The hypomobile temporomandibular joint.

The hypomobile (restricted) temporomandibular joint (TMJ) is usually caused by a restricted joint capsule or by an anteriorly displaced disk. Here, painful unilateral hypomobility (19 mm jaw opening), with normal disk position, caused by voluntary immobilization after a dental procedure, was the presenting symptom. Management included inflammation control, TMJ manipulation (mobilization), and lateral pterygoid muscle relaxation. Inflammation and pain were alleviated by nonsteroidal anti-inflammatory drugs (NSAIDs) and local TMJ ice massage. TMJ mobilization was performed at every visit, to tear joint capsule adhesions and to realign collagen fibers. Exercise consisted mainly of resistive opening (the patient resists an upward force applied to the chin), with the jaw maintained at full opening. This produced lateral pterygoid muscle relaxation at full length, aiding in the restoration of a pain-free 44 mm opening.