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

TEMPOROMANDIBULAR JOINT ARTHROCENTESIS

Temporomandibular joint arthrocentesis is a minimally invasive technique, performed most often under local anaesthesia. Its primary aim is to eliminate inflammatory mediators responsible for pain, decrease intra-articular pressure, release fibrous intra-articular adhesions and moisturize/lubricate the TMJ. In the early stages of temporomandibular joint problems, the disc and joint are in an inflammatory process leading to pain. This technique enables eliminating these inflammatory mediators, thus contributing to reduce the pain in this joint. Articular overload greatly increases intra-articular pressure and this technique enabling reducing overload. In very initial and particular cases, it allows the disc to be repositioned. In these situations, there is considerable dehydration of the disc and the joint, which is why we inject a viscous substance (hyaluronic acid). This moisturises the TMJ and the articular disc, contributing to harmonious movement of the temporomandibular joint. This whole procedure is done with fine needles so you will not have any scars and can be discharged 30 minutes after the intervention.

TEMPOROMANDIBULAR JOINT ARTHROSCOPY

Arthroscopy is a technique widely used in medicine. It enables us to perform minimally invasive surgical interventions in several joints of the human body such as the temporomandibular joint.

Dr Onishi is credited with having first introduced an arthroscope in the Temporomandibular Joint (TMJ) in 1975. This was the start of minimally invasive surgery to treat TMJ intra-articular problems (keyhole surgery). This technique enables the insertion of a tiny endoscope into the joint that makes an accurate diagnosis. It also enables small interventions to reposition the disc, treating areas of chronic intra-articular inflammation, eliminating joint adhesions, etc. Nowadays, there are many quality scientific studies that recommend arthroscopy for intra-articular treatments with success rates above 90% in some series. This technique enables fast recovery and leaves a small mark on the skin that is almost imperceptible, with the patient being discharged 6-8 hours after the intervention.

OPEN SURGERY OF THE TEMPOROMANDIBULAR JOINT

Open surgery is reserved for more complex cases. There are several techniques within open surgery that you can discuss with your doctor. This approach enables placing a prosthesis of the temporomandibular joint.