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The Physical Therapy Board 
of Craniofacial & Cervical Therapeutics
HomeCertification Development

Development of the Examination

Development of the examination has been guided by Measurement Research Associates, an independent psychometric testing service for the dental and medical profession. Annual review and updating is performed according to statistical analysis, clinical and scientific advances and to ensure parity with the specialty certification examination requirements of the APTA. Each successful candidate is designated as a "Certified Cervical and Temporomandibular Therapist" (CCTT) with name, practice location and contact information posted within the PTBCCT website (www.ptbcct.org) for those seeking a qualified physical therapist within this specialized field.

 

STUDY GUIDE

 

HOW TO PREPARE FOR THE EXAMINATION

 

  1. The examination blueprint and study guide that follows outlines the specific content areas of knowledge that are included in the examination.
  2. A few sample questions are provided and presented in the exact same format as those included in the examination.
  3. A suggested reading list of books and journal articles for review are included. Please note that the PTBCCT does not endorse any of the specific texts nor state that the list is entirely comprehensive. Furthermore, the list does not in any manner represent that questions on the examination have been taken directly from these sources.

 

 

Subject Areas Consist of the Following Categories: Items Percentage
1. Temporomandibular & Cervical Anatomy 17 15%
2. Temporomandibular & Cervical Biomechanics 23 21%
3. Management of Cervical Spine Disorders 6 5%
4. Dental Terminology 5 5%
5. Epidemiology of Cervical & Temporomandibular Disorders 5 5%
6. Oral Appliances 5 5%
7. Evaluation and Differential Dx. Of TMD & Orofacial Pain 18 16%
8. Temporomandibular Joint Surgery 6 5%
9. Management of TMD & Orofacial Pain 13 12%
10. Evaluation & Differential DX. of Cervical Spine Disorders 12 11%

 

 

Recommended For Review

 

Please note that the following textbooks, chapters, course manuals and journal publications represent references that are continually updated that were submitted by the examination development team of physical therapists, dentists, oral surgeons and the examination review committee in support of each test item.

Items in bold are highly recommended for review.

