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Q. I have TMJ disorder with swelling and facial asymmetry on the right side. Kindly help.

Answered by
Dr. Mousam Chattopadhyay
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Oct 07, 2020

Hello doctor,

I have had some form of TMJ disorder for close to 10 years at this point. I never had any treatment for it since it never hindered or affected me in any way, aside from clicking in my jaw. However, I believe I am beginning to see the effects of letting it go untreated. I severely grind my teeth at night, and even when wearing a mouth guard, I still often wake up with a sore jaw from clenching so hard.

Aside from that, one of my main concern is how asymmetrical my face has become. My right jaw almost looks swollen compared to my left. This is something that has gotten worse over time. I noticed some asymmetry years ago, but it has gotten worse over time, and now it is extremely pronounced. I do intend to speak to my dentist about this. However, I am currently unable to do so with COVID-19 still ongoing, and right now, I am doing some research. I understand that it may be hard to diagnose without x-rays and such, but I am looking for the best guess as to whether this is bone or muscle related. I have looked up what some of my options could be, and it seems like the two most common are surgery and Botox injections into the masseter muscle to induce atrophy and slim the jaw. More specifically, I wonder if this can be relieved with something relatively inexpensive such as Botox (surgery is not an option due to the price). I am not looking for perfect symmetry. I want to reduce the size of my right jaw, if possible. I am currently on Flonase and Zyrtec for allergy.

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Hello,

Welcome to icliniq.com.

First and foremost, I want you to make sure you do not need any form of surgery. I have seen many cases, and trust me, you are nowhere near.

Secondly, the real useful image was the last one that was cropped (attachment removed to protect patient identity). It is too hard to diagnose the treatment if the teeth are not visible and how they are arranged to respect your face (talking about symmetry). So I need more images, do not crop any of them.

Try opening your lips as wider as possible and jaw closed in one image and jaw opened in another image. And yes, you have a swelling on the right side, but it is not due to TMJ (temporomandibular joint) issue.

Swelling can be due to third molar impaction, effects from clenching on a regular basis. The tooth towards the right side seemed to be crowded. Orthodontic treatment might help, but it might take a longer time as per your age, and chances of relapse are much more. But commenting without seeing the requested images will be blind guesses. So for that, kindly upload the requested images. I am sure I may found out the reason for your swelling on the right side of the face. Please include a picture of the chewing side of the teeth on the right side.

Another aspect I think I must include, kindly let me know whether you have a sinus infection (sinusitis). Sinus infection might lead to swelling of the face.

Bruxism or clenching issue is very common. Stress triggers it. Avoid coffee, tea, caffeinated drinks, etc. Improve sleep habits, music, yoga, and workout. These steps can minimize clenching.

Let us deal one issue at a time. First, we will find out the reason for swelling on the right side of your face. Either you may have a chronic cold and cough issue that might lead to sinusitis leading to a swollen right side. Or dental issue for that reason, upload the images.

You do not need a Botox injection or any form of surgery, for sure.

Thank you doctor,

I have attached the pictures. You asked a few profile side view just in case that might be helpful. You will probably notice that I have a broken tooth on my right side from a few months ago that I have not been able to fix yet due to the pandemic.

Also, I have had ongoing sinus issues for a couple of years. I have been to the doctor many times for random flare-ups of sinus issues, and usually, they tell me that I have a lot of pressure and give me a steroid and an antibiotic. However, I am fairly certain that this asymmetry started before I ever started having sinus issues. Also, I forgot to mention that I have had all four wisdom teeth removed.

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Hello,

Welcome back to icliniq.com.

I went through the attached images (attachment removed to protect patient identity), and I appreciate your efforts in helping me out.

You will be very pleased to hear that the entire asymmetry issue you are facing is due to sinus infection towards the upper right side. If you go through the images, you uploaded. You will notice, your entire face looks symmetrical except the upper right cheek. It happens when the sinus gets blocked, and infection occurs, leading to inflammation and swelling. You need to get that drained out.

I have noticed the broken tooth, but as no flash is used, they were bit hazy. A simple root canal should solve the issue. But my major concern was to check for any abscess formation leading to swelling, but no such issue was found.

The TMJ joint is like a door hinge, I know you have a clicking sound, and it is best you already got third molars extracted. But this asymmetry issue is not due to.TMJ or abnormal muscle or bone growth. It is totally due to sinusitis and the area got swelled up leading to asymmetrical face. Once you get that fixed I am sure everthing is going to be fine.

For now, I would advice steam inhalation, breath the steam in. Add a small amount of salt in the water before boiling it. Inhaling the steams opens the blocked sinuses. Get medical help from local clinic or hospital as the sinus needs draining. X-ray might be needed.

Take tablet Azithromycin 500 mg once daily after meal for five days. You just need the broken tooth to be fixed.

You do not need any costly corrective surgery or Botox injection, as you are fine. The issue is due to chronic sinusitis.

I hope this helps.


The Probable causes:

Sinus infection leading to inflammation and swelling on the right side cheek.

Investigations to be done:

The broken tooth was not clearly identified. If possible upload an image and I will let you know, whether root canal is possible or not.

Probable diagnosis:

Chronic sinusitis.

Treatment plan:

Medications given. Might need draining. Steam inhalation.

Preventive measures:

Avoid cold or chilled food items.


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