Learning outcome
- Temporomandibular Dysfunction (TMD)
- Myalgia M. masseter
- Trigeminal neuralgia
- N. occipitalis major neuralgia
- Cervicogenic headache
- Sensory loss in C2, C3, C4 dermatomes
Special tests and standard examination
Special tests head/jaw
- Sensibility of peripheral nerves of the head
- Sensibility of dermatomes of the head
Standard examination of the jaw
- Inspection
- Active movement
- Passive movement
- Isometric movement
- Palpation
Case 2
You are working as a junior doctor (LIS 1) at a general practitioner's office. Your next patient is a 39-year-old woman. She works as a journalist, with a hectic workday. Previously healthy, had braces as a teenager. She comes for a check-up due to pain on the left side of her face, located around the ear. She reports that she has had such pain for two years. Your colleague has treated the patient for suspected trigeminal neuralgia with Tegretol without effect. She says it hurts to chew and that there are scraping sounds in the jaw joint. The past two months, pain has increased.
Jaw examination
- Perform standard jaw examination
- Inspection
- Active movement
- Passive movement
- Isometric movement
- Palpation
Inspection of the jaw joint
Active jaw joint movement
Passive jaw joint movement
Isometric jaw joint movement
Palpation of the jaw joint
Clinical findings
- On examination, it is found that the patient is unable to open their mouth as expected.
- You become aware of a clicking sound from the jaw joint when she opens her mouth.
- She reports pain in the jaw joint on palpation.
What is wrong with the patient?
The patient's symptoms are consistent with temporomandibular joint osteoarthritis. No curative treatment. The purpose of the treatment is to relieve symptoms and prevent worsening of the condition. When stressed, many people clench their teeth. Some are not aware of this, as it can also occur during sleep. Women are more affected than men.