Journal Articles

  1. Do TP, Heldarskard GF, Kolding LT, et al. Myofascial trigger points in migraine and tension-type headache. The Journal of Headache and Pain. 19(1), 2018.
  2. Gil-Martinez A, Paris-Alemany A, López-De-Uralde-Villanueva I, et al. Management of pain in patients with temporomandibular disorder (TMD): challenges and solutions. Journal of Pain Research. Volume 11: 571-587, 2018.
  3. Landgraf M, Biebl J, Langhagen T, et al. Children with migraine: Provocation of headache via pressure to myofascial trigger points in the trapezius muscle? - A prospective controlled observational study. European Journal of Pain. 22(2): 385-392, 2018.
  4. Michelini G, Corridore A, Torlone S, et al. Dynamic MRI in the evaluation of the spine: state of the art. Acta Biomed. 89(1-S): 89-101, 2018.
  5. Kraus S, Prodoehl J. Disc displacement without reduction with limited opening: A clinical diagnostic accuracy study. Physiotherapy Theory and Practice. 33(3): 238-244, 2017.
  6. Kraus SL, Prodoehl J. Outcomes and patient satisfaction following individualized physical therapy treatment for patients diagnosed with temporomandibular disc displacement without reduction with limited opening: A cross-sectional study. Cranio. 1-8, 2017.
  7. van der Meer HA, Speksnijder CM, Engelbert RHH, et al. The Association Between Headaches and Temporomandibular Disorders is Confounded by Bruxism and Somatic Symptoms. Clin J Pain. 33(9): 835-843, 2017.
  8. Yang Z, Wang M, Ma Y, et al. Magnetic Resonance Imaging (MRI) Evaluation for Anterior Disc Displacement of the Temporomandibular Joint. Medical Science Monitor. 23:712-718, 2017.
  9. Giraudeau A, Jeany M, Ehrmann E, et al. Disc displacement without reduction: a retrospective study of a clinical diagnostic sign. Cranio. 35(2): 86-93, 2016.
  10. Heidsieck DS, Smarius BJ, Oomen KP, et al. The role of the tensor veli palatini muscle in the development of clef palate-associated middle ear problems. Clin Oral Investig. 20(7): 1389-401, 2016.
  11. Julsvoll EH, Vøllestad NK, Robinson HS. Validation of clinical tests for patients with long-lasting painful temporomandibular disorders with anterior disc displacement without reduction. Manual Therapy. 21: 109-119, 2016.
  12. Khalifa GA, El-Kilani NS, Shokier HM. Physiotherapy Maneuver Is Critical to Recover Mouth Opening After Pediatric Trauma. J Oral Maxillofac Surg. 74(12): 2465-2479, 2016.
  13. Kumazaki Y, Kawakami S, Hirata A, et al. Ipsilateral Molar Clenching Induces Less Pain and Discomfort than Contralateral Molar Clenching in Patients with Unilateral Anterior Disc Displacement of the Temporomandibular Joint. Journal of Oral & Facial Pain and Headache. 30(3): 241-248, 2016.
  14. Manfredini D, Segù M, Arveda N, et al. Temporomandibular Joint Disorders in Patients With Different Facial Morphology. A Systematic Review of the Literature. Journal of Oral and Maxillofacial Surgery. 74(1):29-46, 2016.
  15. Michiels S, Naessens S, Van de Heyning P, et al. The Effect of Physical Therapy Treatment in Patients with Subjective Tinnitus: A Systematic Review. Front Neurosci. 10: 545, 2016.
  16. Harrison AL, Thorp JN, Ritzline PD. A proposed diagnostic classification of patients with temporomandibular disorders: implications for physical therapists. Journal of Orthopaedic and Sports Physical Therapy. 44(3): 182-97, 2014.
  17. Kietrys DM, Palombaro KM & Mannheimer JS. Dry needling for management of pain in the upper quarter and craniofacial region. Current Pain & Headache Reports. 18(8): 437- 446, 2014. 
  18. Kraus SL. Characteristics of 511 patients with temporomandibular disorders referred for physical therapy. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 118(4): 432-439, 2014.
