Síntomas óticos referidos en desórdenes temporomandibulares. Relación con músculos masticatorios / Otological symptoms among patients with temporomandibular joint disorders

Middle ear muscles have a common embryological and functional origin with masticatory and facial muscles. Therefore, symptoms referred to the ear may originate from the stomatognathic area. When a primary otológica! cause is discarded in the diagnostic work up for tinnitus, vertigo, hypoacousia, hyperacousia, ear pain or sensation of occluded ear, a temporomandibular joint dysfunction may be the cause of these symptoms. Temporomandibular joint dysfunction is twice more common among women and has environmental, physiological and behavioral causes. Among patients with this dysfunction, the prevalence of ear pain, tinnitus and dizziness varies between 33 and 76 percent.

Trigeminal Autonomic Cephalalgia by Neurogenic Palatine Compression: A Clinical Report and Review / Cefalea Autonómica Trigeminal por Compresión Neurogénica Palatina: Reporte de Caso y Revisión

This clinical report presents the evolution of a possible intraoral traumatic trigeminal autonomic cephalalgia simulating a probable cluster headache. A 50-year-old female patient had severe right-hand side pain for 7 years with autonomic signs and symptoms, such as lacrimation, conjunctival injection, rhinorrhoea, nasal congestion, forehead perspiration, myosis and eyelid edema. The episodes of pain lasted 4 or 5 months with 3- or 4-month remission periods between the painful onsets. The headaches presented an episodic pattern (1 to 3 attacks daily) lasting three to six hours. The patient had used five prosthetic sets continuously (24 h) for 20 years and the current prosthesis was 7 years old. Accidentally, after the alleviation of the maxillary denture due to it rested on a marked irritated incisive papilla the symptoms disappear. The patient has been periodically checked over a 5 year period since, without recurrence of her pain and autonomic symptomatology. The possible pathophysiology is discussed.

Se presenta un caso de cefalea autonómica trigeminal que simula una cefalea en cluster probable con potencial origen traumático intraoral. Mujer de 50 años que reportaba dolor derecho de intensidad severa con 7 años de evolución. El dolor se presenta con síntomas vegetativos como epifora, irritación de la conjuntiva ocular, rinorea, congestión nasal, sudoración frontal, miosis y edema palpebral. Los episodios de dolor se presentaban intermitentemente en el año, con duración de 4 a 5 meses y periodos de remisión de 3 a 4 meses. Las cefaleas se presentaban de manera episódica en el día (1 a 3 episodios) que duraban de 3 a 6 horas. Se observa prótesis intraoral en mal estado, con 7 años de realizada. La paciente reporta la elaboración de 5 juegos protésicos hasta la fecha y que usa constantemente en el día y la noche. Accidentalmente, y antes de la remisión a otro especialista, los síntomas desaparecen después del alivio mecánico en la zona anterior de la prótesis, que comprimía e irritaba la papilla incisiva. La paciente ha estado bajo controles periódicos durante 5 años y medio, sin recurrencia de los síntomas. La posible fisiopatología es discutida.

Músculo tensor del tímpano: músculo masticatorio extraño / Tensor tympani muscle: strange chewing muscle

Con este trabajo se pretende alertar al medico y al odontólogo en el entendimiento y la integración del manejo interdisciplinario para la detección de síntomas de oido comunes en patologías diferentes, brindando mayores herramientas en la fase conservadora de la terapia para esta sintomatología compartida. La fisiología del músculo tensor del tímpano y su funcionalidad en el oído medio ha sido velada aun cuando su disfunción y relaciones anatómicas están explicando un grupo de síntomas óticos confusos a la evaluación clínica convencional. Los músculos del oído medio comparten un origen embriológico y funcional común con los músculos masticatorios y faciales. En este artículo se pretende hacer énfasis en la dimensión neurológica y anatómica de la funcionalidad (individual y compartida) de estos músculos entre si y el sistema estomatognático. La tonicidad aumentada de este músculo deja de ser un fenómeno sin conexiones lógicas,ofreciendo a su actividad normal o disfuncional el protagonismo que se merece y redefiniendo su funcionalidad e importancia en la comprensión de los síntomas óticos referidos muy en común con síntomas de otras patologías de origen extra-ótico. El tinitus, vértigo, sensación de oído tapado, hipoacusia, hiperacusia y la otalgia son síntomas que al evaluanoser primarios de patologías en oído, deben ser descartados por el medico y relacionados con patologías vecinas que pueden producirlos. Ya existe la necesidad de entender los desordenes temporomandibulares y la sintomatología referida cráneo-facial desde una perspectiva neurofisiológica y músculo-esquelética comprendida en el sistema estomatognático. En la práctica diaria se observa con frecuencia una sintomatología común para los síntomas oticos y los desordenes temporomandibulares que se deben entender bajo una perspectiva amplia, anatómica, neuroanatómica y clínica

