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Physical Therapy Guide to Jaw Fracture (Temporomandibular Joint Fracture)

Temporomandibular Joint (TMJ) fracture (jaw fracture) is the second most common fracture to the bones of the face. Only the bones of the nose are broken more frequently. The jaw bone (mandible) or skull bone section of the jaw (temporal bone) may be broken near or through the TMJ. The injury normally occurs due to trauma to the face, such as a direct hit. The joint itself may be damaged as well as the muscles that move the jaw. After the bone heals, it may be difficult to open or move the jaw. Physical therapists help people who have sustained TMJ fractures to relieve their pain and restore movement and function to the jaw.

What is Temporomandibular Joint Fracture (Jaw Fracture)

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.


How Does it Feel?

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
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

How Is It Diagnosed?

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 computed tomography (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.

How Can a Physical Therapist Help?

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.

Can this Injury or Condition be Prevented?

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.

Real Life Experiences

Fred is a 35-year-old dad who enjoys exploring nature with his daughter Lily. During the first warm spring day this month, Fred and Lily decided to go for a bike ride at a nearby state park. Once at the park, Fred realized that he had forgotten to bring his helmet. But Lily had hers firmly in place. He decided not to go back home to get his helmet, and they set off on the bike path.

After about a mile, Fred looked back over his shoulder to see how Lily was doing. He suddenly lost his balance, and rode off the trail, losing control of the bike on the uneven ground. He fell on his right side, hitting the side of his face. He felt a sharp pain on the right side of his jaw. Lily screamed. He assured her that he was alright, but noticed that he couldn't move his jaw very well to speak. A couple who witnessed the accident called 911, and comforted Lily. They called Fred's wife, and waited with Lily until she came to take her home. The ambulance arrived and took Fred to the local hospital.

An x-ray confirmed that Fred had fractured his mandible near the TMJ. The emergency physician diagnosed a TMJ fracture. Fortunately, the break was less severe. The physician prescribed 3 to 4 weeks of rest, and a soft diet. She also instructed Fred to see an oral and maxillofacial surgeon. The surgeon agreed with the physician, and also prescribed a mouth splint to ensure the jaw rested in a proper position.

A month later, the surgeon examined a new x-ray and told Fred his jaw was completely healed. But Fred complained that it still hurt, and felt heavy, and that he still couldn't fully open his mouth. The surgeon recommended physical therapy.

Fred's physical therapist conducted a full examination, and noted that Fred had reduced range-of-motion in the jaw. She applied gentle hands-on techniques (manual therapy) to ease the soreness and encourage movement. She taught Fred gentle exercises that he could do at home to help speed his recovery.

Fred attended physical therapy sessions twice a week that included manual therapy and gentle exercises, and noted that his jaw began to feel a lot better after just a couple of sessions. Fred's physical therapist added more movement and strengthening exercises as he improved.

Just this week, Fred was released from physical therapy, pain free, with his jaw function fully restored. On Saturday, he went for his first bike ride with Lily since his accident. This time, he made sure that he was wearing his helmet!

This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.

What Kind of Physical Therapist Do I Need?

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.
During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

Further Reading

The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.

The following articles provide some of the best scientific evidence related to physical therapy treatment of jaw fracture. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.

Kisnisci R. Management of fractures of the condyle, condylar neck, and coronoid process. Oral Maxillofac Surg Clin North Am. 2013;25(4):5–73-590. Article Summary on PubMed.

Furto ES, Cleland JA, Whitman JM, Olson KA. Manual physical therapy interventions and exercise for patients with temporomandibular disorders. Cranio. 2006;24:283–291. Article Summary on PubMed

Michelotti A, De Wijer A, Steenks M, Farella M. Home exercise regimes for the management of non-specific temporomandibular joint disorders. J Oral Rehabil. 2005;32:779–785. Article Summary on PubMed.

*PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.

Authored by Eric S. Furto, PT, DPT, MTC, FAAOMPT. Revised by Jennifer Miller, PT, MPT, board-certified clinical specialist in sports physical therapy. Reviewed by the editorial board.

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