Differential Diagnosis
The patient's symptoms of headache, ear and temple pain, exacerbation by chewing, tenderness and crepitus on palpation of the mandible, and a clicking sound on opening and closing of the mouth suggest a condition affecting the temporomandibular joint (TMJ). Here is a differential diagnosis organized into categories:
- Single most likely diagnosis
- Temporomandibular Joint Disorder (TMJ Disorder): This condition is characterized by pain and dysfunction of the TMJ and surrounding muscles, which can cause the symptoms described. The clicking sound, tenderness, and crepitus are classic signs of TMJ disorder.
- Other Likely diagnoses
- Bruxism: This condition involves grinding or clenching of the teeth, often accompanied by TMJ pain and dysfunction, which could explain the exacerbation of pain by chewing.
- Dental problems (e.g., abscess, impaction): Dental issues can refer pain to the ears and temples and could be exacerbated by chewing.
- Tension headache: Muscle tension in the face and neck can cause headache and ear pain, and may be related to TMJ dysfunction.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Temporal arteritis: This condition involves inflammation of the blood vessels in the temples and can cause headache, jaw pain, and visual disturbances. Although less likely, it is a serious condition that requires prompt diagnosis and treatment.
- Trigeminal neuralgia: This condition involves sudden, severe facial pain and can be triggered by chewing or other facial movements.
- Rare diagnoses
- Eagle syndrome: This condition involves an elongated styloid process that can cause pain in the face, neck, and ears, and may be exacerbated by chewing.
- Otosclerosis: This condition involves abnormal bone growth in the middle ear and can cause ear pain, hearing loss, and other symptoms.
- Rheumatoid arthritis or other autoimmune disorders: These conditions can cause TMJ pain and dysfunction, although they are less common causes of the patient's symptoms.