Preauricular Pain Research Articles

Diagnosis of Giant Cell Tumor of Temporomandibular Joint with Ultrasound-guided Core Needle Biopsy

Temporomandibular joint (TMJ) tumors may initially present with symptoms similar to TMJ internal derangements and myositis of masticatory muscles. However, malignant tumors and specific types of benign tumors, such as giant cell tumors, may need aggressive surgical intervention. The current case is a 41-year-old man who initially presented with right preauricular pain. Computed tomography (CT) revealed a destructive bone lesion over the right TMJ with temporal bone destruction. A biopsy conducted with an ultrasound-guided core needle confirmed that the lesion was a giant cell tumor. Giant cell tumors can eventually destroy the surrounding tissue. Magnetic resonance imaging and CT have been traditionally used to evaluate TMJ disorders, whereas ultrasonography provides real-time imaging for evaluating the joint structure, movement, and biopsy guidance. For a TMJ tumor, a precise diagnosis is necessary for adequate planning of treatment. Ultrasound-guided core needle biopsy is a safe and effective method for confirming a diagnosis.

Unrecognized bilateral temporomandibular joint dislocation after general anesthesia with a delay in diagnosis and management: a case report

IntroductionAnterior bilateral temporomandibular joint dislocation is not an uncommon occurrence and has been reported before. However, its diagnosis can easily be overlooked, especially by clinicians who are unfamiliar with this pathology. Continuous discussion of the pathology is required to prevent delays in diagnosis, which can lead to long-term sequelae for the patient.Case presentationWe present the case of a 66-year-old Somali woman who experienced a bilateral anterior temporomandibular joint dislocation after a general anesthetic for an exploratory laparotomy for excision of a pelvic sarcoma. She first presented in the intensive care unit with preauricular pain and an inability to close her mouth, and was initially misdiagnosed and treated for a muscle spasm. The cause of her misdiagnosis was multifactorial - opioid-related sedation, language and cultural barrier, and unfamiliarity with the pathology. Her diagnosis was proven 18 hours after the completion of surgery with a plain X-ray. A manual closed reduction was performed with minimal sedation by oral surgery.ConclusionWe provided an in-depth discussion of temporomandibular joint dislocation and suggest a simple test that would prevent delayed diagnosis of temporomandibular joint dislocation in any patient undergoing general anesthesia. A normal mandibular excursion should be tested in every patient after surgery in the postoperative care unit, by asking the patient to open and close their mouth during the immediate postoperative recovery period or passively performing the range of motion test.

Bilateral first branchial cleft anomaly with evidence of a genetic aetiology

Anomalies of the first branchial cleft (FBC) are uncommon, and recognizing them can be difficult. Although present at birth, many cases do not become evident until later in childhood or adolescence, with an initial clinical presentation in adulthood being encountered only rarely. Typically, FBC anomalies present as a unilateral cyst, sinus, or fistula associated with the external auditory canal, or with swelling or an inflammatory opening in the peri-auricular/parotid area. They are commonly misdiagnosed and are often treated inadequately before being excised completely. A 40-year-old woman presented to the maxillofacial outpatient clinic with an episode of bilateral pre-auricular tumefaction, initially diagnosed as temporomandibular dysfunction syndrome. This was associated with bilateral pre-auricular pain that increased with mandibular movements. In relation to the patient's history, and given the bilateral presence of a pre-auricular pit, a diagnosis of FBC anomaly was made. Further investigation showed a related asymptomatic history in five other cases across four generations of the same family. The authors describe here the case, the diagnostic methodology, and the wide local excision technique used for removal of the branchial sinus.

Para-articular osteochondroma of the temporomandibular joint

A para-articular osteochondroma is a rare osteocartilaginous tumour that arises in the soft tissue adjacent to a joint but with no attachment to the bone. To our knowledge, this is the first case of one reported in the region of the temporomandibular joint (TMJ). The patient presented with severe preauricular pain caused by a para-auricular osteochondroma, which arose in the preauricular region just external to the TMJ.

Ontoereikende diagnostiek bij een fractuur van het collum mandibulae

A 13-year-old boy was presented to oral and maxillofacial surgeon with chin and preauricular pain after afallfrom his skateboard. A panoramic radiograph did not show any indication of a fracture of the mandibular collum. Two weeks later, the boy was referred by his orthodontist to the department of Oral and Maxillofacial Surgery of a medical centre in connection with a relapse ofa class III malocclusion despite a recently completed treatment of that problem. A computertomogram displayed a fracture of the mandibular collum. In case afracture of the mandibular collum is suspected, imaging from 2 directions is always required.

