EpistemisStiffness of the temporomandibular joint
Specialty: Musculoskeletal.
Why it occurs
- Temporomandibular joint disc dysfunction (disk displacement with or without reduction)
- Severe nocturnal or daytime bruxism (generates joint overload and hypertrophy of the masseter muscle)
- Osteoarthritis or rheumatoid arthritis of the temporomandibular joint
- Direct trauma to the jaw or prolonged mandibular hyperextension (long dental procedures)
- Spasm of the lateral pterygoid muscle
- Masticating myofascial pain syndrome
Initial workup
Dental panoramic radiography (orthopantomography) | Open and closed mouth MRI of the temporomandibular joint (gold standard for assessing the articular disc and synovial inflammatory changes) | TMJ CT with 3D reconstruction if bone ankylosis is suspected.
red flags
Severe progressive mandibular rigidity (interincisor opening < 20 mm) accompanied by ipsilateral otalgia, odynophagia, hard and non-mobile cervical adenopathy, or non-reducible mandibular deviation with progressive weight loss (suggests neoplasia of the masticatory space or infratemporal fossa).
Standard management
- Diazepam — 2-5 mg orally at night; muscle relaxant for severe bruxists
- Ibuprofen — 400 mg every 8 hours orally during periods of painful exacerbation
- Intra-articular injection of hyaluronic acid or ultrasound-guided infiltration of methylprednisolone in the upper joint space.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Musculoskeletal
- Listed causes
- 6
- Treatment options
- 3