Clinical Images  |   August 2017
Obliterated Temporomandibular Joint
Author Notes
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Murray R. Berkowitz, DO, MA, MS, MPH, Professor, Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine, Georgia Campus-Philadelphia College of Osteopathic Medicine, 625 Old Peachtree Rd NW, Suwanee, GA 30024-2937. E-mail:
Article Information
Imaging / Neuromusculoskeletal Disorders / Clinical Images
Clinical Images   |   August 2017
Obliterated Temporomandibular Joint
The Journal of the American Osteopathic Association, August 2017, Vol. 117, 542. doi:
The Journal of the American Osteopathic Association, August 2017, Vol. 117, 542. doi:
A 55-year-old woman presented to the osteopathic manipulative medicine clinic with multiple daily right parietofrontal headaches over 3 weeks without trauma. Symptoms began intermittently 8 months prior with progressively increasing frequency. Medications included pregabalin (75 mg twice daily), verapamil (40 mg 3 times per day), and oxcarbazepine (600 mg twice daily). A 0.5-cm right deviation of the mandible with asymptomatic jaw opening was identified and treated with muscle energy technique, which reduced the right mandibular deviation to 0.25 cm. Active trigger points of the temporalis and splenius cervicis muscles were treated with counterstrain technique, 0.5 mL injection of lidocaine 2% (20 mg/mL), and progressive inhibition of neuromuscular structures, and she continued her medications, but her symptoms remained. Panorex imaging (image, arrow) revealed obliteration of the right temporomandibular joint (TMJ), erosion of the condylar process of the mandibular head, and narrowing of the joint space. The patient was referred to oral/maxillofacial surgery for definitive care. 
Obliteration of the TMJ is consistent with secondary headache due to TMJ disorder.1,2 Chronic daily headache (occurring >15 days per month) affects roughly 3% to 5% of the general population throughout early to late adulthood.3 Persistent headaches despite osteopathic manipulative treatment, lidocaine, and medication may be reason to consider TMJ disorder.4,5 
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