Journal of Oral & Facial Pain and Headache, 04/1995

Varying opinions are found in the literature regarding the role of the ligaments associated with the temporomandibular joint, eg, with respect to recording of mandibular positions and diagnisis and to treatment of patients with temporomandibular disorders. A literature survey was done to explore controversies of anatomy and function of the temporomandibular joint ligaments. Only 20 research-based anatomic/functional articles were registered in the Index Medicus system under the selected headings from 1897 to 1995. By examining the reference lists of the articles found, 22 more articles not included in Index Medicus were identified. Thus, the total number of original publications concerning the temporomandibular ligaments was limited. Although the conventional textbook descriptions of the anatomy of the ligaments are fairly consistent, there are several controversies and unanswered questions. Information about the functional role of the ligaments is especially insufficient. The results of this survey indicate that there is a need for addiitional anatomic and functional investigations of ligaments associated with the temproomandibular joint.

Temporomandibular disorders is a common form of chronic pain affecting the head, face, and jaw. The distinguishing symptoms of this disorder include pain and impairment of the masticatory function, and frequent display of symptoms, ranging from aches in the head, neck, ears, and eyes, to atypical toothaches, throat symptoms, and occlusal changes. It is recognized that pain is a complex, multifactorial experience including not only sensory dimensions, but also affective and cognitive factors. Recent recommendations regard temporomandibular disorders as a dualaxis disorder with physical and psychologic dimensions, but little research has incorporated measures of multidimensional pain characteristics in the assessment of temporomandibular disorders. This article is a review of the literature on the psychophysiologic factors contriuting to temporomandibular disorders and its limitations. Recommendations for future research are also given. i .

This study examines the incidence of and the potential correlates of sexual and physical abuse among facial pain patients. An anonymous survey composed of standardized self-report measures of abuse, pain, and psychologic status was distributed to 120 adult facial pain patients following their initial evaluations. Forty-five questionnaires were returned by mail. In addition, 206 charts were randomly selected from a population of 520 new patients seen at the Orofacial Pain Center during the same time period that data from the anonymous survey were collected. Results of the anonymous survey indicated that 68.9% of the patients reported a history of abuse. Conversely, a chart review revealed that only 8.5% of the patients indicated a history of abuse on the clinic questionnaire. History of abuse was significantly related to greater pain severity, depression, psychologic distress, and various personality characteristics. Overall, this study indicates that the assessment of the history of abuse may be an important factor in the evaluation and treatment of facial pain.

Pain-pressure thresholds (PPTs) and stimulus-response (S-R) curves in masseter muscles and index dingers of 11 female patients with chronic jaw-muscle pain were compared with that of 11 matched control subjects. Experimental hyperalgesic and hypoalgesic conditions in the masseter muscles of control subjects were induced by intramuscular injuction of 5% saline and of local anesthetic, respectively. The PPTs were found to be significantly lower in the masseter muscles of apin patients than in those of control subjects. The mean slopes of the S-R curves were significantly lower in the masseter muscles of pain patients than in those of control subjects. The mean slopes of the S-R curves were significantly steeper for the masseter muscles of pain patients (0.481 ± 0.213) than of control subjects (0.274 ± 0.201, P.0256). There were no statistically significant differences in PPTs or S-R curves for the index finger. The PPTs in masseter muscles of control subjects were not significantly affected by injection of 5% saline; however, the slopes of the S-R curves for the masseter muscles were significantly steeper for saline-injection values compared to baseline values (21.7% ± 29.6%, P.037). Injection of local anesthetic into masseter muscles of control subjects increased the PPTs significantly and reduced the slopes of the S-R curves significantly as compared to baseline values (-22.9% ± 34.6%, P.155). The present results suggest that PPTs and S-R curves are valuable tools for quantitative description of chronic and experimental jaw muscle pain.

Pain-pressure thresholds of the head and neck region of 31 patients (aged 13 to 50 years; mean, 28.4 ± 9.6 years) suffering from episodic tension-type headache and 32 female control subjects (aged 15 to 46 years; mean, 26.6 ± 8.6 years) were recorded with an electronic algometer by the same blinded observer. The multivariate analysis of variance revealed that the algometer values obtained from different age groups of patients and control subjects were statistically different, but the values for the right-side muscles were not statistically different from the corresponding values for the left-side muscles. The pain-pressure thresholds of the patient group were lower than those of the control group for the superior sternocleidomastoid muscles, middle sternocleidomastoid muscles, and trapezius insertion muscles (P.01) but were not statistically different for the anterior temporal, middle tempora, posterior temporal, deep masseter, anterior masseter, inferior maseter, medial pterygoid, posterior digastric, splenius capitis, and upper trapezius muscles (P.01). The results may indicate that pain-pressure thresholds of the head and neck region should be considered in the diagnosis of episodic tension-type headache. The results may also propose that the increased pain sensitivity of the head and, especially, the neck region, may be included in the pathogenetic mehanism in episodic tension-type headache.

The accuracy of orthopantomography in reproducing the temporomandibular joint area was analyzed on a dry skull. The results based on this study of a single skull revealed that the radiographic image of the temporomandibular joint did not correspond to the anatomic condylar and fossa components or to their actual relationships. To a large extent, changes in skull position affected the radiographic temporomandibular joint image, simulating anterior condylar flattening, osteophytes, narrowing of joint space, and left/right condylar asymmetry. Orthopantomography may have questionable reliability for temporomandibular joint diagnostic purposes.

Viscosupplementation is a relatively new treatment concept for restoring the normal rheologic properties of the osteoarthritic joint. It is most often used for the knee. This case report describes results that were achieved using viscosupplementation following conservative therapy for a patient with osteoarthritis of the temporomandibular joint. Further study in the use of these treatments is recommended.

A case of chronic unilateral mandibular dislocation with development of fibrous ankylosis is presented. This was an unusual presentation of intracapsular tissue ankylosis to the eminentia, as well as retrocondylar cicatrix combined with contralateral mandibular osseous compensations and remodeling with resulting ramus impingements upon relocation of the condyle. Various diagnostic and therapeutic considerations are reviewed and discussed.