TMJ Examination

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Anatomy

Inspection

  1. Oral exam
  2. Head/chin deviations
    • C curve occurs due to hypomobility, the mandible deviates to the involved side, then returns to centre
    • S curve occurs due to hypermobility as a result of poor neuromuscular control.

Palpation

Retrodiscal space
  1. Retrodiscal space. Line your finger tips up of fingers 2 through 5. Palpate the right and left TMJ with the posterior finger at the tragus. Allow a slight inferior angle of finger alignment.
  2. Coronoid Process: Begin with mouth closed, palpate inferior to the zygomatic bone. Ask the patient to open their mouth. If the coronoid process does not move forward to touch your finger then ask them to open further or adjust your finger location. Check all easily accessible coronoid aspects. Verbal cues are generally required for maintaining an open mouth. Palpation of the medial aspect can be accomplished intraorally if required.
  3. Masseter

Movement

  1. Range of motion. normal jaw opening is ~4-7cm, with a wide range of normal[1].

Videos

MCQs

1 Which are symptoms of TMD?

Muscle pain
TMJ Pain.
Difficulty with mouth opening.
Difficulty with lateral deviation.
Sounds associated with movement
All of the above

2 Bruxism and TMD…

Have perfect correlation
Have high correlation.
Have low correlation.
Have no correlation.

3 The temporalis muscle inserts onto…

The mandibular condyle and is in front of the zygomatic arch
The mandibular condyle and is in behind the zygomatic arch
The mandibular coronoid process and is in front of the zygomatic arch
The mandibular coronoid process and is behind of the zygomatic arch

4 The masseter inserts onto…

The mandibular condyle
The coronoid process
The zygomatic arch
The maxilla

5 Roughly how many fingers wide should your mouth open?

~one
~two
~three
~four
~five

6 What other joint or joint complex should you examine?

The shoulder
The neck
The ACJ
The SCJ

7 Does joint effusion on MRI correlate with pain?

Yes
No


References

  1. Zawawi KH, Al-Badawi EA, Lobo SL, Melis M, Mehta NR. An index for the measurement of normal maximum mouth opening. J Can Dent Assoc. 2003;69(11):737-741