Patient Profile
Female, 30 years old, office worker. Three-year history of TMJ pain and clicking.
Main Complaint
Bilateral TMJ pain and jaw clicking for 3 years, worse when chewing.
History of Present Illness
Over the past 3 years, she gradually developed clicking in both TMJs while opening the mouth. Pain worsened when chewing hard foods, with limited mouth opening and persistent head tension. She had multiple visits to dentists and physical therapists, including occlusal adjustment, physiotherapy, and painkillers. Relief was temporary and symptoms kept returning, strongly affecting eating and mood.
Relevant History
No significant jaw or facial trauma. No rheumatoid arthritis. High work stress, prolonged computer use, occasional night-time teeth grinding, and suboptimal sleep.
Examination
Both TMJ regions were slightly swollen. Mouth opening was limited and accompanied by clear clicking. Multiple tender nodules could be felt in the temporalis, masseter, and pterygoid muscles; pressing them radiated pain to the preauricular and temporal region. Behind the ear, along the mastoid and nuchal lines, there were several trigger nodules, with tightness and tenderness in the upper trapezius and sternocleidomastoid. Neck and shoulder movements were somewhat restricted.
Diagnosis
- Western medicine: Temporomandibular joint disorder (TMJ dysfunction syndrome).
- TCM: “Er jia tong” (ear and cheek pain), a type of “jin bi” (tendon-bi), often from liver qi stagnation and qi–blood stasis in the channels.
- SNAN perspective: A continuous high-tension chain from neck and shoulder to skull base to TMJ. Multiple myofascial trigger points and fascial adhesions around the TMJ act as structural lesions maintaining the dysfunction.
Treatment – Mini Ren-SNAN Acupuncture
Mini Blade Needle, 0.35 mm × 25 mm, insertion depth < 10 mm.
- Neck and skull base (prone):
Systematic palpation along the lower and upper nuchal lines and mastoid region. Trigger bands and nodules in the upper trapezius, levator scapulae, sternocleidomastoid, and cervical splenius were released with shallow, longitudinal “解结” needling. - TMJ and masticatory muscles (supine):
Tender nodules in the temporalis, masseter, and pterygoid muscles and around the TMJ capsule were carefully treated with gentle, shallow nodule-releasing techniques, minimizing local soreness or swelling.
Treatments were given twice weekly, 5 sessions per course.
Results
After the first treatment, she felt obvious relief of neck and head tension. TMJ clicking and pain decreased. After 3 sessions, mouth opening improved significantly and chewing became only mildly uncomfortable. After 5 sessions, TMJ pain and clicking had essentially disappeared, and chewing was normal. Over 1 year of follow-up, occasional mild discomfort appeared only under extreme fatigue and resolved with simple self-relaxation.
Clinical Insight
TMJ pain is not just a “joint problem.” The neck–skull base–TMJ muscle complex forms a continuous tension chain. Chronic myofascial trigger points and fascial adhesions are often the real reason symptoms persist. Mini Ren-SNAN Acupuncture combines “neck-origin tension release” with “local nodule release,” restoring coordinated jaw movement in a relatively short time. This structural approach complements dentistry and physiotherapy and can be particularly valuable for stubborn TMJ disorders.