This work seeks to alert medical and odontological staff to understanding and using interdisciplinary handling for detecting different pathologies’ common otic symptoms. It offers better tools for this shared symptomatology during therapy’s conservative phase. Tensor tympani muscle physiology and function in the middle ear have been veiled, even when their dysfunction and anatomical relationships may explain a group of confused otic symptoms during conventional clinical evaluation. Middle ear muscles share a common embryological and functional origin with chewing and facial muscles. This article emphasizes that these muscles share a functional neurological and anatomical dimension with the stomatognathic system; these muscles’ increased tonicity ceases to be a phenomenon having no logical connections. It offers functionality and importance in understanding referred otic symptoms in common with other extra-otical symptom pathologies. Tinnitus, vertigo, otic fullness sensation, hyperacusia, hypoacusia and otalgia are not only primary hearing organ symptoms. They should be redefined and related to the neighboring pathologies which can produce them. There is a need to understand temporomandibular disorders and craniofacial referred symptomatology from neurophysiologic and muscle-skeletal angles contained in the stomatognathic system. Common symptomatology is frequently observed in otic symptoms and temporomandibular disorders during daily practice; this should be understood by each discipline from a broad, anatomical and clinical perspective

Tensor tympani muscle: strange chewing muscle.

This work seeks to alert medical and odontological staff to understanding and using interdisciplinary handling for detecting different pathologies common otic symptoms. It offers better tools for this shared symptomatology during therapy s conservative phase. Tensor tympani muscle physiology and function in the middle ear have been veiled, even when their dysfunction and anatomical relationships may explain a group of confused otic symptoms during conventional clinical evaluation. Middle ear muscles share a common embryological and functional origin with chewing and facial muscles. This article emphasizes that these muscles share a functional neurological and anatomical dimension with the stomatognathic system; these muscles increased tonicity ceases to be a phenomenon having no logical connections. It offers functionality and importance in understanding referred otic symptoms in common with other extra-otical symptom pathologies. Tinnitus, vertigo, otic fullness sensation, hyperacusia, hypoacusia and otalgia are not only primary hearing organ symptoms. They should be redefined and related to the neighboring pathologies which can produce them. There is a need to understand temporomandibular disorders and craniofacial referred symptomatology from neurophysiologic and muscle-skeletal angles contained in the stomatognathic system. Common symptomatology is frequently observed in otic symptoms and temporomandibular disorders during daily practice; this should be understood by each discipline from a broad, anatomical and clinical perspective.

[Otological symptoms among patients with temporomandibular joint disorders]. / Síntomas óticos referidos en desórdenes temporomandibulares. Relación con músculos masticatorios.

Middle ear muscles have a common embryological and functional origin with masticatory and facial muscles. Therefore, symptoms referred to the ear may originate from the stomatognathic area. When a primary otological cause is discarded in the diagnostic work up for tinnitus, vertigo, hypoacousia, hyperacousia, ear pain or sensation of occluded ear, a temporomandibular joint dysfunction may be the cause of these symptoms. Temporomandibular joint dysfunction is twice more common among women and has environmental, physiological and behavioral causes. Among patients with this dysfunction, the prevalence of ear pain, tinnitus and dizziness varies between 33 and 76%

Hamular Bursitis and its possible craniofacial referred symptomatology: two case reports.

