(Keywords: tmj anatomy, trigeminal neuralgia, chiropractic help, tmj ear pain, tmj exercises, migraine headaches)
TMJ anatomy is NOT a highly academic tour of this complex joint, but it will give you some insights, and understanding of how the Temporo-Mandibular-Joint can cause SEVERE
It is also the joint that contributes to a complex painful condition called Trigeminal Neuralgia.
Click here for more info, and scroll down. TMJ ear pain ...
Shall we sully forth on our TMJ anatomy tour? It will help you understand any TMJ symptoms you may be having and how it can cause such severe migraine and facial paim and, yes, even cause your neck pain.
The Temporal bone is the large bone on the side of your head. It has a neat little socket into which the jawbone fits.
The Mandible is the the anatomical name of the jawbone.
Hence Temporo-Mandibular and then of course Joint to get TMJ.
This picture is taken from a book called Grays Anatomy. Come back later and take a short tour about this amazing man. A real pioneer. Click here for more about Henry Grays Anatomy tour.
Notice the mandible has two prongs.
Notice two features in this second picture of our TMJ anatomy tour.
A very powerful trio, strong enough to bite your finger off! As we will see in due course, these muscles can contribute to your headache and facial pain, if the TMJ is not functioning as it should.
You will discover FOUR primary jaw muscles on your TMJ anatomy tour. They open, close, protrude and move the jaw sideways, enabling you to talk, chew, and swallow. We'll come to the fourth muscle in due course.
There are THREE kinds of TMJ anatomy pain:
1. Primary muscle pain is not really common but overuse, as in chewing gum, but in association with disc malfunction can commonly causes jaw pain, headache and sometimes neck pain.
The important feature on this leg of our TMJ anatomy tour is the disc or meniscus that rides in the joint, functioning as a moving shock absorber between the condyle and the fossa (or, socket), separating bone from bone. It's a unique structure, quite different to anything else in the body. As you open your jaw the condyle first rotates and then slides forward in the fossa.
When the disc malfunctions, often after the jaw has been opened too wide, or taken a blow as in a punch, then it gives the familiar clicking and popping sound often associated with TMJ pain.
Please, please, do not slap your child's face, your spouse, even your enemy. You may just cause them a life time's TMJ anatomy pain.
2. Joint related pain may occasionally result from inflammation, as in rheumatoid arthritis, but more usually from degeneration of the tissues within the TMJ. This wear and tear in the joint, and dislocation of the meniscus are the two most common joint disorders of the TMJ.
Note two things here. How the condyle (posterior prong) sits in its fossa, and the position of the normal disc. See how the disc is attached another very important muscle, the lateral pterygoid? Because of this attachment to the disc, this muscle can become supremely, exquisitely, extremely painful.
This is the muscle that opens the jaw, pulling the condyle forwards out of its fossa, protected by the disc from grinding bone on bone. Used on one side only, it moves the jaw from side to side when chewing the cud. Juggle your jaw from side to side - that's the Lateral Pterygoid you are using. Now protrude the jaw, push it forwards. That's the two Lateral Pterygoids working together. See in the next picture how the condyle has slid forwards out of its fossa? That's normal.
Dislocated disc (meniscus)
Notice in the next picture how the disc has been displaced forwards. This is definitely not normal. Should you now open your jaw there will be a popping sound as the disc pops back behind the prong of the jawbone (the condyle). When this happens repeatedly the disc starts to wear, and sets up a pain pattern in the muscles around the jaw joint.
Try placing the pads of your index fingers in your ear, and slowly open your mouth. Do they open nicely together? Any clicks or pops?
Often patients are terrified of words like disease and degeneration sometimes used in describing this wear-and-tear process. No need, it's no different to your hair turning grey. What is now clearly recognised in the literature though is that, untreated, joint malfunctions, or fixations as we call them, lead to unnecessary, premature degeneration. Every time the displaced disc has to pop over the condyle, it is probably equivalent in terms of wear and tear to 100 openings of a healthy jaw.
3. Nerve pain or Trigeminal neuralgia
See that long black structure in the picture below? (in the next pic it's highlighted in green). That is the huge trigeminal nucleus extending right down into the spinal cord in the neck.
It's called the TRI-geminal nerve, because it has three different sensory branches, seen here in green, blue and brown, supplying primarily the face, teeth, sinuses and TMJ. It is by far the largest cranial nerve.
Whilst I don't want to overdo the complexity of TMJ anatomy, this next slide will show you how the TMJ can cause neck pain, perhaps CAUSE subluxations, and how subluxations in the cervical spine can make the TMJ vulnerable to injury.
