The fifth edition of the Guidelines for the assessment, diagnosis, and management of orofacial pain was published by the American Academy of Orofacial Pain (AAOP) in 2013. These AAOP Guidelines include Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and Expanded TMD Taxonomy that had not been published at that time. DC/TMD are evidence-based validated diagnostic criteria which cover most common TMDs and can be used for both clinical and research settings. Expanded TMD Taxonomy covers the full range of TMDs based on ontology, in which a consensus-based classification system and associated diagnostic criteria that have clinical and research utility for less common but important TMDs are provided. These two criteria were established through international collaboration by the International RDC/TMD Consortium Network and Special Interest Group on Orofacial Pain of the International Association for the Study of Pain (IASP). There were two diagnostic criteria for TMDs, that is, Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), which were published in 1992 and have been extensively used in research settings, and the AAOP Guidelines, which provide clinicians with criteria for accurate diagnoses of TMDs, until the fifth edition of the AAOP Guidelines was published. The AAOP Council decided to adopt DC/TMD and Expanded TMD Taxonomy in 2012, then the two diagnostic criteria for TMDs were consolidated. These common tools facilitate the comparison of data among different study samples, the establishment of a working consortium of multi-national clinical centers having the capability to conduct interdisciplinary basic, translational and clinical research on an international and collaborative level, and the development of comparable evidence-based diagnostic criteria through research collaboration. It is also noted that these common tools will be revised as new evidences are accumulated.

View full abstract

In 2013, the International Headache Society (IHS) published the beta version of the third edition of the International Classification of Headache Disorders (ICHD-3β). These criteria, which are based on expert consensus, serve as diagnostic criteria for research and as a guide to clinicians. The reason for providing a beta version is to ensure consistency with the International Classification of Diseases 11th Revision (ICD-11), which is currently under revision, and the IHS plans to publish the beta version as the ICHD-3 in 2016. ICHD-3β classified headache disorders into 3 parts and 14 groups. Part 1 (groups 1-4) comprised groups of primary headaches lacking an organic cause and representing discrete physiological disorders not associated with any other illness or pathology. Included in this category are: 1) migraine; 2) tension-type; and 3) trigeminal autonomic cephalalgias (TACs). Many diseases belonging to this group need differentiation from temporomandibular disorders (TMDs) because they can occasionally present with facial pain. Part 2 (groups 5-12) covered groups of secondary headaches; or organic headaches symptomatic of an underlying problem. Headaches attributed to TMD are classified in group 11 as type 7 (11.7). To diagnose such headaches (11.7), the use of DC/TMD diagnostic criteria defined by the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group, is recommended. Part 3 (groups 13, 14) involved groups of "Painful cranial neuropathies and other facial pains". Many diseases that are familiar to orofacial pain experts belong to this part, including trigeminal neuralgia, glossopharyngeal neuralgia, burning mouth syndrome (BMS), and persistent idiopathic facial pain (PIFP). To correctly diagnose TMDs, a full knowledge of differential diagnoses is required. To this end, TMD/OFP experts must be aware of the classification and diagnostic criteria of ICHD-3β.

View full abstract

Questioning is indispensable to estimate Axis II of Temporomandibular Disorders (TMD). The value of Axis II of TMD combines the chief complaint, history of symptoms and objective findings, and is useful. It is recommended to use "Diagnostic and Statistical Manual of Mental Disorders" (DSM) when checking a mental disease by using the value of Axis II. DSM-5, which was revised as the 5th edition in 2013, is used at present. The term "Somatoform Disorders" disappeared in DSM-5 and the term "Somatic Symptom and Related Disorders" appeared newly, and so a disease called Somatic Symptom Disorder and Illness Anxiety Disorder was established. This diagnostic name can now be used, but further study is necessary.

View full abstract

The purpose of this study was to elucidate the characteristics of patients with temporomandibular disorder (TMD) in our hospital by using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) score sheet for physical and psychosocial screening at the first visit. The subjects were 287 TMD patients (65 men and 222 women) who underwent their initial medical examination between June 2012 and May 2014. Physical screening was performed as per RDC/TMD Axis I. For psychosocial screening, we analyzed the grades of chronic pain scale, depression and somatization in RDC/TMD Axis II and evaluated their relationship to Axis I. The results of physical screening showed that 49.1% of subjects fell into group I (muscle disorders), which was the most common. In terms of Axis II diagnoses, depression was moderate to high in 34.0% of all subjects, and the severity of non-specific physical symptoms was moderate to high in 43.3% of subjects. In terms of the grading of chronic pain, psychosocial problems by pain were observed in 9.6% of subjects. When depression and somatization were compared to each group in RDC/TMD Axis I, they were both shown to be significantly higher in group I patients than in group II and group III patients (p<0.01). The above results show the importance of an approach towards psychosocial factors in group I patients, and suggest the usefulness of evaluating Axis II.

