Preauricular Pain Research Articles

Ultrasound Elastography in Temporomandibular Disorders: A Narrative Review.

A class of intricate musculoskeletal diseases known as temporomandibular disorders (TMDs) affects the temporomandibular joint (TMJ) and its supporting structures. The majority of individuals will at some point in their lives experience some degree of TMD symptoms, as these diseases are highly prevalent in the general population. TMDs are multifactorial and are attributed to various physical and biopsychosocial factors. The TMD patients typically experience preauricular pain, tenderness of masticatory muscles, and joint sounds, and these in turn affect their quality of life. To carry out the appropriate course of treatment, it is critical to make an accurate and timely diagnosis. The TMDs are classified as myofascial pain, internal disc derangement, and degenerative disorders of TMJ. Myofascial pain, which is identified by palpating the affected muscles of mastication and tenderness, is one of the most common findings. The muscles in this condition become stiff due to the contraction of myofibrils and are known as trigger bands. The diagnosis of trigger bands involving the masticatory muscles commonly involving the masseter muscle in myofascial pain to date is subjective, and palpation is the only tool used for its diagnosis. An objective assessment of the masticatory muscles is desirable for accurate diagnosis and treatment planning. Various tools like electromyography and hardness meters have been for assessing muscle stiffness, but their application in TMJ muscle disorders has not yielded valuable results. A novel diagnostic method called ultrasound elastography evaluates muscle stiffness both qualitatively and quantitatively using an elastogram and the muscular elasticity index. In this paper, we will review the ultrasound elastographic techniques utilized for the diagnosis and management of TMDs.

Association Between Temporomandibular Joint Disorders and Metastatic Breast Cancer—A Mapping Review

Aim: The authors of the present study speculate that metastasis of breast cancer cells to the temporomandibular joint (TMJ) region mimics classical signs and symptoms of temporomandibular disorders (TMD). The aim of this mapping review was to investigate the association between metastatic breast cancer (MBC) and TMD. Materials and Methods: The focused question was, “Is there an association between MBC and TMD?” Indexed databases (PubMed/Medline, EMBASE, OVID, Scopus, Google Scholar, and Web of Science) were electronically searched up to and including March 2022. These databases were searched using different combinations of the following keywords: cancer, carcinoma, temporomandibular disorders, temporomandibular joint, disc displacement disorder, nociception, and tumor. Original clinical studies that meet the inclusion criteria were included. The risk of bias (RoB) was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for case reports. The structure of this current evidence-based review was tailored to primarily condense the relevant information. Results: Fifteen case reports were selected after screening the retrieved records from the electronic search. Fifteen out of 16 patients were women aged between 32 and 78 years. All patients were diagnosed with MBC, and most presented with adenocarcinoma. The symptoms identified in patients with TMD included: (a) preauricular pain; (b) preauricular swelling; (c) limited mouth opening; and (d) malocclusion. Fourteen of the included studies had a low RoB, while one had a moderate RoB. Conclusion: Based on the currently available evidence, a direct association between TMD and MBC or vice versa cannot be established. Routine visits to medical and oro-dental healthcare providers can contribute toward early diagnosis and management of TMD and MBC.

Radiological Study of Synovial Chondromatosis of the Temporomandibular Joint

Abstract Temporomandibular joint disorders (TMDs) are usually accompanied by changes in the bone structure of the TMJ brought on by degenerative processes. Osteophytes, erosion, flattening, subchondral sclerosis, pseudocysts, TMJ remodeling, articular cartilage abrasion, bone degradation, and synovial inflammation are among the characteristics of degenerative joint disease. Synovial chondromatosis (SC) is one of the degenerative joint conditions, which is defined by the growth of cartilaginous nodules, which are typically loose in the joint space of the synovial membrane. Its appearance in the TMJ, however, is more uncommon than in other large joints such as the knee and hip and is accompanied by preauricular pain, swelling, and restricted mouth opening. However, we recently encountered cases of degenerative joint disorder, i.e., of SC of TMJ, which showed the typical histopathological findings along with the typical imaging findings on Panoramic radiography (PAN) TMJ and cone-beam computed tomography images.

