Myofascial Pain — ORE Part 1 MCQ

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EasyOral MedicineMyofascial PainORE Part 1

A 45-year-old woman presents with bilateral facial pain that is dull, aching, and worse in the morning. She has limited mouth opening (30 mm) and tenderness of the masseter and temporalis muscles bilaterally. There are no TMJ clicks. What is the most likely diagnosis?

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Correct answer: D — Myofascial pain dysfunction syndrome

Explanation lettering: D = shown as A · C = shown as B · B = shown as C · A = shown as D

The diagnosis is myofascial pain dysfunction syndrome (A). The key discriminating features are: bilateral muscle tenderness on palpation (masseter and temporalis), dull aching pain worse in the morning (typical of muscle-mediated pain linked to nocturnal habits such as clenching), and critically, the absence of TMJ clicking or crepitus. Myofascial pain is the most common TMD diagnosis and is managed conservatively in primary care. Option B (disc displacement) is excluded by the absence of joint sounds. Option C (osteoarthritis) typically presents unilaterally with joint degeneration and clicks/crepitus. Option D (trigeminal neuralgia) presents as sharp, paroxysmal, burning pain with no muscle tenderness or opening limitation. Option E (temporal arteritis) is rare at this age, requires systemic features and elevated inflammatory markers, and is not associated with jaw muscle tenderness.

Reference: Gloucestershire Hospitals NHS Foundation Trust Oral & Maxillofacial Surgery, Summer 2025 GDP Letter, citing RCS Faculty of Dental Surgery guidance (2023–2024) on Management of Temporomandibular Disorders; supported by PubMed 24572441 and NHS quality statements on TMD in primary care. https://www.gloshospitals.nhs.uk/media/documents/TL_V5.1_Summer_2025_GDP_letter.pdf