Spontaneous pain attacks: neuralgic pain

Paroxysmal orofacial pains can cause diagnostic problems, especially when different clinical pictures occur simultaneously. Pain due to pulpitis, for example, may show the same characteristics as pain due to trigeminal neuralgia would. Moreover, the trigger point of trigeminal neuralgia can either be located in a healthy tooth or in the temporomandibular joint. Neuralgic pain is distinguished into trigeminal neuralgia, glossopharyngeal neuralgia, Horton's neuralgia, cluster headache and paroxysmal hemicrania. In 2 cases trigeminal neuralgia is successfully managed with a neurosurgical microvascular decompression procedure according to Jannetta. Characteristic pain attacks resembling neuralgic pain result from well understood pathophysiological mechanisms. Consequently, adequate therapy, such as a Janetta procedure and specific pharmacological therapy, is availabl

Influence of mandibular length on mouth opening

Theoretically, mouth opening not only reflects the mobility of the temporomandibular joints (TMJs) but also the mandibular length. Clinically, the exact relationship between mouth opening, mandibular length, and mobility of TMJs is unclear. To study this relationship 91 healthy subjects, 59 women and 32 men (mean age 27.2 years, s.d. 7.5 years, range 13-56 years) were recruited from the patients of the Department of Oral and Maxillofacial Surgery of University Hospital, Groningen. Mouth opening, mobility of TMJs and mandibular length were measured. The mobility of TMJs was measured as the angular displacement of the mandible relative to the cranium, the angle of mouth opening (AMO). Mouth opening (MO) correlated significantly with mandibular length (ML) (r = 0.36) and AMO (r = 0.66). The regression equation MO = C1 x ML x AMO + C2, in which C = 0.53 and C2 = 25.2 mm, correlated well (r = 0.79) with mouth opening. It is concluded that mouth opening reflects both mobility of the TMJs and mandibular length

Therapeutic outcome assessment in permanent temporomandibular joint disc displacement

In permanent temporomandibular disc displacement (TMJ-DD) outcome studies many authors claim positive effects of arthroscopic surgery, arthrocentesis and physical therapy. This literature review was undertaken to analyse whether the claimed effects are based on acceptable methodology. The recorded papers were analysed by two independent observers according to (1) method of investigation, (2) therapeutic intervention studied, (3) therapeutic outcome variables used, and (4) claimed effectiveness of the intervention. Agreement between observers was calculated. Twenty-four papers were found in which therapeutic outcome of interventions on temporomandibular disorders were studied. Six studies applied a true experimental design. Each of these six studies compared a different set of interventions. Twenty-two papers used maximal mouth opening (MMO) as an outcome variable, nine studied pain intensity on a visual analogue scale, one paper assessed the mandibular function impairment questionnaire. Kappa for overall agreement concerning the reviewing criteria was 0.82 (P < or = 0.001). No distinguishing effects on MMO, pain or function impairment were reported between arthroscopic surgery, arthrocentesis and physical therapy. Results of methodological sound outcome studies evaluating the effects of arthroscopic surgery, arthrocentesis and physical therapy are needed

Function impairment and pain after closed treatment of fractures of the mandibular condyle

BACKGROUND: To determine the prognosis of fractures of the mandibular condyle after closed treatment. METHODS: Patients (n = 144) with a fracture of the mandibular condyle, all treated closed, were included in the study. Fracture types and position of the fracture parts were determined on radiographs. Follow-up was after 12 months in which the average pain, experienced during the last week (visual analog scale, 100 mm), and mandibular functioning were assessed (mandibular function impairment questionnaire (MFIQ)). RESULTS: Data of 116 (81%) patients, 41 women (35%) and 75 men (65%), were available for analysis. Condylar neck fractures were most common (52%). Bilateral fractures were present in 28% of the patients. Pain (visual analog scale score >0) was found in 9% of the patients. Impaired mandibular function was found in 40% (MFIQ >0) and 24% (MFIQ > or =4) of the patients. The most important risk factor for pain was being a woman. The most important risk factors for function impairment were > or =25 years of age and gross displacement of the fracture parts. CONCLUSION: The overall prognosis of mandibular function and pain after closed treatment of condylar fractures is good. The most important risk factor for pain persisting for 1 year after closed treatment of a condylar fracture is being a woman. The most important risk factors for function impairment are an age of > or =25 years and gross displacement of the fracture parts

