 567–8 Craniocervical angle, mouth and, 392 juvenile headaches, 606–7 breathing and, 622, 627, 628 post-anaesthesia dizziness, proximal techniques, 556–7, Craniocervical dysfunction/pain case study, 307 564, 566 aetiology, 3–4 prognosis, 12, 23 sliders, 557, 557–8, 565, 566 biopsychosocial approach, rehabilitation in mouth tensioners, 558, 566 4 breathing children, 649–50 neuromuscular rehabilitation, hormones, 17 vertigo, 476 353, 353–4 risk factors, 17, 17 Craniocervical dystonia (CCD) oculomotor rehabilitation, 512, assessment/examination, 161 case study, 445, 445 515 cervical instability, 125–41 classification/incidence, 444 pacing exercise, 555, 557 children, 594–6, 667 clinical features, 444–5 pain management and, 551–2, differentiation tests see neurobiology, 444 555, 557 Differentiation tests passive neck extension/flexion pain mechanisms and, 552, 554 see also Assessment; specific and, 443–6, 445 palpation (direct influence), techniques cognitive/psychological 558–60 children, 16, 16, 392 effects, 445 adhesions around nerve, effects on other systems, pathobiology, 445 559, 560 595 second category tests, 445–6 adhesions of connective juvenile headache and, 594– Craniocervical extension, tissue (intraneural), 559 6, 665–7, 666 mandibular growth and, symptoms, 595 101, 101–2

690 Index Craniocervical headaches, Craniocervical tinnitus, 475, 475 muscular see Muscular migraine vs., 600 Craniodynamic mobilization see dysfunction Craniocervical joints, Cranial neuromobilization non-craniomandibular facial rehabilitation in mouth Craniofacial abnormalities pain, 2 breathing children, 649 hearing defects, 419 ‘non-specific’, 6 Craniocervical junction, 99, 111 mouth breathing and, 624–7 pathobiology see juvenile headache, 594 palate and growth, 419–20 case study, 665, 666 see also Dentofacial Pathobiological mechanisms prognosis, 12, 23 Craniocervical movements, development regions influencing, 160 trismus, 249 Craniofacial accessory movements symptoms Craniocervical region cranial bones see Cranial associated symptoms, 73 assessment, 161 accessory movements behaviour, 69 children, 594–6, 641–4 localization/nature, 68–9 mouth breathing/abnormal Eagle’s syndrome, 528 variability, 69 breathing patterns, 641–4 facial bones see Facial synonyms, 8 see also Assessment; specific therapeutic communication, techniques accessory movements 83–96 children juvenile headache, 597, 597 treatment see Treatment/ abnormal areas in newborn mouth breathing in children, management and future development, see also Headache; specific 370–1 644 conditions arthrokinematics, adults vs., vagal neurodynamics and, Craniofacial manual therapy, 596 juvenile headache, 606 assessment/examination, 530–1 Craniofacial morphology, head 594–6, 641–4 see also specific regions/techniques posture and, 369–70 infantile cerebral palsy, Craniofacial dysfunction/pain Craniofacial pain syndromes, 2 371–2 aetiology/contributory factors, assessment/treatment, 9 craniofacial morphology, head dysgnathia and, 285–6 posture and, 369, 369–70 3–4, 17, 17, 23, 67 Craniofacial region definition, 594 birth trauma, 69–70 accessory movements see dysfunction see Craniocervical chronic sinusitis, 71–2 Craniofacial accessory dysfunction/pain cranial synostosis, 70–1 movements neuraxis, 430 meningioma resection, case airflow and morphology, 72 neuromusculoskeletal assessment structures, 20–1 study, 660–2, 661 children, 596–8, 639–41, 644 pain see Craniocervical migraine, 72 guidelines, 59–82 dysfunction/pain occipital condyl fracture Maddox tests integration, posture changes due to changed and, 371 512 breathing patterns, predisposing factors, 69–70 mouth breathing/abnormal 617–36 surgery, 73 posture control system, assessment/examination breathing patterns, 639– 594–6 chronic pain syndromes, 9 41, 644 see also Head/neck posture guidelines, 59–82 recording, 674 reciprocal craniomandibular juvenile headache, 596–8 subjective examination, connection, 97–118, 174, subjective examination, 68–73 285–6, 286, 295 see also Assessment; specific functional investigation, 68–73 techniques 303–4 see also Assessment; specific changed breathing patterns models of, 97–8, 98 and see Mouth breathing posture and, 322 techniques functional anatomy, 31–58 as source of dysfunction, 18 ‘atypical’, 6 neurocranium see topography, 22 Neurocranium trigger point prevalence, 259, see also Atypical facial pain neuromusculoskeletal 259 (AFP) structures, 21 see also Atlanto–occipital joint; pain see Craniofacial Cervical spine; Occipital– case studies, 7 dysfunction/pain atlas region (O–C1) chronic syndromes, 2, 9, palpation see Palpation sensory maps, 13–14, 14 285–6 somatotopia, 13–15, 14 classification, 10, 10 see also Classification systems current issues, 1–30 epidemiology, 2–3, 325 children/adolescents, 3 gender, 2–3 juvenile headache and, 596–8 mandibulofacial dysostosis and, 377

Index 691 as source of dysfunction, 19 Craniomandibular muscular dysfunction see temperature/sweating, 197 dysfunction/pain Muscular dysfunction topography, 22 viscerocranium see aetiology/contributory factors, onset, 65 3–4, 65–6, 67, 215 pathobiology see Viscerocranium bruxism and, 239–40 Craniofacial Therapy Academy craniocervical injury see Pathobiological mechanisms craniocervical contribution prognosis, 23 (CRAFTA®) tools, 669–78 to (below) slight, case study, 656–7, 657 Craniomandibular accessory maxillary adenocystic symptoms, 64 carcinoma, case study, movements, 204–10 662–4, 663 associated symptoms, 63 anterior–posterior movements, trauma, 65, 66, 105–6, 106 behaviour, 63–5 diurnal changes, 64 208, 209 articular (joint dysfunction) see localization/nature, 62–3 bilateral movement, 205, 205–6 Temporomandibular joint variability, 63–4 capsule stiffness, 229 dysfunction synonyms, 8 capsulitis, 228 treatment see Treatment/ clinical patterns, 209–10 assessment/examination management definition, 204, 358 in craniocervical pain see vertigo, 476 disc disease Craniomandibular see also specific conditions assessment in Craniomandibular interference see degenerative, 223–4 craniocervical pain Craniomandibular displacement without differentiation tests see dysfunction/pain Differentiation tests Craniomandibular malformations, reduction, 220, 222 guidelines, 62–8 plagiocephaly and, 375 displacement with hip abduction and, 304–5, Craniomandibular region 305 anatomy/functions, 31–58 reduction/reposition, see also Assessment; specific afferent input, 98–9, 99 219–20 techniques craniocervical connections dorsal disc displacement, 222–3 classification see Classification see below retrodiscal inflammation, clinical patterns/management, musculoskeletal support, 225, 227 Eagle’s syndrome and, 528 215–84 322 habitual luxation, 231 contribution to craniocervical neuromusculoskeletal indications, 206, 207–8, 209 interpretation, 209–10 dysfunction see under structures, 20, 98, 110 longitudinal caudal movement Craniocervical somatosensory structures, bilateral, 205, 205–6 dysfunction/pain interpretation, 210 craniocervical contribution to, 110 unilateral, 206, 206 98, 98–109, 296 assessment/examination muscle dysfunction and, 313 biomechanical model, 100, pain mechanisms/sources, 205, in craniocervical pain see 209–10 100–1 Craniomandibular posterior–anterior movements, cervical movement, 101, assessment in 209, 209 craniocervical pain reliability, 206 101–2, 102 testing at end of session, clinical/functional model, guidelines, 62–8 204–5 palpation, mouth breathing transverse lateral, to the right, 103, 103–5 207, 207–8, 210 mandibular position, 98–9 in children, 641 transverse medial, to the left, neuroanatomic model, 98–9, physical examination, 208, 208 trismus treatment, 251, 252 99 159–214 unilateral movement, 206, 206 neurodynamic model, 101, see also Assessment; specific Craniomandibular assessment in craniocervical pain, 113 101–3, 102 techniques case study, 306–7 neurophysiology, 103 developmental abnormalities EMG, 298, 298–300, 299–300f pain, 98 hip abduction tests, 304, 304–5, prevalence, 104, 104–5 see Dysgnathia 305 see also Whiplash/whiplash- dysfunction see kinesiography, 300–2, 301, 302f, 303f associated disorders Craniomandibular occlusal plane, 302–4, 303, 304 (WAD) dysfunction/pain epidemiology, 2–3, 325 neuromusculoskeletal children/adolescents, 3 plasticity, 339–56 gender differences, 2–3 pain see Craniomandibular masticatory cycle, 312 dysfunction/pain multistructural nature, 215–16 reciprocal craniocervical connection, 97–118, 174, 286

692 Index craniocervical dysfunction Decompression splints, 291 Desensitization, 344 and, 62, 109–13, 295–308 Deep bite, 289, 289 Desmal (membranous) Deep cervical flexors, 139 functional investigation, ossification, 32, 33, 36 303–4 stabilization exercises, 155 Development see Growth/ Deep overbite, 288, 288 models of, 97–8, 98 Deep temporal nerves, 38 development neuromuscular control, 286 Deflection (shift; swinging Developmental abnormalities posture effects, 322 as source of dysfunction, 19 opening), 217, 220 cervical instability, 120 topography, 22 Degenerative disease congenitally missing teeth, 289 trigger point prevalence, 259, 259 craniofacial see Craniofacial see also specific components capsule stiffness, 228 Craniomandibular rotation cervical instability, 120 abnormalities (global control), 331–2, 332 disc disease, 223–4, 224, 225, craniomandibular region see Cranioneurodynamics see Neurodynamics 227, 228 Dysgnathia Craniosynostosis see Cranial see also specific conditions maxillofacial deformity, 413, synostosis Deglutition see Swallowing Cranium see entries beginning Dehydration, juvenile headache, 414 cranio-/cranial; Skull palate, 419–20 Crepitations, 62 580, 581 plagiocephaly and, 375 cervical instability, 123 Demyelinization, 431 Deviation (ocular), passive neck craniomandibular, 7, 217, 219 after meningioma resection, peripheral neurogenic pain, 73 flexion and, 443 Dens axis fracture, accessory Diabetes mellitus, cranial nerve 660 case study, 656 nerve dysfunction, 487–8 pathology, 431 closing click, 218, 218 Dental arches, 286 oculomotor neuropathy, 518 deep overbite, 288 Diagnosis, 1 degenerative disc disease, mouth breathing and, 625 classification compatibility, 6–8 overbite, 287 pain mechanism, 15 223 Dental examination regions vs. structures, 19 disc disease without malocclusion, 290–1 Diaphragm, mouth breathing and post-anaesthesia dizziness, 306 adaptation to, 632 reduction, 220 Dental treatment rehabilitation in children, 648 disc disease with reduction, braces/splints see Orthodontic Diaries, pain see under Pain 217–18 braces/splints assessment/measurement malocclusion/dysgnathia, bruxism, 241 Diet capsule stiffness aetiology, 228 291 capsulitis, 228 craniomandibular pain and, 67 not due to disc craniomandibular dysfunction juvenile headache, 580 Differentiation tests, 161, 170–8 displacement, 219 and, 65 cranial nervous system opening click, 218, 218 degenerative disc disease, 224 subluxation/luxation, 219, 230 disc displacement craniocervical vs., 171, 176–7, temporal bone and, 381 177 Cricothyroid, vagal dorsal, 223 neurodynamics, 530, 530, with reduction/reposition, craniofacial vs., 171, 178 532–3 craniomandibular vs., 171, Crossbite, 169, 512 220 anterior, 288 without reduction/ 177–8 laterognathia and, 290 craniofacial vs. craniocervical, mouth breathing and, 625 reposition, 222 Crossed shoulder syndrome, 645 inferior alveolar nerve 171, 176 ‘Crucifix structure’, palatine craniomandibular vs. sutures, 415, 415 neuropathies and, 461 Crying baby’s torticollis, 69, 658 malocclusion, 352 craniocervical, 171–6 retrodiscal inflammation/ cervical accessory D irritation, 227 movements, 174, 174–5, Deafness see Hearing loss see also Teeth 175 Decision making, physiotherapist, Dentition see Teeth cervical physiological Dentofacial development movements, 172 26 mouth breathing and, 617–18, cervical physiological occlusion (spatula 621, 622, 624–7, 625 technique), 171–2, 172 tongue position and, 620, 620 mandibular movements in see also Craniofacial cervical positions, 175–6 rotation test in prone abnormalities position, 174 Dentures, pain, 88–9 rotation test in sitting Depression, juvenile headache position, 173, 173 and, 579, 580

Index 693 craniomandibular vs. degeneration and, 225, 227 Diurnal bruxism, 241 craniofacial, 171, 176 differentiation tests, 175–6 Divergence (eyes) dorsal/posterior, 222–3, 225, functional, 170–1 cranial nerve dysfunction, 163 principles, 171 226 orbital techniques, 411 structural, 170 clinical features, 222 Dizziness, 7 test choice, 170–1, 177 dental/medical treatment, clinical features, 122–3 validity, 171 see also specific tests 223 associated symptoms, 483 ‘Difficult’ patients, 85 home management, 223 craniocervical disorders and, Digastric muscle manual therapy, 222–3 anatomy/function, 203, 203, lateral/medial, 222, 226 295 MRI, 219 cervical instability, 122–3 318, 319–20 muscular dysfunction and, whiplash, 229 EMG, 298, 298–9 316–17, 321 definition, 483 head extension and, 628 with reduction/reposition, 217– head position and, 322, 483 innervation, 319–20 20, 226 mandibular disorders and, 295 clinical features, 218–19 post-operative, case study, reciprocal, 351 dental treatment, 220 mouth breathing and, 623, 628 home management, 220 306–7 palpation, 162, 203, 204 manual therapy, 219–20 tinnitus and, 476 mechanisms/models, 217– vestibulocochlear nerve and, trigger points, 267, 267–8 Digastric nerve, 41 18, 218 483–4 Diploe, 33, 36 whiplash-associated disorders, see also Vertigo Diplopia Dolichocephalic face, mouth 107 cervical instability, 122 without reduction/reposition, breathing and, 625 cranial nerve dysfunction, 163 Dorsal cochlear nucleus (DCN) 220–2, 221, 226 abducens nerve, 521 clinical features, 220 disinhibition strategies, 475, case study, 519 dental treatment, 222 475, 477 oculomotor nerve, 511, 518 establishing site of ophthalmic nerve, 448 tinnitus, 474, 475, 477 passive neck flexion and, instability, 315 vertigo, 477 home management, 222 Dorsal root ganglia, 429 443 manual therapy, 220, 222 abnormal impulse generating trochlear nerve, 520 mechanisms/models, 220, orbital techniques, 411 sites, 73 Disability, juvenile headache, 572, 221 ‘Double bite’, 287 573, 574, 575 Disc position, ideal, 225 Double crush hypothesis, 76–7 Disc–condyle relationship, 316 Disorder inhibition, 189 ‘Double’ Maddox tests, 511 Disc disease (TMJ), 217–27 Distal neurodynamic Drawings, children’s experience craniocervical dysfunction and, 107 neuromobilization, 556, 562, of pain, 573 definition, 217 565 Drop attacks, cervical instability, degenerative, 223–4 Distraction (attention) strategies aetiology, 223 formal hypnosis 122 capsular stiffness and, 228 (hypnotherapy), 94 Dry eyes, 407 clinical features, 223 juvenile headache, 605, 607 Dural headache, 427, 500 compressive therapy, 223–4 Distraction techniques, 94 Dura mater, 19, 35 dental treatment, 224 cranial neuromobilization and disc displacement and, 225, pain management, 555 abnormal impulse generating sliders, 557 sites (AIGS), 432 227 frontal region, 366 home management, 224, 224 deformations, 377 children, 598 manual therapy, 224 occiput–C1 test, 135, 135 connections to surrounding displacements see Disc orbital region, 403 displacement (TMJ) frontomaxillary, 406 tissues, 430 retrodiscal inflammation see palatomaxillary region, 417 inflammation/irritation, 103 Retrodiscal inflammation/ parietal region, 366, 367 irritation parietoparietal region, 390–1 craniofacial pain and, 70 Disc displacement (TMJ), 225, temporoparietal region (T/P), innervation, 427 226–7 380 anterior, 225, 226, 315, 321 TMJ, 353, 354 nociceptors, 103 clinical reasoning, 25 Distress, tinnitus, 476 intracranial neurogenic pain, 74 neurocranium growth effects, 596 optic nerve, 498, 500 spinal vs. cranial, 427 children, 598 sutures and, 34 temporal bone and, 382, 383

694 Index trochlear nerve dysfunction, sphenopalatine ganglion case study, 299 521 and, 420 Electronic axiography, disc Dynamic balance test, 601, 601 temporal bone and, 381 displacement (TMJ), 219 Dynamic coordination exercises, palatal abnormalities and, 419 Electronystagmogram (ENG), 506 surgery, craniofacial pain/ Elevation, static (isometric) capsule stiffness, 230 Dynamic load test, 192 dysfunction, 72 muscle tests, 190 Dynamic muscle tests temporal bone and, 383 Embryonic development, skull, tumours, passive neck flexion craniomandibular region, 32–3, 33 191–2 and, 443 EMG see Electromyography zygomatic/maxillary interpretation, 191–2 (EMG) see also specific tests development and, 413 Emotional factors Dysarthria, cervical instability, Earache see Ear(s), pain/infection Eardrum, tinnitus and, 473 craniomandibular 122 Eccentric muscle activation dysfunction/pain, 67 Dysgnathia, 285–94 myogenic, 237 lateral pterygoid muscle, 351–2, central sensitization, 14 352 juvenile headache, 572, 573, chronic pain and, 285–6 578, 579–80, 581, 581 classification of positional masseter muscle, 351, 351 omohyoid muscle, 352, 352 pain and, 87, 572 anomalies, 286–90 Ectopic pacemakers see Abnormal Empathy, juvenile headache craniomandibular pain, 65 head/neck posture and, 324 impulse generating sites management, 605 laterognathia, 290 (AIGS) Enchondral bones, 33 orthodontic examination/ Edinger–Westphal nucleus, 501 Enchondral ossification, 33 Elastic stiffness, viscoelastic End-feel, assessment of active treatment, 290–3 structures, 233 see also Malocclusion Electrogenetic muscle stiffness, movements with Dyskinesia, kinesiography 233 overpressure, 186 Electromyographic stimulation End of range movements (mandibular), 301 (EMS), hemifacial spasm kinesiography (mandibular), Dyslexia, birth trauma, 69 and, 468 301, 302 Dysphagia see Swallowing Electromyography (EMG) retrodiscal inflammation, 225 cranial muscles, 298, 298 Endoneurium, 426, 426 dysfunction cranial nerve assessment Endplate hypothesis, trigger point Dystonia accessory nerve assessment, pathophysiology, 257–8, 258 Endurance training, rehabilitation craniocervical see 487 in mouth breathing Craniocervical dystonia cranial nerve tumours, 482 children, 651 (CCD) hemifacial spasm, 468 Endurance, trigger point diagnostic, 298, 298–300 identification, 261 definition, 443–4 electrode placement, 298, 298 Environmental factors functional, 299–300 growth/development, 630 E contraction symmetry, 300 juvenile headache, 580 muscle force, 299 Epineurium, 426, 426 Eagle’s syndrome, 525–8 occlusion quality, 299, 300 Episodic neuropathic pain, 74 case study, 528 kinesiography and, 301 Equilibrium see Balance/ clinical features, 525 mandibular hypomobility, 216 equilibrium styloid elongation, 382, 383, masticatory muscles, 298, 298, Ergonomic factors 525, 527 318, 320 cervical instability, 156–7 temporal bone and surgery, head/neck posture and, 98 juvenile headaches, 607 382, 383 pain and, 235, 313 Esophoria therapy, 526 trigger points, 235 definition, 508 mouth breathing and, 623–4, Maddox cross tests, 510 Ear(s) 624, 628 Maddox rod tests, 509, 509 craniofacial dysfunction/pain neck muscles, 298, 298 Esotropia and, 69, 72 differentiation tests, 174 accommodative, 508 craniomandibular dysfunction whiplash-associated definition, 508 symptoms, 64 Maddox cross tests, 510 nutrition of, 474 disorders, 107 Maddox rod tests, 509, 509 otomandibular structures, 473, needle, 482 Ethmoidal nerve, 39, 446, 447 473–4 pain relationship, 235–6 Ethmoid bone, 51, 384, 402 pain/infection resting EMG, 298–9, 299–300 Eugnath dentition, 287, 287 abducens nerve dysfunction, 521 juvenile headache and, 578–9

