Temporomandibular

Temporomandibular refers to the temporomandibular joint (TMJ) and the surrounding region of the jaw, including the muscles of mastication and supporting ligaments. The TMJ is the bilateral, synovial joint where the mandible meets the temporal bone, near the ear. It functions as both a hinge and a gliding joint, allowing opening, closing, and complex movements essential for chewing, speaking, and swallowing.

Anatomy and movement: The joint contains an articular disc that divides the joint space into upper and lower compartments, a fibrous capsule, and ligaments such as the lateral, stylomandibular, and sphenomandibular ligaments. The primary muscles involved are the masseter, temporalis, and the medial and lateral pterygoids. Movement includes hinge actions for initial opening and translational movements for wide opening and grinding, with coordination between both joints.

Disorders and causes: Temporomandibular disorders (TMD) describe pain, impaired function, and joint sounds. Common problems include myofascial pain, disc displacement with or without reduction, and osteoarthritis of the TMJ. Predisposing factors include bruxism (tooth grinding), malocclusion, jaw trauma, arthritis, stress, and poor posture. Symptoms may include jaw pain, limited mouth opening, clicking or locking, and facial or earache.

Diagnosis and treatment: Diagnosis relies on clinical examination; imaging such as MRI can assess disc position, while CT may evaluate bone changes. Management emphasizes conservative approaches: patient education, soft diets, nonsteroidal anti-inflammatory drugs, physical therapy, heat or cold therapy, and occlusal splints. Behavioral modifications and stress management can help. In persistent cases, injections or surgical options (eg, arthroscopy, discectomy, joint replacement) may be considered, though these are relatively uncommon.