Myofacial Pain

Dysfunction
Syndrome
MPDS

The Department Of Oral Medicine

Nivedha Vaithyanathan And Radiology
CRI
Introduction
MPDS is a non inflammatory,
musculoskeletal disorder that
involves muscles of mastication.
Muscle spasm develops
because of occlusal disharmony
or para functional habits
This can result in pain,
restriction of jaw movements,
joint sounds etc
This condition may be associated
with trigger points (hyper irritable
spots in the muscles)
Palpation of trigger points may
elicit pain at a different
location(reffered pain)
Trigger points develops as a result
of over use of masticatory muscles
mainly due to bruxism
Aetiopathogenesis
Occlusal interferences such as
premature contact, recent
restorations (high points) or
orthodontic problems like deepbite
or increased overjet or even stress
can predispose the patient to
Parafunctional habits.
The clenching or grinding of teeth
leads to overuse and thus fatigue of
masticatory muscles resulting in
pain
Etiology
Abnormal occlusion
Abnormal occlusion (Scissors Bite)

Prosthetic problems
Orthodontic problems
Oral habits
Dental restoration Dental Restoration

Tooth loss Oral Habits

Dental irritation
Joint problems
Classification

Spasm of lateral pterygoid muscle

Spasm of elevator muscle

Spasm of lateral pterygoid and elevator muscle

Clinical Features
Age and sex: middle age, <women

Onset: Episodes of several times in a day with

extended symptom free intervals. Usually
increased episodes seen during increased
emotional tension
Symptoms: Pain

1.Pain - due to myalgia, arthralgia or both - pain localised to

the pre auricular area - can radiate to temporal, frontal, and
occipital region
2.Noise such as clicking or popping/snapping sounds on
mandibular movements.
3. Tenderness on palpation of muscles of
mastication
4. Limited movement of the jaw Tenderness on palpation
of muscles of mastication

Others:
1.Tinnitus - auriculotemporal nerve
Otalgia

2.Otalgia

3.Hearing loss - chorda tympani nerve

Tinnitus
 Pain Muscle tenderness

Diagnosis
LASKIN'S CRITERIA
(From Laskin 1969
Positive Inclusionary Signs:

1.Unilateral pain
2.Muscle tenderness
3.Audible clicking sound
4.Restricted jaw movements Restricted Jaw movements
Negative Exclusionary Signs:

1.No joint tenderness when palpating through the

external auditory meatus.
2.No clinical, radiographic, or biochemical evidence of
organic joint disease
Management
Removal of the cause:

1.Dental causes : Correction of

occlusion. Yoga & meditation

2.Stress management:
Counselling, yoga, meditation,
any activity the patient might
enjoy (eg:music) Correction of occlusion
Others:
Trigger point injection: Injection of local anaesthetic procaine
into the trigger points.
Cooling followed by heat: Application of ice pack into areas of
pain (rapid and of short duration). This should be followed by
heat application to warm up the skin.
Massage therapy and gentle stretching exercises.
Electric stimulation/Transcutaneous electric nerve stimulation
(TENS) therapy: This is useful in the management of trigger
points and pain control.
Medical Management
Treatment for MPDS typically includes medications, trigger
point injections or physical therapy.

Medications:-
1) Analgesics:
*Aspirin : 2 tabs 0.3 to 0.6gm/ 4 hourly.
*Piroxicam : 10 to 20mg /3 to 4 times a day.
*Ibuprofen: 200 to 600mg/3 times a day.
*Pentazocine: 50mg/2 to 3 times a day.
Medical Management
2) Muscle Relaxants:
*Valium/librium: 5 to 10mg/2 to 3 times a day.
*Methocarbamol: 500mg/2 to 3 times a day.

3) For patients suffering from chronic myofacial pain

dysfunction syndrome with depression, Anti depressants can
be given.
Amitriptyline: 10 to 25mg/3 times a day or at bedtime.

4) Benzodiazepines with acetaminophen

Developmental disorder of TMJ
Developmental disturbances involving the TMJ
may be in the size & shape of the condyle.
1-HYPERPLASIA:
usually occurs after puberty & is completed by 18 to 25 years of age. Local
factors, such as trauma or infection can initiate condylar hyperplasia

CLINICALLY

1-Limitation of opening
2-Deviation of the mandible to the side of the enlarged condyle
3-Pain occasionally associated with the hyperplastic condyle on
opening.
4-Facial asymmetry associated with condylar hyperplasia characterized
by a convex ramus on the affected side & a concave shape on the
normal side
 TREATMENT

Early detection & surgically

corrected hyperplasia may
prevent the facial deformity

Clinical photographs and 3-dimensional virtual

reconstructions of patient with left-sided condylar
hyperplasia before treatment (left) and one year after
condylar reduction of 8 mm (right)
2-HYPOPLASIA:
caused by trauma & infection
CLINICALLY
1-Deviation of the mandible to the affected
side
2-Facial deformity
3-short wide ramus, shortening of the
body of mandible in the affected side,
while the other side show elongation of
mand body & flatness of the face
TREATMENT
Early surgical treatment to limit facial A Case 1, a 20-year-old man with Goldenhar syndrome.
Pruzansky III, O2 M3 E2 N1 S2, previous autologous
deformity reconstruction with fibular free flap. B Case 2, 22-year-
old women with Goldenhar syndrome. Pruzansky IIb, O0
M2b E3 N0 S3, previous mandibular distraction.
3-AGENESIS:
Characterized by
1-Deviation of the mandible to the
affected side
2-Facial deformity
TREATMENT:

Rib grafts have been used to replace the

missing condyle to minimize the facial
deformity
In this case the mandibular articular fossa
(the articular fossa or articular eminence
is found to be small or absent) is rarely
seen in cases of maxillary or mandibular
agenesis (agenesis).
SYNDROMES ASSOCIATED WITH DEVELOPMENTAL DISORDER OF TMJ
HYPOPLASIA OR APLASIA OF THE MANDIBULAR CONDYLE

1. Primary Condylar Aplasia and Hypoplasia:

Mandibulofacial dysostosis (Treacher Collins syndrome)
Hemifacial microsomia (first and second branchial arch syndrome)
Oculoauriculovertebral syndrome (Goldenhar syndrome)
Oculomandibulodyscephaly (Hallermann-Streiff syndrome)
Hurler's syndrome
2. Secondary Condylar Hypoplasia
HYPERPLASIA

Bifidity (double mandibular condyle, double-headed condyle)

Thank you