Index 695 European Workgroup for Manual imbalance, 409, 511 Eye-following test, 506–7, 507–8 Medicine (EWMM), innervation and see Eye movements, 409 cervicogenic pain vs. juvenile headaches, 588 Oculomotor dysfunction examination, 506–18 scoliosis and, 511 cover test, 506 Evidence-based medicine (EBM), movement examination see eye-following test, 506–7, 159 under Eye movements 507–8 see also specific muscles Maddox tests see Maddox Evidence-based practice (EBP), Extraoral techniques tests neurodynamic techniques, craniomandibular anterior– neurodynamics and, 507 433–4 posterior movements, 208, orthoposition measurement, 209 507 Evolutionary aspects masseter muscle palpation, 201 motor control, 341 medial pterygoid muscle oculomotor control, 501, 501, of posture, 224 palpation, 201 502, 503, 506 skull shape, 343, 343 zygomatic region, 412 dysfunction see Oculomotor Eye(s) dysfunction Exercises accommodation, 448, 506, 506 see also Oculomotor system bracing/clenching treatment, anatomy/function 248–9 anatomical variation, 409–10 rehabilitation and see capsule stiffness, 230 bulb position, factors Oculomotor rehabilitation capsulitis, 228 cervical stabilization, 144, 154, affecting, 509 see also Extraocular muscles; 154–6 innervation, 498 specific movements degenerative disc disease, 224, 224 see also Oculomotor F disc displacement system; specific nerves dorsal, 223 Face with reduction/reposition, lacrimal system, 407 contours of, 46, 48, 412 220 ‘mechanically-determined functional divisions, 401–2 without reduction/ growth/development, 34–5, 166 reposition, 222 position’, 509 juvenile headache and, 596 excessive protrusion treatment, musculature see Extraocular maxilla and, 412–13, 413, 255–6 413–14 at home see Home management muscles mouth breathing and, 617– peripheral facial paresis, 469 convergence, 507 18, 618, 624–7, 626 retrodiscal inflammation/ growth/development, 409 orbital region, 409 irritation, 227 ideal position (orthoposition), palate and, 419–20 tinnitus management, 475 zygomatic bone and, 404, trismus, 253 507 412–13, 413 see also specific exercises movements see Eye movements see also Craniofacial neurodynamic tests abnormalities; Exophoria Dentofacial development definition, 508 oculomotor, 505 nerve endings, sensitivity, 559 Maddox cross tests, 510 ophthalmic nerve, 446 profile, 162, 169–70 Maddox rod tests, 509, 510 pain/dysfunction proportions/measurements cranial nerves and, 163, 163, height (N–GN), 168 Exotropia mouth breathing in Maddox cross tests, 510 448, 499–500 children, 640 Maddox rod tests, 509, 510 craniofacial pain and, 69 normal, 164 passive neck flexion and, 443 craniomandibular see also Measurements skeleton see Viscerocranium External acoustic meatus, 51, 52 dysfunction and, 64 see also entries beginning facial External occipital protuberance, deviation see Ocular Facial accessory movements 55 deviations cranial vs., 401–2 Extortion, ocular torticollis, 520 divergence, 411 general techniques, 402–5 Extraocular muscles dry eyes, 407 maxilla, 405 following meningioma mouth breathing in accommodation and, 448, 506 children, 644 activities during eye-following resection, 660–2, 661 orbital region, 402–3 oculomotor see Oculomotor zygomatic bone, 403–5 test, 508 anatomy/function, 44, 409, 501, dysfunction temporal bone and, 381 502, 503 see also specific dysfunctions innervation see Oculomotor passive neck flexion and, 443 surgery, craniofacial pain/ system dysfunction, 72 dysfunction see also Orbital region; specific components

696 Index nerve compression during, facial muscles/expression, Fascia 420 465, 465–6 cranial nervous system, 22 craniofacial region, 21 specific techniques, 405–21 secretions, 465–7 craniomandibular region, 20 maxilla, 414–15 taste, 465 sutures and, 34 mouth breathing in cranial neuromobilization, 467, children, 644 468, 533, 557, 566, 568 Fasciculation orbital region, 405–11 dysfunction eye muscles, 660 zygomatic region, 411–14 atypical facial pain see passive neck flexion and, 443 tongue muscles, 490 see also individual techniques; Atypical facial pain specific bones/regions (AFP) Fasciitis see Myofacial pain Bell’s palsy, 553 syndrome (MPS) Facial affective scale, pain following meningioma assessment in children, 590, surgery, 660 Fast twitch fibres, plasticity, 342 591 hearing loss, 480 Fibromyalgia see Myofacial pain hemifacial spasm, 467–8 Facial asymmetry indicators, 163 syndrome (MPS) cranial nerve dysfunction, 163 mouth breathing and, 629, Fila olfactoria, 43 craniomandibular pain, 65 646 Five D’s of Coman, 73 masticatory muscles, 162, 162 neuropathies, 382, 474, Flexor withdrawal reflex, 234 measures, 161, 161 563–6, 564 Fontanelles, extra bones, 49 orbital growth, 409 pain (neuralgia), 420, 470, Foramen magnum, 55, 368 parietal region dysfunction, 472 Foramina 392, 392, 393 pathodynamics, 467 plagiocephaly and, 375 peripheral paresis, 111, 112, cervical movement and, 102 temporal region effects, 381 469–70, 563–6, 564 palatine, 415, 415 torticollis and, case study, petrosal bone and, 386 Forward head posture (FHP), 657–60 radiotherapy and, 382 clinical course, 659–60 temporal bone and, 382 mandible position and, 98 hypotheses, 658 tinnitus see Tinnitus Fractures KISS, 658, 660 trauma, 560 physical examination, 658 facilitation techniques, 469–70 accessory nerve dysfunction, subjective examination, neurodynamics, 461–3, 467 487–8 657–8 mouth breathing and, 629, therapy, 658–9 646 ‘blow-in’, 410 rehabilitation and, 467, 468 occipital–atlas region (O–C1), 371 Facial bones see Viscerocranium; starting position/method, orbital region, 410, 411, 450, 450 specific bones 462–3, 462–3 skull base, olfactory nerve physical examination, 461–77, Facial expression 467 dysfunction, 495–6 conduction tests, 465, 465–6 comments, 467–72 ‘Freeway space’, 647 passive neck flexion and, 443 palpation, 463–5, 464, 467, Frenzel glasses 528 Facial middle line, 163 recording, 675 eye-following test, 506, 507 Facial muscles, 270 see also conduction tests; rotation tests, 481, 481 neurodynamics (above) Frictioning, trigger point conduction tests, 465, 465–6 see also specific branches hypertrophy, 288 Facial neuralgia, 470, 472 treatment, 262 passive neck flexion and, 443 atypical see Atypical facial pain Frontal bone re-education, 565 (AFP) trigger points, 269, 269–70, 270 sphenopalatine ganglion and, accessory movements, 386–9 see also individual muscles 420 frontonasal region (F/N), Facial nerve (VII) Facial pain see Craniofacial 386–7, 387 anastomoses, 470, 471 dysfunction/pain frontoparietal (coronal) Facial scale, pain assessment in region (F/P), 387–9, 388 hypoglossal facial nerve children, 590, 590 frontosphenoid region anastomosis (HFA), Facilitation techniques, facial (F/S), 386 492–3 nerve (VII), 469–70 ophthalmic nerve Falls, rotation tests, 481 neurodynamics, 448 anatomy/functions, 39, 41, 41–2, 461 anatomy/functional anomalies, 465 connections, 49, 51, 54, 386, brainstem nuclei, 36, 37 386 branches, 461, 462 orbital anatomy, 402, 403 digastric innervation, 320 see also specific branches growth/development, 70 neonatal cranium, 50 conduction tests, 465–7, 467 palpation, 48, 53 sutures, 53 Frontal lobe, cranial synostosis complications, 393

Index 697 Frontal nerve, 38, 39, 446, 447 lateral pterygoid muscle and, occipitosphenoid region Frontal region, 386, 387 201, 207 dysfunction, 373 assessment, 389, 389 vagus nerve (efferent), 531 pain (neuralgia), 524 deformation, 377 Gain (illness), pain and, 88, 89 paralysis, atlas fractures general distraction technique, Gasser’s ganglion see Trigeminal and, 371 366 ganglion (Gasser’s ganglion) radiotherapy and, 525 olfactory neuropathy, 496 Gastrointestinal dysfunction, gag reflex, 524 specific accessory movements, neuromobilization, 565 migraine and, 533, 575 physical examination, 522–9, 386–9 Gender differences, 2–3, 17, 325 524 frontonasal region (F/N), comments, 524–9 juvenile headache, 572 conduction tests, 524, 524, 386–7, 387 migraine, 61 frontoparietal (coronal) puberty, 630, 630 531–2, 532 General health, juvenile neurodynamic test, 522–3, region (F/P), 387–9, 388 frontosphenoid region headaches and, 579 523, 524 Generalized dystonia, palpation, 523–4, 524, 529 (F/S), 386 recording, 677 see also specific components classification/incidence, see also individual branches Frontal sinusitis, craniofacial 444 Glossopharyngeal neuralgia, Genetic factors 524 dysfunction/pain, 71 dysgnathia/malocclusion, 286 Glossopharyngeal neuromas, Frontal suture, 54 overbite, 287 524–5 progenia, 289 Glove anaesthesia, 93 extra in children, 48 growth/development, 630 Goal attitude, 90 neonatal cranium, 50 juvenile headache, 579 Gomphosis, 33, 36 Frontal tubercle, 49 Genicular ganglion, 41 innervation, 34 Frontomaxillary region (F/M) Genioglossus muscle, 243 Goniometer, 169 accessory movements, 406 hyperactivity, 244 Graded craniocervical flexion test, palatal stress and, 418 Geniohyoid muscle, mouth 139–40, 140 Frontomaxillary suture, 53, 55 breathing and, 623–4 Greater superficial petrous nerve, Frontonasal angle, 169, 169 Gerber registration, 292 39, 41–2 Frontonasal dysplasia, 387 Glasses, ill-fitting, 450, 559 Growth/development Frontonasal region (F/N) Global muscle(s), 310, 311 adolescent growth spurt, 618, accessory movements, 386–7, 387 directionality, 326 629, 630–1 anatomical/pathological dysfunction, 311–12 bones/bony structures, 32–3, correction, 329–31 33 problems, 387 extensibility of, 331–2 cranial/neurocranium see anatomy, 387 mobilizers see Mobilizer Frontonasal suture, 53 muscles Neurocranium Frontoparietal (coronal) region stabilizers see Stabilizer face/viscerocranium see muscles (F/P) Glossopharyngeal nerve (IX) Viscerocranium accessory movements, 387–9 anatomy/function, 43, 45, 45–6, relative growth differences, 522, 522 anterior–posterior thumb motor components, 522 70 technique, 388–9 neural container, 555 skull see Skull sensory components, 522 spine, 630–1 longitudinal thumb styloid process and, 525–6, see also individual bones/ technique, 388 527 structures posterior–anterior thumb dysfunction definition, 629 technique, 388–9 dentofacial abnormal impulse starting position/method, generating sites (AIGS), mouth breathing and, 388, 388 432 617–18, 621, 622, 624–7, 625 anatomy, 387 case study, 525, 526–7 Frontosphenoid region (F/S), craniocervical tinnitus, 474 tongue position and, 620, Eagle’s syndrome, 525–8 620 accessory movements, 386 hyperthyroidism, 525 Frontozygomatic suture, 53, 55 indicators, 163 ear(s), 413 Functional synergy, 340 neuromas, 524–5 eye(s), 409 Function, definition, 339 neuropathies, 524–5 factors affecting, 630 juvenile headache and, 592–3, G 593 Gag reflex glossopharyngeal nerve (afferent), 524, 531

698 Index neuromuscular system, mandibulofacial dysostosis retrognathia/prognathia, 598–601, 630–1 and, 377 324 cerebral palsy, 372 motor skills, 372, 593, 593 post-anaesthesia, case study, vertical occlusion other systems vs., 598, 306 dimension and, 323–4 598–9 sphenopalatine ganglion maxillary adenocystic principles, 629–30 and, 420 carcinoma and, 663 Guided attention, bruxism tumours, 62 muscular dysfunction and, 314, management, 242 children/adolescents see 314, 322–4 Guilt, 93 trismus, 249 Gums, inspection, 170 Juvenile headache classification/diagnostic neurodynamic effects, 101, H 101–2, 102f criteria, 4–8, 5, 6, 575 Habits see Parafunctions criticisms in juvenile neutral, 244 Habitual luxation, 230–1 palate and, 421 Habitual reverse technique (HRT), headache, 575–7 vertebral anomalies and, diagnosis compatibility, 237 369–70 bruxism treatment, 241–2 6–8 vertigo/dizziness and, 322, 483 Habitual unilateral supine differential diagnosis, 72 see also Cervical spine, posture dural, 427, 500 Hearing loss position, 370 as growing health problem, 571 cranial nerve dysfunctions, 480 Habituation, 344 mixed, 577 localization, 479 primary, 577–8 palatal abnormalities, 419 juvenile headache, 580 secondary, 577–8 temporal bone and, 382, 383 ‘Habsburg jaw’, 289 synonyms, 8 tests Haemangiomas, cavernous, optic see also specific types Head and neck cancer, accessory Rinne test, 479, 479–80 nerve dysfunction and, 500 Weber test, 479, 480 Hamulus–papilla–incisiva (HPI) nerve dysfunction after, Helkimo Clinical Dysfunction 488–9 Index, 66, 68 plane, 302–3 Head/neck posture, 98 Hemifacial spasm, 467–8 Hand function, evolution, 341 activities of daily living and, Hemiparesis, facial nerve Hand–mouth coordination, 340–1 323 neurodynamics, 467, 468 Hands-on vs. hands off adaptations, 111–12, 112, 323 Hepatopathy, oculomotor nerve biomechanical effects, 100, 100, dysfunction, 518 techniques, neuromuscular 101 Heterophoria, 507, 508 rehabilitation, 349 breathing patterns and, 369, Heterotropia, 507, 508, 508 Hands, size and therapy, 375–6 622–3 Hip abduction tests, 304, 304 Head airway obstruction and, craniomandibular assessment bones/bony structures see in craniocervical pain, Skull 324–5 304–5 craniomandibular dysfunction craniocervical angle effect, method, 304, 305 symptoms, 64 post-anaesthesia dizziness, injury, 371 622, 627, 628 facial pain and, 410 mouth breathing effects, 306 frontal deformation, 377 neonates, 370 olfactory nerve dysfunction, 627–9, 629, 632, 642–3 occiput–atlas dysfunctions, 305 see also Breathing/breathing plagiocephaly and, 374 495 History taking, 61 pain see Headache patterns; Mouth bruxism, 240 position of see Head/neck breathing cervical instability, 124–5, 141, control mechanisms, 322–3, posture 349, 627, 627 142, 143 size and therapy, 375–6 airflow/breathing, 323 craniofacial dysfunction/pain, see also Face; Neck ocular system, 322 Headache tonic neck reflex, 320, 322 69–70 aetiology/contributing factors, vestibular system, 322 craniomandibular craniofacial/craniomandibular 23 pain and, 314 dysfunction/pain, 64, 67 acoustic neuroma surgery craniofacial morphology and, juvenile headache, 579 369–70, 626 malocclusion/dysgnathia, and, 566 effects, 160, 628 cranial dysfunction and, 72 evolution, 224 290–1 craniocervical/mandibular mandibular position and, 98, mouth breathing in children, 185, 314, 314, 619, 628 disorders and, 295 capsular stiffness, 229 638 recording, 670

Index 699 HIV infection/AIDS, secondary, 98, 108, 196 neurodynamics, 489–90, 492 vestibulocochlear nerve trigeminal neuralgia, 459 indications, 492 dysfunction, 482 trigger points, 258 mouth breathing and, 629, see also Pain 646 Home management Hyperalgic zones, 14 neuromobilization, 353, 353, capsule stiffness, 230 Hypermobility 557, 558 capsulitis, 228 cervical spine see Cervical passive neck flexion and, cranial neuromobilization, 565, 443 568–9 hypermobility starting position/method, degenerative disc disease, 224, definition, 217 490, 491 224 mandibular (TMJ), 217 tongue inspection and, 491 disc displacement dorsal, 223 capsule stiffness, 229 neuromobilization, 353, 353, with reduction/reposition, diagnosis/management, 232 557, 558, 561, 565, 568 220 habitual luxation, 230 without reduction/ muscular dysfunction, physical examination, 489–93, reposition, 222 492 mouth breathing in children, 318–19 comments, 492–3 651 Hypersensitivity, 344 conduction tests, 490–2, 492 retrodiscal inflammation/ Hyperthyroidism, neurodynamics see irritation, 227 neurodynamics (above) subluxation/luxation, 230 glossopharyngeal nerve palpation, 490, 491, 492 habitual, 231 dysfunction, 525 recording, 676 Hypnosis Homunculus bruxism management, 241 Hypomobility motor, 341, 341–2 formal (hypnotherapy), 91–2, cervical, mouth breathing in juvenile headache and, 594, 93–4 children, 644 608 amnesia suggestions, 94 cervicothoracic junction, 151, somatosensory see under contraindications, 94 151, 156 Somatosensory cortex direct suggestion, 93 definition, 216 distraction, 94 mandibular, 216–17, 218 Hormone(s), craniofacial pain in shifting the pain, 93–4 women, 17 time gaps, 94 Hypothesis-oriented assessment, self-hypnosis, 91 59–60 Horner’s syndrome, 498–9 case study, 96 Hyoid see also Imaginative contributory factors, 65–6 Hypoxia biomechanics, 100, 100 techniques cranialization, 110 Hypoglossal canal, 368 capsular stiffness, 228 muscles attached, 319, 320, 648 Hypoglossal facial nerve endplate dysfunction, 257 palpation, 161, 246 position/pressure anastomosis (HFA), 492–3 I Hypoglossal nerve (XII) cervical spine effects, 320 Idiopathic facial pain see Atypical factors affecting, 319, 323, anatomy/function, 39, 42, 42–3, facial pain (AFP) 489, 490 352 brainstem nucleus, 36, 37 ‘Idiopathic neuralgias’, 459 head/neck posture and, 323 cervical plexus connections, Idiopathic orofacial pain see hypoglossal nerve 122, 123 tongue innervation, 243, 489 Craniofacial dysfunction/ palpation, 490, 491 pain neuromobilization and, 561 conduction tests, 490–2, 492 ‘If necessary’ tests, 192 neutral position control, motor system, 491–2, 492 Ignitions see Abnormal impulse tongue inspection, 490–1 generating sites (AIGS) 327–8, 328 Illness gain, pain and, 88, 89 vagal neurodynamics, 530, dysfunction, 492 Imaginary movements airway effects, 493 cortical representations and, 530, 532–3 atlas fractures, 371 342 range of motion, 246, 648 cervical instability and, 122 motor responses and, 237 rehabilitation in mouth indicators, 163 Imaginative techniques, 92–3, 95, mouth breathing and, 629, 95 breathing children, 648, 648 646 brace–relax technique, 247, 248 swallowing dysfunction, 245–6 neck-tongue syndrome, 553 cortical representation and, 342 Hyperacusis, 476 palsy, 493 oculomotor rehabilitation, Hyperalgesia, 15 petrosal bone and, 386 515–16 aetiology/pathophysiology, hypoglossal facial nerve 236, 236 anastomosis (HFA), 492–3 craniocervical dystonia, 444 primary, 196

700 Index Impairment, classification, 10, 10 Internasal suture, 55 medial pterygoid muscle, Inca bone, 48 International Association for the palpation, 201, 201 Incidence, 2–4 Incisive foramen, 55 Study of Pain (IASP), zygomatic region, unilateral Incisive fossa, 415, 415 classifications/definitions, techniques, 411–12, 412 Incisive nerve, 452 6 Incisors hemifacial spasm, 467 Intraorbital swelling, cranial pain, 572 nerve dysfunction, 163 mouth breathing effects, 625 International Classification of in children, 640 Function (ICF), 6, 9 Involuntary movements, 346 impairment (tissue damage), Ion channels, abnormal impulse observation/measurement, 162, 573 164 juvenile headache, 573–4 generating sites (AIGS), 431 level of activity, 573, 574 Ischaemia protrusion in overbite, 287, 288 participation, 574, 574 Individual reality, 85 International Classification of capsular stiffness, 228 Infantile cerebral palsy, Headache Disorders-II endplate dysfunction and (ICHD-II), 575 craniocervical region, 371–2 juvenile headache and, 575–7, trigger points, 258 Infection(s) 576 peripheral nerve pathology, International Headache Society abducens nerve dysfunction, (IHS), classifications/ 560 521 definitions, 4, 5 Isometric tests see Static atypical facial pain, 472 oculomotor nerve, 518 diagnosis compatibility, 6–8 (isometric) muscle tests throat infections, cervical juvenile headache, 572, 575 criticisms, 575–7 J instability, 125 primary vs. secondary vestibulocochlear nerve Jaw headaches, 577 craniomandibular dysfunction dysfunction, 482 neuralgias, 459 and, 64 Inferior alveolar nerve, 38, 40–1, Interview, juvenile headache joint see Temporomandibular joint (TMJ) 452 assessment, 587–8 lower see Mandible functional neuroanatomy, Intra-articular dysfunction movement limitations, 63, 216–17 458–9 craniocervical/cervical joints socket, 55 neuropathies, 461 rehabilitation in mouth upper see Maxilla palpation, 454–5 breathing children, 649 Inferior cerebellar artery, whiplash-associated Jaw jerk (reflex), 234 disorders, 107 mandibular nerve conduction trigeminal neuralgia, 459 tests, 456, 456–7 Inferior orbital fissure, 54, 55 craniomandibular see whiplash-associated disorders, Inferior temporal line, 53 Temporomandibular joint 107 Infrahyoid muscles dysfunction Joint(s) head extension and, 628 Intracranial neurogenic pain, 74 degrees of freedom, 340 hyperactivity, 140, 244 Intracranial pressure, raised, 521 dysfunction see Joint palpation, mouth breathing in Intraoral inspection, 169–70, 170 dysfunction Intraoral techniques mobilization see Joint children, 641, 642 mobilization techniques reciprocal innervation, 354, craniomandibular anterior– neuromuscular control, 347 posterior movements, 208, palpation, 641 354, 355 209, 209 stability, 309–10 Infraorbital foramen, 51, 54, 55 see also specific joints Infraorbital margin, 55 masseter muscle Infraorbital nerve, 38, 40, 448, 449 direct intraoral length test, Joint dysfunction, 3 193, 193 cervical instability, 150–2 midfacial trauma and, 410, 411 indirect intraoral length children, 637 Infratrochlear nerve, 39 test, 193 intra-articular see Intra- Inion, 51 palpation, 200, 201 articular dysfunction Inspection see Observation/ ischaemia, 228 maxilla loss of control, 310 inspection general bilateral techniques, muscle dysfunction and, 310, Intercanthal distance, 167–8 405, 405 313–15, 314 Interference, pain mechanism, 17, maxillary nerve see also Muscular neurodynamics, 449 dysfunction 18 periarticular, 217 Intermaxillary region (M/M), accessory movements, 415–16, 416 Intermaxillary suture, 55 Intermediate nerve, 41 Internal carotid artery, optic nerve dysfunction and, 500