On the right hand side you have the four functions of the Trigeminal nerve. Focus only on the one labelled "Pain and Temperature". If you follow it along the "Spinal Trigeminal Tract" you will see that its sensory nucleus (called the "Spinal Trigeminal nucleus") is right down in the neck. From there a dark-coloured tract reaches up into the sensory cortex of the brain (those two dark arrows) where the pain is perceived.
So, noxious pain and temperature signals from the TMJ feed right down into the neck, where they meet up with other nerves from the neck, swapping messages. Pain!
Enough, right! Well done, you're a perseverer!
There's nothing simple about the human body. Nothing! and certainly not the TMJ anatomy. "Fearfully and wonderfully made" as one great surgeon named his book. Amen!
I said there are four jaw muscles. The fourth, the Internal Pterygoid is also a jaw closer. I include it here, partly for completeness, but also so that you can see the four branches of the Trigeminal nerve in situ. One motor branch to the muscles of the jaw, and three sensory nerves (labelled 1st Div, 2nd and 3rd). See the proximity of the nerve to the Internal Pterygoid muscle? This is why jaw muscle pain can so readily become intense nerve pain.
For anatomy students only: See the tiny branches supplying the Tensor Tympani muscle in the inner ear (dampens overly loud sounds) and the Tensor Veli palatini muscle that has two vital functions: in swallowing it helps raise the soft palate so food doesn't enter the sinuses, and opens the auditory tube, allowing for equalising the pressure between the inner ear and the outside air. Vital for example when driving up a steep hill, or ascending in an aeroplane. That pop in the ear... Tensor Veli Palatini doing its job.
So, the very complex fifth cranial nerve, the Trigeminal nerve, is almost continuously in use in chewing, speaking, swallowing, hearing and bringing sensory information from the teeth, face, jaw joints to the brain.
Not a pain, but there is an irritating condition, sometimes it becomes extreme, ringing in the ears, that is common and sometimes associated with vertigo, and sometimes a result of a TMJ anatomy problem. But not usually, alas. But if you have crackling sounds, pain and stiffness coming from your jaw, then your tinnitus MAY be coming from the TMJ. May. If there is hearing loss, then Meniere's disease also needs to be considered.
Vertigo, similar to but not quite the same as dizziness, is a dreadful condition that we will consider elsewhere at Chiropractic Help in a chapter about Benign Paroxysmal Positional Vertigo ( Vertigo dizziness ) ...
Like all other chronic joint conditions there is no real permanent ‘cure’ for TMJ anatomy wear-and-tear. An acute pain or click which has just begun, correctly addressed should pass over, and the trick is not to allow it to become chronic. Like any other condition, once you know it's not going to get better on its own, then it's better to contact the relevant health professional sooner rather than later.
Not unlike neck and back pain, good care of chronic TMJ pain aims at reducing the pain, restoring normal function, and avoiding the known no-no’s. Like biting a whole apple and chewing gum.
The pain and dysfunction is often temporary, lasting a few days or weeks, even a month or two perhaps, so adventurous surgery which cannot be reversed should only be contemplated when all else has failed. Your first port of call, of course! should be your chiropractor.
I have done no research in my practice, but I would guess at least 75% of patients have good to very-good results with chiropractic treatment of the TMJ.
What will your chiropractor do? Firstly a good history of how the pain or clicking started, how long it's been there, what aggravates it etc. Whether you are getting headaches, and any of the sharp stabbing pain associated with Trigeminal Neuralgia. Then there will be an examination of the TMJ anatomy, and your neck. Treatment will include mobilising the joint, treating any active trigger points in the muscles, and stretching of the muscles and the joint capsule.
The good news? This is a very treatable condition. You don't have to live with TMJ anatomy pain for month after month. The bad news? If the pterygoids have active trigger points, they can only be reached from inside the mouth, and the treatment may be wretchedly painful, sometimes lasting a few days. Hang in with your chiroprator, that pain too will pass. This treatment is very effective.
What can you do for yourself? Jaw exercises for TMJ? An iceblock rubbed directly on the painful spot, followed by moist heat (Tip: do it in the shower) will help. Now that you've taken your TMJ anatomy tour, you know where to find these muscles, right? Gently massage them. Your chiropractor will give you some stretches and, for more tips about TMJ exercises, click here. TMJ exercises ... If appropriate, your Chiropractic neck pain treatment may include cervical spine adjustments neck too, if there are associated fixations. For more about the neck adjustments, click here. Neck pain treatment ... For an interesting case from the Coalface, click on this link and scroll down to Mrs Hol. Chiropractic Coalface ...
Interestingly, research shows that migraine sufferers, clench their Temporalis muscles 14x more often ... More about Migraine headache / TMJ headaches.
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