Infratemporal space pathosis mimicking TMJ disorders

Article Abstract:

Four case reports are presented to illustrate the problems involved in correctly diagnosing disorders of the temporomandibular (jaw) joint (TMJ). Other disorders in the infratemporal space (below the skull's temporal fossa) can cause symptoms similar to those associated with TMJ dysfunction. In one case, a 51-year-old man developed right facial pain and displacement of the jaw to the left. He underwent jaw surgery but his symptoms only progressed. A muscle biopsy revealed the presence of cancer and the patient, after undergoing chemotherapy and radiation, died 18 months after the diagnosis was made. In the second case, the patient developed tightening of the jaw and an inability to open his mouth, with hearing loss and facial swelling. Tests showed a soft tissue abnormality near the joint which turned out to be the result of infection; the patient had undergone extraction of a tooth several weeks previously. The third patient had reduced mobility of the lower jaw and had undergone surgery for a mass in front of the ear. After another surgery, a large tumor (mucoepidermoid) was found that involved the base of the skull, the mastoid process, and the back part of the jaw. The tumor recurred several times in spite of further surgery and chemotherapy. Finally, a 12-year-old girl with TMJ pain was initially treated with diazepam, soft diet, heat, and rest. When pain continued, further tests showed a tumor (fibrosarcoma) that was treated with chemotherapy and radiation. The cases, in which each patient was first treated for TMJ dysfunction, show that the early phases of disease of the infratemporal space can simulate that disorder. Dentists should be aware of the possibility of the presence of serious disease whenever symptoms do not respond to treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Tumors, Facial pain

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A case report: acoustic neuroma confused with TMD

Article Abstract:

A case report of a 33-year-old man is presented to illustrate how an acoustic neuroma (a kind of brain tumor) can produce symptoms similar to those of temporomandibular joint dysfunction (TMD), severe pain in the jaw joint. The patient was referred to an orthodontist in April 1989 for severe pain and began treatment for TMD. Several teeth were removed, but the pain persisted and the patient was referred to an oral and maxillofacial surgeon in January 1990. Although the patient requested surgery, he was given pain-relieving medication and referred to the author of the article. By this time, the patient could not work or sleep because of the pain, which had become particularly intense during the previous 10 days. A complete orthodontic examination was carried out and an orthopedic apparatus was constructed. Medication to help the patient sleep and to control joint inflammation was prescribed. When pain continued, pain-relieving medication was injected into the muscle, but relief was only temporary. After consultation with an ear, nose, and throat specialist, the patient returned to the author, still with pain and decreased ability to open his mouth. An audiogram revealed a hearing loss and the patient was referred for a computerized tomography scan (an X-ray of the brain). This revealed a brain tumor, which was successfully removed. The patient was left with some paralysis on the left side of his face. Patients with TMD-like symptoms that do not improve with treatment should be evaluated further. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Acoustic neuroma

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Identifying acute pulpalgia as a factor in TMD pain

Article Abstract:

Toothache may cause symptoms of a temporomandibular disorder (TMD), but the two may be distinguished. Both pain originating in tooth pulp and TMD can produce pain in the chewing muscles or the jaw joint. Pain originating from a tooth was the eventual diagnosis for 11 out of 362 patients referred to a clinic specializing in TMD disorders. Tooth pain was identified as the source by tapping teeth, applying hot or cold stimuli to the suspected tooth, and injecting anesthetic near the suspected tooth to see if it relieved the pain. X rays were not helpful. Ten of the patients were followed up after tooth treatment or extraction. Five were symptom-free, four noted improvement, and one had no change in TMD symptoms. All had previously reported throbbing pain, and all reported complete relief. Symptoms suggesting teeth as the origin or contributing factor were pain that waked the patient, throbbing pain, and increase in pain when drinking hot or cold liquids.

Toothache

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