  19. Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: Recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Groupdagger. Journal of Oral Facial Pain. 28: 6-27, 2014.
  20. Schiffman E, Velly A, Look J, et al. Effects of four treatment strategies for temporomandibular joint closed lock. International Journal of Oral and Maxillofacial Surgery. 43(2): 217-226, 2014.
  21. La Touche, R, Paris-Alemany A, Mannheimer JS. et al. Does Mobilization of the Upper Cervical Spine Affect Pain Sensitivity and Autonomic Nervous System Function in Patients with Cervico-Craniofacial Pain?  A Randomized Controlled Trial. Clinical Journal of Pain. 29(3): 205-215, 2013.
  22. Naeije M, Te Veldhuis AH, Te Veldhuis EC et. al. Disc displacement within the human temporomandibular joint: a systematic review of a 'noisy annoyance'. J Oral Rehabil. 40: 139-58, 2013.
  23. La Touche R, Paris-Alemany A, von Piekartz H, Mannheimer JS et al. The Influence of Cranio-Cervical Posture on Maximal Mouth Opening and Pressure Pain Threshold in Patients with Myofascial Temporomandibular Pain Disorders. Clinical Journal of Pain. 27(1): 48-55, 2011.
  24. Liu XM, Zhang SY, Yang C, et al. Correlation between disc displacements and locations of disc perforation in the temporomandibular joint. Dentomaxillofacial Radiology. 39(3):149-156, 2010.
  25. Maizlin ZV, Nutiu N, Dent PB, et al. Displacement of the Temporomandibular joint Disk: Correlation Between Clinical Findings and MRI Characteristics. Journal of the Canadian Dental Association. 76:a3, 2010.
  26. Naeije M, Kalaykova S, Visscher CM, et al. Evaluation of the research diagnostic criteria for temporomandibular disorders for the recognition of anterior disc displacement with reduction. British Dental Journal. 208(3): 113-113, 2010.
  27. Klasser GD, Greene CS. Oral Appliances in the management of temporomandibular disorders. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endontology. 107(2): 212-23, 2009.
  28. Mito T, Ishizaki K, Suzuki K, Sato S. Mandibular lateral translation during symmetric mandibular movement. International Journal of Stomatology & Occlusion Medicine. 2(1): 24-31, 2009.
  29. Gilbert JW, Wheeler GR, Lingreen RA, et al. Imaging in the position that causes pain. Surg Neurol. 69(5) 463-5, 2008.
  30. Suzuki F, Fukami T, Tsuji A, et al. Discrepancies of MRI findings between recumbent and upright positions in atlantoaxial lesion. Report of two cases. European Spine Journal. 17(S2): 304-307, 2008.
  31. Ekberg EC & Nilner M. Treatment outcome of short and long-term appliance therapy in patients with TMD of myogenous origin and tension-type headache. J Oral Rehab. 33: 713-721, 2006.
  32. Shhati-Chafai-Leuwer S, Wenzel S, Bschorer R, et al. Pathophysiology of the eustachian tube- relevant new aspects for the head and neck surgeon. Craniomaxillofac Surg, 34: 351-354, 2006.
  33. Visscher CM, Hofman N, Mes C, Lousberg R, Naeije M. Is temporomandibular pain in chronic whiplash associated disorders part of a more widespread pain syndrome? Clin J Pain 21(4): 353-357, 2005. 
  34. Teachey WS. Otolaryngic myofascial pain syndromes. Current Pain and Headache Reports. 8(6): 457-462, 2004.
  35. Jinkins JR, Dworkin J. Proceedings of the State-of-the-Art Symposium on Diagnostic and Interventional Radiology of the Spine, Antwerp, September 7, 2002 (Part two). Upright, weight-bearing, dynamic kinetic MRI of the spine: pMRI/kMRI. JBR-BTR. 86(5): 286-93, 2003.
  36. Leuwer R, Schubert R, Kucinski T, et al. The muscular compliance of the auditory tube: a model-based survey.Laryngoscope. 112:1791-1795, 2002.