Metastatic Colon Adenocarcinoma Presenting as Left Preauricular Pain

Metastatic Colon Adenocarcinoma Presenting as Left Preauricular Pain

A case of malignant melanoma discovered as a result of metastatic disease of the temporomandibular joint

We report the case of a patient with malignant melanoma discovered upon her experiencing pain when opening her mouth. In 2009, a 42-year-old female patient was referred to the Sakai Municipal Hospital because of preauricular pain when opening her mouth. We suspected a malignant tumor because a simple X-ray showed a radiolucent lesion in the mandibular condyle, and this was confirmed after computed tomographic (CT) and magnetic resonance imaging (MRI) scans. We also detected fluorine-18-deoxyglucose accumulation in the left mandibular condyle, right inferior lobe of lung, and lymph nodes throughout the body during a positron emission tomography PET-CT scan. We performed a biopsy on the bronchoscopic tissue and malignant melanoma was confirmed by histopathology. The patient was subsequently treated at another hospital with systemic chemotherapy along with radiotherapy applied to the left mandibular condyle, but the lymph node tumor enlarged. Accordingly, palliative therapy was given, and the patient died from the tumor 10 months after her first consultation. We could find the malignant melanoma by identifying the radiolucent lesion in the TMJ on panoramic X-ray. Hence, it is crucial not to overlook images indicating bone destruction in the mandibular condyle if there is a malignant tumor in the TMJ.

Osteochondroma of the temporomandibular joint: report of 2 cases emphasizing the importance of personalizing the surgical treatment

Osteochondromas (OCs) are rare in the craneofacial area (0.6%). We present 2 cases of OC of the mandibular condyle, emphasizing the surgical decision of each case. CASE 1: In a 48-year-old woman with facial asymmetry, left cross-bite, and mandible deviation to the left, a computerized tomographic (CT) scan confirmed the presence of a bony expansion of the right condyle. The clinical diagnosis was osteochondroma. The patient underwent condylectomy with costochondral reconstruction. CASE 2: In a 76-year-old woman with a 1-month history of right preauricular pain, CT showed a deformed right condyle with a bony mass at the base of the temporal bone and the articular fossa. OC of the skull base was diagnosed, with possibly a concurrent lesion of the condyle. The patient underwent condylectomy with the removal of the skull base mass and an inmediate TMJ reconstruction by means of an appropriately sized stock total TMJ prosthesis. It is necessary to personalize the temporomandibular joint reconstructive options.

Osteochondroma of mandibular condyle: a 5-year follow-up

Introduction: Osteochondroma (OC) is one of the most common benign tumours of the axial skeleton, but is rarely found in the facial bones. There is debate whether this represents a true tumour or an exostosis. Its clinical presentation in mandibular condyle is usually with a combination of preauricular pain, mandibular dysfunction and facial asymmetry.

Clinical and radiologic findings of synovial chondromatosis affecting the temporomandibular joint

Our aim was to study the clinical and radiologic findings of synovial chondromatosis (SC) affecting the temporomandibular joint (TMJ) and provide references for diagnosis and treatment. Twenty patients confirmed as SC histopathologically were included in the investigation. Nineteen cases were treated with arthrotomy and 1 case with arthroscopy. The clinical manifestations, radiographic findings, histopathologic features, surgical treatment, and differential diagnosis were combined to study this disease. The SC features of TMJ on magnetic resonance (MR) images were summarized on proton density-weighted (PD) and T2-weighted images. Synovial chondromatosis of TMJ occurred more often in women and on the right. Symptoms included preauricular pain, swelling, limitation of mouth opening, crepitations, and deviation on opening. The detection rate of calcified loose bodies was 30% on conventional radiographs and 53.3% on computerized tomography. Multiple small ring-like or tubular signals could be seen on PD and T2-weighted MR images. SC mainly affected the superior joint space; it could involve the inferior space when a perforated or deformed disc was present. SC could extend into intracranial fossa, infratemporal fossa, and lateral pytergoid muscle. The characteristic ring-like signals could be found on MR images of the patients with SC of TMJ. This lesion should be differentially diagnosed with TMJ disorders and preauricular masses. Considering its recurrence and the different behavior of SC in different patients, various treatment strategies should be considered.

