The Temporomandibular Joint

This chapter discusses the two distinct sources of symptoms arising from the temporomandibular joint. The first arises from the muscles, joint structures, and other associated tissues as a result of abnormal physical activity within the joint. The second is from pathological changes in the joint itself. The predominant complaint is of pain. The severe attacks of pain occur predominantly in the early morning in some patients, whereas in other patients they are more common at the end of the day. The patient most commonly complains of a click, representing the movement of one component of the joint over the others. The patient may report difficulty in wide opening, often associated with the imminent onset of a loud click. Some patients with temporomandibular joint disturbances complain of swelling over the maxilla. Examination of the temporomandibular joint and face should begin by observing the degree of symmetry of the mandible and face and by observing the path of excursion of the mandible on opening and closing. Radiographic techniques used to investigate the joint include the lateral oblique view, used routinely to demonstrate the anatomy and range of opening of the joint.