Traumatic Functional Pathology of the Human Masticatory System

Includes the pathology that occurs in any situation of dynamic mandibular position (chewing, yawning, etc.) or static (postural) in which there is an impact and/or impingement of one or more structures located in the masticatory system mobile part (jaw, muscles, teeth, prosthesis, etc.) against one or more structures located in the zygomatic orifice and /or in the upper maxilla (maxillary, teeth, prosthesis, etc.).

In general, we may say that the problem is lack of space for the jaw and muscles to move freely when chewing, talking, etc., without getting trapped, knocked down or limited in the extent of their normal movements.

These traumatic functional disorders have been divided into two large interrelated pathological entities:

-   Maxillo-Mandibullar Impingement, MMI (known as Compromiso Articular Temporomandibular , CAT) which includes the Burning Mouth Syndrome (BMS)

-       Temporal Muscle Syndrome (TMS)

In the MMI there is a limitation in the functional range of motion and impaction and in the TMS there is inpingement.

They may have unilateral or bilateral character and also match both pathologies, MMI and TMS, overlapping their symptoms and signs.

           MMI at zygomatic orifice level has been previously described but the rest of this traumatic pathology, TMS and MMI at the upper jaw level, is our contribution.

General Characteristics
Patients with these masticatory traumatic pathologies request consultation motivated primaraly by two symptoms: headaches, migraine type or tensional and motivated by palpation in certain cranial areas (TMJ, ear, temple, etc.) and/ or loss of stability (dizziness or vertigo).

Patients usually don’t associate any of these symptoms with their masticatory system, so they are referred for consultation after being seen by ENT specialists, neurologists, physical therapists, chiropractors, psychologists, psychiatrists, acupuncturists, rehabilitators, Maxilos, dentists, etc., or online by visiting our website.
       They have been frequently subjected over a long period of time with treatments based on ineffective drugs and splints without getting a correct diagnosis  and clinically proven, economically plundered and worse, most of them in a very deteriorated pshycological state, depressed, desperate, hopeless and distressed. Most of these patients while explaining their medical history need to cry in order to vent for all the misunderstandings they have gone through due to a lack of credibility when they explain what they feel, their symptoms, in different parts of their anatomy and hearing how professionals reply to them that it can not be, has nothing to do with one another, you are becoming  somatic, imagining things that are not, that can not be.

A very common thought among these patients is that they suspect they have something serious in their head and nobody can find it, give them a diagnosis. They know that something is wrong with them and nobody is able to find it. They live with this thought, go to sleep and wake up with it, day after day, year after year.

The first necessary mean, so these patients do not reach the situation of incorporating them into a  rotating loop by different specialists where they can not scape, it happens because our colleagues and other medical and paramedical specialties are aware of these new functional traumatologic pathologies that will detail below, and submit to a simple, fast and practical differential diagnosis to this type of patients that come with pain and / or loss of stability because it doesnŽt consist on putting them in that “mixed bag” that is migraine and/ or  Meniere.

A complementary analytical complex is not required, it is enough with a good anamnesis, inspection, Romberg’s test and above all a good palpation of pain areas or trigger points that we will complement with a local anesthesia test in doubtful cases if we want to check and  be sure of the diagnosis.

We have found that different diagnosed headaches as migraine, tensional,etc., and symptoms of dizziness, vertigo, MeniereŽs syndrome, Burning Mouth Syndrome (stomatodynia), etc. are symptoms of these traumatic functional pathologies. Here is when drama begins for these patients: they are diagnosed with disease symptoms that are turned into diseases and also tell them that are difficult and have a rare healing because they donŽt know their cause and end up convincing them that they have to assume them for life with medication treatment.

In general we can say that the problem is reduced to lack of space, so temporal muscle and jaw itself can carry out their normal movements during mastication, phonation, etc..., trapping the temporal muscle in the zygomatic orifice and tapping the jaw, due to its proximity to the superior maxillary.

Incidence of these functional pathologies is very high, 1 out of 10 people and affecting more women in a ratio of 4 to 1.

Experience has shown us that many craniomandibular dysfunctions (CMD) were partially wrong in the diagnosis and many of these symptoms we thought proper for CMD, were actually from MMI and/or TMS. It does not mean that CMDs do not exist, but their proportion with the MMI/CMD is 1 CMD for every 10 MMI/TMS.

I. Dynamic
A.- Maxillo-Mandibular Impingement, MMI
-1. Extraarticular:
-a.At the zygomatic orifice:
-In the opening:
                  - By unilateral or bilateral coronoid process hyperplasia.
                  - By zygomatic orifice decrease.
                  - JacobŽs disease.
-b. In the maxilla:
- In the opening.
- In the lateralities.
- In the protrusive.
- At closure:          
- All possibilities according  to the impacting structures.
- By increasing vertical dimension at the maximal intercuspidation (double occlusion, etc.,)
-c. By oppression of the lingual nerve: Burning Mouth Syndrome (BMS).
-2. Intraarticular:
-a. In an unilateral TMJ subluxation. Pathogenesis of the TMJ subluxation: unilateral mastication and functional and occlusal imbalance. In both cases the TMJ that suffers the most is the usual chewing side.
B.- Temporal Muscle Syndrome (TMS): 
-1. Extraarticular:
-a.At the zygomatic orifice:
-At the opening:
By unilateral or bilateral coronoid process hyperplasia
Decrease of the zygomatic orifice.
-On one laterality or lateralities.
-On the protusive
-2. Intraarticular:
a.In an unilateral TMJ subluxation.Pathogenesis of the TMJ subluxation: unilateral mastication and functional and occlusal imbalance. In both cases the TMJ that suffers the most is the usual chewing side.
II. Static. Postural. Pressure habits: MMI, BMS /or TMS.
A.    Passive:
-1. Lying: on the sleeping or resting side (bed, sofa tv, reading, etc): Pillowing.
-2. Sitting: head support with one hand (studying, computer, travel seat, etc.)
    B.   Active:
          -1. To perform any kind of physical activity required by the potrusion: Sport,
                phonation, etc.
          -2. To perform any kind of physical activity that involves keeping neck bending:
                use of computers, reading, sewing, etc.

Pathogenesis of the Maxillo-Mandibular Impingement (MMI), Burning Mouth Syndrome (BMS) and Temporal Muscle Syndrome (TMS):
A.    Evolutionary theory.
         -1. By bipedestation: need to protrude at a certain degree of opening due to a
               lack of retromandibular space:is a space problem.
         -2. By retrognathism: keep the same content but container value has
              decreased: is a space problem.
B.    Iatrogenic.

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