Osteoma in the temporomandibular joint (Case report)

Osteomas are benign slow growing osteogenic tumors mostly arising in the craniofacial region and characterized by the deposition of differentiated and mature either or both cancellous and compact bone. Osteoma accounts for 2-3% of all bone primary tumors with an incidence of 10-12% among all benign skeletal neoplasms. Objective: The objective of this work is to describe a clinical case of an osteoma in the temporomandibular joint diagnosed in the maxillofacial surgery service of the General Hospital of Pachuca in the State of Hidalgo, Mexico. Clinical Case: A 39-year-old female patient who comes to the General Hospital Pachuca, Mexico due to pain and noises in the right preauricular region of 6 years of evolution, with facial asymmetry, mandibular deviation to the left and limited mouth opening. Clinically, facial asymmetry, mandibular deviation to the left, right posterior crossbite, anterior open bite mainly on the affected side, preauricular pain, joint sounds, and limitation of mandibular movements were observed. Radiographic examination revealed a trapezoidal mass measuring 2.5 by 2.0 cm, with alteration of the condyle-mandible anatomy on the right side. An insertional biopsy is performed, reporting an osteoma, and surgical intervention is continued. Conclusion: The osteoma in the temporomandibular joint is a rare lesion, its timely value is essential for its treatment. Surgical resection is the gold standard treatment, which is based on a radical excision that extends to the altered normal bone, with the contextual objective of achieving an optimal aesthetic result by choosing the least invasive surgical treatment possible.

An unusual cause of jaw pain

A 49-year-old woman was referred to the Maxillofacial Surgery Department of our University to evaluate a worsening jaw pain lasting since three-years. She experienced increasing preauricular pain in the area of the left temporomandibular joint (TMJ), during the day and night, and a progressive limitation of mouth opening over the past few years. The patient denied bruxism or jaw clenching. She had been treated by various health professionals, including physiotherapists, osteopaths and orthodontists over the years.

Open Reduction and Internal Fixation Versus Closed Reduction and Maxillomandibular Fixation of Condylar Fractures of the Mandible: A Prospective Study.

BackgroundThe choice of surgical versus nonsurgical treatment for fractures of the condylar process has its own limitations and remains a controversial issue. Improved knowledge of anatomy, technique, and technology combined with adequate experience with careful planning of surgical technique can avoid all the possible complications.AimTo compare open reduction and internal fixation with closed reduction and maxillomandibular fixation in the management of condylar fractures.Materials and methodA prospective study was carried out among 22 patients who had minimally displaced or displaced condylar fractures. The patients were divided into two groups of 11 each: group A patients treated with open reduction and rigid internal fixation and group B patients treated with closed reduction and maxillomandibular fixation. Follow-up examinations were performed at one week, one month, three months, and six months postoperatively.ResultsPreauricular pain was significantly decreased (p < 0.001) in both groups postoperatively but more significantly decreased in the open reduction group. There was a significant improvement in the mouth opening at every follow-up to a maximum mean of 37.36 mm in group A and a mean of 33.64 mm in group B. Significantly more improvement in protrusive and lateral movements and reduced deviation on mouth opening at every follow up was observed in the open reduction group.ConclusionBoth the treatment options for condylar fractures of the mandible yielded acceptable results with significant clinical differences in terms of occlusion, mouth opening, functional movements, and pain among patients with open reduction.

Is there any differences in magnetic resonance imaging findings of painful temporomandibular joint between patients with and without vertigo?

Background/Aim: Temporomandibular disorder (TMD) is an umbrella term and consists of pathological situations about temporomandibular joint (TMJ) internal structure, masticatory muscle and associated structures. Otalgic complaints are included in the group of complaints within TMJ associated structures and are frequently seen with TMD. The aim of this study is to evaluate the magnetic resonance imaging findings (MRI) of patients who had unilateral pain in the preauricular region, diagnosed with vertigo. Material and Methods: The present retrospective and cross-sectional clinical study was carried out on patients presenting with preauricular pain referred to XXX University Faculty of Dentistry Department of Oral and Maxillofacial Surgery between 2018 and 2020. There were 2 groups as vertigo and health groups. MRI findings were the primary predictor variables, while pain was the primary outcome variable, recorded on a visual analog scale (VAS). Results: 120 patients were included in the study. The patients included in both groups are between 19 and 65 years of age and there is no significant statistical difference between mean ages of the groups (p&gt;0.05). The VAS values varies between 6 and 9 in both groups. There is no significant statistical difference between mean VAS values of the groups (p&gt;0.05). On the painful side there is no significant difference between the groups in terms of disc/condyle relation (p&gt;0.05). On the other hand moderate effusion (61.4%) was significantly higher in the healthy group while severe effusion (54%) was significantly higher in the vertigo group (p&lt;0.01). Conclusions: Although both groups had the same pain scale, it was observed that the vertigo group had more dramatic MRI findings in terms of disc/condyle relation and presence of effusion. This study is the first to evaluate the disc/condyle relation and the presence of effusion through MRI in vertigo patients diagnosed with TMD.

