Anatomical background and symptoms
TMJ biomechanics are closely related to its complex structure. The mandibular condyle is ellipsoidal in shape. The lower head of the lateral pterygoid muscle (m. pterygoideus lateralis) attaches to the anterior surface of the condylar process, while its upper head attaches to the biconcave articular disc itself.
Internal joint dysfunctions present with a characteristic set of symptoms:
- Pain in the muscles involved in mastication;
- Difficulty opening the mouth;
- Intermittent locking and clicking in the joint;
- Occlusal changes and general functional impairment.
Conservative regimen and pharmacotherapy
The basis of successful treatment is providing relative rest for the masticatory muscles and ligamentous apparatus. The patient is prescribed a gentle regimen, which includes a strict diet consisting exclusively of soft foods. In some cases, jaw immobilization with a sling bandage is indicated. An important rule: the range of mouth opening must be limited to the threshold beyond which crunching or clicking occurs, or the jaw shifts to the side.
Pharmacological support is used to relieve muscle spasm and correct psycho-emotional status. The treatment regimen usually includes:
- Tranquilizers (Seduxen, Elenium, Tazepam);
- Muscle relaxants (Mydocalm);
- Analgesics.
Physiotherapy treatment
Hardware methods are widely used to relieve pain syndrome and relax muscles.
Transcutaneous electrical nerve stimulation (a type of reflexology) has high efficacy. Its main advantages are non-invasiveness and the complete absence of toxic and allergic reactions. Patients are also prescribed bilateral electrophoresis with an anesthetic targeting the masticatory muscles (a standard course consists of 10 procedures). Magnetotherapy and fluctuotherapy are used as additional physiotherapeutic methods.
Therapeutic exercises
Joint exercises are prescribed strictly after the acute pain syndrome subsides. They should be performed three times a day, mandatory in front of a mirror for visual control of movements.
The technique involves smoothly opening and closing the mouth without lateral shifting of the mandible. The patient should place index fingers on the condylar heads while gently supporting the jaw with the remaining fingers. The goal of the gymnastics is to gradually increase the range of mouth opening while maintaining rectilinear movements to prevent muscle strain.
Prognosis and prevention
Subject to all recommendations, positive results (pain relief and normalization of range of motion) are observed within 3–4 weeks. However, if the patient retains uncorrected occlusal disorders, the improvement may be only temporary.
To prevent the syndrome and avoid ligament strain, it is necessary to:
- Normalize the bite in a timely manner;
- Exclude excessively coarse and hard foods from the diet;
- Avoid excessive mouth opening (e.g., during yawning, complex tooth extractions, or prolonged dental treatment).
Briefly: answers to topical questions
Which ligaments reinforce the temporomandibular joint?
- Intracapsular ligaments fix the articular disc to the temporal bone anteriorly and posteriorly, and also connect the lateral margins of the disc to the lateral surfaces of the neck of the mandibular condylar process.
- Lateral (temporomandibular) ligament is located laterally outside the articular capsule and is the only proper joint ligament.
- Accessory ligaments — pertain to the joint but are not connected to the joint capsule.
All ligaments are formed by fibrous inelastic connective tissue.
Class and exam questions
What is the difference between TMJ dysfunction and osteoarthritis?
Osteoarthritis is a degenerative-destructive disease primarily affecting the articular cartilage, followed by bone tissue proliferation (sclerosis, osteophytes). Dysfunction, however, is mainly associated with muscle spasm and internal derangements, often without destruction of bony structures.
When can jaw gymnastics be started?
Therapeutic physical culture is prescribed strictly after acute pain is relieved. Forcing exercises can lead to masticatory muscle strain and worsening of the condition.
What should acute TMJ pain be differentiated from?
Acute joint pathology (e.g., infectious arthritis) must be differentiated from a mandibular condyle fracture and acute otitis media.
Why can joint pain return after successful treatment?
Most often, relapses and temporary improvements are associated with uncorrected occlusal disorders (malocclusion) remaining in the patient, which continue to traumatize the joint.
What else to study on this topic
- Radiological signs and stages of TMJ osteoarthrosis development
- Features of MRI diagnostics of the articular disc position in internal dysfunctions
- Differential diagnosis of infectious arthritis and condylar process fracture
- Clinical presentation and causes of TMJ ankylosis development
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Other topics in "Chapter 13. Temporomandibular Joint Disorders (V.V. Bekreev)"
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