A temporomandibular joint (TMJ) facture occurs when the mandible and/or temporal bone is broken near or through the TMJ, the joint connecting the jaw bone to the skull. Like other bones in the body, the mandible, also known as the jaw bone, and the temporal bone, the bone on the skull that forms the upper part of the jaw joint, can break when subjected to trauma. TMJ fractures occur due to direct trauma to the face. The jaw most often breaks along the condyles, which are rounded projections on the jaw bone. Fracture also may occur with a dislocation of the joints.

Motor vehicle accidents, assault, sports injuries, and falls are the most common causes of TMJ fractures. Men aged 20 to 29 years are most likely to sustain these injuries, and are approximately 3 times more likely than women of the same age to do so.

Following a TMJ fracture, especially if the inside surface of the mouth is torn, there also is a risk of infection, which can lead to osteomyelitis of the jaw. Blows to the head severe enough to cause a TMJ fracture can also cause a concussion.

Following a TMJ fracture, you may experience:

• Jaw pain.
• Swelling and possible bruising in the area.
• Jaw fatigue.
• Difficulty opening your mouth to eat or talk.
• Ringing in your ears.
• Dizziness.
• Headache.
• Loose or broken teeth.
• Popping sounds in your jaw.
• Neck pain.
• A change in the way the teeth fit together.
• A locking jaw.
• A bump you can feel with your fingers on the jaw bone or joint.

In cases of facial trauma and pain, diagnosis is made by an emergency medicine physician at a hospital or other emergency clinic. X-rays or a CT scan will be ordered to determine the existence and severity of a fracture. If the jaw is dislocated, the physician will return it to its normal position.

• A less severe fracture is diagnosed when the bone is still in place, but has a small fracture line where the bone has broken.
• A more severe fracture can involve a larger fracture line, partially displaced sections of bone, or a dislocation.
• An extreme fracture involves displaced segments of bone or fragmented bone, with a significant alteration of bone structure.

There are several treatments to help a TMJ fracture safely heal.

• If the fracture is less severe, your physician will recommend resting the jaw by:
  • Eating soft foods, or going on a liquid diet.
  • Limiting jaw use such as speaking or brushing your teeth.
• If the fracture is severe, your physician may consider a form of splint therapy to hold the jaw steady and rest it in a proper position for healing.
• If the fracture is extreme, surgery may be required, or the jaw may be set and wired closed to prevent any movement and ensure complete healing.

All of these treatments allow the jaw to heal, but often result in TMJ stiffness. The muscles used to move the jaw also may become tight and weak. You may not be able to eat, drink, or open your mouth as you normally would. Your physical therapist will work with you to help restore your jaw's normal movement, function, and muscular strength.

Once you have completed a course of rest or splinting, your physical therapist can help restore the natural movement of your jaw and decrease your pain. During your first visit, your physical therapist may:

• Review your medical history, and discuss any previous surgery, fractures, or other injuries to your head, neck, or jaw.
• Evaluate the quality and quantity of movement of your jaw and neck.
• Assess your posture and observe how your neck moves.
• Examine the TMJ to find out how well it can open, and whether there are any abnormalities in jaw motion following the fracture.

Following the examination, your physical therapist will select the appropriate treatments to improve your jaw movement and relieve your pain.

Improving Your Jaw Movement

Stretching and Motion Exercises.Your physical therapist may prescribe stretches and range-of-motion exercises for the jaw. The instruction will include guidelines for frequency and intensity of movement to ensure your safe performance of all your exercises.

Manual Therapy. Your physical therapist may also apply skilled hands-on techniques (manual therapy) to gently increase your jaw movement and relieve your pain.

"Low-Load" Exercises. Your physical therapist may teach you special "low-load" strengthening exercises that don't exert a lot of pressure on your TMJ, but can help strengthen the muscles of the jaw and restore a more natural, pain-free motion. Your physical therapist also will teach you exercises that help you increase the opening of your jaw and improve the way it works.

Relieving Your Pain

If your pain is severe, your physical therapist may apply physical modalities, such as electrical stimulation or deep heat, to reduce pain and improve motion.

As TMJ fractures result from trauma to the face, avoiding situations that lead to violent behavior or accidents is key to prevention. Wearing proper helmets and mouth guards will help you avoid sports-related TMJ fractures. Safe driving practices reduce motor-vehicle accidents, but in the event of an accident, wearing your seat belt will reduce traumatic forces to the face and head. Preventing falls with proper footwear, keeping walking paths clear, and other safety practices also help reduce risk. Your physical therapist can help assess your home and work environments and your daily activities to lessen your risk of injury.

All physical therapists are prepared through education and experience to treat patients who have bone fractures. You may want to consider:

• A physical therapist who is experienced in treating people with orthopedic or musculoskeletal problems. Some physical therapists have a practice with a craniofacial focus, meaning that they focus on movement disorders related to the skull and facial structures.
• A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopaedics physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist (or any other health care provider):

• Get recommendations from family and friends or from other health care providers.
• When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with TMJ fracture.
• Be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.