Index 701 TMJ see Temporomandibular biopsychosocial factors, pain joint dysfunction 578–9 biopsychosocial levels, 578, 578–9 whiplash-associated disorders, KISS and, 665–7, 666 definitions/categories, 107 migraine/vasomotor, 534, 572–3, 588 dimensions, 572, 573, 578, zygapophyseal, trigger point 534–6, 535 604–5 pathophysiology, 257 cervicogenic, 594–6 function and, 573–4, 574 mechanisms, 572, 573, Joint mobilization techniques migraine vs., 600, 601, 603–4 591–2, 604–5 cervical instability, 150–2 child’s experience of, 574–5 patterns, 575, 665, 667 automobilization, 152 continuum model, 591–2, 592 hypomobile adjacent joints, coping strategies, 578–9, 580, primary, 577–8, 600, 601 150–2, 151 quality of life and, 574, 574 hypomobile painful joints, 592, 593 secondary, 577–8, 600, 601 150, 151 definition, 579 tension headaches unstable painful joints, 152, diagnostic criteria/ 152 epidemiology, 571 muscular dysfunction, 326 classification, 6–7, 572, 575 ICHD-II classification, 575, criticisms, 575–7 Jugular foramen, 45, 55 improvements, 576–7 576 cranial nerves, 533 migraine, 575, 576, 576–7, ‘unspecific’, 572 occipitosphenoid region Juvenile headache assessment/ dysfunction and, 373 577 tension headache, 575, 576 management, 587–616 Jugular ganglion, 45 validity/specificity, 575, 577 cognitive–behavioural therapy, Jugular vein, occipitosphenoid disability due to, 572, 573, 574, 575 592, 592, 604 region dysfunction and, 373 epidemiology, 3, 571–2 ‘collaborative clinical Juvenile headache, 571–85 factors associated with recurrent headache, 605 reasoning’, 579, 608 aetiology/contributory factors, general characteristics, 575 continuum model as basis for 577–8, 579–82 growth/development and, acquired factors (parental/ 592–3, 593 treatment, 591–604 coping), 578–9, 580 hypothesis categories, 579–82 coping strategies and, 594 categorization, 579 International Classification of craniofacial accessory classification and, 575 Function, 573–4, 574 cognitive/emotional/ management see Juvenile movements, 597, 597 psychological, 572, 573, headache assessment/ distraction strategies, 605, 607 578, 578–9, 579–80, 581, management management guidelines for 581 migraine/vasomotor craniofacial dysfunction, age of onset, 572 recurrent headache, 604–8 596–8 associated symptoms, 575 behaviour guidelines, 605 daily life activities, 580 case study, 534, 534–6, 535 movement breakdown, 607 dysfunctional craniocervical cervicogenic vs., 600, 601, neurodynamics, 598, 599, 599, afferent input, 594–6, 595 606–7 environmental factors, 580 603–4 age-related differences, growth, 580 epidemiology, 571, 572 history, 579 ICHD-II classification, 575, 598–9, 599 model, 582, 582 migraine/vasomotor musculoskeletal, 392, 413, 576, 576–7, 577 580, 582 medication, 533, 534 headaches, 533–4, 535 nervous system neurodynamics, 533–4, 535 research report, 600, 601 predisposition, 598 pain dimensions, 572 pacing, 607–8 sleep disorders, 580–1 parental questionnaire, 533, pain mechanism model, 604–5 trigeminal nucleus and, palpation 591–2 533 craniocervical junction, 596 vestibular dysfunction, 601, vestibular disorders and, craniofacial region, 597 604 physical examination, 594–604, 601, 604 665, 667 assessment see Juvenile mixed, 577 craniocervical region, headache assessment/ neuromusculoskeletal management 594–6 dysfunction, 582 craniofacial region, 596–8, associated symptoms, 575, 577 atlanto–occipital balance/motor skills and, 601 597 case studies dysfunctions, 580 equilibrium/balance, 601, parietal region dysfunction, 601–4, 602, 604 392 nervous system, 598–601 zygomatic region and, 413 physiotherapy, 606–7, 667 craniofacial, 606

702 Index hands on vs. hands off, 604 juvenile headache, case study, stretching, accessory indications, 606 665 movements, 207 strategies, 592–3 sustained atlas technique, maxillary adenocystic Lateral pterygoid nerve, 452 carcinoma, 663 Lateral view, ideal postural 606, 606 subjective examination, 587–91, mild craniomandibular alignment, 638 dysfunction and, 656 Lateroflexion of occiput–C2 to 665 interviews/questionnaires, mouth breathing in children, right in sitting, 130, 130 645, 650 Lateroflexion of occiput–C2 to 533, 533, 587–8 localization/quality, 573, L right in supine, 130–1, 131 Laterognathia, crossbite and, 290 588, 588 Labia see Lip(s) Laterotrusion (mandible) pain measures, 589–91 Lacrimal bone, 51, 54 see also Pain assessment/ definition, 188 orbital anatomy, 402, 403 disc displacement without measurement palpation, 55 treatment goals, 605, 608 Lacrimal frontal region (La/F), reduction, 220 treatment plan, 605–8 excessive protrusion treatment, accessory movements, 406–7 case study, 608 Lacrimal gland, 447 255–6 long-term, 605, 607–8 indications for dysfunction, 182 manual therapy, 606–7 facial nerve assessment, 466–7 measurement, 182–3, 183 short-term, 605, 608 milking, 466–7 range of motion in sitting, see also specific techniques Lacrimal maxillary region (La/ Juvenile rheumatoid arthritis, 182–3 craniomandibular M), accessory movements, cervical position and, 185 dysfunction/pain, 66 406–7, 407 during mouth opening, 185 Lacrimal nerve, 38, 39, 446, 447 reference data, 184, 184 K Lacrimal system range of motion in supine with accessory movements, 406–7, overpressure, 188, 188 KIDD (kinematically induced 407 retrodiscal inflammation, 225 dysgnosia and dyspraxia), anatomy, 407 static (isometric) muscle tests, 596 Laevis suture (sutura plana), 33 190–1 Lambdoid suture, 49, 51, 55, 391 in upper cervical flexion and Kinematics, craniocervical region abnormality/synostosis, 391–2 lateroflexion, 178 in children vs. adults, 596 age-related changes, 394 Learning, protective mechanisms, palpation, 48, 52, 53 344 Kinesiography (mandibular), Laryngeal mask airway (LMA), Levator scapulae, rehabilitation in 300–2 accessory nerve mouth breathing children, dysfunction, 488 650 bradykinesia, 301 Laryngeal nerves, 43, 46, 47 Ligaments dyskinesia, 301 superior see Superior (upper) cranial nervous system, 22 electromyography (EMG) and, laryngeal nerve craniocervical region, 20 Lateral glides, 153, 153 craniomandibular region, 20 301 Lateral pterygoid muscle crepitations, 219 end of range movements, 301, anatomy/function, 195, 317–19, oculomotor muscles, 409 318 proprioceptive information, 302 inferior head (IHLP), 317, 347 habitual vs. post-relaxation see also individual ligaments 318–19 Limbic system, motor control, movement patterns, 302, superior head (SHLP), 317, 344 303 Linear stress tests, 127–38 masticatory muscles, before/ 318 alar ligament, 130–2 after treatment, 301–2 eccentric activation, 351–2, 352 lateroflexion of occiput–C2 method, 300–1, 301 excessive protrusion, 253 KISS (kinematic imbalance due to head extension and, 628 to right in sitting, 130, suboccipital strain) length tests, 195, 195 130 syndrome, 15–16, 101, 370, mouth breathing and, 624, 628 lateroflexion of occiput–C2 595 palpation, 201 to right in supine, 130–1, facial asymmetry and 131 torticollis, 658, 660 mouth breathing in likely results, 129 juvenile headache, 580, 595, children, 641 rotary stress to right: 665–7, 666 occiput–C2 in sitting, Kyphosis trigger points, 267, 267 131, 131–2 biomechanics, 100, 100 retching reflex, 201, 207 cranial basilar, 377

Index 703 transverse stress to left: Load tests, 192 juvenile headache, case occiput–C2 in supine, Local muscle(s), 310, 310–11 study, 665 132, 132 dysfunction, 311 in mouth breathing, 622 case report, 143–4 stabilizers see Stabilizer low back pain during components, 127 function, 128 muscles development, 631 risks, 127–8 Local twitch response (LTR), Luxation (mandible) see tectorial membrane, 134–8 trigger points, 260 Subluxation/luxation distraction test occiput–C1, Locked jaw, bruxism, 240 Lymph nodes 135, 135 Locking, cervical instability, 123 Long ciliary nerves, 39, 447 enlargement, causes, 198 linear stress C2–C3 towards Longitudinal movement(s) palpation, 198, 199 anterior, 137, 137 craniomandibular M linear stress C3–C2 towards bilateral, 205, 205–6 anterior, 137, 137–8 interpretation, 210 Macrotrauma, capsule stiffness, unilateral, 206, 206 228 linear stress occiput–C1 towards anterior, 135–6, frontoparietal region, 388 Maddox tests 136 occipitosphenoid region, 374 case study, 514–15 orbital region disadvantages, 510–11 linear stress occiput–C2 ‘double’, 511 towards anterior, 136 frontomaxillary, 406 evaluating results, 509, 509–10 zygomaticomaxillary indications, 511 transverse stress to the left integration into assessment, C2-C7, 138, 138 region, 406 512 parietoparietal region, 389–90, Maddox cross, 510, 510–13 transverse ligament, 132–4 Maddox rod, 507, 509, 509–10 anterior shear test, 133–4, 390 methods, 509–10 134 sphenoid bone, 376 monocular, 511 posterior–anterior relative temporoparietal region, 380 oculomotor dysfunction– to C2 in upper cervical Long sitting slump (LSS) posture relationship, 511–12 flexion, 134 age differences, 598–9, 599 optical range, 510 Sharp–Purser test, 133, 133 cranial neuromobilization and reliability, 511 utility, 512 Lingual coordination, AFP management, 555 rehabilitation in mouth juvenile headache, 599, 599 Magnetic resonance imaging breathing children, 648 (MRI) management, 607 Lingual nerve, 38, 40, 451, 452 research report, 600, 601 cerebral palsy diagnosis, 372 anomalies, 454 vasomotor headaches and, 533, cranial nerve responses to entrapment, 74, 559 535 neurodynamics, 207–8, 451 Long-term memory, protective movement, 429–30 palpation, 454, 454 mechanisms, 344 craniomandibular dysfunction passive neck flexion and, 443 Longus capitis, 139 Longus colli, 138 after whiplash, 107 Lingual re-education, mouth Loose bodies, crepitations, 219 local muscle dysfunction, 311 breathing in children, 647–8 Lordosis neurodynamic studies, passive cervical spine Lip(s) biomechanics, 104 neck flexion, 440–1, 441 altered breathing patterns and, cervical instability and, 125 TMJ dysfunction 622 lumbar spine mouth breathing in juvenile headache, case disc displacement, 219 children, 640 lateral pterygoid in biting, craniomandibular study, 665 dysfunction/pain, 66 in mouth breathing, 622 symptomatic TMJs, 319 cleft, 419 thoracic spine, cervical vestibulocochlear nerve exercises, 246, 246 instability and, 125 movements, trismus Lower face height (subnasal–GN), dysfunction, 482 management, 250 168 Maitland Concept, 152 observation/measurement, 162 Lower motor neurone lesions Major occipital nerve, neural upper–lower distance, 168 (LMNLs), facial nerve sensory perception, 13–14 neurodynamics, 467 container, 555 stimulation, craniofacial Lower nasal concha, 55 Major petrosal nerve, 41 movement re-education, 15 Lumbar spine Major zygomatic muscle, trigger swallowing dysfunction, 245 instability, 121 lordosis points, 269, 269 Lip elevator muscles, mouth Malocclusion, 3 breathing and, 624 adaptation to, 286, 289 aetiology, 286, 287, 288, 289, 290

704 Index mouth breathing, 624–5, dynamic direction/through Mandibular head, 52, 57 625, 627 range control, 330, 330 observation/measurement, 164–5, 165 anthropometric measures, 169 habitual vs. post-relaxation palpation, 197, 229, 656 bruxism aetiology and, 239, 241 patterns, 302, 303 swelling/oedema, 197 classification, 286–9 temporal bone relationship, head/neck posture, 103, 380–1 class I, 287, 287, 324 103–4, 314, 314 class II/1 (overbite), 287, Mandibular hypermobility, 217 hypermobility see capsule stiffness, 229 287–8, 296, 314, 324 Mandibular diagnosis/management, 232 class II/2 (deep overbite), hypermobility habitual luxation, 230 inferior head of the lateral 288, 288 hypomobility, 216–17, 218 pterygoid, 318–19 class III (progenia), 288, muscular dysfunction and, Mandibular hypomobility, 216–17, 288–9, 324, 350 313–15 218 cover bite/deep bite, 289, see also Kinesiography Mandibular implants, inferior 289 (mandibular); alveolar nerve neuropathies, crossbite, 169, 288, 290 Temporomandibular 461 open bite, 289–90 joint (TMJ) clinical implications, 287–8, observation/measurement, Mandibular initiation manoeuvre, 289, 290 164–6, 165 excessive protrusion, 255 craniocervical dysfunction, see also Measurements; specific techniques Mandibular nerve (V3) 296, 296, 297 otomandibular structures, 473, anatomy/function, 19, 38–9, 39, muscular dysfunctions, 321– 473–4 40–1, 451, 452 palpation, 56–8 anastomoses, 458 2, 352 passive neck flexion and, 443 branches, 451 postural changes, 314, 314, position differences between altered breathing patterns branches, 457–9 324 and, 622, 623, 623 digastric innervation, 320 visual function, 511 craniocervical injury/ mouth opening and, 110, facial growth and, 381 dysfunction, 98–9, 303–4 185–6, 459 orthodontic examination, eccentric closing positions, primary afferents of first 290–1 315 neurone in trigeminal palate and, 419 factors affecting, 97 brainstem complex, 457 tinnitus and, 473 head position and see under see also specific branches treatment, 241, 290–3, 352 Head/neck posture assessment, 451–5, 458 final, 292–3 laterotrusion see palpation, 454, 454–5, 458, goals, 290 Laterotrusion (mandible) 461 outlook, 293 post-anaesthesia dizziness, recording, 675 physiotherapy, 292, 292 case study, 306 see also conduction tests: splints, 291–2, 293 protrusion see Protrusion neurodynamics (below) teeth grinding, 292 (mandible) conduction tests, 455–7, 458, see also Dysgnathia resting see Mandibular 461 Management see Treatment/ resting position afferents (corneal reflex), management retrusion see Retrusion 455 Mandible, 51, 57 (mandible) efferents, 455–7 afferent input, 98–9, 99 see also Occlusion isometric tests, 456, 456 depression see Mouth opening verticalization, 377 jaw jerk, 456, 456–7 (depression) see also entries beginning muscle palpation, 455 elevation see Mouth closing mandibular/craniomandibular; purpose, 455 (elevation) specific components; sensory assessment, 455–6, growth/development Temporomandibular joint 456 abnormalities see (TMJ) dysfunction, 457–61 Mandible–whiplash model, 105–6, following meningioma Dysgnathia 106 resection, 661 craniocervical extension Mandibular angle, 51, 57 mouth breathing in Mandibular branches of facial children, 646 and, 101, 101–2 nerve, 41, 461, 462 neurogenic inflammation, neonatal cranium, 50 palpation, 464, 464 427 spurts, mandibular nerve Mandibular corpus, 51, 54, 57 effects, 458 temporal bone and, 380–1 movement, 216–17 craniomandibular pain and, 312

Index 705 neuropathy, 74, 185, 457 disc displacement hyperactive see Bracing/ peripheral vs. brainstem dorsal, 222–3 clenching with reduction/reposition, lesions, 455 219–20 hypertrophy, 288 role in craniocervical pain, without reduction, 220, 222 innervation, 40 kinesiography 110–11 juvenile headache, 606, 606–7 toothache, 178 retrodiscal inflammation/ method, 300–1, 301, 302 neurodynamics, 435, 451, 453, resting position before/after 453–4, 458, 461 irritation, 227 comments, 454 subluxation/luxation, 230 treatment, 301–2 differences between neuromuscular relaxation, habitual, 231 branches, 457–9 tinnitus management, 475 301–2 mandibular hypomobility, trigger points, 262, 262–3 observation/measurement, 162, see also specific techniques 216 ‘Martyrs’, communication 162, 164 mouth breathing in overuse, trigger point strategy, 84 children, 646, 646 Massage, peripheral facial paresis, pathophysiology, 257 range of motion of pain 469 lateropulsion, 454 Masseteric nerve, 452 motor output changes, reference value/reliability, Masseter muscle 235–6 453–4 anatomy/function, 192–3, 318, pain mechanisms, 236, starting position/method, 320 312–13 451, 453 direct intraoral length test, 193, palpation, 162, 200–1 symptom intensity, 454 193 excessive protrusion, 254 transverse movements, eccentric activation, 351, 351 proprioception, 321 207–8 EMG, 298 spasm see Trismus neuromobilization, 461, 552, tension in, 93 functional, 299, 300 tone, 162 553 resting position, 298–9 sequence of movements, head extension and, 628 head/neck posture and, 98 indirect intraoral length test, mechanism, 233, 233 554 193 parafunctions, 233–4 Mandibular osteosarcoma, 62 mouth breathing and, 628 trismus and, 249 Mandibular plane angle, 165–6, palpation, 264, 264, 265, 265 whiplash-associated extraoral, 201 166 intraoral, 200, 201 disorders, 107 mouth breathing and, 625, 626 mandibular nerve trigger points, 264–7, 320, 560 Mandibular ramus, 51, 54, 57 see also individual muscles Mandibular resting position assessment, 455 Mastoid fontanelle abnormal breathing patterns mouth breathing in extra bones, 49 neonatal cranium, 50 and, 623, 623 children, 641 Mastoid process, 51, 51, 55 rehabilitation, 647 pars profunda, 318 cranial nerve palpation, 528 definition, 619 development, 35 EMG, 298–9 trigger points, 265, 265 palpation, 52 ideal, 98, 326 pars superficialis, 318 post-operative scars and kinesiography, 300–2, 301, 302f neuromuscular rehabilitation, trigger points, 264, 264 neuromobilization, 561 326–7, 328 trigger points Mature organism model (MOM), normal breathing patterns and, 619, 619 EMG activity and, 235, 313 16, 604 tongue resting position and, pars profunda, 265, 265 Maxilla, 51, 54, 55 647 superficialis, 264, 264 Mandibular shift (deflection; Masseter nerve, 38 accessory movements, 414–15 swinging opening), 217, 220 Masticatory cycle, general bilateral intraoral, Mandibular width (GO–GO), 167 craniomandibular pain and, 405, 405 Mandibulofacial dysostosis 312 intermaxillary region (MFD), 377 Masticatory muscles (M/M), 415–16, 416 Manual therapy anatomy/functions, 317–21, interpalatine region, 416 capsule stiffness, 229–30 318, 321 maxillofrontal region capsulitis, 228 central influences, 234–5 (M/F), 414 cervical instability, 150 cranial nerve dysfunction and, maxillosphenoid region degenerative disc disease, 163 (M/S), 414 223–4 EMG see Electromyography maxillozygomatic region (EMG) (M/Z), 414 palatine region, 415–16

706 Index palatomaxillary region McGrath’s modified cognitive– craniomandibular (P/M), 417 behavioural therapy for dysfunction/pain, 66 juvenile headache, 604 unilateral technique, 414–15 dorsal disc displacement, 223 adenocystic carcinoma, case Meaning of pain, 87–8 retrodiscal inflammation/ Measurements, 160–70 study, 662–4, 663 irritation, 227 craniofacial pain, 69 anthropometric see Meersseman test, 304, 304, 305 growth/development Anthropometric Membranous ossification, 32, 33, measurements abnormalities, 413–14, 418, (cephalometry) 36 419, 419 Memory see also Dysgnathia frontal extraoral, 161, 161 laterotrusion, 182–3, 183 protective mechanisms, 344 ear disorders and, 413 mandible, 164–7 reciprocal innervation, 346 facial growth and, 412–13, Men, craniofacial dysfunction/ asymmetry, 165 413, 413–14 extraoral mandibular head, pain, 2–3 neonatal cranium, 50 Ménière’s disease, vertigo, 476 palate, 419–20 164 Meninges occlusal plane, relationship intraoral mandibular head, with other body planes, inflammation, abducens nerve 302–4 164–5, 165 dysfunction, 521 palpation, 55 length, 165, 166 regions, 401, 405, 414 plane angle and profile, mandibular nerve branch, 40 palatine see Palate maxillary nerve branch, 40, 452 see also entries beginning maxillo-/ 165–6, 166 nociceptive input, 234, 426, 533 maxillary; Zygomatic arch/ resting position, 165 passive neck flexion and, 440 bone (cheek bone) masticatory muscles, 162, 162, Meningioma Maxillary facial pain see 164 facial pain after resection, case Craniofacial dysfunction/ mouth breathing effects, 626, pain 640 study, 660–2, 661 Maxillary hypoplasia, palate and, mouth opening, 179, 179 optic nerve effects, 500 419 overbite, 179–80, 180, 181 Meningitis, passive neck flexion Maxillary nerve (V2) overjet, 180, 180 abnormal impulse generating protrusion, 181, 182 (PNF), 440 sites (AIGS), 432 retrusion, 182, 182 Mental foramen, 51, 54, 57 anatomy/functions, 38, 39, 40, upper lip/incisors, 162 448, 449 vertical face, 163–4, 164, 166, palpation, 58 palate innervation, 415, 420 168 Mental nerve, 451, 452 see also specific branches see also Observation/inspection entrapment, 450–1, 559 Mechanical influences, growth/ neurodynamics, 451 physical examination, 448–51, development, 630 Metabolic changes, 458 Mechanoreceptor activity comments, 450–1 capsule stiffness, 228 vestibulocochlear nerve neurodynamic test, 449, 450, head/neck posture, 322 dysfunction, 482 Meckel’s cavity (trigeminal Metaphoric patterns, 92 458 cavity/cave), 37, 446 Metastases, cervical instability, palpation, 449, 450, 458 Medial palatine suture, 55 120 recording, 675 Medial pterygoid muscle MGP (McGregor’s plane)–OP trauma, 450 anatomy/function, 194, 318, 319 (odontoid plane) angle, 100, Maxillary region, 401, 405, 414 length test, 194, 195 100 Maxillary sinus, growth pattern, palpation Microtrauma 412–13 extraoral, 201 capsule stiffness, 228 Maxillary sinusitis, craniofacial intraoral, 201, 201 changes in muscle strength, dysfunction/pain, 71–2 mandibular nerve 312 Maxillofacial deformity, 413, 414 loss of joint control and, 310 Maxillofrontal region (M/F), assessment, 455 Microvascular decompression accessory movements, 414 mouth breathing in (MVD), hemifacial spasm, Maxillosphenoid region (M/S), 468 accessory movements, 414 children, 641 Middle meningeal artery, Maximal forward head posture trigger points, 194, 266, trigeminal nerve (FHP), mandibular position relationship, 533 and, 98 266–7 Midface sutures, 419 swelling, 162 Midfacial trauma, 410 Medial pterygoid nerve, 452 Migraine Median palatine suture, 55 aetiology/contributory factors Medication bruxism and, 239 cranial blood flow, 72 genetic factors, 579

