TEMPOROMANDIBULAR DISORDERS

 
 

DEPARTMENT OF TEMPOROMANDIBULAR DISORDERS AND OROFACIAL PAIN

 
The Temporomandibular Joint Disorders and Orofacial Pain Department of the Instituto Português da Face is dedicated to the prevention, evaluation, diagnosis, treatment and rehabilitation of painful and Disorderal pathologies of the face.

Symptoms of Orofacial Pain may appear discreetly (in cases of postoperative interventions on the face or in oncological contexts) or more intensely (Temporomandibular Joint Disorders, Neuropathic Pain, Headaches or Migraines). Our multidisciplinary team aims to provide the best health care for patients suffering from Pain or Orofacial Disorders.

The most common diagnoses in patients with Orofacial Pain particularly include: Temporomandibular Joint Disorders, Cluster Headache, Rhinosinusitis, Migraines, Tension Headaches, Oral Pathology (Burning Mouth Syndrome, Oral Lichen Planus).
 
OROFACIAL PAIN COVERS
 
  • Temporomandibular Joint Disorders
  • Pain of Cervicofacial Masticatory Muscles
  • Facial Neurovascular Pain
  • Facial Neuropathic Pain
  • Headache
  • Migraines
  • Oral Pain
 
 
 

TREATMENT OF TEMPOROMANDIBULAR JOINT DISORDER

 
 
 
 
 
 
 
 

TEMPOROMANDIBULAR JOINT

 
Everyone has two temporomandibular joints, one on each side of the jaw. The temporomandibular joint acts like a sliding hinge (the only joint of the human body with movements in the three axes) driven by a complex muscular network in a very particular anatomy. The temporomandibular joint is composed of bone components (mandibular condyle and temporal fossa), fibrocartilaginous components (articular disc), synovial components (membrane and synovial fluid) and muscle components (cervicofacial muscle chains). Between the mandibular condyle and the temporal fossa lies an articular disc. This disc may be displaced (out of place) in some cases of temporomandibular disorder, and this disc displacement may give rise to pain in the temporomandibular joint.

The temporomandibular joint (TMJ) is located in front of the ear, and enables us to make essential movements such as chewing, talking, smiling and even yawning. On average, the temporomandibular joint is moved 2000 times a day, but we are not normally aware of this articulation on a daily basis. When the joint hurts, clicks or limits normal mouth opening, it is at this point that we remember the TMJ. When this joint is abnormal, it is referred to as TMJ Disorder (TMD).

 
 
 
 
 

CERVICOFACIAL MUSCLES

 
The movement of the temporomandibular joint is dependent on the cervicofacial muscles. It is the harmonious relationship between the contraction of some muscle chains and the relaxation of others, in an unconscious way, that enables us to speak, chew, yawn, etc ... Why do most patients who have TMJ changes also have problems with the cervical and facial muscles? The answer is simple: whenever we are contracting the chewing muscles excessively, we are also overloading the temporomandibular joint, thus causing great intra-articular stress. This stress can be so great that it moves the disc from its normal position to an abnormal position.

Stress and anxiety are phenomena that contribute to major muscular overload, especially in the cervical chains and masticatory muscles. Who hasn't already felt their teeth clenched and grinding against one another in times of stress? This constant clenching of teeth causes prolonged tensions in the muscles that end up having a negative effect, causing major muscle injuries. These muscle injuries are reflected in pain, muscle tiredness, tension headaches, and can even cause tinnitus in some patients. It is normal for patients to refer to a constant pounding, throbbing pain throughout the day in the masseter and temporal area.
 
 
 
 
 
 
 
The two most important muscles in chewing are the masseter muscle and the temporal muscle
 
 
 
 
 

CAUSES OF TEMPOROMANDIBULAR JOINT DISORDER

 
In many patients it is difficult to determine precisely what caused the problem in the temporomandibular joint. We know that stress, anxiety, trauma to the temporomandibular joint contribute to an excessive load on the temporomandibular joint that can lead to pain and inflammation of the TMJ. This overload can move the disc out of its normal position. This disc displacement may be associated with temporomandibular joint pain that can vary from mild to very intense, locked mouth when chewing that can vary from mild to severe locking and/or clicking of the temporomandibular joint.
 

SIGNS AND SYMPTOMS

 
The most frequent symptoms of TMD are:

1- Pain in the joint site;
2- Hearing/feeling clicks when moving the jaw;
3- Stuck or locked mouth;
4- Difficulty in mouth opening;
5- Pain in the head (which often spreads to the neck and back);
6- Stiffness of the joint,
7- Tiredness in the muscles of mastication.
 

DIAGNOSIS

 
The team Instituto Português da Face will ask you to fill in some questionnaires, provide a clinical history and undergo a suitable objective examination to obtain diagnostic hypotheses.

In the clinical history we will ask when you started to feel your complaints, how the disease progressed, if you had previous treatment, what level of pain you have felt in the last six months, if you feel that your mouth opening has worsened. To help us, you can and should think about and record the history of your temporomandibular disorder.

In the objective exam we will carry out some tests to your joints that, combined with the clinical history and the questionnaires, will help us in the diagnosis.

After the first consultation, there may be a need to request:
  • Magnetic resonance imaging of temporomandibular joints and/or
  • Computed Tomography to temporomandibular joints and/or
  • Orthopantomography and/or
  • Front Rx

In some situations, temporomandibular joint arthroscopy can also be used as a means of diagnosis.
 
 
 

TREATMENTS FOR TEMPOROMANDIBULAR PAIN

 
 

NON-SURGICAL TREATMENTS

 

SURGICAL TREATMENTS

 
 

OTHER FREQUENT PATHOLOGIES THAT CAUSE OROFACIAL PAIN

 
 
 
 
 
 
 
 
 
 
IPFACE TEAM HIGHLIGHTED FOR THE DEPARTMENT
 
 
DEPARTMENT COORDINATOR
 
 
 
Team
 
 
 
 
 
PROF. DR DAVID ÂNGELO
 
 
 
DR DAVID SANZ
 
NELSON VILAÇA
 
 
 
DR CARLOS NABUCO
 
ADRIANO ROCKLAND
 
 
 
DR JOÃO PIMENTEL
 
 
 
DR MARTA GALRITO
 
 
 
DR LIA LEITÃO
 
 
 
 
 
 
 

MAKE YOUR PRE-BOOKING NOW