Observe deviations in the path of the mandible during opening and closing, as well as the range of vertical and lateral movement.
Palpate the joints, and listen for clicking and crepitus during opening and closing of the jaw; use a stethoscope to characterize and locate these sounds accurately. Note any tenderness over the joint or masticatory muscles (temporalis, masseter)
while palpating externally and over the lateral pterygoid and buccinator muscles (distal and lateral to upper molar teeth) and the medial pterygoid muscle (pterygomandibular ligament and medial aspect of anterior faucial pillar) with the patient’s mouth open. Explore the anterior wall of the external auditory meatus for tenderness and pain that are usually associated with capsulitis. (See Chapter 10, Temporomandibular Disorders for descriptions of more detailed evaluation and imaging of the temporomandibular joint.)Palpate the joints, and listen for clicking and crepitus during opening and closing of the jaw; use a stethoscope to characterize and locate these sounds accurately. Note any tenderness over the joint or masticatory muscles (temporalis, masseter)