Dislocation of the TMJ

Written by Dr. John Summer

The temporomandibular joints (TMJs) connect the jawbone to the skull much like two hinges,
one located on each side of the head just in front of the ear.  Each TMJ consists of a fibrous
disk held down on the top of the condyle (the back end of the jawbone) by 2 collateral ligaments
which act like chinstraps holding a hat down on a head.  The only disk movements they permit
are rotations forward and backward.

TMJ disorders nearly always start with a dislocation of the disk (below right).  In the normal TMJ
(below left) the disk functions as a cushion between the condyles and the underside of the skull
so these bones never rub directly against each other.   When the jawbone gets driven backward
into the front of the ear, the disk gets squeezed out forward from its highly lubricated joint
compartment, much like squeezing a watermelon seed out from between two fingers.
 Subsequently, the retrodiskal tissues are pulled into the place of the disk between the opposing
bones where they get mashed by normal chewing forces.

The disk may get dislocated forward (as above), to either side (medially or laterally), partly
forward and partly to one side, or rotationally so that only one side of the disk gets dislocated
forward.  Whatever the direction of the disk dislocation, it pulls the fragile vascular retrodiskal
tissues from behind or beside the disk into the space between the two bones where the disk
had been.  Trapped in this location, the fragile vascular tissues can get easily injured by normal
functional forces.  In early stages of disk dislocation, the retrodiskal tissues acquire all the
characteristics of a chronic bruise - with blood outside of the vessels, swelling, heat, and pain. 
In later stages of disk dislocation, the retrodiskal tissues toughen up by losing their blood and
nerve supply to become fibrotic pads of scar tissue which may be well able to withstand normal
chewing pressures for life.

FORWARD DISK DISLOCATION

At least half of disk dislocations occur in a forward direction. Initially the forward dislocated disk

1/4
Dislocation of the TMJ

Written by Dr. John Summer

forms an obstacle in the path of the condyle during jaw movements.  The lower jawbone can
open part way without clicking, because the condyle is able to push the dislocated disk in front
of it until the ligaments become taut.  Further opening caused the chin to deviate off to the
affected side, because the dislocated condyle stops moving forward while the condyle of the
other side keeps moving forward.  Further jaw opening requires the dislocated condyle to jump
over the back end of the dislocated disk and onto it's thin center - causing a click or pop.  Thus
the opening click occurs near wide opening, because it doesn't occur until the ligaments
attached to the back of the disk become taut; and the closing click is softer and occurs when the
jaw is more nearly closed, because the disk doesn't re-dislocate until the condyle reaches the
depth of the socket where the disk can no longer fit as seen below.

2/4
Dislocation of the TMJ

Written by Dr. John Summer

In lateropening,
mouth
process stages
is illustrated
ofand
forward
the
below.
lower
disk dislocation,
jaw cannot open
the disk
past
usually
the point
stops
where
going
it used
back into
to click.
place The
during