A rare case of temporomandibular joint synovial chondromatosis with cranial base extension

Synovial chondromatosis is an uncommon benign lesion in which the synovial membrane within the joint forms cartilaginous nodules and loose bodies due to cartilaginous metaplasia. It is rare to develop in the temporomandibular joint, and may be accompanied by cranial base expansion or temporal bone morbidity. A 41-year-old male patient visited our hospital complaining of preauricular pain and crepitus. On CT and MRI, increased synovial fluid in the joint cavity, loose body, temporal bone erosion and cranial base expansion were observed. It was diagnosed as synovial chondromatosis through imaging and clinical symptoms. After arthrocentesis, the symptoms slightly decreased, and arthrotomy was performed for complete resolution of the pain. The patient's pain and crepitus were resolved, and no recurrence of the lesion was observed.

Questionnaire-Based Assessment of the Masticatory Function and Facial Nerve Recovery Post Pterional Approach in Brain Tumors Surgery.

Background: The pterional approach for craniotomy, one of the most used surgical intervention in neurosurgery, results in a series of postoperative changes that, if they persist, affect the patient’s life, social reintegration, and his/her physical and mental recovery. The aim of the present study was to develop and validate a questionnaire for indicating directly affected masticatory muscles groups and facial nerve branches, in patients undergoing the pterional approach in neurosurgery, so that the recovery therapy can be monitored and personalized. Methods: A self-reporting questionnaire consisting of 18 items (12 for postoperative masticatory status and 6 for facial nerve branches involvement), validated on fifteen patients, following three steps: items development, scale development, and scale evaluation, was prospectively applied twice, at a one-year interval (T0 and T1), with thirty-two patients suffering from vascular or tumoral pathology and surgically treated through a pterional approach. Results: No statistically significant correlation could be found between postoperative outcomes and age or gender. Facial nerve branch involvement could not be correlated with any of the assessed variables. Pathology and time elapsed from surgery were statistically significantly correlated to preauricular pain on the non-operated side (p = 0.008 and p = 0.034, respectively). Time elapsed from surgery was statistically significantly correlated to the ability to chew hard food, pain while yawning, and preauricular pain during back and forward jaw movements and gradual mouth opening. Conclusions: We created and validated a valuable patient-centered questionnaire that can be employed as a tool for postoperative assessment of directly affected masticatory muscles and groups of facial nerve branches.

A Synovial Cyst of the Temporomandibular Joint.

A 25-year-old woman without personal medical history complained of a unilateral preauricular pain, increased by temporomandibular joint (TMJ) mobilization, that had been evolving for a few months. She had no history of traumatic injury. Clinical examination revealed a tender right preauricular mass, and a reduced mouth opening, with a maximal opening of 33 mm. Oral examination revealed normal occlusion. Magnetic resonance imaging (MRI) …

Relationship between Pathological Occlusal Changes and the Signs and Symptoms of Temporomandibular Dysfunction.

