TMJ therapy

Therapy of the temporomandibular joint (TMJ) follows a step-by-step plan. Surgery of the TMJ is only rarely the therapy of choice.

Temporomandibular joint (TMJ) therapy

Problems with the temporomandibular joint (TMJ) can have a very wide range of causes. Symptoms include headaches, popping of the TMJ, dislocation of the jaw, restricted mouth opening, and highly intense pain. However, only rarely is surgery the first-line therapy.

Detailed history-taking, thorough clinical intraoral and extraoral examination and appropriate X-ray procedures are necessary in order to arrive at a correct diagnosis. Depending on the findings, further diagnostic investigations such as slice imaging using CT or MRI may be useful complementary diagnostic tools.

Like the knee joint, the joint of the TMJ contains an articular disk. This is the commonest cause of popping of the TMJ (in some 40% of the population). This popping may be felt – and audible – during the opening and/or closing of the mouth. Unless there are other symptoms, therapy is not necessary in most cases.

Highly restricted mouth opening (trismus) may be caused by trauma or a reflex. In the case of trismus triggered by a reflex, muscle relaxant medication in combination with painkillers leads to rapid improvement. A fracture of the TMJ, however, should in most cases be surgically treated. If there are problems with closing the mouth (lockjaw), it is essential to rule out dislocation of the TMJ. If this has in fact occurred, the jaw should be set back into its original position without further delay.

Strong and frequent strain such as chewing hard food, stress or grinding (bruxism) may lead to signs of wear in and around the TMJ. Degenerative joint problems (arthropathy) are common. In-depth diagnostic procedures are necessary so that the right therapy can be chosen. Besides pain, the clinical manifestation of degenerative problems is usually a sensation of friction around the mandibular condyle (about 1 cm in front of the ear canal).

Fractures in the region of the TMJ also necessitate a careful consideration of conservative and surgical therapy. In particular, the clinical symptoms (restricted mouth opening, dental occlusion), the degree of dislocation and the loss of vertical lower-jaw height are crucial parameters when deciding on the best form of therapy.

For the majority of TMJ problems, however, conservative measures are initially applied, such as pain controll, drug-induced muscle relaxation, physiotherapy, temporary immobilization or splint therapy. In some cases it is helpful to incorporate other medical disciplines, such as psychosomatics, into the treatment in order to deal with the pain and cope with stress situations more effectively. If these measures don’t lead to improvement, minor invasive procedures such as TMJ irrigation may, as a next step, lead to the alleviation of symptoms.

Surgery is available as a last resort in TMJ therapy. The difficulty with surgical procedures on the TMJ is its close proximity to the facial nerve, which may be damaged; this can lead to a (temporary or permanent) paralysis of the facial muscles on the side affected. Such operations should therefore only be carried out if surgery is clearly indicated and there is a definite prospect of improving symptoms.

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