Temporo Mandibular Joint Diagnostics and Treatment in Germany

The Joint is part of your skull with ist fossa but also part of your lower jaw with the condyles. As a whole it is a very complex Joint with many muscles for many different moves. There are many things and conditions, not to talk about traumatic situations and accidents in life that can cause irritations of that complex system. It is formed by the mandibular condyle and the glenoid fossa of the temporal bone; a cartilaginous articular disk functions as a cushion between the joint surfaces. The anatomic most importand details shown in the graphic are:1. Mandibular fossa 2. Articular disk 3. Condylar head 4. Articular tubercle 5. Masseter 6. Acoustic meatus. To treat this it needs very much experience and last not least wide spread diagnostics.

The term temporomandibular disorders is an umbrella term for conditions causing dysfunction of the jaw joint or pain in the jaw and face, often in or around the temporomandibular joint (TMJ), including masticatory and other muscles of the head and neck, the fascia, or both. A person is considered to have a temporomandibular disorder only if pain or limitation of motion is severe enough to require professional care. Temporomandibular disorders typically are multifactorial, but most are related to problems with muscles or joints. Internal derangements of the TMJ cause disturbed movement of the mandibular condyle in the glenoid fossa or against the cartilaginous articular disk. This disk, shaped like a donut with a closed hole or like a mature red blood cell, serves as a cushion between joint surfaces. Causes for this disturbed movement include clenching gnashing and grinding of the teeth, trauma, arthritis, and malocclusion and missing teeth. Even the trauma of persistent gum chewing can be enough to damage the joint.

Disorders of the TMJ must be distinguished from the many conditions that mimic them. Pain exacerbated by finger pressure on the joint when the mouth is opened implicates the TMJ. Manual analysis of TMJ-functions means that patients are first asked to describe the pain and designate painful areas. The cervical and occipital muscles and each of the major muscle groups involved in mastication are palpated for general tenderness and trigger points (spots that radiate pain to another area). Patients are observed opening the mouth as wide as is comfortable. When patients open and close their mouth with the junction of the maxillary and mandibular central incisors (normally in the midline) lined up against a vertical straight edge, the mandibular midline typically deviates toward the painful side. Palpation and auscultation of the joint during opening and closing may reveal tenderness, catching, clicking, or popping. Condylar motion can best be palpated by placing the 5th fingers into the external auditory meatus and exerting very gentle forward pressure as patients move the jaw. The average-sized patient can open the mouth at least 40 to 45 mm (measured between upper and lower central incisors). To account for differences in patient size, a patient should be able to fit 3 fingers (index, middle, ring) in the mouth on top of each other.Trismus, the inability to open the mouth, may indicate temporomandibular disease (the most common cause), pericoronitis, scleroderma, arthritis, ankylosis of the TMJ, dislocation of the temporomandibular disk, tetanus, or peritonsillar abscess. Unusually wide opening suggests subluxation or type III Ehlers-Danlos syndrome.

To show you how complicated sometimes the TMJ-diagnostic is here are some symptom and following conditions that Mimic Temporomandibular Disorders: a.)Headaches: Sinusitis, Temporal arteritis, Tension, migraine, and cluster headaches b.)Pain: Postherpetic neuralgia Reflex sympathetic dystrophy or traumatic neuroma after head or neck surgery, Toothache, Trigeminal neuralgia c.) Pain accompanied by hearing problems: Obstruction of the ear canals or eustachian tubes, Otitis media d.)Pain in the head, neck, and other areas of the body: Fibromyalgia, Generalized myofascial pain e.)Pain, numbness: Intracranial aneurysm, Metastatic tumors f.)Pain that radiates to the temporomandibular joint region: Whiplash injuries affecting muscle or cervical spine g.)Pain that worsens when the patient swallows or turns the head: Cervical spine or muscle disorders, Eagle’s syndrome (calcified styloid process), Glossopharyngeal neuralgia, Subacute thyroiditis h.)Trismus: Depressed fracture of the zygomatic arch, Infection,Osteochondroma of the coronoid process, Pericoronitis.