Oromandibular dystonia and hormonal factors: twelve years follow‐up of a case report

Oromandibular dystonia (OMD) is a focal neurological movement disorder characterized by involuntary sustained and often painful muscle contraction, usually producing repetitive movements or abnormal positions of the mouth, jaw and/or tongue. We report on a 30-year-old woman affected with OMD with a 12-year follow-up. Focal dystonia involved an involuntary activity of the lateral pterygoid muscles causing forceful jaw displacement in the maximal protrusive position. These episodes initially occurred during jaw function and increased up to an open-lock with bilateral pre-auricular pain. Dystonic spasms were absent during sleep and were reduced temporarily by sensory tricks. Treatment with botulinum toxin type A (BTX) was performed during three different sessions over a 1-year period. Electromyographic-guided BTX injections into the lateral pterygoid muscles were given with cannula electrodes. Botox reduced the involuntary activity of the muscles. Recurrence and exacerbation of dystonic symptoms occurred during the two pregnancies and completely disappeared immediately after both deliveries with prolonged symptom-free periods. During the last 8 years, the patient had a slight relapse of symptoms during flu attacks, periods of stress and during menses. The temporal pattern of these symptoms indicates a possible relationship between OMD and hormonal factors.

Dislocation of a fractured mandibular condyle into the middle cranial fossa: a case treated by an extracranial approach

Penetration of the mandibular condyle into the middle cranial fossa is a rare complication usually due to blunt traumas to the chin. Particular anatomical and dynamic conditions can lead to the intracranial dislocation of the condyle in spite of the fracture of the condylar neck that usually prevents this event from dissipating the kinetic force of the impact. We report the case of a 10-year-old female patient suffering from symphyseal and bilateral condilar fracture with intrusion of the left condyle into the middle cranial fossa. The diagnosis of intracranial dislocation was initially missed because of the nonspecific symptomatology and insufficient radiologic data provided by conventional investigations (plain X-rays and panoramic views). The persistence of the limitation of the mouth opening and the worsening of the preauricular pain with irradiation to the temporal region led us to perform further radiological investigations (computed tomography scan and magnetic resonance imaging) that revealed the intracranial complication. A successful removal of the displaced condyle was carried out through an extracranial approach, and at a 3-year follow-up temporomandibular joint function is satisfactory. The case is reported to emphasize the need for careful radiological investigation in case of condylar fractures and the effectiveness of the extracranial route to surgically treat these rare complications.

Association between high signal intensity in the posterior disc attachment seen onT2weighted fat-suppressed images and temporomandibular joint pain

We sought to determine whether high signal intensity in the posterior disc attachment (PDA) seen on T2 weighted fat-suppressed MRI is associated with temporomandibular joint (TMJ) pain and joint pathology. This study was based on 283 TMJs of 177 patients (31 males and 146 females, mean age 32.7 years) with TMJ disorders showing anterior disc displacement. MRI evaluation included assessment of signal intensity in the PDA and TMJ status (disc displacement with reduction, disc displacement without reduction and disc displacement with bone changes). Clinical criteria that were considered positive indicators of TMJ pain included the presence of pre-auricular pain during palpation, jaw function and assisted or unassisted mandibular opening. Association of signal intensity in the PDA with joint pain and TMJ status was analysed using chi2 test. Joint pain was reported in 47 (77.0%) out of 61 joints with high signal intensity in the PDA and in 97 (43.7%) out of 222 joints with low signal intensity in the PDA (P<0.0001). High signal intensity in the PDA correlated closely with more advanced joint pathology. In joints with anterior disc displacement with bone changes, TMJ pain was more commonly reported in joints with high signal intensity in the PDA than with low signal intensity in the PDA (P<0.0001). High signal intensity in the PDA on T2 weighted fat-suppressed MRI is associated with TMJ pain in TMJ disorders with anterior disc displacement with bone changes in the mandibular condyles.