This study aimed to investigate whether there is a correlation between pathological occlusal changes and the signs and symptoms of temporomandibular dysfunction (TMD). This cross-sectional, quantitative, non-randomized clinical trial was conducted on 150 participants. We examined adult patients of both genders with occlusal interference, malocclusion and dental absence in the posterior region of the dental arch that were associated or not associated with painful symptoms. The questionnaire was administered, and the intra- and extra-oral clinical examination was performed on each patient, including the evaluation of the temporomandibular joint (TMJ) to investigate the presence of dysfunction. The mean age of the participants was 33 years (±2.3), and 103 (68.7%) of them were women and 47 (31.3%) were men. Tooth loss and malocclusion were more prevalent in females. Tooth loss showed a statistically significant association with all the signs and symptoms of TMD (p=0.02). Patients with multiple teeth losses experienced preauricular pain during mandibular opening and closing. There was no association between malocclusion with tooth loss and the signs and symptoms of TMD in 65 patients (p>0.05). Only in the patients with Class II malocclusion there was a significant association with 2 signs of TMD (crackling and bruxism). There was no association between malocclusion and tooth loss with the signs and symptoms of TMD. The signs and symptoms of TMD were more frequent in the patients who presented multiple teeth loss without malocclusion.

FUSOCELLULAR NEOPLASM OF THE JAW: A CHALLENGE FOR DIAGNOSIS AND TREATMENT

A female, 21 years old, type-I diabetic, presented with right pre-auricular pain and limited jaw function. Discrete facial asymmetry and swelling were noted. Panoramic radiograph showed a mixed, expansive, multilocular lesion in the right mandibular ramus about 6 cm wide and undefined margins. After incisional bone biopsy, anatomopathologic study revealed a fusocellular neoplasm with osteoid deposition. Immunohistochemistry showed a Ki-67 proliferative index of about 20% with positive ALFA acute myeloid leukemia, vimentin, and CD-34 markers. S-100 and desmin markers were negative. Hypothesis for the diagnosis was ossifying fibroma or low-grade osteosarcoma. After biopsy, the patient had increased pain and swelling. Aggressive treatment through surgical resection and immediate reconstruction with a microvascular free fibula flap was indicated. Final diagnosis after resection was ossifying fibroma. The patient remains disease-free after 6 months. Fibro-osseous lesion diagnoses are often challenging, and aggressive treatment may be indicated when low-grade malignant disease is suspected. A female, 21 years old, type-I diabetic, presented with right pre-auricular pain and limited jaw function. Discrete facial asymmetry and swelling were noted. Panoramic radiograph showed a mixed, expansive, multilocular lesion in the right mandibular ramus about 6 cm wide and undefined margins. After incisional bone biopsy, anatomopathologic study revealed a fusocellular neoplasm with osteoid deposition. Immunohistochemistry showed a Ki-67 proliferative index of about 20% with positive ALFA acute myeloid leukemia, vimentin, and CD-34 markers. S-100 and desmin markers were negative. Hypothesis for the diagnosis was ossifying fibroma or low-grade osteosarcoma. After biopsy, the patient had increased pain and swelling. Aggressive treatment through surgical resection and immediate reconstruction with a microvascular free fibula flap was indicated. Final diagnosis after resection was ossifying fibroma. The patient remains disease-free after 6 months. Fibro-osseous lesion diagnoses are often challenging, and aggressive treatment may be indicated when low-grade malignant disease is suspected.

Nonodontogenic Odontalgia Referred from the Temporal Tendon: A Case Report

IntroductionTemporal tendonitis (TT) is an orofacial pain disorder that can refer pain to the maxillary and mandibular molars, temporomandibular joint, masticatory muscles, eye, or ear. Patients often present to a dentist or physician with complaints reflecting these referral patterns, yet many healthcare providers are unfamiliar with TT because of the scarcity of literature published on this clinical entity. This may lead to diagnostic confusion, iatrogenic harm, and prolonged patient suffering. Methods and ResultsThis case report describes TT that presented as maxillary and mandibular posterior tooth pain, preauricular pain, and decreased mandibular range of motion. Patient history and examination were suggestive of TT. Local anesthetic injection adjacent to the tendon eliminated all pain complaints and improved range of motion. The patient was given education on the condition and self-care instructions. At 1-week follow-up, the patient reported resolution of her pain complaint. ConclusionsAs healthcare providers familiarize themselves with appropriate diagnostic and treatment options for TT, delayed or unnecessary care can be avoided, and proper management strategies can be implemented.

Synovial Chondromatosis of the Temporomandibular Joint – Clinical, CT, MRI, Surgical and Histological Findings: Case Report

Synovial chondromatosis is a benign metaplastic disorder, rarely located in the temporomandibular joint. The present study describes a 50-year-old woman with unilateral pre-auricular pain, crepitus and swelling of the area. The clinical, imaging, surgical and histopathological findings established the diagnosis of unilateral TMJ synovial chondromatosis.