Groningen temporomandibular total joint prosthesis: An 8-year longitudinal follow-up on function and pain

Total temporomandibular joint replacement is a surgical procedure for patients with severe temporomandibular joint afflictions affecting quality of life, which have not responded beneficially to previous conventional surgery. The aim of this study was to assess the long-term outcome of the Groningen temporomandibular joint (TMJ) prosthesis in patients with chronic pain and mutilated temporomandibular joints following multiple surgical procedures, with respect to prosthesis failure, the patient's postoperative level of satisfaction and longitudinal changes in maximum mouth opening, functional mandibular impairment and pain. Eight female patients were studied in whom Groningen TMJ prostheses were inserted, two unilaterally and six bilaterally. The Groningen TMJ prosthesis was mechanically successful during 8years of follow-up in seven out of eight patients with a disc dislocation being seen in one patient (7%). Patients were satisfied, despite the limited improvement of the maximum mouth opening, and pain scores. Although the decline of MFIQ scores during 8years of follow-up was significant compared to baseline (p=0.027), the effects of the prosthesis on maximum mouth opening, function and pain were limited. This may be due to persistent chronic pain and the adverse effects of multiple previous surgical procedures

The smallest detectable difference of mandibular function impairment in patients with a painfully restricted temporomandibular joint

Mandibular functions such as speech, laughing, yawning, mastication, and taking a large bite may be impaired if temporomandibular disorders exist. The Mandibular Function Impairement Questionnaire is a validated instrument that scores perceived difficulty of representative mandibular functions in relation to jaw complaints. However, the reliability of the Mandibular Function Impairment Questionnaire has never been adequately tested. Generalizability and decision studies are currently proposed to assess the reliability of a measurement device. The smallest detectable difference is the smallest statistically significant amount of change to be detected with a measurement device. The purpose of this study was to assess the reliability of the Mandibular Function Impairement Questionnaire in terms of the smallest detectable difference. Twenty-five consecutive patients with painfully restricted temporomandibular joints completed the Mandibular Function Impairement Questionnaire on two separate measurement days, one week apart, using two consecutive sessions per day. Spearman's r was calculated for test-retest reliability. Variance components such as patients, measurement days, repetitions, and all their interactions were analyzed in the generalizability study. In the decision study, the smallest detectable difference was calculated for different days and repetitions. Spearman's r varied from 0.69 to 0.96. The between-patient variance and the error variance contributed 81% and 19% to total variance, respectively. The Mandibular Function Impairment Questionnaire is a reliable instrument for the assessment of mandibular function impairment. The minimal amount of change to be detected is 14 units on a scale of 0 to 68. Reliability in terms of the smallest detectable difference increases if the measurement is repeated twice on two separate days: The smallest detectable difference improves to 10 units. Record 2 of 3 - MEDLINE (R) Advanced

Effect of an intraoral retrusion plate on maxillary arch dimensions in complete bilateral cleft lip and palate patients

OBJECTIVE: The aim of this study was to analyze maxillary arch dimensions in patients with complete bilateral cleft lip and palate treated with an intraoral retrusion plate prior to lip closure. PATIENTS: The effects of the intraoral retrusion plate were evaluated on serially obtained maxillary casts of 14 patients with complete bilateral cleft lip and palate. RESULTS: The Student's t test for dependent observations showed a significant decrease in distance between the premaxilla and the cleft lateral segments during active treatment. This decrease correlated with an increase in deviation of the premaxilla in relation to the vomer. For each millimeter decrease in distance between the premaxilla and the cleft lateral segments, an average increase in deviation of 4.0 degrees was found. Left and right cleft widths decreased significantly, premaxillary width increased significantly, and transverse dimensions did not change significantly. CONCLUSION: From this study it can be concluded that active presurgical treatment with an intraoral retrusion plate induces a significant decrease in distance between the premaxilla and the lateral segments. This decrease is frequently accompanied by an increase in deviation of the premaxilla relative to the vomer