The diagnosis of craniofacial pain is conditioned by the interdisciplinary management of its presentation especially in the absence of unique and objective signs. Bursitis is a pathological entity recently found in the hamular area and should be included in the diagnosis for exclusion of temporomandibular disorders (TMD), ear-nose-throat pathologies, due to the similar symptomatology to other head and neck conditions. The hamular process bursitis is a painful condition that can easily be confused with glosopharinge or trigeminal neuralgia that generates an uncomfortable feeling in the oropharinge with ipsilateral referred--heteretopic-symptomatology to the head. This pathology, in chronic states, can be responsible for the amplification of the pain perceived by the central excitation effect. In this report are presented two clinical cases of hamular bursitis and its conservative therapeutic management. The recognition of the inflammation of the bursa of the tensor veli palati muscle supplies the specialist with another tool in the management of craniofacial pain.

Bursitis Hamular y su posible sintomatología craneofacial referida: Reporte de dos casos / Hamular Bursitis and its possible craniofacial referred symptomatology: Two case reports

El diagnostico del dolor craneofacial esta condicionado al manejo interdisciplinario por lo confuso de su presentación especialmente en la ausencia de signos únicos y objetivos. La bursitis es una entidad patológica recientemente notificada en la zona hamular y que debe ser vinculada al diagnostico por exclusión en desordenes temporomandibulares (DTM) y patologías de oído, nariz y garganta, debido a la sintomatología similar a la de otras condiciones que afectan la región de cabeza y cuello. La bursitis del proceso hamular es un patología dolorosa que puede fácilmente ser confundida con neuralgia del glosofaríngeo o del trigémino que genera gran incomodidad en la orofaringe con sintomatología heterotopicareferida y patrón ipsilateral a cara. Esta patología en estados crónicos puede ser responsable de la amplificación del dolor percibido por efecto de excitación central. En este reporte se presentan dos casos clínicos de Bursitis Hamular y su manejo terapéutico conservador. El reconocimiento de la inflamación de la bursa del tendón del músculo tensor del velo palatino suministra al especialista una herramienta más en el manejo del dolor craneofacial

The diagnosis of craniofacial pain is conditioned by the interdisciplinary management of its presentation especially in the absence of unique and objective signs. Bursitis is a pathological entity recently found in the hamular area and should be included in the diagnosis for exclusion of temporomandibular disorders (TMD), ear-nose-throat pathologies, due to the similar symptomatology to other head and neck conditions. The hamular process bursitis is a painful condition that can easily be confused with glosopharinge or trigeminal neuralgia that generates an uncomfortable feeling in the oropharinge with ipsilateral referred – heteretopic - symptomatology to the head. This pathology, in chronic states, can be responsible for the amplification of the pain perceived by the central excitation effect. In this report are presented two clinical cases of hamular bursitis and its conservative therapeutic management. The recognition of the inflammation of the bursa of the tensor veli palati muscle supplies the specialist with another tool in the management of craniofacial pain

Temporomandibular disorders: referred cranio-cervico-facial clinic.

The bond between temporomandibular disorders and referred craniofacial symptomatology is more and more evident. In it subsists the prevailing necessity of understanding the temporomandibular disorders and the cranio-cervico-facial referred symptomatology from a neurophysiologic and muscle-skeletal perspective contained in the stomatognatic system. Diagnosis in head and neck areas is difficult because of its complex anatomy. Some painful craniofacial syndromes exhibit the same symptoms although they don.t seem objectively possible and that is what confuses the specialist and the patient. Pain in the head and the neck is one of the most complex to diagnose because of its varied origins that can be neurological, vascular, muscular, ligamental and bony. This article seeks to show some reasonable anatomical and pathophysiological connections of this muscle-skeletal disorder expressed with symptoms like tinnitus, otic fullness, otalgia and migraine among others. Disciplines in health such as neurology, the otolaryngology and dentistry share common anatomical and pathophysiological roads constructed in an increased muscular activity that generates muscle-skeletal disorders and is difficult to locate referred craniofacial symptomatology. This revision aspires to sensitize the medical specialist and the odontologist in the understanding of the important interdisciplinary handling in the detection of this disorder. This offers better tools in the conservative therapy phase of this craniofacial referred symptomatology.