Investigation of copy number variations on chromosome 21 detected by comparative genomic hybridization (CGH) microarray in patients with congenital anomalies

BackgroundThe clinical features of Down syndrome vary among individuals, with those most common being congenital heart disease, intellectual disability, developmental abnormity and dysmorphic features. Complex combination of Down syndrome phenotype could be produced by partially copy number variations (CNVs) on chromosome 21 as well. By comparing individual with partial CNVs of chromosome 21 with other patients of known CNVs and clinical phenotypes, we hope to provide a better understanding of the genotype-phenotype correlation of chromosome 21.MethodsA total of 2768 pediatric patients sample collected at the Genetics Laboratory at Oklahoma University Health Science Center were screened using CGH Microarray for CNVs on chromosome 21.ResultsWe report comprehensive clinical and molecular descriptions of six patients with microduplication and seven patients with microdeletion on the long arm of chromosome 21. Patients with microduplication have varied clinical features including developmental delay, microcephaly, facial dysmorphic features, pulmonary stenosis, autism, preauricular skin tag, eye pterygium, speech delay and pain insensitivity. We found that patients with microdeletion presented with developmental delay, microcephaly, intrauterine fetal demise, epilepsia partialis continua, congenital coronary anomaly and seizures.ConclusionThree patients from our study combine with four patients in public database suggests an association between 21q21.1 microduplication of CXADR gene and patients with developmental delay. One patient with 21q22.13 microdeletion of DYRK1A shows association with microcephaly and scoliosis. Our findings helped pinpoint critical genes in the genotype-phenotype association with a high resolution of 0.1 Mb and expanded the clinical features observed in patients with CNVs on the long arm of chromosome 21.

Septic Arthritis of the Temporomandibular Joint without an Apparent Source of Infection: A Case Report

Septic arthritis of the temporomandibular joint (TMJ) is a rare disease that is characterized by preauricular pain, edema, malocclusion, trismus and abscess formation in the TMJ region. An 85-year-old male visited our hospital with the complaint of left-sided TMJ swelling, pain and trismus. Septic arthritis of the left TMJ was diagnosed on the basis of considerable elevation of CRP (Creactive proteins) and CT imaging findings. The patient was treated with oral Faropenem at 450 mg daily, but CRP increased three days after the initial visit. He was hospitalized and treated with intravenous administration of cefazolin at 2 g and clindamycin at 1.2 g daily for six days. Propionibacterium species and Veillonella species grew in a culture of the joint aspirate, but there was no apparent source of infection. After acute infectious symptoms had passed, the patient was treated with oral amoxicillin at 750 mg daily for eight weeks and was instructed to do jaw opening exercise. The patient was discharged on the 11th hospital day. After three weeks of the hospital discharge, the patient healed completely. To avoid serious complications, clinicians should include septic arthritis of the TMJ in the differential diagnosis of preauricular pain, trismus and swelling.

Diagnóstico de mieloma múltiple a raíz de una lesión osteolítica mandibular

PurposeMultiple myeloma is a neoplasic proliferation of plasma cells with systemic repercussion and osteolytic lesions. The initial diagnosis by a mandibular lesion is extremely rare. Therefore we present a clinical case of multiple myeloma diagnosed following pain and swelling from an ostelytic mandibular lesion, and we review the literature in order establish a clinical profile and a typical radiological image that would allow us to suspect the diagnosis with more certainty. Material and methodsA 46 year-old woman comes to the Emergency Department complaining about preauricular pain and swelling. The orthopantomography shows a radiolucid multilolocular image along the mandibulary ramus and condyle. The histology and extension follow up concludes with a multiple myeloma diagnosis. A systematic review of Pubmed database was made searching for mandibular lesion at initial diagnosis of multiple myeloma within the last 5 years. ResultsWe found 13 cases including ours The mean age was 61 years with a slight male predominance; the most common clinical presentation was a firm to hard mandibular swelling with or without mucosal ulceration; and the most characteristic radiological image was a uni or multilocular osteolysis, with periostic reaction in one case. ConclusionsA mandibular lesion as a first sign of multiple myeloma is infrequent. Nevertheless, a maxilofacial surgeon should suspect a plasma cell neoplasia in cases of mandibular osteolytic images and start further studying without delay.