  37. Mannheimer JS & Montalbano R. Postoperative management for surgical procedures to the temporomandibular joint. Orthopedic Physical Therapy Clinics of No Am. 11(2): 235-261, 2002.
  38. Kalaykova S, Lobbezoo F, Naeije M. Effect of chewing upon disc reduction in the temporomandibular joint. Journal of Orofacial Pain. 25(1): 49-55, 2001.
  39. Murray GM, Phanachet I, Uchida S, et al. The role of the human lateral pterygoid muscle in the control of horizontal jaw movements. J Orofacial Pain. 15(4): 279-305, 2001.
  40. Svensson and Graven-Nielson. Craniofacial Muscle Pain: Review of Mechanisms and Clinical Manifestations. J Orofac Pain. 15(2): 117-45, 2001.
  41. Visscher CM, Lobbezoo F, Boer W de, Zaag Jac van de, Naeije M. Prevalence of cervical spinal pain in craniomandibular pain patients. Eur J Oral Sci. 109:76-80, 2001.
  42. Linton SJ. A review of psychological risk factors in neck and back pain. Spine. 25: 1148-1156, 2000.
  43. Visscher CM, Huddleston Slater JJR, Lobbezoo F, Naeije M: Kinematics of the human mandible for different head postures. J Oral Rehabil. 27(4): 299-305, 2000.
  44. Danielle AWM, Geert JMG, et al. Ultrasound therapy for musculoskeletal disorders: a systematic review. Pain: 81, 1999.
  45. Eriksen W, et al. Job characteristics as predictors of neck pain. Journal of Occupational and Environmental Medicine.  41(10): 893-902, 1999.
  46. Rantanen J, Thorsson O, Wollmer P, et al. Effects of therapeutic ultrasound on the regeneration of skeletal myofibers after experimental muscle injury. Am Sports Med. 27(1): 54-59, 1999.
  47. Visscher CM, Boer W de, Naeije M. The relationship between posture and curvature of the cervical spine. J Manip Physiol Therapy. 21(6):388-391, 1998.
  48. Bailey DR. Sleep disorders: Overview and relationship to orofacial pain. Dental Clinics of No Am. 41(2): 189-209, 1997.
  49. Heir GM. Differentiation of orofacial pain related to lyme disease from other dental and facial pain disorders. Dental Clinics of No Am. 41(2): 243-258, 1997.
  50. Okeson JP & Falace DA: Nonodontogenic toothache. Dental Clinics of No Am. 41(2): 367-383, 1997.
  51. Pollmann W, Keodel M & Pfaffenrath V. Headache and the cervical spine: A critical review. Cephalgia. 17(8): 801-816, 1997.
  52. De Wijer, J. Rob J. de Leeuw, Michel H. Steenks, et al. Temporomandibular and cervical spine disorders: self-reported signs and symptoms. Spine. 21: 1638, 1996.
  53. De Leeuw R, Boerin, G, Stegenga B, et al. Clinical Signs of TMJ Osteoarthrosis and Internal Derangement 30 years After Nonsurgical Treatment. J Orofac Pain. 8(1): 18-24, 1994.
  54. Carlson CR, Okeson JP, Falace DA, et al. Reduction of pain and EMG activity in the masseter region by trapezius trigger point injection. Pain. 55: 397-400, 1993.
  55. Greenman PE. Principles of manipulation of the cervical spine. J Man Med 6, 106-113, 1991.
  56. Levine HL. Otorhinolaryngologic causes of headache. In Diamond S (ed). Headache. Medical Clinics of No Am. 75: 677-692, 1991.
  57. Schmitt HP. Anatomical structure of the cervical spine with reference to the pathology of manipulation complications. J Man Med 6: 93-101, 1991.
  58. Rocabado, M. Journal of Craniomandibular Disorders: Facial & Oral Pain.3(2): 75 – 82, 1989.
  59. Wazen JJ: Referred otalgia. Otolaryngologic Clinics of No Am. 22(6): 1205-1215, 1989.
  60. Steiger HJ. The anatomy of headache. J Man Med. 3: 15-17, 1987.
  61. Dvorak J & Panjabi MM. Functional Anatomy of the Alar Ligaments. Spine.12:2, 1987.
  62. Mohl, N. Head Posture and its Role in Occlusion. New York State Dental Journal, Vol 47, 1976