View full abstract

The external auditory canal (EAC) consists of a bony part and a cartilaginous part. Foramen tympanicum (Huschke's foramen) can be observed sometimes in the bony part (tympanic bone) as a developmental abnormality. However, it is rare in clinical dentistry. In this study we report a 66-year-old female patient with chief complaints of trismus and temporomandibular joint (TMJ) pain in December 2009. She had visited our ENT (Ear, Nose, Throat) clinic the previous year for resonant vibration of voice. Herniation of the posterior tissue of TMJ disc into EAC was observed; the degree of herniation was associated with opening/closing of the mouth, so she was referred to our clinic. The mouth opening without pain was 22 mm at the initial examination, and that with pain was 30 mm. On panoramic radiograph, right TMJ arthrosis deformity was suspected. On CT, a bone defect of approximately 5.5 mm in diameter was observed with herniation of the posterior tissue of TMJ disc. From these findings, a diagnosis of foramen tympanicum with TMJ arthrosis was made. There was no association with the chief complaints of trismus and TMJ pain. At present, her trismus without pain is 35 mm, and observation has been made with mouth-opening training.

View full abstract

We report a case of osteoarthrosis of the temporomandibular joint with severe ossification of the dislocated articular disc. A 61-year-old woman was referred to our clinic with disturbance of mouth opening. Five years earlier, she had first experienced pain in the left temporomandibular joint region at mouth opening and disturbance of mouth opening. She visited a dental clinic and had been treated with a stabilization splint for about 4 years, which reduced the pain of the temporomandibular joint. However, because the degree of mouth opening was not improved, she was referred to our department. Clinical examination revealed that the maximum mouth opening was 23 mm between the upper and lower left incisors with slight pain. A panoramic radiograph and CT scans revealed widespread belt-like calcification around the left temporomandibular joint, and hyperplasia of the mandibular condyle. Both discectomy and condylectomy were performed under general anesthesia. Histologically, the articular disc contained a large ossified mass and some calcified bodies were also included in the articular capsule. The maximum mouth-opening distance improved to 35 mm after the surgery. Neither particular change of facial appearance nor facial nerve paralysis was detected after the surgery. The postoperative course was uneventful, with a maximum mouth opening of 35 mm maintained, and no stomatognathic dysfunction occurred for 2 years and 6 months.

View full abstract

Osteochondroma, a relatively rare benign tumor that occurs in the orofacial region, consists of mature hyaline cartilage. We report the case of a 39-year-old man with an osteochondroma on his left mandibular condyle who presented with an occlusion anomaly and masticatory dysfunction. He had been aware of a swelling in the anterior portion of his left ear since 2007 and an asymmetry in complexion since 2010. A gradual mandibular shift towards the right and malocclusion and masticatory disturbance were also experienced. He visited our hospital in January 2013. We confirmed a bone-like hard phyma in the left mandibular condyle. The mandible was shifted 12 mm to the right. Panoramic radiography showed a well-demarcated radiolucent lesion between the left mandibular fossa and the mandibular condyle. Computed tomography (CT) revealed a lobular lesion (39×30×29 mm) that covered the cortical bone, and irregular osteosclerosis was observed inside the cortical bone. After a clinical diagnosis of osteochondroma or osteoma, the tumor was resected, along with the mandibular condyle, under general anesthesia. The upper part of the tumor was in contact with the base of the skull. Since an adhesion was observed between part of the tumor and the base of the skull, we did not resect the upper part of the tumor. Upon histopathological examination, the tumor was diagnosed as an osteochondroma. No progression of the residual tumor has been observed during a two-year follow-up period.

View full abstract

Although there are several reports of mandibular condylar hyperplasia (CH) cases, occurrence in infancy is uncommon. The main symptoms of CH are facial asymmetry, occlusal disturbance, and dysfunction, and thus the condition is not generally seen or treated in infants. Here, we present a case report of CH in a 1-year-old infant, who showed limited mouth opening and was treated by a condylectomy procedure but needed retreatment with a temporalis muscle fascia flap because of recurrent limitation of mouth opening.

View full abstract