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Chapter 8: Temporomandibular Joint and Facial Pain

Sally Ho

Description of the Symptom

This chapter describes pathology that may lead to temporomandibular joint and facial pain. Local causes of temporomandibular and facial symptoms include pathology of the temporomandibular joint, associated articular and periarticular structures (shading), and the facial bones including the sinuses, excluding the frontal bones and pharynx. Remote causes are defined as occurring outside these areas.

Special Concerns

  • Fever with jaw and tooth pain

  • Pain in masseter area with changes in salivation

  • Progressive limitation of mandibular ROM and increasing pain

  • Severe facial pain with hypersensitivity to touch

  • Sudden onset of severe headache

  • Stiff neck associated with fever

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CHAPTER PREVIEW: Conditions That May Lead to Temporomandibular Joint and Facial Pain
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CHAPTER PREVIEW: Conditions That May Lead to Temporomandibular Joint and Facial Pain
T  Trauma
REMOTE LOCAL
COMMON

Headaches:

  • Cervicogenic headache 81

Anteriorly displaced disk with or without reduction 86

Dental trauma:

  • Edentulism and denture wear 87

  • Malocclusion 87

  • Tooth injury 87

Dislocations:

  • Dislocation of the mandibular condyle into the middle cranial fossa 89

Internal derangement of the temporomandibular joint 92

Trismus 95
UNCOMMON

Headaches:

  • Post-traumatic headache 82

Dislocations:

  • Dislocation of the mandibular condyle 89

Fractures:

  • Mandible 90

  • Maxilla 90

  • Orbit 90

  • Temporal bone 91

  • Zygomatic arch 91
RARE
Not applicable

Dislocations:

  • Botulinum toxin–induced dislocation 89
I  Inflammation
REMOTE LOCAL
COMMON

Aseptic

Systemic lupus erythematosus 84

Septic

Otitis media 84

Aseptic

Adhesion of the temporomandibular joint 85

Ankylosing spondylitis 85

Capsulitis of the temporomandibular joint 86

Herpes zoster 91

Myofascial pain disorder syndrome 92

Retrodiscitis of the temporomandibular joint 94

Rheumatoid arthritis of the temporomandibular joint 94

Synovitis of the temporomandibular joint 94

Temporal arteritis 95

Septic

Acute viral parotitis 85

Dental infection:

  • Tooth abscess 87

Osteomyelitis of the mandible 93

Periodontal disease:

  • Alveolar osteitis 93

  • Gingivitis 93

  • Periodontitis 93

Sinusitis 94
UNCOMMON
Aseptic Aseptic
Multiple sclerosis 82 Facial nerve palsy 90
Septic Septic
Not applicable Not applicable
RARE
Not applicable Not applicable
M  Metabolic
REMOTE LOCAL
COMMON
Chronic fatigue syndrome 80 Gout of the temporomandibular joint 91
Fibromyalgia 81 Pseudogout of the temporomandibular joint 93
UNCOMMON
Adverse effects of medication 80 Effects of radiation/chemotherapy 90
RARE
Not applicable Not applicable
Va  Vascular
REMOTE LOCAL
COMMON
Angina pectoris 80 Avascular necrosis 86
UNCOMMON
Not applicable Not applicable
RARE
Not applicable Not applicable
De  Degenerative
REMOTE LOCAL
COMMON
Osteoarthrosis/osteoarthritis of the cervical spine 83

Ankylosis of the temporomandibular joint 86

Osteoarthrosis/osteoarthritis of the temporomandibular joint 92
UNCOMMON
Not applicable Not applicable
RARE
Not applicable Not applicable
Tu  Tumor
REMOTE LOCAL
COMMON

Malignant Primary, such as:

  • Brain tumor 84

Malignant Metastatic:

Not applicable

Benign:

Not applicable

Malignant Primary:

Not applicable

Malignant Metastatic:

Not applicable

Benign, such as:

  • Acoustic neuroma 96

  • Ganglion cyst of the temporomandibular joint 96
UNCOMMON
Not applicable

Malignant Primary, such as:

  • External auditory canal tumor 96

  • Neoplasm in the temporomandibular region 97

  • Parotid gland tumor 97

Malignant Metastatic:

Not applicable

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