Head and neck pain: T-M joint syndrome.

Abstract

AbstractThe otolaryngologist is frequently consulted by patients with a confusing array of complaints of pain in the head and neck region. It is the purpose of this paper to re‐introduce the problem of the temporomandibular joint pain dysfunction syndrome and stress its frequent occurrence.Costen in 1934 and 1944 brought to the attention of otolaryngologists the problem of temporomandibular joint dysfunction. In his 1944 report he stated that the diagnosis of tic doloreaux had been frequently made in patients with temporomandibular joint pain dysfunction syndrome. The number of cases included in this report are those collected over the past six months. Between June and December of 1973, 25 patients with the diagnosis of temporomandibular joint pain dysfunction syndrome were asked to fill out a questionnaire covering the history and symptomatology of their problem. Just over 50 percent were under the age of 50, with the largest number between the ages of 30 and 49. No patients had symptoms less than three months and most of the patients had symptoms from three months to one year. Unilateral symptoms were present in all but four cases, and the right side was most frequently involved. Many physicians were consulted and averaged 2.3 for each patient. All but two patients described pain in multiple areas, the most frequent combinations being the joint, ear and lower jaw; however, most patients were unaware of joint pain primarily. One patient complained only of throat pain and one complained only of pain in the lower jaw. Eight patients described “popping” in the joint, and eight had a history of teeth clenching or bruxing. Thirteen complained of fullness or pressure along with tinnitus and vertigo on an intermittent basis. Four case histories are presented to exemplify certain problems.The history is one of many nerve roots involved with pain in and around the ear, pain down the side of the neck, a gnawing aching tight feeling under the jaw to a burning sensation down the skin of the neck. In most all patients treatment has often been given by many doctors. They frequently present to the examiner as an individual with a large psychosomatic overlay.Physical examination reveals subjective pain and tenderness in the joint, clicking or crepitation upon auscultation of the joint, spasm of the external pterygoid, tenderness of the masseter muscle, deviation of the mandible on opening, impaired motion of one or both condyles and a generalized sensitiveness of the skin in the involved region.Representative X‐rays are presented. Intra‐articular injection of 1 cc. of 2 percent lidocaine will relieve some or all of the symptoms the patient is experiencing. Complications of the injection have been minimal. A small number of patients obtained complete relief of their head and neck pain after three to five injections. A possible mechanism to explain the genesis of the syndrome is presented. Treatment is varied and not agreed upon. Three patients have been treated by the insertion of a temporomandibular joint prosthesis.