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Temporomandibular joint disorders - (TMJ)
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Temporomandibular joint disorders - (TMJ)

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Joint Dysfunction

Temporomandibular joint dysfunction is defined as any abnormality in joint function that impairs mandibular mobility. A lateral deviation of the jaw observed when the mouth is slowly opened may be a sign of joint dysfunction. Some patients complain of noises (clicking, popping, grating or grinding) and restricted mouth opening.[7] Patients frequently acknowledge these symptoms and report many seemingly unrelated vague symptoms of the head, neck and shoulders. Commonly reported symptoms may be classified as musculoskeletal, auditory, visual, oral/ dental or aerodigestive (Table 1).


Subjective and Objective Findings in Patients with Temporomandibular Joint Disorder

Area affected

Subjective  Objective
Face Pain  Tenderness, muscle spasm, asymmetry
Head Muscular headache Tenderness over temporalis muscle, muscle spasm
Eyes Retrobulbar pain Blepharospasm
Sinus Pain or pressure Tenderness
Ears Otalgia  Preauricular tenderness
Jaw Pain, Clicking or popping, Abnormal movement   Temporomandibular joint crepitus, Deviation or deflection on opening, Reduced range of motion
Mouth  Limited opening,  Locking open or closed, Pain on opening Opening compromised, Locked open or closed, Trismus
Teeth Bruxism,  Pain, Malocclusion, Dentures Worn occlusal surfaces of teeth, Loose molars, Missing or malaligned teeth, Poorly fitting prosthesis
Throat Sensation of foreign object in throat Anterior or posterior neck pain

Adapted from the K-F-S Index of Temporomandibular Joint Symptoms. National Capital Center for Craniofacial Pain, Vienna, Va. Used with permission.

On physical examination, the hallmark of temporomandibular joint disorder is decreased range of mandibular motion.[3] Range of motion is easily assessed by measuring maximum mouth opening and lateral movement of the mandible. Mouth opening is measured between the biting edges of the incisors and is normally 50 mm. Lateral movement is measured by active movement of the mandible to each side of the midline between the maxillary incisors. Normal lateral movement is 12 mm on each side of the midline. Any disparity from these norms should alert the physician to impaired mandibular range of motion.

If the range of motion is not impaired, dysfunction may be detected when mandibular motion is accompanied by clicking, deflections, deviations or pain (Figure 3). Other findings include spasm and tenderness of various facial or neck muscles, preauricular tenderness, facial asymmetry, malocclusion and chronic postural head tilting (Table 1).

The list of possible etiologies for temporomandibular joint disorders is extensive (Table 2).[2,9] The classification includes traumatic, iatrogenic, idiopathic, systemic, congenital, infectious and psychogenic causes.[4,7] The most frequent causes of temporomandibular joint disorders are head and neck trauma, and idiopathic and iatrogenic injuries. [11]


Etiologies of Temporomandibular joint Dysfunction
Traumatic Systemic
Osteoarthritis (OA). Rheumatoid arthritis
Maxilla/mandibular trauma    gout
Condylar fracture Paget's disease
Temporomandibular joint subluxation Psoriatic arthritis
Whiplash    Infectious
Dental   Gonorrhea
Malocclusion  Syphilis
Reconstruction  Tuberculosis
Prosthesis  Actinomycosis
Orthodontic work  Rheumatic fever
latrogenic  Idiopathic
Orthognathic surgery        Congenital
Oral surgery  Aplasia
Endotracheal intubation Hyperplasia, Hypoplasia, Bifid condyle, Psychogenic, Stress, Bruxism

Derived from McDonald [2] and Heir. [9]

Direct blows to the mandible and the maxillae, as well as mandibular whiplash, are commonly sustained in motor vehicle accidents. In severe whiplash cases, the head is thrown backwards and the mandible is uncontrollably hyperextended, resulting in potentially severe injury to the temporomandibular joint.


Temporomandibular joint disorders - (TMJ) > 1 > 2 > 3 > 4

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