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CHAPTER 36: Temporomandibular Disorders

Noshir R. Mehta; Steven J. Scrivani

INTRODUCTION

Pain syndromes that involve the face are very common in clinical practice. Many facial pain syndromes are also unique, given the complex anatomy and specialized sensory innervation of the head, face, and neck. These syndromes represent a clinical diagnostic challenge and deserve special attention. The common descriptive terms for facial pain complaints are frequently misleading. To avoid confusion, pain clinicians should be familiar with the International Headache Society's Diagnostic Classification for Head, Face, and Neck Pain Disorders1 (Table 36-1). Clinicians should be comfortable distinguishing painful conditions that arise from structural pathology, headache syndromes, oral and facial structures, temporomandibular joint disorders, myofascial pain disorders, and primary cranial neuralgias.

TABLE 36-1

International Headache Society: International Classification of Headache Disorders II, Cephalalgia, 2004

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TABLE 36-1

International Headache Society: International Classification of Headache Disorders II, Cephalalgia, 2004

14 CATEGORIES

  • The Primary Headaches: 1–4

  • The Secondary Headaches: 5–12

  • Cranial Neuralgias (central and primary facial pain and other headache disorders): 13–14

The Primary Headaches (1–4)

  1. Migraine

    Without aura

    With aura

  2. Tension-type headache

  3. Cluster headache and other trigeminal autonomic cephalalgias

  4. Other primary headaches

The Secondary Headaches (5–12)

5. Attributed to head and/or neck trauma

6. Attributed to cranial or cervical vascular disorder

7. Attributed to nonvascular intracranial disorder

8. Attributed to a substance or its withdrawal

9. Attributed to infection

10. Attributed to disorder of homeostasis

11. HA or facial pain attributed to disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth, or other facial or cranial structures

12. Attributed to psychiatric disorder

Headache or facial pain attributed to disorders of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structures (11.1–11.8)

11.1 Cranial bones

11.2 Neck

11.3 Eyes

11.4 Ears

11.5 Rhinosinusitis (sinus disorders)

11.6 Teeth, jaws or related structures

11.7 TMJ disorders (TMD)

11.8 Other

Cranial Neuralgias (central and primary facial pain and other headache disorders) (13–14)

Temporomandibular disorders are defined as a subgroup of craniofacial pain problems that involve the temporomandibular joint (TMJ), masticatory muscles, and associated head and neck musculoskeletal structures.2 Patients with temporomandibular disorders most frequently present with complaints of pain, limited or asymmetric mandibular motion, and TMJ sounds.3,4 The pain or discomfort is often localized to the jaw, TMJ, and muscles of mastication. Common associated symptoms include ear pain and stuffiness, tinnitus, dizziness, neck pain, and headache. In some cases, the onset is acute and symptoms are mild and self-limiting. Other patients develop a chronic temporomandibular disorder with persistent pain in association with physical, behavioral, psychological, and psychosocial symptoms similar to those of patients with chronic pain syndromes in other areas of the body5-7 (e.g., arthritis, low back pain, chronic headache, fibromyalgia, and chronic regional pain syndrome), all requiring a coordinated interdisciplinary diagnostic and treatment approach.

Temporomandibular disorders are classified as one subtype of secondary headache disorder ...

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