Temporomandibular Joint Dislocation

One distressing TMJ problem is occasionally seen in the emergency room. A patient may present with the jaw locked open, holding a towel to catch saliva. This usually occurs after a wide opening of the mouth, such as with yawning. Individuals with significant disk derangement or laxity in the joint are prone to it. The treatment is manual reduction of the dislocation by rotating the mandible with the thumbs pressing downward on the mandibular molars inside the mouth. This will often require someone with experience in this procedure, such as an oral surgeon or ENT specialist. Muscle relaxants are often necessary before the reduction.

Neuralgias Involving the Ear

Summary

The key point to make about TMJ syndrome is that it is the most common cause of multiple ear symptoms in patients with normal ears, and that it is often misdiagnosed as a eustachian tube or middle ear disorder. The patient usually presents with unilateral or bilateral fullness in or near the ear, and ache may be present. Thorough evaluation of the TM, its mobility, and hearing can rule out ear disease. A positive history of bruxism, coupled with findings of joint tenderness or crepitance, supports the diagnosis. Patient counseling and anti-inflammatory medicines, along with possible dental consultation and nighttime appliance fitting, are the mainstays of treatment. The primary practitioner can diagnose and initiate treatment for TMJ syndrome, with elective referral to an ENT or dental specialist for confirmation of the diagnosis and further options.

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