Index 707 growth-dependent changes, limbic system, 344 evolution, 341 580 plagiocephaly and, 375 hypoglossal nerve assessment, plasticity, 340–3 peripheral nerve pathology, protective mechanisms, 344 491–2, 492 560 reciprocal innervation see in myogenic disorders, 231–8, plagiocephaly and, 374 Reciprocal innervation 309–10 ‘unknown neurogenic shoulder girdle, 650 see also Muscular subcortical/cortical, 346–8 factor’, 533 Motor development dysfunction vagus nerve and, 533–6 cerebral palsy, 372 output see Motor responses vestibular disorders, 601, juvenile headache and, 593, physical examination, 237 see also specific components 604 593, 594–5 ‘Moulded baby’ syndrome, 370 age of onset, 572 Motor homunculus, 341, 341–2 Mouth with aura (classical), 577 breathing through see Mouth children/adolescents see juvenile headache and, 594, 608 Motor learning breathing Juvenile headache closing see Mouth closing classification/diagnostic cerebral palsy, 372 neuromuscular rehabilitation, (elevation) criteria, 7 craniomandibular dysfunction children, 575, 576, 576–7, 577 353 craniocervical headaches vs., Motor nerves, 38 symptoms, 64 600 measurement epidemiology, 61, 572 assessing function, 531–2 gastrointestinal dysfunction brainstem nuclei, 35–6, 37 overbite, 179–80, 180, 181 and, 575 see also individual nerves overjet, 180, 180 neuromuscular rehabilitation, Motor neurone lesions width, 168 353, 353–5, 354 facial nerve neurodynamics, morphology, mouth breathing without aura (atypical), 6, 7, and, 617–18, 621, 622, 624–7 577 467 opening see Mouth opening Military position (MP), mandibular nerve assessment, (depression) mandibular position and, 98 pain, 361 Milking 457 see also individual components lacrimal gland, 466–7 Motor output see Motor responses Mouth breathing, 244, 369, 620–2 salivary glands, 466 Motor recruitment Catlin’s ‘noxious effects of’, 617, Mime therapy, peripheral facial 618 paresis, 469 global muscle dysfunction, 312 causes/aetiology, 621–2, 625, Mimic muscles dynamic direction/through 626, 638, 641 facial contours, 48 range control, 329–31 children/adolescents see Mouth facial paresis and cervical breathing in children posture, 111, 112 local muscle dysfunction, 309, functional adaptations/ innervation, 41 311 postural changes, 324–5, Mirroring, 86 617–36, 622–9, 632 Mobilizer muscles, 310, 315, 321 pain effects, 313 biomechanics/alignment, dysfunction, 311–12 Motor responses extensibility of, 331–2 622–3, 638–9, 639 lateral pterygoid, inferior head, abnormal/maladaptive, 231–3 children/adolescents see 318 increased/decreased primary cervical, 139 activity, 231, 234–5 Mouth breathing in sternocleidomastoid, 320 masticatory muscles, 233–4 children temporal muscle, 321 pain effects, 235–6 craniocervical posture, 627, trigger points, 263 parafunctions see 627–9, 641–4 Molars, palpation, 55 Parafunctions cranioneurodynamics, 629, Monocular Maddox tests, 511 protective see Protective 646, 646 Mood see Affect deformities/splints EMG analysis, 623–4, 624, Motivation, pain and, 87 628 Motor control, 340–8 cognitive processes and, 236 morphological, 617–18, 620, cerebral palsy, 372 craniocervical dystonia, 445 621, 622, 624–7, 625, 626 feedback mechanisms, 345, 346 functional activities, 231 neuromuscular, 621, 623, feedforward mechanisms, 345, glossopharyngeal nerve 626, 641 346 oral airway, 622 habituation/inhibition, 344 assessment, 531–2 oral/craniofacial, 623, palpation, 196 623–4, 639–41, 644 peripheral facial paresis, 470 soft tissue stretch plasticity and, 237–8 hypothesis, 626 stress (psychological) effects, 232, 235, 236 vagal nerve assessment, 531–2 Motor system control see Motor control

708 Index normal patterns, 618 whole body, 622–3, 623, 639, against resistance (HRT), 242 syndrome, 620 639, 651 static (isometric) muscle tests, transition to, 618, 620 Mouth breathing in children presentation, 637–8 190 aetiology, 621–2, 647 Mouth closing (elevation) sudden parafunctions, 638, 641, 648 assessment, mouth breathing bracing management, 248–9 assessment, 638–46 in children, 641 trismus management, 253 whiplash-associated disorders, aims, 638 habitual eccentric closing 109 anatomical, 640, 642–3, positions, 315 Mouth opening test, whiplash- associated disorders, 109 644–5 sudden Movement(s) craniocervical, 641–4 bracing management, 248–9 accessory see Accessory cranioneurodynamics, 646, trismus management, 253 movements active see Active movements 646 Mouth opening (depression) CSF movement and, 427 functional, 640–1, 643, 645 capsulitis, 228 dysfunction/limitation neuromuscular, 641, 642, with cervical flexion/extension, cervical instability, 123 175–6 muscular dysfunctions and, 643, 643–4, 645–6 depressor–protractor synergy, orofacial/craniofacial, 340 313–15 indications for dysfunctions, re-education/rehabilitation 639–41, 644 179 physical examination, intra-articular dysfunctions see see Neuromuscular Temporomandibular joint rehabilitation 638–46 dysfunction somatotopia and, 14–15 postural alignment (whole limitations, 63 sources, 12 mandibular nerve effects, 110, passive see Passive movements body), 638–9, 639 185–6, 459 strategies, 340 ‘red flags’, 638 maxillary adenocystic voluntary, 344–6, 349 shoulder girdle/thoracic carcinoma, 663 see also Motor control; specific measurement, 179, 179 types spine, 644–6 overbite, 179–80, 180, 181 Movement Assessment Battery for subjective examination, 638 overjet, 180, 180 Children (movement ABC) management, 646–52 in various cervical dynamic tests, 601, 601, 603 aims/goals, 647 positions, 183–4, 184 juvenile headache, 601, 601–3, craniocervical mouth breathing in children, 602, 604 641 case study, 665 rehabilitation, 649–50 muscular dysfunctions, 179, research report, 603–4 home activity programme, 185, 216 utility, 603 noises during, 62–3 method/evaluation, 603 651 see also Crepitations scores, 602 multimodal approach, 647 quality of movement, 217 static tests, 603 orocraniofacial range of motion in sitting Movement breakdown, juvenile active vs. passive, 185 headache, 607 rehabilitation, 647–9, 649 cervical position and, 98, Movement diagrams, 126–7 postural re-training, 651 183–4, 184, 185 cervical instability, 126, 126–7, shoulder/thoracic spine laterotrusion during, 185 150, 150 range of motion in sitting cranial neuromobilization, 553 rehabilitation, 650–1 position, 178–81 disc displacement without timing of interventions, 631 reference data, 183, 183–4, reduction, 221 treatment planning, 646–7 184 trismus, 250 see also specific techniques relativity of maximum Multifidus, 139 oral/craniofacial changes, 621, opening, 184–5 Multiple crush syndromes, 76 621–2, 624–7, 639, 644 starting position and Multiple sclerosis, trigeminal ‘adenoid face’, 625, 626 method, 178–9 neuralgia, 459 anatomical, 640 VROM in frontal plane, 180, Muscle(s) dental abnormalities, 620, 181 atrophy, 342 VROM in sagittal plane, tongue muscles, 490 620, 621, 624–5, 625 180–1 contraction functional activity and, range of motion in supine with muscle tone, 233 overpressure, 186, 186–7 640–1 neuromuscular, 641 rehabilitation, 647–9 posture and adolescent growth spurt and, 629–32 craniocervical adaptations, 641–4, 649–50 shoulder girdle/thoracic, 644–6, 650–1

Index 709 symmetry, EMG, 300 see also individual muscles length–tension relationship, cranial nervous system, 22 Muscle imbalance, 309, 312 311–12, 312 craniocervical region, 21 craniofacial region, 21 breathing patterns, 324–5 masticatory muscles, 162, craniomandibular region, 20 cervical vertebrae effects, 370 233–4 dysfunction see Muscular chronic pain and, 313 head/neck posture and, 98 extraocular muscles, scoliosis trismus and, 249 dysfunction whiplash-associated fatigue, bruxism, 240 and, 511 disorders, 107 fibre types, changes, 342 growth/development and, 630 force, 189 head posture/mouth breathing parafunctions, 233–4 prolonged and pain, 235, 238 functional EMG, 299 and, 628–9 Muscular dysfunction, 107, 108, functions/classification, 310, sensorimotor integration role, 112, 231–75, 309–38 310–11, 315–16 647 bracing see Bracing/clenching global, 310, 311, 321 trigger points, 259 bruxism/bruxomania see local, 310, 310–11, 321 Muscle techniques, capsular masticatory muscles, 317–21 Bruxism mobilizers see Mobilizer stiffness, 230 cervical instability, 149–50 Muscle tests characteristics, 316 muscles children, 637 stabilizers see Stabilizer accessory nerve assessment, 487, 487 mouth breathing and, muscles 649–50, 650–1 inhibition, 189, 235 cervical instability, 139–41 functional stability, 141, 142 clinical importance, 309 trigger points, 259 graded craniocervical contributory factors, 321–5 length flexion test, 139–40, 140 scapulothoracic muscles, hormonal changes, 325 global dysfunction and, 141 nasal airway obstruction, 311–12 trapezius muscle pars ascendens, 141, 141 324–5 length–tension relationship, occlusal disharmony, 321–2 311–12 choice of, 189 parafunctions, 322 communication during, 193 posture, 314, 314, 322–4 shortening, 313–14 craniomandibular dysfunction, proprioception/pain, 322, masticatory see Masticatory 188–95 325 muscles dynamic trigger points see Trigger nociceptors, 235 pain, 189, 194, 234, 260, 309 craniomandibular region, points 191–2 see also specific factors motor response models, global dysfunction, 311–12, 312–13 interpretation, 191–2 316 length tests length changes, 311–12, 312 see also Pain recruitment changes, 312 physical assessment see Muscle cautions, 192 strength changes, 312 craniomandibular region, imbalance see Muscle tests imbalance plasticity, 342 192–5 local dysfunction, 311, 316 recruitment, 309 lateral pterygoid muscle, mandibular protrusion, spasm, 233, 249 excessive, 253–6, 316 195, 195 see also Protrusion as neurodynamic masseter muscle, 193, 193 parameter, 552 medial pterygoid muscle, (mandible) mouth opening, 179, 185, 216 see also Trismus 194, 195 movement dysfunctions and, sphenopalatine region mouth breathing in 313–15 movement effects, 408 children, 643–4 articular vs. myofascial, 313, stiffness, 233, 312, 342 temporal muscle, 194, 194 strength palpation see Palpation 314 static (isometric tests) see Static posture effects, 314, 314 activities of daily living (isometric) muscle tests site of stability dysfunction, and, 311 strength tests, mouth breathing in children, 643, 643, 645 315 changes in global trigger point identification, 261 muscle types, 310, 310–11, 316 dysfunction, 312 types, 188–9 pain models, 312–13 see also specific tests/techniques pathobiology see trigger point identification, Muscle tone (tension) 261 craniocervical dystonia, 444 Pathobiological mechanisms definition, 233 physical examination, 237 styloid process and, 525 factors affecting, 233, 233, 237 synergistic, 340–2 tone/tension see Muscle tone (tension) weakness, trigger points, 259

710 Index psychological component, 232, history of in children, 638 see also specific muscles 235, 237 partial, 620 pain/dysfunction postural alignment in subjective examination, 237 bruxism, 240 swallowing and, 270, 317 children, 639, 639 IASP classification, 6, 6 TMJ, 313, 316–17, 321 reduction/treatment, 647 see also Craniocervical treatment/management see total, 621 see also Mouth breathing dysfunction/pain Neuromuscular resistance, 620 posture/position, 113 rehabilitation Nasal allergies, mouth breathing triggering situations, 237, 242, and, 621–2 see also Head/neck posture 326 Nasal bone, 51, 54 reflexes trigger points see Trigger palpation, 55 points Nasal breathing, 324, 618 head/neck posture, 320 trismus see Trismus anatomical relationships, 620, mandibular position and, whiplash-associated disorders, 620 107, 108 facial development and, 619 98–9 see also individual muscles; rehabilitation in mouth stiffness specific conditions/disorders breathing children, 648 Muscular plasticity, 342 Nasal cavity, 618 acoustic neuroma surgery Myalgia see Myofacial pain Nasal dilator muscles, mouth and, 566 syndrome (MPS) breathing and, 624 Mylohyoid muscle, palpation, 203 Nasal regurgitation, 532 craniofacial pain, 69 Mylohyoid nerve, 452 Nasal septum, 55 juvenile headache, 606 Myoarthropathia of the deviation, mouth breathing plagiocephaly and, 374 masticatory system (MAK) and, 622 thin (‘swan neck’), 125 see Craniomandibular Nasal speech, 532 trauma dysfunction/pain Nasal surgery, bilateral abducens nerve Myofacial pain–dysfunction orbitofrontal nasal syndrome see osteotomy, 409 dysfunction, 521 Craniomandibular Nasociliary nerve, 38, 39–40, 89, whiplash injury see dysfunction/pain 446, 447 Myofacial pain syndrome (MPS), Nasolabial angle, 169 Whiplash/whiplash- 256–7 Nasomaxillary suture, 55 associated disorders pain inhibition defects, 236 Nasopalatine nerve, 38, 40 (WAD) trigger point prevalence, 259 Nasopharyngeal carcinoma, 387 see also Cervical spine see also Craniomandibular Natural position (NP), mandible Neck–tongue syndrome, 122, 492 dysfunction/pain position and, 98 active cranial Myofacial trigger points see Neck neuromobilization, 553 Trigger points assessment, 113 Neonates Myofibrosis see Myofacial pain dissection, accessory nerve cranial anatomy, 48–51, 50, 371 syndrome (MPS) dysfunction, 488–9 anterior fontanelle, 50 Myogelosis see Myofacial pain muscles craniocervical defects, future syndrome (MPS) assessment, 162, 643, 643–4 development and, 370–1 Myogenic torticollis, case study, EMG, 298, 298–300 hip abduction tests, 370 70–1, 72 imbalance, 296 ‘moulded baby’ syndrome, mouth breathing in 370 N occipitofrontal compression, children, 643, 643–4, 363–4 Nasal airways 649–50 scoliosis, 370, 371 function, 618 occipital bone and, 369 squint baby syndrome, 370 obstruction occlusion and, 296, 297 torticollis, 69, 370, 371, 658 biomechanical alterations overuse, trigger point Nerve blocks, sphenopalatine and, 622–3 pathophysiology, 257 ganglion and, 420 dentofacial development rehabilitation in mouth Nerve conduction tests see and, 617–18, 618, 624–5, breathing children, Conduction tests 625, 626 649–50 Nerve growth factor, 325 growth/developmental vestibular system and, 320 Nerve impingement/entrapment susceptibilities, 631 whiplash-associated cervical instability, 122 disorders, 107 lingual nerve, 74 maxillary nerve, 450–1 see also Cranial nerve palsies Nerve roots compression, neuralgia, 459 dorsal root ganglia, 429 abnormal impulse generating sites, 73

Index 711 irritation, cervical instability, Neural structures, cervical implications for clinical 143, 152 instability treatment/ practice, 434–5 management, 152–4 ‘Nerve rubbing’, 560 mandibular nerve, 435 Nerve sprouting, 431 Neurochemistry, mouth breathing and, 629, Nervi nervorum, 427, 467 craniomandibular pain and, Nervous system 67 646, 646 oculomotor, 502–5 central see Central nervous Neurocranium, 32 positive test results, 434–5 system (CNS) anatomy post-acoustic neuroma neonates, 50, 371 children, 598–601 side view, 51 surgery, 566, 567 other systems vs., 598, sutures, 49, 51 recording, 675, 676, 677–8 598–9 view from above, 49 reliability, 433–4 assessment/treatment, 357–400 second category fluids, 427 mouth breathing in oxygen requirements, 428 children, 644 examination, 446–93, pain mechanisms see Pain palpation see Palpation 675–6 passive (accessory) standardization, 434, 435 mechanisms movements see Cranial third category examination, palate and, 420 accessory movements 494–536, 676–8 peripheral see Peripheral responses to, 401–2 tinnitus management, 475 see also specific techniques treatment guidelines, 551–70 nervous system (PNS) definition, 36 trigeminal neuralgia, 460 viscoelasticity, 558 growth/development, 34 variation in responses, 434 see also specific components changes 24 hours vasomotor headaches, Neural container postpartum, 371 533–4, 535, 536 abducens nerve dysfunction, frontal region, 389 see also Cranial juvenile headache and, 596 neuromobilization; 521 occipital bone and, 368 individual nerves accessory nerve parietal region, 391–2 craniomandibular dysfunction, sphenoid bone and, 372 196 neurodynamics, 486, 486 temporal bone and, 380–1 cervical slump test, 177, 177 adhesions, 559 see also specific components mandibular nerve, 178 definition, 555 increased contractile activity, techniques affecting see Neural Neurodynamics 234 cranial nervous tissue, 439–40 interpretation, 551–2 container techniques definition, 430 juvenile headache see under Neural container techniques mandibular hypomobility, 216 Juvenile headache petrosal bone movement, 386 assessment/management direct influence of palpation, therapeutic/diagnostic see misunderstanding of, 551 559–60 Neurodynamic techniques pain management and, 551–2, 555 indirect cranial Neurodynamic techniques parameters, 552, 553 neuromobilization, 555 aims, 551 passive vs. active tests, 552 advantages/disadvantages, biopsychosocial theories and, rehabilitation 562 434, 566 facial nerve, 467, 468 case study, 566 cervical instability, 152 neuromuscular, 353, 353–4 case report, 143 oculomotor, 512, 515 inferior alveolar neuropathy, cranial nervous system, see also Cranial 461 439–550 neuromobilization categories, 440, 440 treatment guidelines, 551–70 Neuralgia CT/MRI studies, 440–1, 441 see also specific techniques facial nerve development of, 435 Neurogenic inflammation, 427, atypical see Atypical facial diagnostic power, 434 431 pain (AFP) dura mater and, 500 juvenile headache, 594 sphenopalatine ganglion evidence-based practice, Neurogenic pain, 13, 431 and, 420 433–4 craniocervical dystonia, 444 glossopharyngeal nerve, 524 first category examination, episodic neuropathic, 74 ‘idiopathic’, 459 440–6, 674 intracranial, 74 International Headache Society hearing examination and, neck flexion, mouth opening (IHS) classification, 5, 459 480 and, 111, 111 nerve root compression, 459 superior (upper) laryngeal nerve, 532–3 trigeminal nerve see Trigeminal neuralgia see also Pain ‘Neural pathodynamics’, 431 Neural plasticity see Neuroplasticity

