What is the pathophysiology of TMJ syndrome?

Updated: Jan 02, 2018
  • Author: Vivian Tsai, MD, MPH, FACEP; Chief Editor: Herbert S Diamond, MD  more...
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Answer

The pathophysiology of TMJ syndrome is not entirely understood. It is believed that the etiology is likely multifactorial and arises from both local insults and systemic disorders. Local problems frequently arise from articular disc displacement and hereditary conditions affecting the structures of the joint itself, such as hypoplastic mandibular condyles. A study by Tallents et al found TMJ displacement in 84% of patients with symptomatic TMJ versus 33% of asymptomatic subjects. [3]

The TMJs can also be affected by conditions such as rheumatoid arthritis, juvenile idiopathic arthritis, [4] osteoarthritis, and diseases of the articular disks. In addition, hypermobile TMJs, nocturnal jaw clenching, nocturnal bruxism, jaw clenching due to psychosocial stresses, and local trauma also play a significant role.

A study of 299 females aged 18-60 years suggests that compared with nonsmokers, female smokers younger than 30 years had a higher risk of temporomandibular disorder than older adults. [5]

As described by Hegde, a strong understanding of how the trigeminal nerve innervates the TMJ and surrounding structures explains the pain and referred pain patterns of TMJ disorders. [6] Irritation of the mandibular branch (V3) of the trigeminal nerve results in pain locally at the TMJ and also to other areas of V3 sensory innervation, which include the ipsilateral skin, teeth, side of the head, and scalp.


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