It is also one of the joints 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? Full steam ahead! It will help you understand any TMJ symptoms you may be having and how it can cause such severe migraine and facial pain.

The BONES

The Mandible is the the medical name of the jawbone.

Hence Temporo-Mandibular and then of course Joint to get TMJ.

Notice the mandible has two prongs.

1. The posterior prong (hidden in the picture above behind some ligaments which hold the jawbone firmly in place) fits snuggly into a hollow in the Temporal bone, just in front of the ear.

2. The anterior prong is for the attachment of the Temporalis muscle. See how much leaverage this gives the Temporalis muscle which covers the side of the head? - hence its awesome power.

MUSCLES

• The actual TMJ joint, where the posterior prong fits into a socket in the temporal bone.

• The three muscles that slam the jaw closed.

  1. The huge flat Temporalis muscle that is attached to the other prong (or condyle), and another jaw closer,

  2. the Masseter muscle.

  3. The third, the Internal Pterygoid we'll come to later.

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, in association with disc malfunction 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.

   
   

   
   
   
   

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   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.
   
   This information is then fed back to the brain via the largest cranial nerve, the Trigeminal nerve which supplies the face and has a spinal nucleus deep in the neck. This is how the pain from a clicking jaw causes facial pain, and can be referred to the neck.

   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 the dark 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. See the proximity of the nerve to the Internal Pterygoid muscle? This is why jaw muscle pain can so readily become intense nerve pain.

   

   
   
   
   
4. Tinnitus
   

   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.

TREATMENT

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.

For an interesting case from the Coalface, click on this link and scroll down to Mrs Hol. Chiropractic Coalface.

Find the best San Diego TMJ treatment specialist that can help treat severe oral healthcare complications and reduce ongoing discomfort.

1/10/2009

Migraine

IMPORTANT CONSIDERATIONS

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