Leiomyosarcoma Ex Pleomorphic Adenoma of the Parotid Gland: A Case Report and Literature Review.

There is only one previously reported incident in the English literature of sarcoma ex pleomorphic adenoma of the parotid and there are only 8 cases of primary parotid leiomyosarcoma. In our case, a 79-year-old female patient presented to our care with left preauricular pain, swelling, and facial weakness. After CT imaging, she underwent left total parotidectomy. A spindle cell lesion was identified intraoperatively and the facial nerve was sacrificed. Subsequent analysis of the lesion yielded a diagnosis of leiomyosarcoma ex pleomorphic adenoma. After 30 fractions of radiation therapy, scans were negative for tumor. However, 18 months after first experiencing symptoms, she was found to have metastases to the brainstem and lung. When diagnosing sarcoma ex pleomorphic adenoma of the parotid gland, it is important to perform thorough immunohistochemical staining and exclude a previous history of sarcoma or other sources of metastases. Complete resection is critical due to the tumor's local aggressiveness and metastatic potential. Although these tumors are not very responsive to chemotherapy or radiation, adjuvant treatment is commonly used when margins are unclear.

Carotid Body Tumors: Series of Case Report and Retrospective Analysis: An Institutional Audit

Aim: The aim was to perform a retrospective audit of rare vascular neoplasm Carotid body tumor (CBT) in our cancer center. Materials and Methods: An institutional retrospective audit was performed in Curie Manavata Cancer Centre, Nasik, India from 30th June 2013 to 30th June 2014. Total of 5 patients were diagnosed with CBT in a period of 6 months. Results: Out of 5 patients who were diagnosed with CBT, 2 (40%) were males and 3 (60%) were females with a ratio of 1:1.5. The types of CBT were familial in 2 patients (40%), sporadic in 2 patients (40%) and hyperplastic in 1 patient (20%). The clinical presentation of the 5 cases was, 3 patients (60%) had a painless, progressive swelling, 2 patients (40%) had pre-auricular pain, and 1 patient (20%) was identifi ed in routine follow-up. All patients underwent surgical excision of CBT with no need to pre-operative embolization. 40% of patients had cranial nerve injury and hematoma formation. 1 out of 5 patients received post-operative adjuvant radiotherapy due to large tumor size and lymphatic spread. No recurrence was found after a follow-up of 6 months. Conclusion: Surgical management of CBT remains a challenge for head and neck surgeon. Despite a reduction in stroke and mortality, there can be a signifi cant morbidity associated inadvertent adjacent cranial nerve injuries. However, our audit shows these tumors can be managed well with meticulous planning and execution of the surgery.

A case report of a primary synovial chondromatosis of temporomandibular joint, producing medial displacement of the articular disc

AbstractSynovial chondromatosis in the temporomandibular joint (TMJ) is a rare benign cartilaginous metaplasia characterized by the formation of loose bodies within the synovial joint space. This condition presents a specific triad of semiological characteristics featuring pain, swelling, and limitation of function. We will present a clinical case of a 49 years‐old female patient who presented to the clinica Davila's maxillofacial service with severe functional alterations in her right TMJ. Clinically, the patient had a maximum aperture of 15 mm wide, alteration of mandibular dynamics and preauricular pain. Posterior conducting a complete clinical examination and conclusive magnetic resonance imaging (MRI) findings it was decided to perform surgery on the joint. Articular cavity was exposed through a preauriclar approach, where the joint capsule presented no evident alteration. After opening the capsule, we were able to identify and extract multiple cartilaginous bodies both above and below the disc space. The articular surfaces were in good condition, while the articular disc was shifted to the medial portion of the cavity. The removal of the loose bodies was held the meniscopexy of the articular disc with a small joint anchor. The immediate post‐operative period was uneventful, and the patient did not present any alteration with respect to motor function of facial expression. At the 6‐week control, we recorded an increase in maximum mouth opening of 30 mm and a reduction of the pain. Six months later, we recorded an even wider mouth opening with no signs or evidence of recurrence.