Background
The TMJ is a synovial joint between the condyle of the mandible and the articular tubercle of the temporal bone. There is an articulating disk within the joint space that is liable to be caught between the hyaline surfaces. The joint is supplied by the V (Trigeminal) nerve - pain may be intense.
Pathology may be due to local (bruxism/teeth grating) or systemic (OA or rheumatoid arthritis).
History
- Pain (usually unilateral) in muscles of mastication
- Radiates to ear & is worse on chewing
- Jaw may lock on opening
- Ear popping or clicking is usually present
- History of teeth grinding may be present but patient often unaware (ask partner)
- F:M = 4:1, 20-40yo
Exam
- Limited jaw opening (normal > 4cm between incisors)
- Masseteric spasm and swelling
- Audible TMJ click
- TMJ tenderness (in ext auditory meatus, mouth open)
- Joint crepitus
Differential Dx
- Dental trauma / infections
- TMJ dislocation / #
- Headache: Cluster, Migraine, Tension
- Otitis media
- Trigeminal neuralgia
- Sinusitis
Investigations
- ESR if temporal arteritis suspected
- No imaging required unless trauma (#)
Management
You need to inform the patient that there is no quick fix for this.
Oral treatment
- Analgesia & anti inflammatory (regular paracetamol with ibuprofen/Diclofenac)
- Oral Diazepam as a muscle relaxant (acute or nocturnal)
Topical treatment
- Topical heat and massage (heat pack to face)
- Topical anti inflammatory (Voltarol® gel)
Referral
- Referral to the dental hospital for a mouth guard the following morning