Traditionally causes of<unk>  are divided into intra-articular (factors within the temporomandibular joint TMJ) and extra-articular (factors outside the joint, see table). Commonly listed causes of<unk>  Intra-articular: * Internal derangement of TMJ / meniscus displacement. * Fractured mandibular condyle or intracapsular fracture. * TMJ dislocation. * Traumatic synovitis. * Septic arthritis. * Osteoarthritis. * Inflammatory arthritis (e.g. rheumatoid or psoriatic). * Ankylosis. * Osteophyte formation. Extra-articular: * Trauma not involving the mandibular condyle (e.g. a fracture of another part of the mandible, fractures of the middle third of the facial skeleton, fractures of the zygoma or zygomatic arch). * Post surgical edema, e.g. removal of impacted lower wisdom teeth, or other dentoalveolar surgery. * Recent prolonged dental treatment (e.g. root canal therapy). * Following administration of inferior alveolar nerve block with local anesthetic (medial pterygoid). * Hematoma of medial pterygoid. * Acute infections of the oral tissues, especially involving the buccal space or muscles of mastication. * Odontogenic infection. * Peritonsillar abscess. * Acute parotitis, e.g. mumps. * Pericoronitis. * Submasseteric abscess. * Tetanus. * Tetany. * Local malignancy. * Myofascial pain / temporomandibular joint dysfunction. * Radiation fibrosis. * Fibrosis from burns. * Submucous fibrosis. * Systemic sclerosis. * Myositis ossificans. * Coronoid hyperplasia. * Malignant hyperpyrexia. * Epidermolysis bullosa. * Drug associated dyskinesia. * Psychotic disturbances, hysteria. Joint problems Ankylosis * True bony ankylosis: can result from trauma to chin, infections and from prolonged immobilization following condylar fracture * Treatment – several surgical procedures are used to treat bony ankylosis, e.g.: Gap arthroplasty using interpositional materials between the cut segments. * Fibrous ankylosis: usually results due to trauma and infection * Treatment –<unk>  appliances in conjunction with physical therapy. Arthritis synovitis Meniscus pathology Extra-articular causes Infection * Odontogenic- Pulpal * Periodontal * Pericoronal * Non-odontogenic- Peritonsillar abscess * Tetanus * Meningitis * Brain abscess * Parotid abscess * The hallmark of a masticatory space infection is<unk>  or infection in anterior compartment of lateral pharyngeal space results in<unk> . If these infections are unchecked, can spread to various facial spaces of the head and neck and lead to serious complications such as cervical cellulitis or mediastinitis. * Treatment: Elimination of etiologic agent along with antibiotic coverage *<unk>  or lock jaw due to masseter muscle spasm, can be a primary presenting symptom in tetanus, Caused by Clostridium tetani, where tetanospasmin (toxin) is responsible for muscle spasms. * Prevention: primary immunization (DPT) Dental treatment * Dental<unk>  is characterized by a difficulty in opening the jaw. It is a temporary condition with a duration usually not longer than two weeks. Dental<unk>  results from some sort of insult to the muscles of mastication, such as opening the jaw for a period of time or having a needle pass through a muscle. Typical dental anesthesia to the lower jaw often involves the needle passing into or through a muscle. In these cases it is usually the medial pterygoid or the buccinator muscles. * Oral surgery procedures, as in the extraction of lower molar teeth, may cause<unk>  as a result either of inflammation to the muscles of mastication or direct trauma to the TMJ. * Barbing of needles at the time of injection followed by tissue damage on withdrawal of the barbed needle causes post-injection persistent paresthesia,<unk>  and paresis. * Treatment: in acute phase: * Heat therapy * Analgesics * A soft diet * Muscle relaxants (if necessary) * Note: When acute phase is over the patient should be advised to initiate physiotherapy for opening and closing mouth. Trauma Fractures, particularly those of the