3/4
 Dislocation of the TMJ

Written by Dr. John Summer

SIDEWAYS
The
ligament
cause
which
dislocated
disk
ADAPTATION
began
disks,
symptoms
TMJs
normally
functioned
frequently
made
researchers
rear
normal
tissue.  does
no
“pseudodisks”.
Most portions
with
people
of failing
itmay
researchers
showing 
vascular
These
collagen
fragile DISK
clicking,
disks
not also
diagnosing
asymptomatic
in
very while
form
examining
some
contained
with
pads are DISLOCATION
popping,
retrodiskal
much
that get
retrodiskal
with
a couldmore
an
people the
dislocated
of the dislocated
like
them obstacle
little other
avascular
these difficult
remnants
vast
not
disk
trueor
and
tissues
elastic
tissue
as opening
one
understand
majority
apparently in
by
dislocations
disk to
elongated,
TMJ
no scar
of holds.
the
which
tissue recapture
shifting
symptoms
were
tissue. 
disk
blood limitations,
opening
tissue
of  Sideways
converted
the
had
no
and
why
elongated
but
had
vessels or
Surgeons
longer
noises
are
been than
rotating
pathway
therefore
in
the
researchers
undergone
others.
so because
same forward
and
converted
suffer
–
into
similar
disks
in  proof to
removing
peoples'
could
a of
rotational
either
 anatomical
Eventually
tough
from
underanthe
thatdislocated
pointed
to Itnot
true
by condyle.
disk
aside
adaptation
significant
they
TMJs
fibrous
dislocated disk
adaptation
really isdue
microscope
disks
out dislocated
conditiondisks.
researchers
were
were
that
pad dislocations
 These
to
elongate. 
that one
response
symptoms. 
really
disks
due
TMJ
that
into
they
could
found
to types
collateral
into
comprised
looked
disks
avascular
had
learned
are
Then
dislocated
cause
in frequently
that
beenaof
called
When
which
wereposition
and that
their
itsevere
scar
of
Because
eventually
anywhere
result,
are
deteriorate
TMJ
process,
1.
over
The
2.
in
the
made
get
and
an
3.
of rare
Another disks
CLOSED
jawbone
though
to. ADHESED
forms
In the
DIAGNOSIS
sideways,
TMJ
harmless
Diagnosing
doesn’t
opening. can
Fortunately,
unique
joint
degree
is
dislocated
Onerequired
that
occurs. 
ligaments
pop
when
disk
can’t
back
before
different
close
opening. 
fixed
sounds the
is
is
independent
rapidly
sound
the
be
More
THE
JAW
in softer
speed
crepitus.
(fine
footsteps
The
X-rays
of
and
where
very
excess
accuracy
prefer
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although
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Thisits
continuously
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measures
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paper
changing
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simple
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noises
withstand
fit
effect
musclejoint.
results
function
joint,
clogged
someone
 Muscles
waste
area.
HEADACHE
the
prognosis
DISK 
the unlocking
called
can
interposed
condyle
balled
maypath
by to
skull.
third
noises.  
unique
fit
off
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far
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the
in
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back
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second
doesn't
into
crepitus),
advanced
below
only
painful,
TMJ. 
MRI
PROBLEM
failures. 
tissue
for
surgery
 Fortunately,
necessary.
The
TMJ TMJ
Displaced
between
edges
the
skull
to
because
condyle surgical
only
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PAIN
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MUSCLE
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from
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obstacle
make
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surgery
TMJ
the of
TMJ
from
LOCK
clicking
together
need
occur
opening
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characteristics
of locations
enough
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mouth
In a
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holding
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mouth
place
due
 Crepitus
fluid. in
reliable
of
dye
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 Swelling
of
they
on
oriented
with disks
being
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tighten
are
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as
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sixties
pathway,
mouth
end, are
unlock. The
certainly
usually
paper
treatment
withDISK
pathway,days
stage
 InitiallyTMJ
basis
RECAPTURING
locked
RESHAPING
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eventually
up. 
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for
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However
because
bones
In
goes. 
disk
bones. 
joint. 
limping. 
common
produces
a
flush
way
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tightening
disorders. 
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muscles
are have waste
full
pressure
less or
out”.
open
attempts,
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dislocated
determine
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at
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opening,
close
During
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is
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to takes
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that
often
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with
orthopedic
pathway,
In the
run called
duringat
itbe
based
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athe
make
back
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failures