712 Index neurovascular vs., 75 craniomandibular rotation, shoulder/thoracic re- peripheral, 13, 73–4, 74 331–2, 332 education, 650–1 Neurological dysfunction cervical instability, 121–2, 152 mandibular anterior subluxation/luxation, 230 cranial synostosis, 393–4 translation, 332 habitual, 231 whiplash-associated disorder, goals, 325–6 timing, 333 107 hypothesis testing, 352, 354 TMJ distraction, 353, 354 Neurological examination inhibition of facial pain by TTBS see Tongue–teeth– cervical instability, case report, mobilization of scar tissue, breathing–swallowing 143 353, 354 (TTBS) motor learning, 353 see also specific techniques craniomandibular dysfunction, neurobiological mechanisms, Neuromuscular spindles, head/ 195–6 340–8 neck posture, 322 habituation, 344 Neuromuscular splints/braces malocclusion/dysgnathia, plasticity and see craniomandibular contribution 290–1 to craniocervical Neuromusculoskeletal dysfunction, 295–308 see also Neurodynamic plasticity post-anaesthesia dizziness, techniques protective mechanisms, 344 case study, 307 Neuromas, 431 reciprocal innervation, 344– whiplash-associated disorders, acoustic see Acoustic neuroma 6, 345, 347, 348, 349 (vestibular Schwannoma) subcortical/cortical, 346–8 107 glossopharyngeal, 524–5 neurodynamic mobilization, Neuromuscular system, 286 353, 353–4 Neuromuscular activation model, see also Neurodynamic plasticity, 340–3, 341 313 techniques see also Muscle(s); Nervous neutral position control, 326–8 Neuromuscular adaptation to cervical spine, 327 system; specific components mouth breathing, 621, 623, hyoid, 327–8, 328 Neuromusculoskeletal plasticity, 626 mandibular rest position, 326–7, 328, 328 339–56 craniocervical assessment in red dot system, 326 muscular plasticity, 342 children, 643, 643–4 scapula, 327 neural plasticity, 340–2, 341 tongue position, 326–7 skeletal (bone) plasticity, 342–3 orofacial assessment in pain management during, 348 Neuromusculoskeletal structures children, 641, 642 principles, 326, 347–8, 348–50 cranial nervous system, 22 active vs. passive craniocervical region, 20–1 thoracic assessment in movements, 349 craniofacial region, 21 children, 645–6 avoidance of cognitive/ craniomandibular region, 20, affective influences, Neuromuscular re-education see 348–9 110 Neuromuscular facilitation of meaningful plasticity see rehabilitation activities, 348 hands-on vs. hands off, 349 Neuromusculoskeletal Neuromuscular rehabilitation, reciprocal innervation, 344–6, plasticity 325–33 345, 347, 348, 349 see also specific structures digastric muscle, 351 Neuropathic pain, 430–1 assessment, 326, 352, 354–5 scaleni/infrahyoid continuous, 74–5 retrospective, 352, 354 musculature, 354, 354, episodic, 74 355 key questions, 76, 76–7, 77 case studies, 350–5 sternocleidomastoid, 348, neurogenic see Neurogenic facial/shoulder pain, 350, 350–1, 351, 355 pain 350–3, 351, 352f rehabilitation in mouth vascular, 74 breathing children neurogenic vs., 75 dynamic direction/through craniocervical re-education, Neuropathies range control, 329–31 649–50 accessory nerve, 488 cervical, 329–30, 330 diaphragmatic re-education, auriculotemporal nerve, 430 craniomandibular rotation 648 craniocervical dystonia, 444 (global control), 331–2, lingual re-education, 647–8 craniofacial, 76 332 facial nerve, 563–6, 564 mandibular, 330, 330, 332 temporal bone and, 382 thoracic, 329 tinnitus and, 474 TMJ control, 331 glossopharyngeal nerve, 524–5 tongue, 330–1, 331 inferior alveolar nerve, 461 mandibular nerve, 74, 185, 457 eccentric activation lateral pterygoid, 351–2, 352 masseter, 351, 351 omohyoid, 352, 352 extensibility of global mobilizers, 331–2

Index 713 mouth opening (depression) Nociceptors, dura mater, 103 general impression, 160 and, 185 Nocturnal bruxism, 241 intraoral inspection, 169–70, Nocturnal teeth grinding, case occipital nerve, 430 170 oculomotor nerve, 518 studies, 91, 93 malocclusion/dysgnathia, olfactory nerve, 496 Non-auditory (subjective) pain see Neuropathic pain 290–1 pathobiological mechanisms, tinnitus, 473 recording, 671 ‘Non-communication children’s tongue, 490–1 16–17, 17, 431 orbital after meningioma predisposing factors, 430 pain checklist’, 589 resection, 660 superior (upper) laryngeal ‘Non-specific facial pain’, 6 pupils, 498, 506 Non-steroidal anti-inflammatory recording, 671, 672 nerve, 430 see also Measurements trauma, 76 drugs (NSAIDs), dorsal disc Occipital–atlas region (O–C1) trigeminal nerve, 457 displacement, 223 accessory movements, 369–72 vestibulocochlear nerve, 482, Nose abnormal in newborn, pain, frontomaxillary 594 movements, 406 future development and, see also specific nerves surgery, craniofacial pain/ 370–1 Neurophysiology, spatula dysfunction, 72 craniofacial morphology, width, 168 head posture and first technique, 172 see also entries beginning naso-/ cervical vertebra, 369, Neuroplasticity, 4, 340–2, 341 nasal 369–70 Nose–chin line, excessive infantile cerebral palsy, amputation and, 341, 341–2 protrusion, 254, 254 371–2 balance/equilibrium and, 237 Nose–diaphragm breathing, occipital condyl fracture craniofacial motor output and, 244 and craniofacial pain, Nostril(s), mouth breathing in 371 237–8 children, 640 starting position and hypoglossal facial nerve Numbness, cervical instability, method, 369 141, 142, 143 structural differentiation, anastomosis and, 482 Numerical rating scale, pain 369 muscular dysfunction and, assessment in children, 589, dysfunctions 589 hip abduction tests, 305 237–8 Nystagmus mouth breathing and, 628 phantom sensations, 342 eye-following test, 506 vasomotor headaches, 534 somatotopia, 236, 237–8, 341, oculomotor function, 505 fractures, 371 oculomotor rehabilitation, 513, juvenile headache examination, 341–2 515 596 see also Neuromusculoskeletal passive neck flexion and, 443 see also Atlanto–occipital joint vestibular nerve examination, Occipital bone plasticity 480, 481 accessory movements, 368–75 Neuropsychology, whiplash- accessory nerve assessment, O 486, 486 associated disorders, 108–9 juvenile headache, 597, 597 Neurosyphilis, oculomotor nerve, Obesity, mouth breathing and, mouth breathing in 622 children, 644 518 movements against C1, Neurovascular pain, 74 Objective tinnitus, 473 369–72 Observation/inspection, 160–70 movements against parietal neurogenic vs., 75 bone, 373–5 Neurovegetative instability, cervical instability, 125 movements against case report, 143 sphenoid bone, 372–3, juvenile headache and, 580 486 Neutral position control, 326–8 chin, 164 movements against Neutral zone, cervical changes, cranial nervous tissue, 162–3, temporal bone, 373 petrosal bone and, 385 120 163 vagal nerve assessment, 530, Newborns see Neonates accessory nerve assessment, 532 Newborn scoliosis, 370, 371 see also specific movements Nociception 486–7 hypoglossal nerve craniocervical dystonia, 445 juvenile headache, 594–5, 595 assessment, 490–1 neural pathodynamics, 430–1 excessive protrusion, 254 neuroplasticity and pain, 4 extraoral inspection, 671 pain adaptation model, 234–5, 313 prolonged input effects, 234 see also Pain Nociceptive neurogenic convergence, 105 Nociceptive pain, 13, 149, 430–1 craniocervical dystonia, 444

714 Index anatomy/functional Occipitoparietal region (O/P) divergence, 411 connections, 49, 51, 55, 368, accessory movements, 373–5 heterophoria see Heterophoria 368–9, 384 longitudinal, 374 heterotropia see Heterotropia method, 373–4 measurement, 507–8 fracture, 371 posterior–anterior using neonatal cranium, 50 localized thumb Maddox rod/cross see palpation, 48, 51–2 technique, 374 Maddox tests skull growth/development prone starting position, 373–4 pathogenesis, 509 and, 368 supine starting position, 373 posture and, 511–12 Occipital condyle, 55 plagiocephaly, 374–5 range of motion, 361 case study, 514–15 fracture, craniofacial pain and, torticollis, 520–1 371 Occipitopetrosal region (Pe/O), types/classification, 508 accessory movements, 385 see also Oculomotor Occipital nerve dysfunction; specific abnormal impulse generating Occipitopetrosal suture, 383 deviations sites (AIGS), 432 Occipitosphenoid region (O/S) Ocular paresis, 518 craniocervical dystonia, 444 Ocular system, head posture and, neural container, 555 accessory movements, 372–3 322 neuropathy, 430 facial asymmetry, 658 Ocular tilt reaction, 511–12 juvenile headache, 597 Ocular torticollis, 520–1 Occipital neuralgia, case study, starting position and clinical features, 520 306 method, 372, 373 plagiocephaly and, 377 trochlear nerve dysfunction, Occipital region range of motion, 361 520–1 anatomy/functional symptoms/signs, 373 Oculomotor dysfunction, 409 connections, 368 see also Spheno–occipital region abducens nerve (VI) and, 387, general compression technique, 521–2 365, 366 (S/O) case studies, 512, 514–15, 519, juvenile headache, 597 Occipitotemporal region (O/T), 520 juvenile headache, 597, 597 diabetes, 518 mouth breathing in children, accessory movements, 373 examination/assessment, 644 Occiput techniques 500–22 specific accessory movements, deviation measurements, 368–75 craniofacial vs. cranial nervous juvenile headache, 597, 597 system, 178 507–8 occipital–atlas region eye movements see under (O–C1), 369–72 craniofacial vs. craniocervical occipitoparietal region differentiation, 176 Eye movements (O/P), 373–5 recording, 677 occipitosphenoid region juvenile headache, 597 infections, 518 (O/S), 372–3 vestibulocochlear nerve oculomotor nerve (III) and, 387, occipitotemporal region 518–19, 520, 554 (O/T), 373 assessment, 478 ophthalmic nerve (VI) and, 448 see also specific movements Occlusal plane posture and, 511–12 structural differentiation, 369 rehabilitation see Oculomotor see also specific components ideal, 302–3, 303 rehabilitation other body planes and, 302–4, responses during testing, Occipitofrontal muscle, trigger 518–19 points, 270, 270 304 trochlear nerve (IV) and, Occlusal splints, 291–2, 293 519–21 Occipitofrontal region, general Occlusion (teeth), 169, 170 whiplash, 443, 554 compression techniques, see also Ocular deviations; 363–5 bite taking, 296, 298 individual nerves; specific excessive protrusion and, 254 conditions angulation (diagonals), 363–4, factors affecting, 286 Oculomotor muscles see 597 forces, 304 Extraocular muscles malocclusion see Malocclusion Oculomotor nerve (III) combinations, 364–5 muscular dysfunction and, adrenaline sensitivity, 518 juvenile headache, 597, 667 anatomy/function, 43, 44, 44, mouth breathing in children, 321–2 500–1, 501 normal (eugnath dentition), brainstem nuclei, 36, 37, 501 644 rotational movements, 364, 365, 287, 287 quality, functional EMG, 299, 365 starting position and method, 300 TMJ effects, 285–6 363 see also Mandible transverse movements, 364 Occlusion line, 161, 161 Occupational factors, bone plasticity, 343 Ocular deviations

Index 715 divisions, 501 eye movements see Eye orbital region, 411 eye muscles/movement, movements, examination sensory distribution, 448 eye pain and dysfunction, 448 501, 506 Maddox tests integration, physical examination, 446–8, dysfunction, 518–19 512 458 comments, 448 case study, 519, 520 neurodynamic tests, 502–5, neurodynamic test, 446–8, frontonasal pathology, 387 504, 505, 507, 512, 513 infection, 518 447, 458 palsy, 518 palpation, 505, 505, 513 palpation, 448, 448, 458 whiplash, 554 recording, 677 recording, 675 physical examination, 513 responses during, 518–19 see also specific branches conduction tests, 513 rehabilitation see Oculomotor Optic canal, 403, 496 neurodynamic tests, 503–4, rehabilitation Optic chiasma, 44, 496, 497 Odontalgia Optic nerve (II) 504, 505, 513 atypical, IASP classification, 7 anatomy/function, 43, 44, 44, palpation, 513 non-specific, 6 496, 497 recording, 677 Odour, olfactory nerve cavernous sinus and, 500 responses during testing, assessment, 496 dura, 498, 500 Oedema see Swelling/oedema orbital growth and, 409 518–19 Oestrogen, 325 temporal bone and, 382 Oculomotor reflex, 111 Olfactory bulb, 44 dysfunction Oculomotor rehabilitation, Olfactory cortex, 44 eye pain/dysfunction, Olfactory nerve (I) 512–18 anatomy/function, 43, 43–4, 499–500 case studies, 512, 514–15, 519, 494, 494 Horner’s syndrome and, temporal bone and, 382 520 dysfunction 498–9 general, 516–18 indicators, 163 indicators, 163 neuropathy, 496 meningiomas, 500, 660 combinations/variations, trauma, 495–6 neuritis, 500 518 neurodynamics trauma, 500 rehabilitation and, 496 vascularization and, 498–9, eyes closed, 517–18, 518 starting position/method, functional position changes, 499 495, 495 visual field defects, 499, 499 516, 516 physical examination, 494–6, visual loss, 500 indications, 516 physical examination, 496–500, neck position changes, 516, 495 499 comments, 495–6 comments, 498–500 517 conduction tests, 495, 496 conduction test, 498, 498, transfers, 516 neurodynamic tests, 495, uncoupling craniocervical 499 495 neurodynamics, 496–7, 497, and eye movements, 517, palpation, inability to, 496 517 recording, 676 499 local, 513, 515–16 Olfactory tract, 44 palpation, inability to, 497 duration, 513, 515 Omohyoid muscle, eccentric recording, 676–7 imagination and, 515–16 activation, 352, 352 Optic neuritis, 500 neurodynamics and, 512, One finger technique, Optic tract, 44, 44, 496, 497 515 intermaxillary movements, Oral airway, breathing see Mouth speed/direction, 515 415 breathing starting position, 513 ‘Onion-ring model’, 578, 578 Oral breathing see Mouth Oculomotor system Open bite, 289–90 breathing anatomy/function, 44, 500–2, mouth breathing effects, 625 Oral facial activity, limitations, 63 501, 502, 503 Open dialogue, juvenile Oral modification, rehabilitation abducens nerve see headaches, 587–8 in mouth breathing Abducens nerve (VI) Opening click, 218, 218 children, 648 oculomotor nerve see Open mouth breathing see Mouth Orbicularis oculi Oculomotor nerve (III) breathing anatomy, 270 trochlear nerve see Ophthalmic nerve (VI) trigger points, 269, 269 Trochlear nerve (IV) anatomy/function, 37, 38, 39, Orbicularis oris, mouth breathing see also Eye movements 39–40, 446, 447 and, 624 dysfunction see Oculomotor divisions, 446 Orbit, 54 dysfunction physical examination, 500–22, 513 comments, 518–22 conduction tests, 505, 513

716 Index anatomical variation, 409–10, irritation, 227 juvenile headaches, 607–8 410 Orthodontics, 3 Paediatrics see Children Pain asymmetric growth, 409 see also Dental treatment fracture, 410, 411, 450, 450 Orthophoria, definition, 508 assessment see Pain ‘Orthophorization’, 509 assessment/measurement maxillary nerve and, 450, 450 Oscillating movements, brace– Orbital region, 54, 401 attitudes to, 87 relax technique, 247, 248 cervical instability, 122 anatomy, 402, 403, 405–6 Ossification, 32–3 clinical reasoning and, 24 cranial nervous connective Os tribasilare, 34 cognitive/affective dimension, tissue, 410–11 Otalgia, non-specific, 6 lacrimal system, 407 Otic ganglion, 45 348–9 superior orbital fissure, Otic line, 161, 161 communication in therapy see 410–11 Otitis media with effusion, palatal variations, 409–10, 411 Communication venous drainage, 411 abnormalities, 419 coping strategies, 348–9 Otogenic tinnitus, 474–5, 475 cranial accessory movements, facial growth and, 409 Otomandibular dystonia, 444 fractures, 410 361–2 frontal plagiocephaly and, 408–9 see also Craniocervical dystonia definition, 572 general compression/ (CCD) dimensions, 572, 573, 578, distraction techniques, Otomandibular structures, 473, 604–5 402–3, 403, 403 473–4 experience of pain/dysfunction following meningioma Oval foramen, 55 children’s, 572–3, 573, 578 Overbite, 179–80, 180, 181, 296 individuality, 12, 87–8 resection, 660–2, 661 factors affecting, 86–9, 87 frontonasal movements, aetiology, 287, 288 features/components, 84, 84, class II/1, 287, 287–8 86–8 386–7 class II/2, 288, 288 gain, 88, 594 maxillary adenocystic clinical implications, 287–8 as health problem, 83 inhibition, 236 carcinoma, 662–4, 663 craniocervical dysfunction, localization/quality, 61 sinus function and, 410 296 atypical facial pain, 472, 472 specific accessory movements, craniofacial region, 68–9 post-anaesthesia dizziness, craniomandibular region, 405–11 case study, 306 frontomaxillary region 62–3 Overjet, 180, 180 juvenile headache, 572–3, (F/M), 406 decreased in overbite, 288, 288 lacrimal frontal region increased in overbite, 287, 287 573, 575, 588, 588 mouth breathing effects, 625 pain diary, 64, 65 (La/F), 406–7 whiplash-associated lacrimal maxillary region Overpressure, craniomandibular active movements in supine, disorders, 109 (La/M), 406–7, 407 186–8 see also Subjective precautions, 408 sphenopalatine region advantages/utility, 186 examination end-feel, 186 management (S/Pa), 407–8 overpressure definition, 186 zygomaticomaxillary region range of motion in supine with cranial neuromobilization, 551–2, 555, 557 (M/Z), 406 laterotrusion, 188, 188 see also Eye(s); specific mouth opening, 186, 186–7 distraction strategies, 94, protrusion, 187, 187 605, 607 components retrusion, 187, 187–8 Orbital sutures, synostosis, 412 Overuse goals, 12 Orofacial pain see Craniofacial craniomandibular pain, 65 lack of trust, 581 trigger point pathophysiology, see also specific treatments dysfunction/pain 257 meaning of, 87–8, 572–3 Orofacial stimulation, trismus, 250 Oxygen requirements, nervous mediators, protective Oromandibular dysfunction see system, 428 mechanisms, 344 motor output changes, 235–6 Craniomandibular P muscle responses to, 234–5, dysfunction/pain 312–13 Orthodontic braces/splints Pacing exercise musculoskeletal, 189, 194, 234, bruxism treatment, 241 cranial neuromobilization, 555, 260, 309–10, 325 craniofacial pain and, 70, 413 557 static (isometric) testing, degenerative disc disease, 224 dorsal disc displacement, 222, 189 223 temporal muscle(s), 194 palate and, 418 retrodiscal inflammation/

Index 717 viscerocranium movements, visual analogue scale, 14, 61, frontonasal movement and, 402 108, 195, 589, 589 387 see also Muscular question schemes for pain mouth breathing and, 625 dysfunction conditions, 95 shape and, 417, 418 forces on, 418–19 neurocranium movements, whiplash-associated disorders, growth patterns, 418, 419, 402 108 419–20 influence on midface as neurodynamic parameter, see also Subjective examination; structures, 418 552 specific tools/instruments innervation, 415 nervous system and, 420 neurogenic see Neurogenic Pain diaries see under Pain physical structures, 417, 417–18 pain assessment/measurement posture and, 421 Palatine bone, 55, 415, 415 neuropathic see Neuropathic ‘Pain games’, 84 orbital anatomy, 402 pain Pain inhibition, 189 palpation, 55 Pain mechanism model of Palatine foramina, 415, 415 nociceptive, 13, 149, 430–1, 444 Palatine nerves, 448 pathobiological mechanisms juvenile headache, 604–5 Palatine process, 55 Pain mechanisms, 11–15 Palatine region, 415–21 see Pain mechanisms accessory movements, 415–17 perception of, 13–14, 14 accessory movements, 205, influence on midface 209–10 alteration/shifting, 92 structures, 418 proprioceptive feedback accumulation, 17, 18 intermaxillary, 415–16 afferent (input) mechanisms, interpalatine region, 416 effects, 325 maxillary nerve psychological component, 84, 13, 73–4, 74, 430–1 juvenile headache, 591, 592 neurodynamics, 449 87, 572–3 ‘tic douloureux’, 566 palatomaxillary region, 417 case study, 88–9 see also Abnormal impulse anatomy, 415, 415 fear of pain, 348–9 sphenopalatine ganglion juvenile headache, 578, generating sites (AIGS) (SPG), 408, 420, 420–1 alteration over time, 15 see also Palate; Palatine bone; 578–9 central mechanisms specific components see also Biopsychosocial Palatine sutures, 415, 415 (sensitization), 13–15, 14, growth/development, 419–20 factors; Psychological 236, 432 Palatine veli tensor nerve, 452 factors juvenile headache, 592 Palatomaxillary region (P/M), referred, 62, 104, 236, 260, 274, peripheral vs., 236, 236 accessory movements, 417 275 somatotopia, 13–14, 14 Palpation, 46–58 see also Trigger points classification, 11–12, 17 autonomic responses, 256, 260 ritual, 88 clinical interpretation and, 15, contours of face, 46, 48 see also specific types/locations 16, 19 craniomandibular region, Pain adaptation model, 234–5, 313 cranial neuromobilization and, 196–204 Pain assessment/measurement 552, 554 definition, 196 algometry, 196, 200, 261, 261, efferent (output) mechanisms, hyoid, 161, 203–4 322 15 juvenile headache children, 589–91 identification in myogenic craniocervical junction, 596 behavioural measures, 589 disorders, 236, 236 craniofacial, 597 biological measures, 589 interference, 17, 18 lymph nodes, 198, 199 body chart, 588, 588 juvenile headache, 572, 573, mandibular head and drawings, 572–3, 573 591–2, 592 surrounding tissue, 197, 229 self-documentation, 588, management and, 604–5 mouth breathing in children, 589, 589–91, 590, 591, 667 summation, 17, 18 orofacial assessment, 641 pain diaries, 64, 65, 588, 590–1 Pain projection, 110 muscles, 198–204 advantages/disadvantages Pain scales see under Pain assessment criteria, 200 in children, 591 assessment/measurement basic principles, 260 juvenile headache, 667 ‘Pair of glasses’ syndrome, 450, cervical, 162, 201–3, 202 pain scales, 14, 61, 108, 195, 559 excessive protrusion, 254 589–90 PAIVMS see Passive accessory colour analogue scale, 590, intervertebral movements 590 (PAIVMS) facial affective scale, 590, Palate, 415–21 591 accessory movements, 415–17 facial scale, 590, 590 anatomy, 407–8, 415, 415 numerical rating scale, 589, disorders 589 developmental, 419–20 verbal rating scale, 589, 589

