Snapshot A 31-year-old woman presents to her primary care physican for facial pain. Her pain is dull-like and worsens with mastication or fingernail biting. The pain begins at the jaw and radiates to the ear. Physical examination is notable for tenderness to palpation of the temporomandibular joint, along with a "knocking" sound when the jaw is opened. Introduction Overview a group of conditions that lead to abnormalities of the muscular and/or articular parts of the temporomandibular joint Associated conditions other chronic pain disorders migraine fibromyalgias myofascial pain syndrome Epidemiology Demographics more common in women greatest risk between 18-44 years of age Risk factors rheumatoid arthritis trauma parafunctional chewing habits fingernail biting jaw clenching/bruxism wind instrument playing ETIOLOGY Pathophysiology Mechanism of injury joint trauma poor head and cervical posture Presentation Symptoms facial pain unilateral and typically dull-like worsens with jaw motion pain can radiate to the ear temporal region mandible posterior neck headache ear or preauricular pain radiates to the jaw, temple, or neck neck pain Physical exam facial or jaw tenderness limited mouth opening temporomandibular joint (TMJ) noises with use Imaging Radiography indications when there is suspicion for articular disc derangement arthropathy malignancy comments CT and/or MRI is used if radiography is abnormal or if there is severe pain on exam, cranial nerve involvement, or previous surgery in the TMJ Differential Trigeminal neuralgia differentiating factors pain is described as paroxsymal and severe stabbing pain Treatment Conservative and lifestyle avoiding triggers indication initial management modalities patients are counseled to adjust head posture sleeping position parafunctiona oral behaviors (e.g., pen chewing) Medical and pharmacologic nonsteroidal antiinflammatory drugs indication initially pharmacologic therapy for pain management muscle relaxants indication pain upon palpation of the mastication muscles Complications Headache Jaw deformity and dysfunction Prognosis Most patients are responsive to treatment and a small percentage of patients develop chronic temporomandibular joint pain