surgery tomovement.
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TENSION
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easily
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itfarsounds
that
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made
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–its
condyle
SURGICAL
surgeryhave
Instead,of
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isthe
ofteneven
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sensory
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a
products,
powerful,
ofA to of into
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treatments
untreated
buildthe
term
surprising
this
shownthe
even
actually
disk adaptation
no
 TREATING
these
and
theup
the
using of
itoff
treatment
not
dislocated
TMJ prevent
these
on
accompanied
condyle
this
occurs
closing,
closed. 
the
condyle
from
get
the
attaching
andof
itTMJ,
TMJ
becomes
requires
diagnose
painless,
the
clearly,
these
squirting
dye
signal
allthe
muscles
reflex
fully
on
of
as
symptoms
TMJ
again.
treatment
ones
during depends
unlocked,
shape
worked
THE
arthritic
disk
cases,
over
opening
up,
easily
stage
location,
at disk
nothing
by
pattern,
adhesion
TMJ rarer
three
maintains
occurs
longer
the that
dislocated
process
stretched
least
closing
that
when
opening.  
 For
by
presence
performed
ofwhich  Most
the of
ifhurt
changing
jaw
up jointis
biting
their
products
tissue
a
relax. 
nerves
regulation
head. 
over
but soon or
running
condition
can’t the
disk
pain
relief,
tobut in TMJ
injection
improved
such
seems
TMJ
works, and
do
however
itsimple
of due
 As
TMJ
locked
point
have
trying
completely,  The
occurs
landing
theThus
intofull
sounds
striking
and
a example
bones
forces,
area
tightening
they whichalso
in
disorderspathways.
diska
to
of
goes
on
and
degraded
is do not
characteristics,
TMJ
distinguish
and
location
half
often
disk
when
the
by
ligaments
opening
injecting
completely
the
dye
produce
FAILUREother
of
surgery. 
high
as
not
tobut
the
itDISLOCATED
ofis
opening. 
hundreds
gets THE
or
on
the
which
only
sounds
they
frequently,
cause
muscles
the
broken
respond
they
number
the pain
forcefully
usually
the
it
In only
damage
knee
hold
As of
out
because
ignored
and the
result
disorders
at
its
in
Thea
over
dislocation
more pushes
so
conditions
may jaw
the
monkeys,
sides
are
adaptation.
the
are
opening,
not
more
disks
noise
of
the
or
the in
tight
way the
rubbing
condition
ofa
into
itshape,
inexpensive
process
the but
failed.
during disk
to
when
misshapen disk.
gets
disk
back seventies
permanent
which
aback
LOCKED
clicka unlock
closing
always
directionother
opening
agets
mouth
a
when
coarse
assisted
orthopedic
be
a disk
all
reasons,
fluid
can
eventually
surgical
morbidity
lastableEven
inflammation.
sensitive
cross
a of
allpain
when
cant
they
themselves
occurs
TMJs
common
indicated
but
ifThe
of
indicate
back
which
TMJ than
ifin
softer
opening
bony
in by
them
sound
the
an
the
there
closed
are
movement
automatically
result,
of the
ankle. 
of
tocaused their
provided
muscles
patient
still
be of in you
a
obstacle
connected
the
different
TMJ it
the made
can
resort
to
the
the have into
recapturing
recaptures
TMJ
length
 The
opening.most
 A
continues.
or
times
the
disk's
pop
permanently
open. 
and
gets
itonto
carried
order
of
isbut
early
noises
the
is
fixed
safe
to areare
detect
into
image
joint
soft
and
directly
of
the
thedon’t
the
make
muscles
their
helped
in
important
the cause
The
bitingby
are
usually
much
cellular
joints.
diagnosis
ofhistory
take
together.
X-ray
be
failures
prevent
care
theback
the
which
iteasy. 
but
which
TMJ
a eventually
are
used
DISK.
Imade
over
(no
a
rate,
nerves
gets been
by even
conditions
measures
various
untilof
locked
jointof
TMJ.
each Whatever
in
position
place
basis. 
at
when
time
the
becomes
any
from
disk
irregularity)
won’t
snapping,
and
pushed
to
the
opened
the obstacle
usually
tissues
resolve
- can
affected
tissues.
TMJTMJ joint
only
can
disorder
reason
head, TMJ 10
more
consider
location
joint
have
long
in
them
braced
massage
millions
which
disk
time.
inferred
aftereven
oralof
in teeth
circulation
are
joint
off
restore
headache
can in
of
cause of
procedure
the
the
to
some
has
 Alternatively,
stages
Further
mouth
noise
to
make posterior
caused
allitionizing
eventually is
closing
TMJ.
create
middle
let
are no
as
Disks
the eliminates
process
 seconds
day,
still
serious
activity
dislocation
the
and and
on can
itin
an
isthough
during
stretched
 It
change
statistics
in
the
capsule
the
produces
is
whichare
limited jaw
long
disk
regulators
so that thethe
was the
capsule
natural
surgery
alldue
twenties,
click.
most
 Unlocking
The
teeth
the
unlocking
the
TMJ
longer
of
more
wider
due
opening
 At with
- Eventually
dislocated
been
has
first
dislocation
slowly.
lower
pain
treatment.
bend
jaw opening
small
the of in
disk
lastof
from
other
condyle
touch
TMJs. 
incannot
of
condyle
accompanied
usually to
TMJ
confined
muscle
jaw
cross
muscle
table
pain
the
functioning
described
stuck
popping,
advance
way
front
by its in
itarthrography
point
is
justThis
symptoms
itprocess
involved
need
progressively
which
clinical
disk
opened
in
the
a band
opening
of
the may
this
to
its
click
disks
the
than
back
radiation),
the its
older
consists
is tothe
called
onlywhich
age
path
unless
transmitting
jawbone
dislocation
functionalis
readiness
is leg
circulation
helps
success. 
headacheslike
types
muscle
the of as
arthritic
(called
decade,
show TMJ,
that
the
pseudodisk
natural
causes
rate
the
symptomatic.