Textbooks and Chapters

  1. Travell J, Simons D, Myofascial Pain and Dysfunction: The Trigger Point Manual. 3rd ed. Wolters Kluwer, 2019.
  2. De Leeuw R. (ed). Orofacial Pain: Guidelines for Assessment, Diagnosis and Management. 6th ed. of the American Academy of Orofacial Pain. Quintessence Books, Chicago, 2018.
  3. Fernández-de-las-Peñas C, Mesa-Jiménez J. Temporomandibular Disorders: Manual Therapy, Exercise, and Needling. Pencaitland, East Lothian, Scotland: Handspring Publishing Limited, 2018.
  4. Kraus, S., Bender, S., Prodoehl J.  Muscle-Based Conditions in Temporomandibular Disorders: A Translational Approach From Basic Science to Clinical Applicability, Editors Gremillion H.A. and Klasser, G.D., © Springer International Publishing AG 2018, pp 141-171.
  5. Mannheimer JS, Kraus SL, Hesse, JR & Visscher  C.  Chapter 9: Cervicogenic Mechanisms of Orofacial Pain and Headaches.  Guidelines for Assessment, Diagnosis and Management In: De Leeuw, R. (ed). Chicago: Quintessence Books, 2008.
  6. Sollecito T. Role of splint therapy in treatment of temporomandibular disorders. In: Fonseca RJ, editor. Oral and Maxillofacial Surgery: Temporomandibular Disorders. 1st ed., Vol. 4. Philadelphia: Saunders Publishers; 2007. p. 145-60.
  7. Fonseca RJ, editor. Oral & Maxillofacial Surgery; Temporomandibular Disorders,vol 4. 1st edition Philadelphia: W.B. Saunders Company. 2000.
  8. Erkonen WE. Radiology 101: The Basics and Fundamentals of Imaging. Philadelphia, PA. Lippincott, Williams and Wilkins, 1998.
  9. Foreman and Croft (eds.) Cervical Acceleration/Deceleration Syndromes. Baltimore: Williams and Wilkins, 1998.
  10. McKinnis, LN. Fundamentals of Orthopedic Radiology. Philadelphia, PA: F.A. Davis Company; 1997.
  11. Boissonnault, WG (ed): Examination in Physical Therapy Practice. Screening for Medical Disease. 2nd edition. Philadelphia: Churchill Livingstone, 1995.
  12. Dunn J & Mannheimer JS. The Cervical Spine.  In Pertes, R.A. (ed.) Clinical Management of Temporomandibular Disorders and Facial Pain. Quintessence Books, Chicago, 1995.
  13. Mannheimer JS. An Overview of Physical Therapy Modalities and Procedures. In Pertes, R.A. (ed.) Clinical Management of Temporomandibular Disorders and Facial Pain. Quintessence Books, Chicago, 1995.
  14. Pertes R, Gross S. Clinical Management of Temporomandibular Disorders and Orofacial Pain. Quintessence, 1995.
  15. Porterfield J, DeRosa C. Mechanical Neck Pain, 1995.
  16. Edeling J. Manual Therapy for Chronic Headache. Oxford: Butterworth Heinemann, 1994.
  17. Kraus SL. Temporomandibular disorders. 2nd. Edition. Clinics in Physical Therapy, Churchill Livingstone, 1994.
  18. Mannheimer, JS. Postoperative Physical Therapy Protocols: Post-arthroscopic Surgery. In Kraus SL (ed). TMJ Disorders:  Management of the Craniomandibular Complex. Second Edition, Churchill Livingstone, 1994.
  19. Mannheimer JS.  Prevention and Restoration of Abnormal Upper Quarter Posture. In Gelb, H & Gelb M (eds.) Postural Considerations in the Diagnosis and Treatment of Cranio-Cervical-Mandibular and Related Chronic Pain Disorders. Mosby, 1994.
  20. Dunn J. Physical therapy. In Kaplan AS, Assael LA (eds). Temporomandibular Joint Disorders: Diagnosis and Treatment. Philadelphia: Saunders, 1992.
  21. Kaplan & Assael. Temporomandibular Disorders: Diagnosis and Treatment. Philadelphia: Saunders, 1991.
  22. Mannheimer JS & Dunn J. The Cervical Spine:  Its Evaluation and Relation to Temporomandibular Disorders.  In Kaplan, A. (ed).  Textbook of Craniomandibular Disorders. WB.Saunders, 1991.
  23. Rocabado M, Iglarsh, ZA. Musculoskeletal Approach to Maxillofacial Pain. Philadelphia: J. B. Lippincott Company, 1991.
  24. Rosenblatt MA. Ocular pain. In Jacobson AL & Donlon WC (eds.) Headache and Facial Pain. New York: Raven Press pp. 169-219, 1990.

Cervical & TMD Course Manuals by the following:

  1. Steve Kraus
  2. Michael Karegeannes
  3. Jeffrey S. Mannheimer
  4. Mariano Rocabado
  5. Patt Rudd
  6. Mark Strickland and Jennifer Hobson

SAMPLE QUESTIONS

 

1. The following reflex has strong validity regarding lesions affecting the upper motor neurons often associated with cervical myelopathy. This reflex, if positive, may denote spinal cord compression or intracranial pathology that should be fully evaluated by a radiologic work-up. A positive reflex sign is present if the patient’s index finger and thumb flex while the clinician snaps / flicks their middle finger. The name of this reflex is?