718 Index general palpation, 198, maxilla, 55 growth pattern, 391–2 200–4 nasal bone, 55 lambdoid region and fusion, palatine bone, 55 malocclusion/dysgnathia, sutures, 54 394 290–1, 291 vomer, 55 petrosal accessory movements, zygomatic bone, 55 masticatory muscles, 162, whiplash-associated disorders, 385 200–1, 254 109 specific accessory movements, see also Trigger points; specific method/evaluation, 199 structures 389–94 mouth breathing in Parafunctions, 162 case study, 392, 392–3 awareness, rehabilitation and, parietoparietal region (P/P), children, 641, 642, 643, 648 645 capsulitis and, 227–8 389–92 specific palpation, 199, craniomandibular synostosis, 391–2 259–60 dysfunction/pain, 64, 66 see also Trigger points influencing activities, 242 case study, 392, 392–3 starting position, 200 juvenile headache, 580 neurological complications, suprahyoid muscles, 162, mouth breathing in children, 203–4 638, 641, 648 393–4 see also specific muscles muscular dysfunction and, 322 see also Cranial synostosis nerves, 204 psychological factors, 232–3 see also specific components cranial see Cranial nerve rehabilitation in mouth Parietal tubercle, 49 palpation breathing children, 648 palpation, 53 neuromobilization, 552, subluxation/luxation, 230 Parietoparietal region (P/P), 389 558–60, 562, 568 see also specific behaviours accessory movements, 389–92 see also Cranial Paraocclusal axiography, 292 case study, 392, 392–3 Parasympathetic nervous system, compression/distraction neuromobilization 529 utility, 558 Paratrigeminal (Raeder’s) technique, 390–1 neurocranium, 48–54 syndrome, 499–500 longitudinal towards calvarium localization, 48 Parents, juvenile headache and cue for palpation, 48 behaviour guidelines, 605 caudal, 389–90, 390 frontal bone, 53 care/behaviour effects, 579–80, longitudinal towards caudal immature structures, 48–51 580 occipital bone, 51–2 inclusion in assessment/ with thumb movement, parietal bones, 48, 53 treatment, 587–8 390 sphenoid bone, 53–4 migraine/vasomotor posterior–anterior sutures, 48, 48, 53 questionnaire, 533, 533 techniques, 391 temporal bone, 52–3 Parietal bones rotation of right region temporomandibular joint, accessory movements, 366, 367, around transverse axis, 389–94 390 52–3, 227–8 parietoparietal region (P/P), see also Sagittal suture quantification/qualification of Parietopetrosal region (Pe/P), 389–92 accessory movements, 385 responses, 196–8 petrosal bone against, 385 Parietopetrosal suture, 383 algometry, 196, 200, 261, 261, anatomy/functional Parodontium, bruxism, 240 connections, 49, 51, 55, 384, Parotid nerve, 452 322 389, 389 Parotid plexus, 41, 41 avoidance reaction, 196 neonatal cranium, 50 Parotid salivary glands, 198 components, 196–8 neurological dysfunction and, palpation, 197 motor responses, 196 393–4 Participation, classification, 10, 10 pain scales, 196 palpation, 48, 53 Passive accessory intervertebral sweating/temperature, 197 Parietal region movements (PAIVMS) swelling/oedema, 197–8 anatomy/functional cervical instability, 138, 144 recording, 673 connections, 389, 389 joint mobilization, 150 referral, 198 general compression/ differentiation tests, 174, reliability, 196, 199 distraction techniques, 366, 174–5 retrodiscal inflammation, 225 367 Passive movements, 358–9 salivary glands, 197 accessory movements see therapist’s experience and, 199 Accessory movements utility, 196 active vs. in neuromuscular viscerocranium, 54–8 rehabilitation, 349 cues, 54–5 cranial nervous tissue lacrimal bone, 55 craniocervical dystonia and, mandible, 56–8 443–6 neuromobilization, 552, 553

Index 719 see also Cranial mouth breathing in children, rehabilitation in mouth neuromobilization 644, 645–6 breathing children, 650 passive neck extension, 443 mouth opening range of respiration, 622 passive neck flexion see motion in sitting, 185 Pediatric Quality of Life Inventory Passive neck flexion subluxation, 230 (PedsQL), juvenile (PNF) trismus, 249 headache, 574, 574 see also Neurodynamic whole person and, 358 Percussions, trigger point techniques Pathobiological mechanisms, treatment, 262–3 definitions/guidelines, 357–62 Perfectionism, juvenile headache grades, 359–60, 360 11–17, 12 and, 580 joint mobilization clinical reasoning and, 24 Periarticular dysfunction, atlas, 658 contributing factors, 23 craniomandibular joint, 217 efficacy, 339 cranial nervous system Perimetry, 499, 499 trismus treatment, 250 Perineurium, 426, 426 malocclusion/dysgnathia, 291 dysfunction, 431–2, 432, 433 Periosteum, 36 nerve compression during, 420 see also Pain mechanisms Peripheral facial paresis, 469–70 neurocranium assessment/ craniofacial/mandibular neuromobilization case study, treatment, 357–400 regions, 16–17 563–6, 564 responses, 401–2 interpretation in children, rehabilitation, 469 see also Cranial accessory 15–16 Peripheral nervous system (PNS), movements muscular dysfunction, 231–8 425–35 physiological see Passive central mechanisms, 234–5 afferent (input) pain physiological movements central vs. peripheral mechanisms, 13, 73–4, 74, trigger points, 260–1, 263 430–1 see also Trigger points mechanisms, 236, 236 see also Abnormal impulse viscerocranium assessment/ motor responses/output treatment, 401–24 generating sites (AIGS) responses, 401–2 changes, 231–3, 235–6 arm nerves, neuromobilization, see also Facial accessory muscle tone, 223, 233–4 movements neuroplasticity and, 237–8 556 see also specific techniques/ pain adaptation mechanism, connective tissue, 426 movments cranial see Cranial nervous Passive neck extension (PNE), 443 234–5, 313 craniocervical dystonia and, stress effects, 232, 235 system 443–6 neuropathic model, 16–17, 17 craniocervical region, 21 Passive neck flexion (PNF), 440–3 pain see Pain mechanisms craniofacial region, 21 case study, 443 peripheral nerves, 559–60 craniomandibular region, 20 craniocervical dystonia and, retrodiscal irritation, 11 definition, 425 443–6 sources of dysfunction, 18–23 fluids, 427 CT/MRI studies, 440–1, 441 classification, 18–19, 23 ganglia, 429 juvenile headache, 599 neuromuscular structures, movement responses, 429–30, non-verbal clues to cranial involvement, 443 20–2 551 starting position/method, 441, patient’s understanding of, pathobiology, 559–60 441–2 ‘tic douloureux’, 566, 568 18 neural pathodynamics, variations/additions, 442–3 topographic expression, 22 430–1 lower cervical flexion and, see also specific regions 443, 443 trigger points, 257–8, 263 Peripheral neurogenic pain, 13 vasomotor headaches and, Patient(s) definition, 73 533–4 communication see mechanisms, 73–4, 74 Passive physiological movements, Communication 358 differences in reaction to pain, Personality cranial neuromobilization, 552 87–8 craniomandibular pain and, 67, disc displacement with medical history see History 235 reduction/reposition, 220 taking juvenile headache and, 579 intervertebral (PPIVMS), 127, physiotherapist relationship, 129, 143 24–5 Petrosal bone profile, 61 accessory movements, 383–6 referral to specialist see general technique, 384, 384 Referral against neighbouring bones, types, 84–5 384–5 Patrick-Kubis hip abduction test, neighbouring bones against, Marx modification, 304, 304 385–6 Pectoral muscle neurodynamic changes, 386

720 Index vestibulocochlear nerve functional demonstration, 672 Pilot treatment, cranial accessory assessment, 478 indications for, 160, 160, 161 movements, 367 juvenile headache, 594–604 anatomy/connections, 383, 384 Pin prick test, mandibular nerve functional interactions, 383 case study, 665, 667 assessment, 455 temporal bone relationship, malocclusion/dysgnathia, 383 Pinto’s ligament, 473–4 290–1 Piriform aperture, 54 plagiocephaly and, 385–6 measurements see Placebo effect, 358 Petrosal nerve, 41, 386 Plagiocephaly, 71 Petrosquamous suture, 52 Measurements Phantom sensations, 14, 14 motor system, 237 frontal, 377 mouth breathing in children, orbital movements, 408–9 neural plasticity, 342 Pharyngeal constrictors, 270 638–46 occipitoparietal Pharyngeal nerve movement diagrams, 126–7, posture and, 374–5 risk factors, 374 of glossopharyngeal nerve, 43, 127, 150, 150, 221, 250 45, 46 muscle tests see Muscle tests petrosal, 385–6 muscular dysfunction, 309–38 symptoms/signs, 374–5, 385 palpation, 558 observation see Observation/ without synostosis, 370 of vagus nerve, 43, 46, 47 Plasticity Pharyngeal paraesthesia, inspection definition, 340 questions prior to, 77 neural see Neuroplasticity craniocervical/mandibular recording, 671–8 neuromusculoskeletal see disorders and, 295 swelling/oedema, 197–8 Pharyngeal plexus, 45, 46, 47 temperature/sweating, 197 Neuromusculoskeletal Pharyngeal tonsil, 45 trigger points, 259–61 plasticity Phonation, assessment, 532 see also individual conditions; ‘Pleasant’ pain, 405 Phonophobia, 476 Plexi Physical examination specific tests/techniques cervical, 122, 123 accessory movements see Physiological movements parotid, 41, 41 Accessory movements pharyngeal, 45, 46, 47 active movements see Active capsule stiffness, 229–30 tympanic, 45 movements capsulitis, 228 vagus nerve, 43, 46, 529, 529 bruxism, 240–1 end of range opening Pneumatization, 33 communication during, 193 Positive memories, 92 cranial accessory movement mandibular kinesiography, Posterior–anterior movements notation, 361–2 301, 302 craniomandibular cranial nervous system, 195–6, extraoral, 208, 209, 209 439–550 retrodiscal inflammation, intraoral, 209, 209 recording, 674–8 225 frontoparietal region, 388–9 craniocervical region, 161 parietoparietal region, 391 cervical instability, 125–41 passive see Passive relative to C2 in upper cervical children, 594–6 physiological movements flexion, 134 craniofacial region Posterior auricular nerve, 41, 452, facial asymmetry, case trismus, 253 461 Physiotherapy neuromobilization, 565 study, 658 palpation, 463, 465 facial pain after bruxism treatment, 241 Posterior cerebral artery, children, 8 trigeminal nerve and, 555 meningioma resection, contraindications/risk factors, Posterior cervical muscles 660–2 head extension and, 628 recording, 674 12, 19, 23, 61–2 rehabilitation in mouth regions influencing decision making, 26 breathing children, 649 craniofacial pain, 160 definition of profession Posterior deep temporal nerve, craniomandibular region, 452 159–214 (WPCT/ICF), 9–11 Posterior ethmoidal nerve, 39, maxillary adenocystic developments, 8 447 carcinoma, 663–4 diagnosis, 9, 10, 10 Posterior fontanelle recording, 671–3 extra bones, 49 slight dysfunction, case hypothetical categories, 11, neonatal cranium, 50 study, 658 12 Posterior inferior cerebellar artery differentiation (of regions/ (PICA), inflammation, 482 structures) see see also Clinical reasoning Differentiation tests juvenile headache hands on vs. hands off, 604 strategies, 592–3 malocclusion treatment, 292, 292 management goals, 12 training, 11 see also Manual therapy; specific techniques Pia mater, cranial, 35

Index 721 Posterior view, ideal postural craniomandibular dysfunction measurement, 181, 182 alignment, 638 and, 304, 305, 305 passive neck flexion and, 443 post-anaesthesia, case study, range of motion in sitting, 181 Posterocranial fossa, innervation, 306 426 cervical position and, 185 Progenia, 288, 288–9 reference data, 184, 184 Post-traumatic headache, IASP Progenic forced bite, 288 range of motion in supine with classification, 7 Prognathia overpressure, 187, 187 retrodiscal inflammation, 225 Postural changes mouth breathing and, 626 static (isometric) muscle tests, birth trauma, 69 palate and, 419 191, 254 craniofacial/craniomandibular postural effects, 324 touch-and-bite exercise, 255, pain and, 314, 314 Prone sleeping position, 256 due to altered breathing Proximal neurodynamic patterns see under Mouth craniomandibular pain, 65 neuromobilization, 556–7 breathing Proprioception, 325 advantages/disadvantages, 562 improving muscular stability, case studies, 564, 566 154 cerebral palsy, 372 Pseudoprogenia, 289 malocclusion effects, 296, 297 facial/shoulder pain, 352 ‘Pseudoregulation occlusion’, 228 plagiocephaly, 374 head posture and, 322 Psychological factors vertical occlusion dimension jaw muscles, 321 bruxism aetiology, 235, 239, 241 and, 323–4 juvenile headache, 594 juvenile headaches, 572–3, motor control, 347, 349 579–80 Postural re-training, rehabilitation influence, 581, 581 in mouth breathing neuromuscular ‘onion-skin model’ of pain children, 651 rehabilitation and, 347–8, 352 experience, 578, 578–9 Posture traumatic experiences, 579 assessment, 161 reciprocal innervation, 345, pain, 84, 87, 572–3 alignment in children, 346 case study, 88–9 638–9 fear of pain, 348–9 Maddox tests integration, muscular dysfunction and, 322, parafunctions, 232–3 512 325 passive movements in bruxism treatment, 242 dystonia, 445 changes in see Postural neutral position and, 326 whiplash-associated disorders, changes Proprioception and sterognosis 108–9 evolutionary aspects, 224 see also Stress (psychological) head see Head/neck posture concept, lingual re- Psychological interventions, ideal alignment, 638 education in mouth bruxism, 241 juvenile headache, 580, 665 breathing children, 647 Psychosis, hypnotherapy lip/incisors and, 162 Proprioceptive stimulation, contraindication, 94 muscular dysfunction and, bracing/clenching Psychosocial disorders, 4 322–4 treatment, 247–8 AAOP classification, 4, 5 oculomotor dysfunctions and, Protective deformities/splints, Psychosocial factors 511–12 231–2 craniomandibular case study, 512, 514–15 learning, 344 dysfunction/pain, 66, 67 palate and, 421 mechanism, 344 Helkimo Clinical Dysfunction plagiocephaly and, 374–5 mouth opening dysfunctions, Index, 66, 68 tonic neck reflex, 320 179, 216 see also Biopsychosocial factors; vasomotor headaches and, 533 passive neck flexion and, 443 Psychological factors post-acoustic neuroma surgery, Psychotherapy, 91–2 Posture control system (PCS) 566 Pterygoid fossa, 55 cervical stability, 119–20, 120, Protocol-oriented assessment, Pterygoid hamulus, palpation, 54 138–9 59–60 Pterygoid muscles head/neck posture, 322–3, 349, Protruberantia mentalis see Chin lateral see Lateral pterygoid 627, 627 Protrusion (mandible) muscle juvenile headache and, 594–6 bimaxillary, 162 medial see Medial pterygoid neuroanatomy, 594 definition, 253–4 muscle neutral position control, 326–8 degenerative disc disease, 223 Pterygoid nerves, 38, 452 whiplash and, 594 excessive (muscular Puberty dysfunction), 253–6, 316 PPIVMS, cervical instability, 127, inspection (intra-/extraoral), 129, 143 254, 254 Pressure, craniofacial pain, 69 physical examination, 254 Priener abduction test, 304, 304 treatment, 254–6, 256 indications for dysfunctions, 181

722 Index boys vs. girls, 630, 630 supine position with mandibular nerve definition, 629 overpressure, 186–8 conduction tests, 456, postural changes and, 629–32 456–7 Pulpitis, 15 muscle tension relationship, Pupil(s) 311–12, 312 whiplash-associated inspection, 498, 506 disorders, 107 oculomotor function, 505 see also Active movements; optic nerve function, 498 specific movements mandibular position and, passive neck flexion and, 443 98–9 Pupillary light reflex, 498, 506 Rapport, good communicative contact, 86 oculomotor reflex, 111 Q posture control system, 594 Reading, difficulty following pupillary light reflex, 498, 506 Quality of life (QoL), juvenile meningioma resection, 660 tonic neck reflex, 98–9, 320, headache, 574, 574 Reality, individual, 85 322 Questionnaire(s), 59–60 Reassessment, 25 vestibulospinal reflexes, examples, 669–78 Reciprocal innervation, 344–6, 345 juvenile headache, 587–8 juvenile migraine, 604 quality of life effects, 574, digastric muscle, 351 Rehabilitation 574 environmental conditions and, vasomotor headaches, 533, mouth breathing in children, 533 346 646–52 see also specific instruments scaleni/infrahyoid craniocervical, 649–50 orofacial, 647–9, 649 R musculature, 354, 354, 355 shoulder/thoracic spine sternocleidomastoid, 348, 350– rehabilitation, 650–1 Radical neck dissection, accessory nerve dysfunction, 488–9 1, 351, 355 neurodynamics and task specificity, 344, 347, 349 facial nerve, 467, 468 Radicular inflammation, case trismus, 250 neuromuscular, 353, 353–4 study, 143, 144 Recording olfactory nerve, 496 body chart, 61, 61, 121, 142, 588, see also Neurodynamic Radiotherapy techniques facial nerve dysfunction, 382 588 glossopharyngeal nerve cranial accessory movements, neuromuscular see dysfunction, 525 Neuromuscular trismus, 234 361–2 rehabilitation examples of, 669–78 Raeder’s (paratrigeminal) movement diagrams see oculomotor dysfunction see syndrome, 499–500 Oculomotor rehabilitation Movement diagrams Range of motion (ROM) pain levels see Pain peripheral facial paresis, 469 axoplasmic movement and, see also specific techniques 427 assessment/measurement Reinterpreting pain, 92 cervical spine, 120 see also specific methods case study, 93 cranial bones, 359, 360 Rectus capitis, 138 Relaxation splints, 291 hyoid, 246 Recurrent laryngeal nerve, 43, 46, Relaxation techniques, 91 mandibular, 178–88 bruxism management, 241 end-feel, 186 47 Remodelling, growth/ interpretation, 184–6 Red dot system, 326 laterotrusion, 182–3, 184, ‘Red flags’, 19, 23, 61–2 development and, 630 184, 188, 188 Repetitive movements, trigger mouth opening (depression) mouth breathing in children, see Mouth opening 638 points, 259 protrusion, 181, 184, 184, Repositioning splints, 291 187, 187 Referral to specialist, 62, 63, 198, Resistance (muscle/joint) reference data, 183, 183–4, 382, 383, 493, 518 184 cervical instability and, 120, retrusion, 181–2, 187, 187–8 cranial nerve pathologies, 469 126, 126–7 sitting position, 178–86 Referred pain, 62, 104, 236, 260, cranial accessory movements, 274, 275 359, 360, 360 Reflex(es) local pain, 361 corneal reflex, 455 as neurodynamic parameter, excessive nociceptive input, 552, 553 234 Resistance, to communication, 85 gag reflex Respiration, 618 glossopharyngeal nerve, biomechanical changes in 524, 531 mouth breathing, 622–3, 623, 632 lateral pterygoid muscle and, 201, 207 muscles used, 618 vagal nerve, 531 inhibitory reflex of temporal muscles, 105 jaw jerk/opening

Index 723 functional adaptations to zygomaticomaxillary Scapulothoracic muscles, cervical mouth breathing, 622, region, 406 instability, 141 632 about a transverse axis Scars/scarring see also Breathing/breathing frontomaxillary region, 406 abnormal impulse generating patterns occipitofrontal compression, sites, 559 364 axoplasmal transport defects, Respiratory obstruction, mouth parietoparietal region, 390 427, 428 breathing and, 621–2 zygomaticomaxillary mobilization region, 406 neuromuscular Retching reflex see Gag reflex rehabilitation, 353, 354 Retina, 496 craniomandibular vs. palpation, 559–60, 560 Retral contact position, location, craniocervical post-operative differentiation mastoid process, 561 292 in prone position, 174 salivary glands, 556 Retrodiscal inflammation/ in sitting position, 173, 173 see also Adhesions irritation, 11, 107, 224–7 maxillary adenocystic Schooling/education, juvenile aetiology, 224–5 carcinoma, 664 headache and, 574 clinical features, 225 dental treatment, 227 Rotation test, 481, 481 Schwannomas, vestibular see diagnosis, 232 Acoustic neuroma functional assessment, 225 S (vestibular Schwannoma) home management, 227 management guidelines, 232 Sagittal suture, 49, 389 Scoliosis manual therapy, 227 cranial synostosis, neurological juvenile headache, case study, medication, 227 complications, 393 665 Retrodiscal space, 224 neonatal cranium, 50 newborn, 370, 371 excessive protrusion, 254 palpation, 48, 53 ocular imbalance and, 511, 512 functional assessment, 225 see also Parietoparietal region plagiocephaly and, 374, 375 Retroprognathia, postural effects, (P/P) Scotomata, 499, 499 324 Salivary glands ‘Screening tests’, cranial accessory Retrusion (mandible) anatomy, 197, 198 exercise, 565 movements, 362 excessive protrusion and, 254 facial nerve assessment, 465–6 Secretions, facial nerve indications for dysfunction, 182 milking, 466 measurement, 182, 182 palpation, 197 assessment, 465–7 range of motion in sitting, surgery Security, children, 16 cranial neuromobilization, ‘Seeing stars’, 480, 481 181–2 556 Segmental changes, local muscle range of motion in supine with facial paresis after, 563–6 scar tissue, 556 dysfunction, 311 overpressure, 187, 187–8 Segmental dystonia, static (isometric) muscle tests, Scaleni muscles, 139 anatomy/function, respiration, classification/incidence, 444 191, 191 622 Segmental instability tests, 120 Reversed crush syndromes, 76 reciprocal innervation, 354, Self-hypnosis, 91 Reversed Horner’s syndrome, 499 354, 355 Semispinalis capitis, 139 Rheumatoid arthritis, self- rehabilitation in mouth breathing children, 650 palpation, 202 hypnosis, case study, 96 trigger points, 272, 273 Rinne test, 479, 479–80 Scammon’s growth curve, 598 Risk factors Scaphocephaly, 391–2 Semispinalis cervicis, 139 trigger points, 272, 273 for craniofacial pain, 17, 17 behaviour disorders, 394 physiotherapy, 12, 19, 23 Scapula(e) Sensomotor cortex, juvenile Ritual, pain and, 89 headache, 594 Rotary stress to right: occiput–C2 craniofacial/craniomandibular pain and, 314, 314 Sensomotor development, juvenile in sitting, 131, 131–2 headache and, 593, 593, Rotation movements juvenile headache, case study, 594–5 665 about a frontal axis, Sensomotor integration frontomaxillary region, 406 mouth breathing in children, feedback 644, 644–5 disturbances, 190 about a longitudinal axis, rehabilitation and, 650–1 eye position and, 509 occipitofrontal compression, motor control and, 346, 509 364 neutral position control, 327 mouth breathing in children, 647 about a sagittal axis see also Motor control frontomaxillary region, 406 occipitofrontal compression, Sensory dimension of pain, 572 364

