TMJ Disorders: Symptoms and Treatment Options

Temporomandibular disorder (TMD)

Hello Doctor, due to extremely poor sleep quality, I have been diagnosed with sleep apnea and underwent orthognathic surgery.
On the day after the surgery, I experienced significant pain in the upper part of both eyes.
It has been a year and a half since the surgery, and while the pain has lessened, I still experience swelling and pain in the upper part of my eyeballs, headaches, and neck pain every day, regardless of day or night.
My sleep quality remains extremely poor.
I have consulted with neurologists, ophthalmologists, and ENT specialists multiple times, and despite undergoing CT and MRI scans, no structural issues have been identified, making treatment impossible.

A month after the surgery, a neurologist mentioned that sometimes jaw muscle issues can lead to eye pain.
After seeing various doctors, I discovered on a website (http://www.healthcentral.com/chronic-pain/tmj-38544-5.html) that symptoms of temporomandibular joint (TMJ) disorder can include headaches, eye swelling (in the upper, lower, or back parts), pressure sensations, and neck stiffness and pain.
Comparing these symptoms to those that appeared after my orthognathic surgery, most align, but I do not have many of the typical symptoms mentioned on most websites, such as difficulty opening my mouth, clicking sounds when opening, inability to bite down, or tightness and pain in the muscles near my ears.

Currently, my biggest issue is waking up feeling a constant ache and stiffness in my head, neck, and the upper part of my eyeballs, as if I had been working overtime all night.
May I ask which specialty or type of dentist I should consult directly? Thank you.

nobody, 40~49 year old female. Ask Date: 2017/05/02

Dr. Chen Taicheng reply Family Medicine

● The initial impression is that the postoperative pain issue is related to the extensive involvement of muscles, blood vessels, and nerves in orthognathic surgery.
If there have been no issues after multiple visits to neurology, ophthalmology, or otolaryngology, it is advisable to seek treatment at a pain clinic in a large hospital or medical center.
● Pain can lead to poor sleep quality, so it may be beneficial to visit a sleep center to assess the current sleep situation, including the possibility of sleep apnea, which can also contribute to symptoms like bloating, headaches, and neck pain.
● Generally, orthognathic surgery does not affect the temporomandibular joint (TMJ).
If there is a need to confirm TMJ disorders, medical centers have specialized departments such as oral and maxillofacial surgery, otolaryngology, or plastic surgery.
In addition to history-taking and physical examinations, imaging studies may sometimes be necessary for diagnosis.
● It is recommended to first visit a pain clinic to alleviate symptoms, then a sleep center to assess sleep conditions, and finally consider whether there is a TMJ disorder.
Wishing you a speedy recovery, Dr.
Chen Tai-Cheng from the Family Medicine Department at Taoyuan Hospital is concerned about you.

Reply Date: 2017/05/02

More Info

TMJ (temporomandibular joint) disorders are a group of conditions affecting the jaw joint and the surrounding muscles that control jaw movement. These disorders can lead to a variety of symptoms, including pain in the jaw, neck, and shoulders, as well as headaches, earaches, and facial pain. Given your history of jaw surgery and ongoing symptoms, it’s important to consider how TMJ disorders might be contributing to your discomfort.

Symptoms of TMJ Disorders
The symptoms of TMJ disorders can vary widely among individuals. Common symptoms include:
1. Jaw Pain: This can occur in the jaw joint itself or in the surrounding muscles.

2. Headaches: Many individuals with TMJ disorders report frequent headaches, which can be tension-type or migraines.

3. Facial Pain: Pain may radiate to the face, particularly around the cheeks and temples.

4. Ear Pain: Some people experience earaches or a feeling of fullness in the ears, even without an ear infection.

5. Neck and Shoulder Pain: Tension in the jaw can lead to muscle strain in the neck and shoulders.

6. Limited Jaw Movement: Some individuals may experience difficulty opening or closing their mouths.

7. Clicking or Popping Sounds: This may occur when moving the jaw, although not everyone with TMJ disorders experiences this symptom.

Potential Causes
TMJ disorders can arise from various factors, including:
- Jaw Misalignment: An improper bite or jaw alignment can lead to stress on the TMJ.

- Muscle Tension: Stress and anxiety can cause muscle tension in the jaw, leading to pain and discomfort.

- Injury: Trauma to the jaw or head can result in TMJ disorders.

- Arthritis: Conditions like osteoarthritis or rheumatoid arthritis can affect the TMJ.

Treatment Options
Treatment for TMJ disorders often begins conservatively and may include:
1. Physical Therapy: Exercises can help strengthen jaw muscles and improve flexibility.

2. Medications: Over-the-counter pain relievers (like ibuprofen) or prescription medications can help manage pain and inflammation.

3. Stress Management: Techniques such as mindfulness, relaxation exercises, or cognitive-behavioral therapy can help reduce muscle tension.

4. Dental Appliances: A dentist may recommend a splint or night guard to prevent teeth grinding and reduce pressure on the TMJ.

5. Injections: In some cases, corticosteroid injections into the joint may provide relief.

6. Surgery: This is typically considered a last resort if conservative treatments fail.

Next Steps
Given your symptoms and the lack of structural issues identified in imaging studies, it would be advisable to consult with a dentist who specializes in TMJ disorders or orofacial pain. These specialists can provide a comprehensive evaluation and may offer treatments tailored to your specific symptoms. They can also assess for any potential jaw misalignment or muscle tension contributing to your discomfort.

Additionally, it may be beneficial to explore physical therapy focused on the jaw and neck area, as well as stress management techniques to help alleviate muscle tension.

Conclusion
TMJ disorders can significantly impact quality of life, and it’s crucial to address the underlying issues contributing to your symptoms. By seeking the appropriate specialist and exploring various treatment options, you can work towards finding relief from your discomfort. Remember to communicate openly with your healthcare providers about your symptoms and any changes you experience, as this will help guide your treatment plan effectively.

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