Temporomandibular Disorder

Presentation

Patients usually complain of poorly localized facial pain or headache that does not appear to conform to a strict anatomic distribution. The pain is generally dull and unilateral, centered in the temple above and behind the eye, and in and around the ear. The pain may be associated with mastication and passive movement of the mandible, instability of the temporomandibular joint (TMJ), crepitus, or clicking with movement of the jaw. It is often described as an earache.

Other, less obvious symptoms include radiation of pain down the carotid sheath, tinnitus, dizziness, decreased hearing, itching, sinus symptoms, a foreign-body sensation in the external ear canal, and trigeminal, occipital, and glossopharyngeal neuralgias.

Patients may have been previously diagnosed with migraine headaches, sinusitis, or recurrent external otitis. Predisposing factors include malocclusion, trauma, recent extensive dental work, or a habit of grinding the teeth (bruxism), all of which put unusual stress on the TMJ.

Clinical signs include tenderness of the chewing muscles, the ear canal, or the joint itself; restricted opening of the jaw or lateral deviation on opening; and a normal neurologic examination.