Question
hi, today i was at the gym playing basketball. i was guarding this guy who was bigger than me with his back towards me. he turned around and his elbow caught my jaw and it hit it like a sledgehammer. it felt like my lower jaw was pushed back into my head towards my ears. now I'm having pain on both sides of my jaw where the lower jaw opens and closes. i have a slight pain in my ears only because the jaw is like shoved up there. i can barely open my mouth wide and can hardly chew. the lower jaw connects  to the upper jaw like the jaw joints. the hit was unintentional and I'm wondering is there anything i can do to relieve the pain and fix the jaw and if i should visit my dentist. thanks for the help.

Answer
Dear Jake,

Forcible impacts to the jaw frequently produce injuries to the Tempromandibular Joint (TMJ), and can result in long term biomechanical injuries called Tempromandibular Disorder (TMD).  Symptoms of TMD include the following:

1) Pain emanating from the TM joints.
2) Other facial pain.
3) Popping or cracking of the joints.
4) Grinding noises in the joint.
5) Closed lock phenomenon (28-33 mm opening).
6) Headaches.
7) Neck pain; spasm.
8) A feeling of fullness in the ears; tinnitus (ringing).
9) Hearing loss (perceived).
10) Deviation on opening.
11) Lateral neck and trapezius pain.

You definitely need to have this checked out soon.  The best way to have this looked at is to seek out the care of a TMJ specialist...these are usually dentists with advanced training, or chiropractic physicians with advanced training.  

The injury is not Lilly to the actual bone, but to the joint capsule that surrounds the jaw bones, the disk contained in between them, or the muscle and ligaments (disk disruption, capsulitis, synovitis, retrodiscal tissue disruption).  

The structures need to be differentiated because there are different treatment options such as splinting, myofascial stripping of the pterygoid muscles in the mouth, resistive exercises, jaw manipulation, and surgery.  Both the dentist or chiropractor will want to analyses joint function, and may utilize x-rays of the joint, although these frequently don't show much.  Tomographs, ultrasound, scintigraphy, CT, MRI, and Video Flouroscopy have all been reported in the literature as useful for analysis of the TM joint as better diagnostic techniques and may need to be ordered.  MRI has been stated to have a 90%+ accuracy in diagnosis of the offending structures.

Several studies have painted a fairly grim picture of the outcome in trauma-induced TMD. It has been shown to respond to conservative therapy in only 36% of cases, as opposed to the 86% recovery seen in non-trauma or idiopathic cases. More recently, Romanelli et al. found that 48% of trauma patients and 75% of non-trauma patients reported recovery from treatment. The trauma patients required significantly more care. The most recent and probably most reliable assessment uses the new TMJ Scale as an outcome assessment. Comparing trauma to non-trauma groups of TMD patients they reported higher symptom levels in trauma patients, but better overall recovery in that group as well. In my clinic, we have about a 60-65% success rate in treating TMD symptoms with manual resistive exercises, very light jaw manipulation, and myofascial release.  We have had to refer a few cases out for specific dental splinting, but none for surgery yet.

In the immediate future, just utilize ice and over the counter medications for pain, and limit any excessive jaw movements opening and closing, an take it easy with foods such as eating apples, corn on the cob, or hard food until you have this examined.  Good luck Jake!

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net