Section 14 Temporomandibular Joint Syndrome
Introduction
     Temporomandibular joint syndrome is a dysfunctional disease caused by disorders in the joints, muscles and nerves. The temporomandibular joint (the joints on either side of the face connecting the lower jaw with the skull) is the only mobile joint in the facial region.
     Temporomandibular joint syndrome is caused by malposition or malformation of the teeth, excessively worn teeth, long-term chewing on one side, traumatic injury of the temporomandibular joint, violent yawning and chewing or the effects of cold and wind. These can lead to the impairment of the temporomandibular joint through damage to muscles, tendons and nerves.
     The onset is usually slow. It is seen often among middle-aged and young women, frequently involving one side, occasionally involving both sides.
The Symptoms of Temporomandibular Joint Syndrome
     The usual symptoms are restrictions in opening the mouth and pain in the joints when opening the mouth or chewing, sometimes accompanied by a snapping feeling. In severe cases there may appear weakness of the masseter (muscle raising the lower jaw) and obvious tenderness anterior to the tragus (prominence in front of opening of the ear). In a few cases there are the symptoms of dysacusis (loss of the ability to interpret sounds) as well as headache and vertigo due to pressure on the temporal nerve and tympanic cord nerve next to the condyloid process.
Self-Massage Along Meridians and Acupoints
      1. Pushing and Kneading the Xiaguan Point (ST 7)
      Performance: Sitting position. The index and middle fingers of one hand push and knead Xiaguan (located in the depression between the zygomatic arch and the mandibular notch) at the affected side for about a minute (see Fig. 1).
      2. Pushing and Kneading the Jiache Point (ST 6)
      performance: Sitting position. The index and middle fingers of one hand push and knead Jiache (located one transverse finger above the mandibular angle orat the prominence of the masseter) for about a minute (see Fig. 2).
     3. Pushing and Kneading the Yifeng Point (TE 17)
     Performance: Sitting position. The thumb, index and middle fingers of one hand push and knead Yifeng (located behind the earlobe and in the depression between the mandibular angle and mastoid process) for about a minute (see Fig. 3).
Notes:
     ① The acupoints mentioned above should be simultaneously pushed and kneaded gently and slowly until a slight distending is felt in the acupoints and the temporal muscle and the muscles responsible for closing and opening the mouth are relaxed.
     ② In the pushing and kneading acupoints, efforts should be made to open and close the mouth slowly, evenly and according to the condition.
     Among the acupoints mentioned above, Xiaguan and Jiache are located on the stomach meridian, and Yifeng on the triple energizer meridian. So the pushing and kneading of these acupoints are effective in relaxing the tendons, activating collaterals, relieving spasm and stopping pain.
     4. Rubbing the Face
     Performance: Sitting position. The palms and fingers are used to rub the face on either side from the mandibular angle to the ear and forehead as in washing the face for about two minutes (see Fig. 4).
     5. Kneading the Temporal Region
     Performance: Sitting position. One hand holds the healthy side of the face and the heel of the palm of the other hand is used to knead the temporal region on the affected side for about two minutes until a warm sensation is felt in the affected part (see Fig. 5).
     6. Pereussing the Temporal Region
     Performance: The fingers of both hands are slightly bent and the tips of the fingers are used to tap the temporal regions, like abird pecking food, for about a minute (see Fig. 6). The percussion should be done swiftly and gently.
     These three methods are effective in stopping pain, easing inflammation and lubricating joints.
Notes:
     1. According to clinical observations, temporomandibularjoint syndrome is usually caused by spasms in the lateral pterygoid muscle, or by spasms in the lateral pterygoid muscle and masseter due to a relative displacement of the condyloid process in the articular disc. So the treatment should focus on relief of spasm and pain. Self-massage along meridians and acupoints is done once a day. It is effective in relieving spasms, stopping pain and easing inflammation. It is especially effective in the patient where the disease has been present a short time and symptoms are light.
     2. Heat can be applied to the affect part with a warm towel or warm wax bag.
     3. Avoid foods that are difficult to chew.
     4. Correct bad chewing habits, such as long-term chewing on one side.
     5. Self-massage along meridians and acupoints is not as effective if there is a fundamental problem with bone structure.