 

A. Upper Babinski Reflex

B. Hoffman’s Reflex

C. Torg-Pavlov Reflex

D. Sugarman’s Reflex

 

2. Eagles Syndrome is craniofacial pain produced by active cervical rotation compressing sensitive cervical spine structures against the elongation of which of the following processes?

 

A. Zygomatic process

B. Styloid process

C. Uncinate process

D. Mastoid process

 

3. Which of the following groups of cranial nerves travel with the spinal tract of trigeminal?

 

A. Olfactory, facial, oculomotor, vagus, and abducens

B. Facial, vagus, glossophayngeal, optic, and trochlear

C. Vagus, spinal accessory, facial, hypoglossal, and glossophyarngeal

D. Glossopharyngeal, vagus, acoustic, trochear, and oculomotor

 

4. In an MRI of the temporomandibular joint taken in the sagittal plane, the part of the temporomandibular disk that is located just behind the posterior band is the?

 

A. Bilaminar zone

B. Epimysium

C. Lateral pterygoid muscle

D. Temporomandibular ligament

 

5. A patient complains of sensibility loss of the skin of the temporal region and around the ear. Moreover, propriosepsis of the temporomandibular joint is affected. Which nerve is most probably affected?

 

A. Auriculotemporal

B. Spinal Accessory

C. Supraorbital

D. Facial

 

6. A physical therapist is manually palpating the area between the lateral border of the trapezius muscle and the posterior border of the sternocleidomastoid muscle, one centimeter below the suboccipital bone. Which muscular structure is she palpating?

 

A. Oblique Capitis Superior

B. Rectus Capitis Anterior

C. Rectus Capitis Lateralis

D.Splenius Capitis

 

7. In a patient presenting with posterior cranial rotation, the lateral cervical X-ray would likely disclose:

 

A. Narrowing of the C5-C6 interspace

B. Advanced degenerative joint disease

C. Multiple disc herniations

D. Decreased distance between the occiput and C1

 

8. A patient has a diagnosis of a displaced disc without reduction of the right temporomandibular joint. Which clinical sign would most likely be expected upon functional examination?

 

A. A deflection upon protrusive movement to the left

B. A deviation of the mandible throughout opening and closing

C. An intermediate “click” with opening and closing

D. A restriction of lateral movement to the left

 

9. A patient has an active mouth opening of 57 mm, a left deviation on opening, a clicking sound at the end of opening and at the beginning of closing, laterotrusion to the left side of 13 mm, and to the right side of 10 mm. She has no history of trauma. What is the most likely diagnosis?

 

A. Anterior disk displacement with reduction of the left temporomandibular joint

B. Anterior disk displacement with reduction of the right temporomandibular joint

C. Hypermobility of the left temporomandibular joint

D. Hypermobility of the right temporomandibular joint

 

10. A female patient complains of recurring headaches manifesting in attacks lasting one to two days. It has a unilateral character, a pulsating quality, and is associated with nausea, photophobia, and phonophobia. What type of headache is she suffering from?

 

A. Cervicogenic headache

B. Cluster headache

C. Migraine

D. Tension-type headache

 

11. A 60 year old female patient is sent to a physical therapist for treatment of myofascial jaw pain. On examination, tenderness of the masticatory muscles to palpation is found on both sides. In addition, with mandibular range-of-motion movements, the patient winces and complains of electric shock-like pains in her left cheek and upper jaw. In addition to myofascial pain, the most likely diagnosis is:

 

A. Atypical odontalgia

B. Glossopharyngeal neuralgia

C. Paroxysmal hemicrania

D. Trigeminal neuralgia

 

 

Answer Key: 1. ( b), 2. (b), 3. (c), 4. (a), 5. (a), 6. (d), 7. (d), 8. (d), 9. (d), 10. (c), 11. (d).