Temporal Mandibular Joint Syndrome – A Common Source of Jaw and Facial Pain

Temporal Mandibular Joint (TMJ) Syndrome presently affects 10 million Americans and afflicts women four times more often than men between 20 and 40 years of age. TMJ syndrome is divided into three categories involving the mastication muscles and the joint.

Treatment outcome is improved with early diagnosis. Some cases of TMJ syndrome are self-limiting but most progress to a chronic state especially those with coexisting ear symptoms.

Myofascial pain dysfunction (MPD) involves the mastication muscles and is considered the most common TMJ disorder. MPD is a stress related disorder with a centrally induced increase in mandibular muscle tension that results in muscle spasm, pain and dysfunction.

Internal Derangement (ID) refers to a mechanical dysfunction between the TMJ articular disc and the mandibular condyle, fossa and articular eminence. There is an organic problem with the joint. The mandibular muscle spasm is secondary to the mechanical joint dysfunction and is not the primary problem as seen in MPD.

Degenerative Joint Disease (DJD) describes the degeneration of the articular surfaces within the TMJ.

The primary symptoms of TMJ are dull jaw pain, increased pain with chewing, limited mouth opening, and jaw clicking or popping. Secondary symptoms include earache, headache, and neck pain. Examination findings demonstrate restricted mouth opening, facial muscle spasms, TMJ tenderness, TMJ clicking or popping, TMJ crepitus, and mandibular lateral deviation. Diagnostic evaluation includes x-rays, CT and/or MRI.

Conservative care consists of analgesics, muscle relaxants, moist heat, massage, and physical therapy. Interventional treatment includes intra-articular TMJ steroid injections, Botox injections of the temporalis muscle, and radiofrequency. TMJ joint arthroplasty is considered as a last result in appropriate candidates with refractory pain.