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An unusual cause of jaw pain

Published:December 09, 2022DOI:https://doi.org/10.1016/j.oooo.2022.12.001
      A 49-year-old woman was referred to the Maxillofacial Surgery Department of our University to evaluate a worsening jaw pain lasting since three-years. She experienced increasing preauricular pain in the area of the left temporomandibular joint (TMJ), during the day and night, and a progressive limitation of mouth opening over the past few years. The patient denied bruxism or jaw clenching. She had been treated by various health professionals, including physiotherapists, osteopaths and orthodontists over the years. She also used with 4 different splints, with little or no symptomatologic relief. Non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants were taken chronically by the patient with little or no result. The patient did not report any previous trauma, infections, arthritis or other rheumatological disease. At physical examination she showed a maximum mouth opening (MMO) of 29 mm with the chin deviating slightly to the left side (Fig. 1 A-1 B). She was painful on palpation of the preauricular and temporal area bilaterally. Furthermore, the masticatory muscles resulted bilaterally painful. Mild swelling in the left TMJ area was observed. An articular crepitus of the left TMJ was perceived. Forcing the MMO, the endfeel was rigid and painful. The computed tomography (CT) (Fig. 2 A-B) and the magnetic resonance imaging (MRI) (Fig. 3 A-B) scans showed an osteoarthritic degeneration of the left TMJ.
      Fig 1
      Fig. 1A-B: Clinical appearance of the patient at first clinical evaluation; a reduction of the mouth opening and a slight deviation to the left are visible.
      Fig 2
      Fig. 2A-B: Coronal and sagittal CT scans shows a moderate osteoarthritis of the left TMJ; it is also possible to notice the sclerotic appearance of the of the left TMJ bones in contrast with the right side.
      Fig 3
      Fig. 3A-B: Sagittal T2w open mouth scan showing the articular disk damaged and anteriorly displaced with no reduction. Coronal T1w MRI scans showing on the left TMJ signal alteration as from arthritic-sclerotic thickening of the mandibular condyle and flattening of the articular surface.

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