The Effect of Intra-articular Injection of Ultracain in the Temporomandibular Joint in Patients With Preauricular Pain

To evaluate the distinguishing ability of intra-articular anesthesia from placebo in orofacial pain patients with pain located in the temporomandibular joint (TMJ) region, aiming at a validation of intra-articular anesthesia injection as a diagnostic test of pain in the TMJ region. A randomized prospective double-blind, placebo-controlled crossover study was conducted among 19 patients (18 females, 1 male) with pain in the TMJ region. The short-term effects of intra-articular ultracain and saline injections on pain and maximum mouth opening were measured and analyzed. Compared with placebo injections, a statistically significant difference in pain scores was found after intra-articular injection of a local anesthetic on Visual Analog Scale values. The maximum mouth opening scores did, however, not differ between the 2 groups. TMJ injection with local anesthesia leads to the decrease of pain in patients with preauricular pain. To establish the source of pain, injection of a local anesthetic in the TMJ may be used as a diagnostic tool. However, the results of diagnostic injections should still be interpreted cautiously.

Resection of the disc and suspension of the lateral wall with the temporal fascia in advanced internal derangement of the temporomandibular joint

The abnormal relation between the disc, the condyle, and the temporal bone indicates internal derangement of the temporomandibular joint. The primary symptoms and findings are: limited and painful opening of the jaw, preauricular pain, and clicking sounds or crepitus. We operated on 11 patients admitting for advanced temporomandibular dysfunction. The abnormally stretched disc was tightened by resection of a wedge of tissue from the posterior of the disc and suturing of the edges. A pedicled flap of temporal fascia was turned on to the joint and its surroundings to mimic a lateral joint capsule. All patients were satisfied with the results as they had less pain and improved mouth opening. The procedures provided satisfactory symptomatic relief and supportive findings.

Estimativa da excursão condilar em pacientes com disfunção craniomandibular: um enfoque multidisciplinar

OBJETIVO: avaliar o padrão de excursão condilar em pacientes com disfunção craniomandibular. METODOLOGIA: a estimativa da excursão condilar da ATM foi estudada em 17 pacientes, 34 ATMs do Serviço de Cirurgia Bucomaxilofacial do Hospital Jaraguá-São Paulo/SP, todos com diagnóstico de disfunção craniomandibular. Foi utilizado o exame radiográfico do tipo transcraniano para verificar a estimativa da excursão condilar, bem como o índice de Helkimo, para classificar o grau de disfunção de cada paciente. As ATMs de cada paciente foram examinadas por três diferentes profissionais com auxílio do exame radiográfico. O exame clínico observou dados como raça, gênero, a queixa principal de cada paciente, presença de dor pré-auricular, dor muscular, estalo nas articulações e limitação da abertura da boca. RESULTADOS E CONCLUSÕES: a dor pré-auricular e os estalidos foram as principais queixas dos pacientes. A excursão condilar mais freqüente foi a normoexcursão, seguida da hiperexcursão, associada com o grau II de disfunção articular de Helkimo.

Mandibular Condyle Dislocation Into the Middle Cranial Fossa: A Case Report and Review of Literature

Impact to the mandible typically results in ipsilateral or contralateral condylar neck fractures. Fracture of the glenoid fossa with a mandibular condyle dislocation into the middle skull base is a rare event. Structural variance is considered to be the determinant for this kind of fracture. Steinhauser proved experimentally that the central part of the glenoid fossa is the weakest part of the skull base. Normally, the lateral and medial elevated margins of the glenoid fossa meet the articular surface, that is the medial and lateral pole, of the mandibular condyle on impact. Da Fonseca remarked that a rounded condyle without any accentuated medial or lateral poles creates a higher pressure onto the bone of the glenoid fossa compared with a scroll shape. The role of the presence of occluding posterior teeth preventing the burst of the glenoid fossa by blocking the upward mandibular thrust, however, is controversial, according to other research. Victims of high-speed accidents with their mouths open who sustain a sudden blow to the chin may possibly be predisposed to undergo these injuries. Until today, only 30 cases have been reported, upon reviewing the English literature, with the first case being reported by Dingman and Grabb in 1963. Among the various nomenclature of this type of injury the term “central dislocation” is spread. Other central dislocations might occur in the hip joint with an intrapelvic dislocation of the femoral head or in the shoulder joint with an intrathoracic dislocation of the humeral head. Clinical features can include preauricular pain, laterognathism, and a limited range of motion without specific neurological signs or symptoms. These often may be misdiagnosed because of joint edema, joint “dislocation,” or radiographically poorly defined subcondylar fractures. Missed or delayed diagnosis of this injury may, therefore, occur. In addition to that, mortality because of intracranial damage from a displaced condyle or from other concomitant cranial injuries might explain the low number of cases reported. Intracranial hematomas, facial nerve paralysis or paresis –22 combined with a unilateral and bilateral cranial base fracture, damages of the eighth cranial nerve with ipsilateral hearing loss, hematorrhoea, leakage of cerebrospinal fluid, and cerebral injuries as contusion or concussion are some of the other findings reported in literature. Because of the complexity of these injuries, a variety of treatment options has been reported in the literature. The overall aim of any treatment, however, is both to prevent additional neurological problems and to obtain a proper occlusion, thus restoring function to avoid future temporomanqibular joint disorders like, for example, ankylosis. This article presents the case of a 9-year-old girl who fell down from a climbing pole in a local playground. The impact on the chin caused a dislocation of the right mandibular condyle into the middle cranial fossa. The treatment and the follow-up of this case is reported to add to the small number of previous case reports and to hopefully be useful for future case management.