724 Index Sensory–discriminative Skin, cranial nerve dysfunction, advantages/disadvantages, 562 dimension of pain, 572 163 case studies, 565, 566 concept, 557 Sensory ganglia, 429 Skin folds, facial contours, 48 facial nerve neuromobilization, Sensory nerves Skull 557 assessing function, 531 adult, 32–5, 49, 51, 54, 55 hypoglossal nerve brainstem nuclei, 36, 37 anatomical subdivisions, 32, 32 mandibular nerve assessment, ancient cultures, 31, 32 neuromobilization, 557 as compliance system, 302, 362 indications, 557–8 455–7 deformation during chewing, juvenile headaches, 607 suture innervation, 34 mandibular nerve see also individual nerves 409–10 Serotonin, trigeminal nucleus and effects on muscle/brain, 32 neuromobilization, 553, 557, evolution, 343, 343 557 juvenile headaches, 592 flattening, 377 Slow twitch fibres, plasticity, 342 Serrate suture (sutura serrata), 33, fractures, olfactory nerve Slump test age differences, 598 34 dysfunction, 495–6 cranial nervous system vs. Serratus anterior, rehabilitation in functional anatomy, 31–58 craniocervical dysfunction, functions, 32 176–7, 177 mouth breathing children, growth/development, 32–3, 33 passive neck flexion and, 443 650–1 post-acoustic neuroma surgery, Sharp–Purser test, 133, 133 frontal region, 389 566 Shifting modalities, 92 juvenile headache and, 596 reliability, 433 Short ciliary nerves, 39 later craniofacial pain and, vasomotor headaches and, 533 Shoulder girdle Smell, olfactory nerve assessment, motor control, 650 69–70 496 mouth breathing in children, occipital bone and, 368 Soft touch, mandibular nerve 644, 644–6, 650–1 orbital region, 409 assessment, 455, 456 muscular dysfunction, 650–1 parietal region, 391–2 Somatosensory cortex neuromuscular rehabilitation plasticity, 343 balance exercises and, 477 mouth breathing in sphenoid bone and, 372 cranial neuromobilization, 554 temporal bone and, 380–1 target tissue rehabilitation, children, 650–1 interindividual differences, 46, pain management, 350, 48 552 moulding, 377 projections to 350–3, 351, 352f neonatal, 48–51, 50 stability, 650–1 oculomotor neurodynamic capsule stiffness, 228 see also Scapula(e); Thoracic tests, 505 juvenile headache and, 594 passive (accessory) movements somatotopia (somatosensory spine see Cranial accessory homunculus), 13–15, 14, 190, ‘Shut Your Mouth and Save Your movements 236 secondary asymmetry, 596 movement re-education, Life’, 617 stress-transduction see Stress- Sideglide technique, cervical transducer forces 14–15 tumours, 62 neurobiology, 13–14, 14 instability, 153, 153 volume, juvenile headache and, pain mechanisms, 236 Sinovertebral nerves, 427 596 plasticity, 236, 237–8, 341, Sinus cavernosus (SC), cervical see also entries beginning cranio-/ cranial; specific components 341–2 movement and, 102 Sleep disorders/disturbance trismus management, 250 Sinuses bruxism, 235, 239, 240, 241 Somatosensory medulla, craniomandibular craniocervical tinnitus, 474 development, 412 dysfunction/pain, 66 Somatosensory reactions, 236 inflammation/infection see juvenile headache, 580–1 Somatotopic maps/ ‘Sleeping nociceptor’ facilitation, representations Sinusitis 15 motor cortex, 341, 341–2 orbital region and, 410 Sleeping position juvenile headache and, 594, see also individual sinuses craniomandibular pain and, 65 Sinusitis Eagle’s syndrome and, 528 608 craniofacial dysfunction/pain, Sliders, 557–8 plasticity, 236, 237–8, 341, 341–2 abducens nerve somatosensory cortex see under 71–2 neuromobilization, 557 frontomaxillary movements, Somatosensory cortex see also Homunculus 406 Spatula technique frontonasal movement and, 387 mandibulofacial dysostosis and, 377 Skeletal abnormalities, overbite, 287 Skeletal (bone) plasticity, 342–3

Index 725 cervical physiological extra bones, 49 Splenius capitis muscle, 139 occlusion, 171–2, 172 neonatal cranium, 50 palpation, 202, 202 Sphenomandibular ligament, 52 trismus, 251, 251–2, 252 Spheno–occipital region (S/O) Splenius cervicis muscle, trigger see also Trott’s method accessory movements, 375–6 points, 273 Speech difficulties, craniocervical/ vasomotor headaches, 536 Splints see Braces/splints synchondrosis, 34 Sports injuries, craniomandibular mandibular disorders and, see also Occipitosphenoid 295 dysfunction, 65 evolution, 341 region (O/S) Squamous suture, 33, 51, 52 glossopharyngeal nerve Sphenopalatine ganglion (SPG), Squint (strabismus) see Strabismus assessment, 532 hypoglossal nerve assessment, 408, 420, 420–1 (squint) 491, 492 afferents/efferents, 421 Squint baby syndrome, 370 vagal nerve assessment, 532 Sphenopalatine region (S/Pa) Stability training, rehabilitation in Sphenobasilar dysfunction, 358 accessory movements, 407–8 Sphenofrontal region (S/F) anatomy, 407–8 mouth breathing children, accessory movements, 376–7 Sphenoparietal region (S/P), 651 deformations and, 377 Stabilizer muscles mandible verticalization, accessory movements, 378 global, 310, 315, 321 Sphenopetrosal suture, 383 dysfunction, 311–12 377 Sphenosquamous suture, 52 masseter, 320 starting position and Sphenotemporal region (S/T), local, 310, 315, 321 dysfunction, 311 method, 376, 376 accessory movements, 377–8 lateral pterygoid, superior unilateral movement of Spinal cord head, 318 sphenoid, 376 anatomical features, 426–9 pain effects, 315 deformation, 377 cranial nerves and, 35 neuromuscular control, 347 Sphenofrontal suture, 53 primary cervical, 138–9 forces on, 408 accessory nerve component, trigger points, 263 mandibulofacial dysostosis 484 Stabilizing splints, 291 Stapedial muscle contraction, and, 377 trigeminal nerve and, 474 tinnitus, 474 Sphenoid bone dura mater, 427 Stapedius nerve, 39, 42 ganglia, 429 Static load test, 192 accessory movements, 375–8 neurological signs in cervical Static (isometric) muscle tests, 192 glossopharyngeal nerve cranial nerve assessment assessment, 523 instability, 121–2 accessory nerve, 487, 487 ophthalmic nerve sensitization, 432 mandibular nerve, 456, 456 neurodynamics, 448 craniomandibular dysfunction, optic nerve assessment, 497 trigger points, 258 189–91, 191 petrosal bone against, 385 Spinal trigeminal tract (STT), clinical interpretation, 189 sphenofrontal region (S/F), coordination, 189–90, 190 376, 376–7 craniocervical tinnitus, 474 elevation, 190 spheno–occipital region (S/ Spine force, 189 O), 375–6 laterotrusion (to left), 190–1 sphenoparietal region (S/P), adaptation, 631 pain, 189 378 adolescent, features, 630–1 protrusion, 191, 254 sphenotemporal region (S/ cervical see Cervical spine retrusion, 191, 191 T), 377–8 craniomandibular dysfunction starting positions/methods, trochlear nerve assessment, 504 symptoms, 64 190–1 vagal nerve assessment, 530, developmental instabilities, 631 willingness to move, 190 531, 532 lumbar see Lumbar spine definition, 189 vestibulocochlear nerve posture, juvenile headache, malocclusion/dysgnathia, 291 assessment, 478 maxillary adenocystic case study, 665 carcinoma, 663 anatomy/functional stabilization systems, 119–21, validity, 189 connections, 51, 54, 372, 375, see also specific tests 375 120 Sternocleidomastoid muscle orbital anatomy, 402, 403 active, 120–1 (SCM), 52, 139 passive, 119–20 accessory nerve assessment, palpation, 53–4 regulating, 120–1 487, 487 skull growth and, 372 trigger points, 263 Sphenoid fontanelle thoracic see Thoracic spine see also Spinal cord; Vertebrae; specific deformities Spinomedullary angle, changes in, 429 Splanchocranium see Viscerocranium

726 Index anatomy/function, 320 Stratum posterior, retrodiscal onset, craniomandibular accessory nerve innervation, inflammation, 225 dysfunction, 65 484, 484 respiration, 622 Stratum superior, retrodiscal slight dysfunction, case inflammation, 225 study, 656 craniocervical dystonia, 445, 445 Strength training, rehabilitation indications for physical in mouth breathing examination, 160, 161 head extension and, 628 children, 651 hyperactivity, 140 juvenile headaches, 587–91 mouth breathing and, 628 Stress (psychological), 7 case study, 665 palpation, 162, 201–2, 202 bruxism aetiology, 235, 239, 241 craniomandibular mouth breathing in children, trigger points, 202, 270–1, dysfunction/pain, 66 638 271 juvenile headache, 605 management, 91, 241 patient history see History pars clavicularis, trigger motor responses, 232, 235, 237 taking points, 270–1, 271 trigger point aetiology, 235, 259 post-anaesthesia dizziness, pars sternalis, trigger points, see also Psychological factors case study, 306 271–2, 272 Stress-transducer forces, 370 purpose, 60 reciprocal innervation, 348, abnormal, 371 questions prior to, 77 350–1, 351, 355 facial growth, 412 recording, 670–1 juvenile headache and, 597 ‘red flags’, 61–2 shortened, case study, 657–60, manual therapy, 606 special questions, 61–2 659 mandibular growth, 381 orbit and, 409–10 case study, 70–1 surgical splitting of, 658 craniofacial dysfunction, Sternum, vagal nerve assessment, Structural instability, 120 Styloglossal muscle, 45 70–3 530, 530 Stylohyoid branch of facial nerve, craniomandibular Stethoscope use 41 dysfunction, 66 disc displacement (TMJ), 219 Stylohyoid muscle recording, 671 maxillary nerve entrapment, symptom behaviour, 61, 63–5 anatomy/function, 318 bruxism, 240 450–1 palpation inability to, 268 cervical instability, 124 Stomach ache Styloid process cranial nervous tissue, 74 anatomy/function, 51, 55, craniofacial, 69 misidentification in children craniomandibular, 63–5 under 5 years, 572 525–6, 527 diurnal behaviour, 64, 124 elongation syndrome see recording, 670 vagus stimulation, 532 variability, 63–4, 124, 143 Stomatodynia, 361 Eagle’s syndrome symptom localization/nature, Stomatognathic system glossopharyngeal nerve and 61 associated symptoms, 63, 73 dysfunction see Eagle’s syndrome, 524–5 body chart, 61, 61, 121, 142, Craniomandibular palpation, 523–4, 524 dysfunction/pain intraneural adhesions, 559 588, 588 Stories, therapeutic value, 92 Stylomandibular ligament, 52 cranial nervous tissue, 74 Strabismus (squint), 409, 507, 508 Subcortical motor control, 346–8 craniofacial region, 68–70 abducens nerve dysfunction, Subjective examination, 60–2, 63 craniomandibular region, 521 bruxism, 240 case study, 519 cervical instability, 121–5 62–3 oculomotor rehabilitation, 513, case report, 141–3, 142 pain diary, 64, 65 515 contributory factors, 65–6, 67 recording, 670 ophthalmic nerve and, 448 cranial nervous tissue, 73–7 see also Pain assessment/ pathogenesis, 509 craniofacial region, 68–73 types/classification, 508 facial asymmetry, case measurement see also Heterophoria; trigger points, 259, 261 Heterotropia study, 657–8 Subjective tinnitus, 473, 477 Straight leg raising (SLR) following meningioma Sublingual salivary glands, 198 accessory nerve assessment, facial nerve assessment, 465–6 487 resection, 660 palpation, 197 direct cranial craniomandibular region, 62–8 Subluxation/luxation neuromobilization, 555 C1–C2, 377 passive neck flexion and, 443 adenocystic carcinoma in craniomandibular joint, 216 reliability, 433 left maxilla, 662–3 vasomotor headaches and, 533 clinical features, 230–1 Stratum inferior, retrodiscal myogenic dysfunction/pain, crepitations/clicks, 219, 230 inflammation, 225 237 habitual, 230–1

Index 727 home management, 230, 231 inferior alveolar nerve craniofacial pain, 69 management guidelines, neuropathies, 461 optic nerve dysfunction, 232 peripheral facial paresis, 470 500 manual therapy, 230, 231 peripheral nerve pathology, trigger points, 261 neuromuscular re- see also Autonomic 560 education, 230, 231 temporal region effects, 381 responses temporal bone movements, Sustained atlas technique, sphenopalatine ganglion and, 381 juvenile headache, 606, 606 420 Submandibular salivary glands, Sutura plana (laevis suture), 33 Symptoms, 1 Sutura serrata (serrate suture), 33, 198 biopsychosocial factors, 4 facial nerve assessment, 465–6 34 craniofacial dysfunction see palpation, 197 Sutures, 33, 34 Subnucleus cordalis, 98–9 Craniofacial dysfunction/ Summation, pain mechanism, 17, age-related changes, 394 pain closure craniomandibular dysfunction 18 see Craniomandibular Superficial temporal nerve factors affecting, 34–5 dysfunction/pain premature (synostosis), diurnal behaviour, 63–4, 124 tympanic chord, 452 localization, intensity and Superior cerebellar artery, 70–1 quality, 61 definition, 36 myofacial trigger points and, trigeminal neuralgia, 459 frontal bone, 53 256 Superior (upper) laryngeal nerve, immature vs. adult, 48 see also Trigger points innervation, 34 pain see Pain 43, 46, 47 neurocranium, 48, 48, 49, 51, 53 psychosocial factors, 66, 67 neuralgia, vagal palpation, 48, 48, 52 recording, 670–1 variability, 63–4, 69 neurodynamics and, 532–3 immature sutures, 48–51 whiplash-associated disorders, neuropathy, 430 viscerocranium, 54, 54 109 Superior nuchal line, 51 see also specific sutures see also Subjective examination; Superior orbicularis oris, mouth Swallowing individual conditions; specific characteristics, 244–5, 245 symptoms breathing and, 624 Synchondrosis, 34, 36 Superior orbital fissure, 54, 410–11 tooth contact, 301 Syndesmosis, 33, 36 Superior sagittal sinus, 35 dysfunction see Swallowing see also Sutures Superior temporal line, 53 Synergy, muscles, 340–2 Suprahyoid muscles dysfunction Synostosis head/neck posture and, 323 cranial bones see Cranial anatomy/function, 319–20 hypoglossal nerve dysfunction, synostosis head extension and, 628 orbital sutures, 412 hyperactivity, 140, 244 492 Synovitis, degenerative disc mouth breathing and, 623, 628 mechanism, 317 disease, 223 palpation, 162 muscles involved, 270, 317, 319 Syphilis, oculomotor nerve, 518 TTBS technique, 244–5 mouth breathing in Swallowing dysfunction, 532 T children, 641, 642 cervical instability, 122, 124 indicators of, 245–6 Tabula externa, 36 trigger points, 267–8 muscular dysfunctions, 317 Tabula interna, 36 see also individual muscles TAC (turned head, adducted hip, Supraorbital incisure, 53 buccinator muscle and, 270 Supraorbital margin, 53 ‘Swan neck’, 125 truncal curvature) Supraorbital nerve, 39, 447 Sweating, craniofacial region, 197 syndrome, 370 Supraorbital notch, 54 Swelling/oedema Tactile stimulation Supratrochlear nerve, 39, 447 mandibular nerve assessment, Surgery craniofacial, 197–8 455, 456 accessory nerve dysfunction, intraorbital, cranial nerve neuromuscular rehabilitation, 349 488–9 dysfunction, 163 trismus management, 250 adenocystic carcinoma of left mandibular head, 197 Target tissue exercises orbital following meningioma maxilla, 662 capsule stiffness (TMJ), 228 resection, 660, 661, 661, 662 craniofacial pain/dysfunction, palpation and, 197–8 Swinging opening (shift; 72 dental see Dental treatment deflection), 217, 220 Eagle’s syndrome and, 382, 383 Symbolic rehearsal, bruxism facial nerve anastomoses, 470 facial pain after meningioma treatment, 242 Sympathetic nervous system resection, 660–2, 661 reactions/responses, 231

728 Index cranial neuromobilization, case study, 381, 381 forces on following facial/oral 552–4 contraindications, 382 trauma, 381 case studies, 565, 568 Eagle’s syndrome, 382, 383 glossopharyngeal nerve mouth breathing in children, inferior alveolar neuropathy, 644 461 assessment, 523 mouth breathing in rotation in occipitofrontal Taste, 42 compression, 365 facial nerve assessment, 465 children, 644 glossopharyngeal nerve against neighbouring bones, see also specific components assessment, 531 Temporomandibular joint (TMJ) salivary gland exercise, 565 378–9, 379, 385 stimulation, trismus neighbouring bones against, compressive forces on, 223 management, 250 disc–condyle relationship, 316 vagal nerve assessment, 531 380, 385 dynamic direction/through specific clinical patterns, Taste receptors, 42 range control, 331 Tears, secretion, 407, 407 382 dysfunction see Tectorial membrane temporoparietal region Temporomandibular joint anatomy/function, 134, 135 (T/P), 379, 379, 380–1 dysfunction linear stress tests see Linear temporopetrosal region effect of dentition on, 285 examination, 19 stress tests (Pe/T), 385 innervation, 228–9 Teeth trochlear nerve assessment, location, 52 movement abrasion, 170, 170 504 excessive habitual, 313 classification, 286 vagal nerve assessment, 530, limitations, 63, 216–17 congenitally missing, 289 mouth breathing in contact, 170 531 craniofacial pain, 69 vestibulocochlear nerve children, 640–1 craniomandibular dysfunction muscular dysfunctions and, assessment, 478 symptoms, 64 anatomy, 51, 52, 54, 378, 384 313 craniomandibular region, 20 neuromuscular rehabilitation effect on TMJ, 285 functional connections, 378, grinding/clenching 378, 382 and distraction, 353, 354 bruxism, 240 mandibular head and, dynamic direction/through whiplash-associated 380–1, 381 range control, 331 disorders, 107 petrosal bone relationship, pain incisors see Incisors 383, 384 innervation, 40–1 AAOP classification, 4, 5 kinesiography, 300–1, 301 neonatal cranium, 50 physical (Axis I), 4, 5 mouth breathing effects on, palpation, 52–3 psychosocial (Axis II), 4, 5 skull growth and, 380–1 see also Craniomandibular 625 see also Zygomatic arch/bone normal (eugnath dentition), dysfunction/pain (cheek bone) palpation, 52–3, 227–8 287, 287 Temporal–craniomandibular permanent dentition, 286 mouth breathing in observation/measurement, 169, differentiation, 176 children, 641 170, 170 Temporal muscle(s) occlusion see Occlusion (teeth) retrodiscal space, 224, 225 pain see Toothache anatomy/function, 193, 321 see also Mandible; Maxilla; palpation, 55 EMG, 298 roots, 56 Mouth closing (elevation); palpation, 55 functional, 299, 300 Mouth opening (depression) swallowing and, 301 resting position, 298–9 Temporomandibular joint therapeutic grinding, 292 head extension and, 628 dysfunction, 107, 185, 216–31 see also Dental treatment inhibitory reflex, 105 arthrogenic, 62–3 Temperature length test, 194, 194 capsule stiffness, 228–30, 232 craniofacial region, 197 mouth breathing and, 628 capsulitis, 227–8, 232 sensitivity, mandibular nerve pain, 194 case study, 656–7, 657 assessment, 455–6 palpation, 200, 265, 265 children, 637, 640–1, 648–9 vestibular function test, 481 mouth breathing in deep overbite and, 288 Temporal bone diagnosis, 232 accessory movements, 378–83 children, 641 disc disease see Disc disease trigger points, 265, 265–6 (TMJ) Temporal nerve hip abduction and, 304 of auriculotemporal nerve, 452, hypermobility, 217, 229, 230, 232 461, 462 of facial nerve, 41 palpation, 464, 464 Temporal pain, tumours, 62 Temporal region

