A temporomandibular joint pain-dysfunction syndrome

Abstract

ACIAL pain which does not respond readily to simple treatment is often alarming to the patient and perplexing to the practitioner. When pain is believed to arise in the temporomandibular joint, treatment is often radical. Administering cortisone, infiltrating the joint with a sclerosing agent, excising the meniscus, and altering the occlusion of the teeth through radical dental treatment, are some of the methods used. Spasm of the masticatory muscles has been found to be a common cause of facial pain. In such cases, pain is accompanied by dysfunction of the mandibular muscles, the symptoms constituting a temporomandibular joint pain-dysfunction syndrome. This syndrome responds to conservative treatment. Since heroic measures are rarely successful, the presentation of some simple effective office procedures seems timely. THE TEMPOROMANDIBULAR JOINT The temporomandibular joint is unique in form and unusual in function. The physiology of this joint, a subject of much controversy, is as yet not clearly understood. Agreement centers mainly about its structure. This is understandable since the anatomy of the temporomandibular joint has been known for centuries. Vesaliusl first observed the articular disc during the sixteenth century, and John Hunter2 in 1771 described this articulation between the mandible and the cranium so completely that there has remained little to add. The temporomandibular joint is a highly specialized joint. It is divided into two compartments by an articular disc or meniscus interposed between the head of the condyle of the mandible and the mandibular fossa of the temporal bone creating a double joint with two pairs of articulating surfaces. Another distinguishing characteristic is that the temporomandibular joints, attached as they are to the end of the U-shaped mandible, constitute the only system of yoked joints in the human body. Neither joint functions without the other. The mandibular joints are loose, hanging joints. Through their ability to turn in practically all directions as they glide, they permit the mandible an extremely wide range of movement. This versatility of movement has pre