Facial pain disorders fall into three categories:
1) The arthrogenous disorders affect the structures of the jaw joint – the temporomandibular joint, also referred to as the T.M.J.
2) Myogenous disorders affect the muscles of the face and jaws. Terminology for the muscle disorders is varied and includes bruxism (tooth grinding), TMD, TMJ SYNDROME, FIBROMYALGIA, AND MYOFACIAL PAIN DYSFUNCTION (MPD).
3) Neurological disorders can also cause facial pain. Examples include the trigeminal neuralgia, reflex sympathetic dystrophy (RSD) and complex regional pain syndromes.
The arthrogenous (joint) category includes disorders, injuries, or diseases affecting the structural or biochemical components of the joint. The two major types are traumatic and non- traumatic.
EXAMPLES OF NON-TRAUMATIC DISORDERS INCLUDE:
- Autoimmune diseases Rhematoid arthritis or Psoriatic arthritis
- Metabolic Gout
- Hypermobility Ehlers- Danlos Syndrome
- Congenital Hemifacial microsomia
- Tumors Synovial chondromatosis
- Avascular necrosis
- Synovitis Inflammation of the joint lining
- Hyperplasia or Hypoplasis Overgrowth or undergrowth
The second type, traumatic injury, can affect the osseous (bone) structures or the soft tissues of the joint. An example of a bone injury would be a fracture of the top part of the lower jaw (condyle). Soft tissue injuries can affect the cartilage and ligaments of the joint. An example would be a dislocation or herniation of the cartilage. Traumatic injuries can result from a direct blow to the face, head, or jaws. They can also result from a hyperextension –hyper flexion mechanism (whiplash). The onset of symptoms after an injury can be immediate or delayed depending on many factors.
The treatment for muscle and joint disorders is generally medical management, which is usually effective. Surgery is an option for patients with joint disorders who fail medical treatment.
MEDICAL MANAGEMENT CAN INCLUDE THE FOLLOW MODALITIES:
- Examination and diagnostic imaging
- Soft diet
- Heat / cold therapy
- Splint therapy
- Physical therapy
Surgery is a consideration for patients with persistent symptoms despite a regimen of medical management. Medical management is effective for 90% or more of patients. Only 10% or fewer patients get to the point of surgical consideration. If surgery is indicated, it can be arthroscopic surgery or open joint surgery. More advanced techniques would include partial joint replacement, muscle flaps, and fat grafts.