Index 729 hypomobility, 216–17, 218 Temporozygomatic region (T/Z), see also Neuromuscular instability, 53, 331 temporal bone movements, rehabilitation 379, 379 clinical, 331 Thumb–chin–mouth opening establishing site of, 315 Temporozygomatic suture, 52 technique, trismus, 253 functional, 331 Tender points, 257 whiplash and, 314–15 Thumb, inhibition of facial pain, see also Mandibular see also Trigger points 353, 354 TENS see Transcutaneous hypermobility Thumb techniques joint noises, 219, 219, 656 electrical stimulation frontoparietal (coronal) region, (TENS) 388–9 see also Crepitations Tensioners, 558 anterior–posterior, 388–9 mouth breathing and, 623 advantages/disadvantages, 562 longitudinal, 388 mouth opening, 179, 185 case study, 566 posterior–anterior, 388–9 muscular, 316–17 concept, 557 intermaxillary region, bilateral, Tension headache 416, 416 movement effects, 313 children/adolescents see occipitoparietal region, noises, 62–3 Juvenile headache anterior–posterior classification/diagnostic movements, 374 crepitation see Crepitations criteria, 5 parietoparietal region, periarticular dysfunction, 217 children, 575, 576 longitudinal caudal, 390 subluxation/luxation, 216, 219, diagnosis compatibility, 6 sphenoid–occipital region, peripheral nerve pathology, bilateral, 376 230–1, 232 560 temporoparietal region, 380 therapy, 232 post-anaesthesia, 306 posture control system and, Thyroid tumour, neck stiffness, rehabilitation in mouth 594 348 breathing children, Test of Motor Impairment (TOMI), 648–9 601 ‘Tic douloureux’, post-acoustic Tetraplegia, glossopharyngeal neuroma surgery, 566–9, tinnitus, 473 dysfunction, 525 567, 568 traumatic Thalamus, plasticity, 237 Therapeutic communication see Time gaps, 94 airbag injuries, 106, 106 Communication Tinnitus, 175 degenerative disease, 223 Thoracic spine surgical, pain/dysfunction articular dysfunction, 650 clinical features, 474, 476 cervical instability and, 125 craniocervical/mandibular and, 72 dynamic direction/through whiplash injuries, 105–6, range control, 329 disorders and, 295 kyphosis see Kyphosis definition, 472 106 lordosis, cervical instability distress, 476 see also specific conditions and, 125 dizziness and, 476 Temporomandibular joint pain mobility assessment, 645 facial nerve dysfunction, 472–7 mouth breathing in children, management and dysfunction syndrome, 644, 644–6, 650–1 IASP classification, 7 rehabilitation, 650–1 balance exercises, 475, 476–7 Temporomandibular joint muscular dysfunction, 650–1 cognitive/behavioural syndrome, 6 Thorax Temporomandibular ligament, 52 altered breathing patterns and, therapies, 476 Temporo–occipital region, 622 dorsal cochlear nucleus temporal bone movements, vagal innervation, 46, 529, 529 379 assessment, 530, 530, 532 disinhibition, 475, 475, Temporoparietal region (T/P), see also Thoracic spine 477 accessory movements, 379, Throat guidelines, 477 379, 380–1 craniomandibular dysfunction self-reduction by manual longitudinal movements in symptoms, 64 cranial pressure, 473 compression and infections, cervical instability, models, 472–6 distraction, 380 125 anatomical/structural, 473, starting position and method, Through range, 359, 360 473–4 379, 380 control, 329–31 cognitive/affective, 474–5, Temporopetrosal region (Pe/T), 476 383, 383, 384 neurophysiological, 474–5, accessory movements, 385 475 temporal bone movements, passive neck flexion (PNF), 443 379 prevalence, 472 Temporopetrosal suture, 383 prognosis, 477 Temporosphenoid region (T/S), types/classification, 473–4 temporal bone movements, craniocervical, 474, 475 379

730 Index objective, 473 mandibular position, 243 frontomaxillary region, 406 otogenic, 474–5, 475 performance of, 245–6 zygomaticomaxillary subjective (non-auditory), swallowing, 244–5, 245 teeth apart, 243, 244 region, 406 473, 477 tongue-up, 243 trigger point treatment, 262, vertigo and, 476 Tonic neck reflex (TNR) Tinnitus retraining therapy (TRT), head/neck posture, 320, 322 263 mandibular position and, 98–9 combination therapy, 263 476 Tonsillitis, mouth breathing and, Transverse occipital suture, extra Tissue pathology, clinical in children, 48 622 Transverse stress tests to the left reasoning, 24 Tonsils, mouth breathing and, 622 C2-C7, 138, 138 Tongue Tooth see Teeth occiput–C2 in supine, 132, 132 Toothache, 7 Trapezius muscle biting, craniomandibular accessory nerve assessment, dysfunction/pain, 66 acoustic neuroma surgery and, 486–7 566 anatomy/function dynamic direction/through accessory nerve innervation, range control, 330–1, 331 bruxism, 240 mandibular nerve, 178 484, 484 hypoglossal nerve assessment, neurodynamic techniques, 435 respiration, 622 491 ‘Tormented person’, pars ascendens accessory nerve assessment, innervation, 40, 42, 43, 489 communication strategy, 84 motor, 243 Torticollis 487 cervical instability, 141, 141 inspection, 490–1 case study, 657–60, 659 palpation, 202–3 movements differential diagnosis, 520 pars descendens myogenic, 70–1, 72 accessory nerve glossopharyngeal nerve assessment, 523, 523 ocular vs., 520 neuromobilization, 561 neonates, 69, 370, 371, 658 trigger points, 268, 268 trismus management, 250 ocular, 377 rehabilitation in mouth muscles, 243 breathing children, 650–1 imbalance and, 512 Trauma, 7 hyoid attachment, 320 trochlear nerve dysfunction, acceleration–deceleration, observation/inspection, 170 105–6, 106 pain, 492 520–1 airbag injuries, 106, 106 palate and posture, 421 plagiocephaly and, 374, 377 birth see Birth stress/trauma passive neck flexion and, 443 Touch see Tactile stimulation capsule stiffness, 228 re-education in mouth Touch-and-bite exercise, excessive cervical spine, 65, 66, 98–109, 105–9 breathing children, 647–8 protrusion, 255–6, 256 instability and, 120, 124–5 coordination, 648 Trance experiences see also Whiplash/ hyoid position/movement, hypnotherapy, 91–2 whiplash-associated 648, 648 imaginative techniques, 92–3 disorders (WAD) proprioception and Transcutaneous electrical cranial nerves see Cranial nerve injury sterognosis, 647 stimulation (TENS) craniomandibular pain, 65 resting position, 647 EMG after, 299 cervical spine injury, 65, 66, resting position masticatory muscle tension, 98–109, 105–9 dentofacial development degenerative disc disease, 223 306, 307 fractures see Fractures and, 620, 620 Transverse ligament frontal region deformation, 377 mandibular resting position KISS syndrome, 370 anatomy/function, 132 macrotrauma, 228 and, 647 stress tests see Linear stress malocclusion, 287 mouth breathing and, 622, microtrauma, 228, 310, 312 tests midfacial, 410 623, 625, 632 Transverse measurements, 167–8 occipital fractures, 371 neuromuscular Transverse movements orbital, 410, 411 maxillary nerve and, 450, rehabilitation, 326–7, 647 of C1 in various mandibular 450 normal breathing patterns, positions, 175, 175 619–20, 620 cranial neuromobilization, 561 stimulation, craniofacial interpretation, 210 lateral, to the right, 207, 207–8 movement re-education, 15 mandibular, 176 swallowing and, 244, 245 medial, to the left, 208, 208 see also entries beginning lingual occipitofrontal compression Tongue–teeth–breathing– techniques, 364, 597 swallowing (TTBS), 237 orbital region breathing, 243–4 bruxism management, 242–6 characteristics, 243 lip exercises, 246, 246

Index 731 retrodiscal inflammation/ muscular dysfunction see hearing loss, 480 irritation, 224–5 Neuromuscular indicators, 163 rehabilitation mouth breathing and, 629, TMJ instability and, 314–15 vertigo, 476 neurocranium, 357–400 646 visual function and, 511 neuromobilization see Cranial neuropathies, 457 see also specific types pain see Trigeminal Traumatic experiences, juvenile neuromobilization pain see Pain, management neuralgia headaches, 579 patient’s expectations, 85 ‘tic douloureux’, 566 Treatment agreement, 89–91 pattern of adjustment, 94–6 neuromobilization, 565, 566, Treatment/management, 23–4 physiotherapy see 568 physical examination, 446–61, algorithms, 25, 26 Physiotherapy 458 atypical facial pain (AFP), 472, postural changes due to comments, 457–61 head position effects, 102 555 altered breathing patterns, neurodynamics, 420, 629, biopsychosocial factors, 4, 9, children, 637–54 success, assessment, 90–1 646 434, 566, 647 treatment agreement, 89–91 recording, 675 bracing/clenching, 247–8, 248, trigger points see Trigger see also specific branches points Trigeminal neuralgia, 459–61 248–9 trismus see Trismus aetiology, 459 bruxism see Bruxism verbal methods, 91–2 case study, 459–60, 460 capsule stiffness, 229–30, 230, viscerocranium, 401–24 diagnosis/assessment, 460–1 see also Rehabilitation; specific pain mechanisms, 13, 432, 432, 232 techniques/treatments 459 capsulitis, 228, 232 Trick movements, 554, 555 pathobiological theories, 459 case studies see Case studies juvenile headaches, 607 vascular compression at CPA, cervical instability see Cervical ‘Trigeminal cave’ (Meckel’s 429, 429 cavity), 37, 446 Trigeminal nucleus, 36, 37, 98, 110, instability management Trigeminal ganglion (Gasser’s 457 communication during see ganglion), 37, 45, 446, 452 juvenile headaches and, 591–2 abnormal impulse generating primary afferents of first Communication sites (AIGS), 432, 432, 457 neurone, 457 cost-benefit analysis, 90, 90 neurogenic pain mechanisms, trigeminocervical nucleus, 98 cranial nervous system see 74, 74 neck reflexes, 99 Trigeminal nerve (V) Trigeminovascular system, Cranial nervous system; anatomy/functions, 37–41, dysfunction, 105 individual nerves 38–9, 39, 44, 446 Trigger points, 199, 256–75, 322 craniomandibular brainstem nucleus see aetiology, 259, 263 dysfunction/pain, 215–84 psychological stress, 235, dental see Dental treatment Trigeminal nucleus exercises see Exercises craniocervical input, 98, 102 259 goals, 12, 23, 89–90 craniomandibular autonomic responses, 256, 260, guidelines capsule stiffness treatment, innervation, 102, 110 261 divisions, 37, 446 bruxism, 240–1 232 meningeal innervation, 426, cervical, 104 cranial nerve palpation, clinical features, 259–61 533 551–70 middle meningeal artery common symptoms, 322 cranial nervous system, craniomandibular region, and, 533 551–70 neural container, 555 261 joint dysfunctions, 232 orbital region, 411 craniocervical muscles, 202, recurrent juvenile headache, somatosensory projections 270–3 604–8 onto, 110 criteria, 257 tinnitus, 477 see also specific branches definitions, 236, 257, 258, 560 hands-on vs. hands off craniocervical tinnitus, 474 facial muscles, 269–70 approach, 23–4 dysfunction masticatory muscles, 194, headaches in children, 587–616 craniocervical dystonia, 444 home therapy see Home ectopic discharges, 432, 432, 264–7, 320, 560 management EMG activity and, 235 hypnotherapy see Hypnosis 457 palpation/localization, 259–60, imagination see Imaginative following meningioma 260, 264 techniques juvenile headache see Juvenile surgery, 660 headache assessment/ management medicines, 66

732 Index basic principles, 260 muscle balance techniques, Tumours craniocervical muscles, 202, 263 adenocystic carcinoma in left maxilla, case study, 662–4, 270, 271, 271, 272, 272, muscle tone after, 234 663 273, 273 options, 261–3 facial pain, 62 facial muscles, 269, 269, 270, percussions, 262–3 post-operative, 660–2, 661 270 transverse movements, 262, glossopharyngeal nerve masticatory muscles, 194, dysfunction, 524–5 264, 264, 265, 265, 266, 263 mandibular osteosarcoma, 62 266, 267, 267 vibrations, 262–3 middle ear, passive neck suprahyoid muscles, 267, see also specific techniques flexion and, 443 267, 268, 268 see also specific muscles mimicking TMJ disorders, 383 pathophysiology, 257–8, 263 Trigonocephaly, 70, 71 nasopharyngeal, 387 central sensitization, 258 Trismus, 249–53 neuromas see Neuromas endplate hypothesis, 257–8, aetiology, 249 optic nerve dysfunction, 500 258 associated symptoms, 249 post-operative accessory nerve overuse, 257 characteristics, 249, 250 dysfunction, 488–9 peripheral nerve pathology, criteria, 249, 249 thyroid, neck stiffness, 348 560 definition, 249 trigeminal neuralgia, 459 zygapophyseal joint mandibular nerve conduction vestibulocochlear nerve dysfunction, 257 tests, 457 dysfunction, 482–3 physical examination, 259–61 radiotherapy-induced, 234 see also specific types muscle tests, 261 temporal bone and, 382 pain threshold (algometry), treatment Turned head, adducted hip, 200, 261, 261, 322 modified Trott technique, truncal curvature (TAC) passive stretching, 260–1 syndrome, 370 see also palpation/localization 251, 251–2 (above) passive mobilization, 250 ‘Twanging’ see Cranial nerve predisposing factors principles, 249–50 palpation craniocervical muscles, 271, recommended activities of 272, 273 Two finger technique, facial muscles, 269, 270 daily living, 252–3 intermaxillary movements, masticatory muscles, 264, Trochlear nerve (IV) 416, 416 265, 266–7 suprahyoid muscles, 268 anatomy/function, 43, 44, 45, Two legs standing test, 480, 480–1 prevalence, 259, 259 501–2, 502 Tympanic chord, 41 referred pain, 260, 274, 275 brainstem nuclei, 36, 37 Tympanic nerve, 43, 45, 46, 452 structure, 258 eye muscles/movement, Tympanic plexus, 45 subjective examination, 259, 502, 506 261 intracranial connections, U suprahyoid muscles, 267–8 521 symptoms orbital region, 411 ULNT see Upper limb craniocervical muscles, 271– unique features, 502 neurodynamic tests 2, 273 (ULNTs) facial muscles, 269–70 dysfunction, 519–21 masticatory muscles, 264, intracranial connections Ultrasound 265–6, 267 and, 521 cerebral palsy diagnosis, 372 suprahyoid muscles, 267–8 ocular torticollis, 520–1 local muscle dysfunction, 311 treatment palsy, 519 active facilitation, 262 pathodynamics, 519 Uncontrolled segmental basic hands on approach, trauma, 519–20 translation, local muscle 262, 262–3 dysfunction, 311 choice, 262 physical examination combination hands on neurodynamic tests, 504, Unilateral chewing, approaches, 262, 263 504, 505, 513 craniomandibular (ischaemic) compression, recording, 677 dysfunction/pain, 66 262 efficacy, 322 Trott’s method, 163–4, 164, 251 Unilateral movement, accessory frictioning, 262 automobilization, 222 movements, 206, 206 disc displacement without reduction, 222 Unilateral posterior–anterior modified, trismus treatment, movement of C2, 174–5 251, 251–2, 252 Unterberger procedure, 306 TTBS see Tongue–teeth– Upper laryngeal nerve see breathing–swallowing (TTBS) Superior (upper) laryngeal nerve

Index 733 Upper limb neurodynamic tests see also individual branches Vertical occlusion dimension, (ULNTs), 152 Validity, differentiation tests, 171 postural effects, 323–4 Vascular compression accessory nerve assessment, Vertigo 487 hemifacial spasm, 468 aetiology, 476 tinnitus, 474 associated symptoms, 483 ocular torticollis, 520 trigeminal neuralgia, 459 cervical instability, 122 passive neck flexion and, 443 Vascular disorders definition, 483 reliability, 433 glossopharyngeal neuralgia, head position and, 322, 483 Upper lip, observation/ management, balance 524 exercises, 476–7 measurement, 162 oculomotor nerve dysfunction, temporal bone and, 382 Upper motor neurone lesions tinnitus and, 476 518 vestibular neuritis and, 483 (UMNLs) vestibulocochlear nerve vestibulocochlear nerve and, facial nerve neurodynamics, 483–4 dysfunction, 482 see also Dizziness 467 Vascular headaches mandibular nerve conduction Vestibular apparatus, 478, 478 dural nociceptors, 103 dysfunction tests, 457 vasomotor see Vasomotor dizziness, 483–4 Upright postural position of the juvenile migraine, 601, 604 headaches rotation test, 481, 481 mandible (UPPM), 98, 326, Vascularization temperature test, 481 619 two legs standing test, 480, see also Mandibular resting optic nerve and, 499, 499 480–1 position vestibulocochlear nerve vertigo see Vertigo head posture and, 322, 483 V dysfunction, 482 neck muscles and, 320 Vascular neuropathic pain, 74 posture control system and, 594 Vagal plexus, 43, 46, 529, 529 Vasomotor headaches, 533–6 Vagus nerve (X) Vestibular nerve children anatomy/function, 478, 478 anatomy/function, 42, 43, 46, associated symptoms/ brainstem nuclei, 36, 37 47, 529, 529 conditions, 534 intracranial course, 481 brainstem nuclei, 35–6, 37, case study, 534, 534–6, 535 conduction tests, 480, 480–1, 529 neurodynamics, 533–4, 535 481, 484 course, 529, 533 questionnaire, 533, 533 dysfunction mechanical interface, 532–3 balance impairment, 480–1, neural container, 555 peripheral nerve pathology, 483–4 plexus, 43, 46, 529, 529 560 neuritis, 482, 483 thoracic/abdominal see also Dizziness; Vertigo innervation, 46, 529, 529 see also Migraine Verbal intervention methods, Vestibular neuritis, 482, 483 dysfunction Vestibular Schwannoma see clinical features/patterns, 91–2 532 facilitation of face muscles by Acoustic neuroma craniocervical tinnitus, 474 (vestibular Schwannoma) indicators, 163 instruction, 348 Vestibular sensation, occipitosphenoid region Verbal rating scale, pain vestibulocochlear nerve dysfunction, 373 (VIII), 477 paralysis, atlas fractures, assessment in children, 589, Vestibulocochlear nerve (VIII) 371 589 anatomy/function, 39, 42, petrosal bone and, 386 Vertebrae 477–8, 478 vasomotor headaches, 533–6 breathing/respiration role, 618 auditory sensation, 477–8 see also Migraine dural connection, 430 vestibular sensation, 477 head posture/mouth breathing see also specific branches neuromobilization, 561, 565 and, 628 conduction tests, 479–81, 484 physical examination, 529–36, malpositioning, 125 auditory nerve function, morphological changes in 532 relation to craniofacial 479, 479–80 comments, 532–6 morphology, 369–70 vestibular nerve function, conduction tests, 531–2, 532 palate and posture, 421 neurodynamics, 529–31, see also Atlanto–axial joint; 480, 480–1, 481 Atlanto–occipital joint; cranial neuromobilization, 568 530, 532 Atlas (C1); Spine palpation, 528, 531, 531 Vertebral artery, vertigo/dizziness recording, 677–8 and, 483 visceral sensation and, 532 Vertebral muscles, head posture/ mouth breathing and, 628 Vertebrobasilar insufficiency, cranial instability, 122

734 Index dysfunction passive (accessory) active cranial balance impairment/ movements see Facial neuromobilization, 554 vertigo, 480–1, 483–4 accessory movements see also Vertigo atlas fractures, 371 differential diagnoses, responses to, 401–2 balance/dizziness and, 229 482–4 see also specific techniques cervical instability dizziness, 483–4 definition, 36 see also Dizziness facial contours and, 46, 48, 412 alar ligament injury, 128–9 hearing loss, 479, 480 growth/development, 34–5, 166 graded craniocervical infections, 482 orbital region, 409 metabolic changes, 482 zygomatic bone and, 404 flexion test, 140 neuropathy, 482, 594 see also specific components history, 124–5 tumours, 482–3 Viscoelastic stiffness, 233 muscle stabilization vascularization, 482 Viscoelastic structures muscle tone, 233 exercises, 156 neurodynamics, 478–9, 479, nervous system, 558 scapulothoracic muscles, 141 484 Vision ‘chronic’, cervical dystonia, 105 dizziness/vertigo and, assessment, 498, 498 craniomandibular dysfunction, 483–4 malocclusion and, 511 65, 66, 105–9 hearing examination and, meningioma resection and, 660 anatomy, 105–7 480 trauma and, 511 articular, 107 passive neck flexion and, see also Eye(s) biomechanics, 100–1, 105–7 443 Visual analogue scale (VAS), 14, capsular stiffness and 61, 108, 196 physical examination, 477–84, children, 589, 589 balance, 229 484 maxillary adenocystic clinical/assessment, 109 comments, 481–4 carcinoma, 663 dynamic muscle tests, 192 palpation, inability to, olfactory nerve assessment, mental distress/cultural 479 496 recording, 676 Visual field, 498, 498, 499, 499 effects, 108–9 see also conduction tests; Visual information, motor control, muscular, 107, 108 neurodynamics (above) 346 neurophysiology/histology, Visualization, cortical Vestibulopathy, 482 representation, 342 105 posture control system and, Visual range of motion see VROM trigger points, 257 594 (visual range of motion) neurological dysfunction, 19, scale 107 Vestibulospinal reflexes, juvenile Volitional synergy, 340 abducens nerve migraine, 604 Voluntary movements, 346 execution of, 344–6, 349 dysfunction, 521 Vibrations, trigger point Vomer accessory nerve treatment, 262–3 palate techniques, 418 palpation, 55 dysfunction, 488, 488 ‘Vicious cycle’ model, 313 Vomeronasal nerves, 44 ophthalmic complications, 554 Viral infection(s) VROM (visual range of motion) scale exotropia, 443 oculomotor nerve dysfunction, advantages, 180 pain mechanism diagnosis, 15, 518 mouth opening frontal plane, 180, 181 16 vestibulocochlear nerve sagittal plane, 180–1 posture control system and, 594 dysfunction, 482 ‘rim lesions’, 124–5 W TMJ instability, 314–15 Virtual mirroring, 86 Wide dynamic range (WDR) Viscerocranium, 32 Weber test, 479, 480 Whiplash/whiplash-associated neurones, 432 anatomy, 54 Wiggle technique, bracing functional divisions, disorders (WAD) 401–2 acceleration–deceleration management, 248 functional ‘Wise action’, 24, 25–6 interrelationships, 402 model, 105–6, 106 Women, craniofacial dysfunction/ sutures, 54 pain, 2–3, 17 assessment/treatment, 401–24 World Confederation of Physical measurement see Measurements Therapy (WCPT), definition mouth breathing in of physiotherapy profession, children, 644 9 observation, 161–70 clinical reasoning, 11 palpation see Palpation World Health Organization (WHO), function classification see International Classification of Function (ICF)