mouthcan't
followed
locked
fully
remains
usually
pathology,
sometimescommon
mouth,
of
the the
(adhesed)
closing
path, may
in
have thirties,
open,
is
begins
stretched
at
andJoint
touch
down
muscles. 
impaired
that
TMJs
needs
produce
dislocation
as
signs. 
point,
the
is well
disk.
or
any
or
quite
going
far
to
muscle is
dislocated
dynamics,
journals
typescan
in
situation
a
duesymptoms
people
processes
disk
the
condyle
when of
change
presence
is
that
tension. 
massaging
relieve
wholetightness. 
locations
blood starts
(including
the
restoration
been
disk everybody.
requires
TMJ verythis
condyle
opening,
open
closed
described
of
for
are
by
that
as
may
including
bedye
of the
or
a
without
become
uneventful,
with
noise
pop
clicking
condyle
and a
flattens
been
much
be
as
 the
to
itadaptation
by a
surfaces
and
pain
and
on
joint. 
to
chains,
tension
areTreating
in
continue
to symptoms
and
locked
months
has
 softer
may adaptation
softening
types
In
further.
the
 This
noise
wide,
the
in
on with
usually
as
possible.
athey
slow.  
arthrography)
already
changes
TMJ and
to
agree is be
treatment
the nerves
and
explains the
sound
disk
more
capsule
by
the
muscles
the
head.
flowa
is
lock,
progression
severe
more
the
be
significant
above
onto
no
made
the
other
opening
the
at
condyle
the
and
running
the so
condyle
the the
joint
diminishing
injected
disasters. 
formation. 
surgery
primary
causing
protect
When away of
because
tightening
walking
the
far
fourties;
wide
and may
unable
permanently
arebeen
anyway.
degenerate
dislocated
usually
usually
sound
closing
occur
until
and
 The
mouth
because
swelling
Damage
You they
pain, out
next
depending
sound
rubbing next
disk
are
outdated.
swollen
thatthe
ina
is
are
affected
Treating
primary
can
to so
common
 Human are
the
andfrom
why
legin
they
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dislocated
immediately
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initfor
flattened
noise. 
like
ofshapeover
cases,
and
the  As
to
involved
explained
or
enough
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benefit
paragraph.
the
harmless
with the
have
eases
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pockets
apply at
which
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of take
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In the
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clinically
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with
have
TMJThe
is mouth
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 Thus
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obstacle
underside
no time
Also
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aplace
mouth
closing
snapping
contrast,
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above
bones
with
designed
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the
inside
which area
the
side
damaged
again.
jaw must
see
to
muscles
fromearlier
the
symptomthe
jaw itthe
lower
to
noise
longer or
a MRI
they
used
 TMJ
the
on
MRI. 
indicationthe
surgical
Because
rarely be
teethtoget
or
will
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scar
on
isis
Iafter
high
MRI
the of
aor
the
outer
tissue
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were
jaw
of
thejaw
in
of
POSTURAL
The
an
balances
back. 
front
detail
full
EAR
A
with
end integral
body
balance
produces
Tinnitustightening
swelling,
TMJ
frequently
treatment
impressive,
treatments
Ear
pain in
“spaciness”. 
bruised
antibiotics. 
tissues
SUMMARY
Studies
their pain
symptoms When
SYMPTOMS
dislocated
of
dislocated
and the
balance
difficulty
pressure
across
narrow
inner
swollen
caused
Subjective
subjective
say. 
muscles. 
and
motor they
eventually
TMJ
than
Having The
can
TMJs,
years in
nerve the
posture.
back
the
and
the part
TMJ,
retrodiskal
eustachian
diameter
the mechanism
that
a(ringing,
haveis in
found
enableare
front
are STRAIN
paper
the
feelings
clearing
between
TMJ pull
TMJ
ear.
but,
only
aand of
However
by
problem
These
dislocated
resolved.
at
or some of
swelling
disks
mechanism,
These
eardrum. 
blockage
can
atubejaw
the
down
whichthe
them
successful.
fourth
hearing
hearing
may of
supplied
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decades.in
in
most entitled
disktissues
the
roaring,
about
the
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littlethe
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disturb
is ear
loss,
loss
adaptation
pointmuscles
jaw
head
head
have
symptoms
pushresults
the
ear.can
can
isat
case
probably half
muscles
 Yours
that
TMJofby muscles
disorientation,
also
However,
tube
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after the
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which
on
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disorder
symptom
is or
actual
hearing
both
the
them the
for
about
diskposture
exert
shown
also
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may
by in
of become
back
1.5
buzzing
same
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and the disrupted.
AND
cause
fluid
dizziness
changes
the in
acausedare
causing
ear be is
the
tinnitus,
fifth
ear
due is
control
don’t
period
does always
front
outside
and ofmechanism. 
millimeters
that
located
patients.
cause
tests
too
25% patients
that
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and
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to BODY
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a
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itthe
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