Relationship between oral parafunctional/nutritive sucking habits and temporomandibular joint dysfunction in primary dentition

The aim of this study was to evaluate the relationship between nutritive and parafunctional habits and the presence of temporomandibular dysfunction (TMD) in children with primary dentition. Ninety nine children, aged 3-5 years, were examined to check for the presence or absence of signs and symptoms of TMD (headache, preauricular pain, earache, masticatory muscle tenderness, deviation on opening, occlusal interference and asymmetric movement of the mandible), oral parafunctions (bruxism, nail biting, finger/thumb sucking, speech alteration, mouth breathing, pacifier and atypical swallowing) and nutritive habits (breast- or bottle-feeding) through interview and clinical examination. The results were submitted to descriptive statistical analysis and Fisher's exact test. The results showed that only atypical swallowing was positively related to TMD (P < 0.0001); other oral parafunctional and nutritive habits were not related to TMD. It was concluded that parafunctional habits, with the exception of atypical swallowing, and feeding methods were not determinants for the presence of signs and/or symptoms of TMD in the sample of children included in the study.

Disc and condyle translation in patients with temporomandibular disorder

The purpose of this study was to elucidate causal relationship between disc and condyle range of movement and clinical signs and symptoms in patients with temporomandibular disorders (TMD), using magnetic resonance imaging (MRI). The subjects comprised of a study group of 191 patients with TMD and a control group of 43 asymptomatic patients. The clinical assessment consisted of range of maximum mouth opening (MMO) and preauricular pain during mandibular function. After clinical and radiographic findings assessment, disc and condyle condition were examined by MRI and the range of movement was accordingly classified. Disc displacement was observed in 156/191 (81.7%) of the study group and 9/43 (20.9%) of the control group. When disc and condyle mobility was presented around the eminence, wider MMO range was maintained, P < .05. Presence of osteoarthrosis (OA) was not correlated with preauricular pain, because OA variables were mild in the study group. Maintenance of disc/condyle translation is an important factor in TMJ function, irrespective of disc displacement or arthritis.

Alterações degenerativas em pacientes com disfunção crâniomandibular

Os processos degenerativos da ATM foram estudados em 17 pacientes, 34 ATMs do Serviço de Cirurgia Bucomaxilofacial do Hospital Jaraguá-São Paulo/SP, todos com diagnóstico de disfunção crâniomandibular. Foi utilizado o exame radiográfico do tipo transcraniano para verificação das degenerações articulares. As ATMs de cada paciente foram examinadas por três diferentes profissionais com auxílio do exame radiográfico. O exame clínico procurou observar dados como raça, gênero, a queixa principal de cada paciente, presença de dor pré-auricular, dor muscular, estalo nas articulações, e limitação da abertura da boca. A dor pré-auricular, e os estalos foram as principais queixas dos pacientes. As alterações degenerativas ocorreram mais nas mulheres com faixa etária entre 20 a 29 anos. Ocorreram na seguinte ordem decrescente: facetamento, eburnação e osteófito. As alterações foram mais marcantes no côndilo do que na eminência articular, já os facetamentos estiveram relacionados com a queixa principal de dor pré-auricular. Foi observado estatisticamente uma correlação de 70% entre o facetamento e a ebunação.