TEMPOROMANDIBULAR JOINT DYSFUNCTION
TEMPORAL ARTERITIS
In this disorder, the temporal artery
and other arteries in the head are
inflamed. Early treatment of
temporal arteritis is vital, because
if the condition is left untreated,
there is a risk of sudden blindness.
Telltale symptoms
If the temporal artery is inflamed, it is usually
prominent and there is a persistent severe
headache and scalp tenderness in the area
ofthe head shown above.
Normal
blood flow
Normal artery
In a normal artery, there is a smooth lining,
and the blood flow through it is sufficient to
meet the needs ofthe tissues it supplies.
Reduced
blood flow
Inflamed artery
In arteritis, the walls ofthe artery become
disrupted and thickened, and blood flow
through it is therefore markedly reduced.
a r t e r y
t h a t
c a r r i e s
o x y g e n a t e d
b l o o d
f r o m t h e h e a r t ) a n d i t s m a i n b r a n c h e s .
T h e i n f l a m e d v e s s e l s b e c o m
e n a r r o w e d ,
r e d u c i n g b l o o d f l o w t h r o u g h t h e m .
CAUSES
T h e
c a u s e
o f
t e m p o r a l
a r t e r i t i s
i s
u n k n o w n , b u t
t h e
c o n d i t i o n
m a y
b e
a s s o c i a t e d
w i t h
p o ly m y a lg ia rh e u m a t ic a
( p a i n a n d s t i f f n e s s i n t h e m u s c l e s o f t h e
h i p s , t h i g h s , s h o u l d e r s , a n d n e c k ) .
SYMPTOMS
T h e m o s t c o m
m o n s y m p t o m i s a s e v e r e
h e a d a c h e o n o n e o r b o t h s i d e s o f t h e
h e a d . T h e t e m p o r a l a r t e r y ( l o c a t e d a t t h e
s i d e o f t h e h e a d a b o v e t h e e a r l o b e ) m a y
b e p r o m i n e n t a n d t h e s c a l p
t e n d e r . I n
a b o u t h a l f o f t h e c a s e s , t h e o p h t h a l m i c
a r t e r i e s s u p p l y i n g t h e e y e s a r e a f f e c t e d ,
w h i c h
m a y
c a u s e s u d d e n b l i n d n e s s i f
u n t r e a t e d .
O t h e r
s y m p t o m s
a n d
s i g n s
i n c l u d e f e v e r a n d p o o r a p p e t i t e .
DIAGNOSIS AND TREATMENT
E a r l y r e p o r t i n g o f s y m p t o m s i s e s s e n t i a l
d u e t o t h e r i s k o f b l i n d n e s s . T h e d i a g n o -
s i s
o f
t e m p o r a l
a r t e r i t i s
i s
m a d e
b y
b lo o d te sts,
i n c l u d i n g
E S R
( e r y t h r o c y t e
s e d i m e n t a t i o n r a t e ) , a n d i n s o m e c a s e s
b y a
b io p s y
( t i s s u e s a m p l e ) o f t h e a r t e r y .
T r e a t m e n t
w i t h
a
c o r t ic o s t e r o id d ru g
u s u a l l y
h a s
a
r a p i d
e f f e c t ;
o t h e r w i s e ,
im m u n o s u p p r e s s a n t d ru g s
m a y b e g i v e n .
T e m p o r a l a r t e r i t i s u s u a l l y c l e a r s u p c o m
-
p l e t e l y w i t h i n t w o y e a r s .
te m p o ra l a rte ry b io p s y
A p r o c e d u r e i n w h i c h a s m a l l s e g m e n t
o f t i s s u e
i s
t a k e n
f r o m
t h e
t e m p o r a l
a r t e r y ( s i t u a t e d a t t h e s i d e o f t h e s c a l p )
a n d e x a m i n e d u n d e r a m i c r o s c o p e . T e m -
p o r a l a r t e r y b i o p s i e s a r e p e r f o r m e d t o
d e t e c t s i g n s o f i n f l a m m a t i o n a n d t h e r e -
b y t o d i a g n o s e
te m p o ra l a rt e r it is
.
te m p o ra l lo b e e p ile p s y
A f o r m o f
e p ile p s y
i n w h i c h a b n o r m a l
e l e c t r i c a l d i s c h a r g e s o c c u r i n t h e t e m p o -
r a l l o b e ( m o s t o f t h e l o w e r s i d e o f e a c h
h a l f o f t h e
c e r e b r u m
) i n t h e
b r a in
.
CAUSES
T h e u s u a l c a u s e o f t h i s t y p e o f e p i l e p s y
i s d a m a g e t o t h e t e m p o r a l l o b e , w h i c h
m a y b e d u e t o a
b irt h in ju ry , h e a d in ju ry ,
b ra in t u m o u r, b ra in a b s c e s s ,
o r
s tro k e .
SYMPTOMS
A t t a c k s o f t h i s f o r m
o f e p i l e p s y c a u s e
d r e a m l i k e
s t a t e s ,
u n p l e a s a n t
h a llu c in a -
tio n s
o f s m e l l o r t a s t e , t h e p e r c e p t i o n o f
a n i l l u s o r y s c e n e , o r
d e ja vu .
T h e r e m a y
a l s o b e g r i m a c i n g , r o t a t i o n o f t h e h e a d
a n d
e y e s ,
a n d
s u c k i n g
a n d
c h e w i n g
m o v e m e n t s . T h e
a f f e c t e d
p e r s o n
m a y
h a v e n o m
e m
o r y o f a c t i v i t i e s d u r i n g a n
a t t a c k ,
w h i c h
c a n l a s t f o r
m i n u t e s
o r
h o u r s . S o m e t i m e s , t h e s e i z u r e d e v e l o p s
i n t o a
g r a n d m a l
s e i z u r e .
DIAGNOSIS AND TREATMENT
D i a g n o s i s
a n d
d r u g
t r e a t m e n t
i s
t h e
s a m e a s f o r o t h e r f o r m s o f e p i l e p s y .
te m p o ro m a n d ib u la r jo in t
T h e j o i n t b e t w e e n t h e m a n d i b l e ( l o w e r
j a w b o n e ) a n d t h e
s k u ll
.
LOCATION OFTHE
TEMPOROMANDIBULAR JOINT
The head ofthe mandible (jawbone)
fits neatly into a hollow situated on
the underside ofthe temporal bone
ofthe skull at the joint.
Temporomandibular
Temporal
Mandible
te m p o ro m a n d ib u la r jo in t
d y s fu n c tio n
P a i n a n d o t h e r s y m p t o m s a f f e c t i n g t h e
h e a d , j a w , a n d f a c e t h a t a r e t h o u g h t t o
o c c u r w h e n t h e
t e m p o ro m a n d ib u la r jo in t s
a n d t h e m u s c l e s a n d l i g a m e n t s a t t a c h e d
t o t h e m d o n o t w o r k t o g e t h e r c o r r e c t l y .
CAUSES
A c o m
m o n c a u s e o f t e m p o r o m a n d i b u -
l a r
j o i n t
d y s f u n c t i o n
i s
s p a s m
o f t h e
c h e w i n g m u s c l e s , o f t e n c a u s e d b y c l e n c h -
i n g
o r
g r i n d i n g
t h e
t e e t h
a s
a
r e s u l t
o f e m o t i o n a l
t e n s i o n .
M a lo c c lu s io n
( a n
i n c o r r e c t b i t e ) m a y
b e a
c o n t r i b u t i n g
T
733
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