mandible and fractures of zygomatic arch and zygomatic arch complex, accidental incorporation of foreign bodies due to external traumatic injury. Treatment: fracture reduction, removal of foreign bodies with antibiotic coverage TMJ disorders * Extra-capsular disorders – Myofascial Pain Dysfunction Syndrome * Intra-capsular problems – Disc displacement, arthritis, fibrosis, etc. * Acute closed locked conditions – displaced meniscus Tumors and oral care Rarely,<unk>  is a symptom of nasopharyngeal or infratemporal tumors/ fibrosis of temporalis tendon, when patient has limited mouth opening, always premalignant conditions like oral submucous fibrosis (OSMF) should also be considered in differential diagnosis. Drug therapy Succinyl choline, phenothiazines and tricyclic antidepressants causes<unk>  as a secondary effect.<unk>  can be seen as an extra-pyramidal side-effect of metoclopromide, phenothiazines and other medications. Radiotherapy and chemotherapy * Complications of radiotherapy: * Osteoradionecrosis may result in pain,<unk> , suppuration and occasionally a foul smelling wound. * When muscles of mastication are within the field of radiation, it leads to fibrosis and result in decreased mouth opening. * Complications of Chemotherapy: * Oral mucosal cells have high growth rate and are susceptible to the toxic effects of chemotherapy, which lead to stomatitis. Congenital and developmental causes * Hypertrophy of coronoid process causes interference of coronoid against the anteromedial margin of the zygomatic arch. * Treatment: Coronoidectomy *<unk> -pseudo-camtodactyly syndrome is a rare combination of hand, foot and mouth abnormalities and<unk> . Miscellaneous disorders * Hysteric patients: Through the mechanisms of conversion, the emotional conflict are converted into a physical symptom. E.g.:<unk>  * Scleroderma: A condition marked by edema and induration of the skin involving facial region can cause<unk>  Common causes * Pericoronitis (inflammation of soft tissue around impacted third molar) is the most common cause of<unk> . * Inflammation of muscles of mastication. It is a frequent sequel to surgical removal of mandibular third molars (lower wisdom teeth). The condition is usually resolved on its own in 10–14 days, during which time eating and oral hygiene are compromised. The application of heat (e.g. heat bag extraorally, and warm salt water intraorally) may help, reducing the severity and duration of the condition. * Peritonsillar abscess, a complication of tonsillitis which usually presents with sore throat, dysphagia, fever, and change in voice. * Temporomandibular joint dysfunction (TMD). *<unk>  is often mistaken as a common temporary side effect of many stimulants of the sympathetic nervous system. Users of amphetamines as well as many other pharmacological agents commonly report bruxism as a side-effect; however, it is sometimes mis-referred to as<unk> . Users' jaws do not lock, but rather the muscles become tight and the jaw clenched. It is still perfectly possible to open the mouth. * Submucous fibrosis. * Fracture of the zygomatic arch. Other causes * Acute osteomyelitis * Ankylosis of the TMJ (fibrous or bony) * Condylar fracture or other trauma. * Gaucher disease which is caused by deficiency of the enzyme glucocerebrosidase. * Giant cell arteritis * Sympathomimetic drugs, such as amphetamine, methamphetamine, MDA, MDMA, MDEA, methylphenidate, ethylphenidate, and related substances. * Infection * Local anesthesia (dental injections into the infratemporal fossa) * Needle prick to the medial pterygoid muscle * Oral submucous fibrosis. * Radiation therapy to the head and neck. * Tetanus, also called lockjaw for this reason * Malignant hyperthermia * Malaria severa * Secondary to neuroleptic drug use * Malignant otitis externa * Mumps * Peritonsillar abscess * Retropharyngeal or parapharyngeal abscess * Seizure * Stroke * Toothache
Trismus
Anismus
Hemifacial spasm
Facial weakness
Strabismus
Dysphagia
Anopsia
Barodontalgia