Photomicrographic evidence of insertion tendonosis: the etiologic factor in pain for temporal tendonitis

Anatomical consideration of ultrasonography-guided intraoral injection for temporal tendinitis

Temporal tendinitis is characterized by acute inflammation often resulting from mechanical stress, such as repetitive jaw movements associated with jaw opening and closing and teeth clenching. Treatment for temporal tendinitis typically involves the administration of local anesthetic or corticosteroid injections. However, the complex anatomical structure of the coronoid process, to which the temporalis tendon attaches, located deep within the zygomatic arch, poses challenges for accurate injections. In this study, we aimed to establish guidelines for the safe and effective treatment of temporal tendinitis by using intraoral ultrasonography (US) to identify the anatomical structures surrounding the temporalis tendon and coronoid process. US was performed using an intraoral transducer on 58 volunteers without temporomandibular joint disease. The procedure involved placing the transducer below the occlusal plane of the maxillary second molar. Measurements were taken for the horizontal distance from the anterior border of the coronoid process, observed at the midpoint (MP) of the US images, and the depth of the coronoid process and temporalis muscle from the oral mucosa. The anterior border of the coronoid process was visualized on all US images and classified into three observed patterns at the MP: type A (anterior to the MP, 56.2%), type B (at the MP, 16.1%), and type C (posterior to the MP, 27.7%). The temporalis muscle was located at a mean depth of 3.12 ± 0.68 mm from the oral mucosa. The maxillary second molar is an intraoral landmark for visualizing the anterior border of the coronoid process. The new location information obtained using intraoral US could help identify the safest and most effective injection sites for the treatment of temporal tendinitis.

Temporal Tendinitis in Craniomandibular Dysfunction (CMD) - Does it Really Exist? A Temporomandibular MRI Investigation

OBJECTIVES

 The aim of the study was to analyze the role of temporal muscle and particularly tendon pathology in patients suffering from craniomandibular dysfunction (CMD) using magnetic resonance imaging.

MATERIALS AND METHODS

 Retrospective analysis of MRI examinations was carried out with regard to temporal muscle fibrosis and fatty degeneration and particularly temporal tendon rupture, thickening, and degenerative signal alterations. Descriptive statistics and the Mann-Whitney U-test were used for statistical evaluation.

RESULTS

 Structural lesions of temporal muscle parenchyma were the absolute exception. PD hyperintensity, pronounced contrast enhancement, or peritendinous fluid collections along the temporal tendon were found only to a small extent, and a (partial) rupture occurred in only one case. The tendon diameter showed only slight variability. The Mann-Whitney U-test provided no results indicating a causal connection between degenerative joint or disc disease and temporal tendon pathology.

CONCLUSION

 A large sample of 128 magnetic resonance imaging examinations provided no evidence of a major role of temporal tendinitis in clinical CMD syndrome.

KEY POINTS

  · Retrospective analysis of temporal tendon in CMD patients.. · Abnormal structural findings along the tendon seen only rarely.. · Obviously no crucial role of temporal tendon lesions in CMD syndrome..

CITATION FORMAT

· Stimmer H, Grill F, Waschulzik B et al. Temporal Tendinitis in Craniomandibular Dysfunction (CMD) - Does it Really Exist? A Temporomandibular MRI Investigation. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1829-6134.

Mechanical sensitivity changes in pericranial muscles after local anesthesia and experimentally induced pain in the temporalis tendon: Implications for headache and facial pain

OBJECTIVES

To assess changes in mechanical sensitivity of the pericranial muscles in healthy individuals after a local anesthetic block of the temporalis tendon. In addition, to assess, if experimentally induced temporalis tendon pain, can lead to an increase in mechanical sensitivity of the pericranial muscles and reports of headache.

METHODS

40 healthy participants were recruited for this randomized, double-blinded, controlled experiment, and were randomly injected with mepivacaine and isotonic saline into the dominant-side temporalis tendon in two different sessions, and either nerve growth factor (n = 20) or isotonic saline (n = 20) in a third session. Mechanical sensitivity was assessed in the temporalis, masseter, and trapezius muscles as well as in the temporalis tendon, on the dominant side, before and 10 minutes after each injection, and in a fourth session two days after the third session. Pain drawings and headache diaries were kept for 30 days after the final session to register any developing pain or headache.

RESULTS

Mepivacaine injection into the temporalis tendon caused a significant decrease in mechanical sensitivity in the temporal tendon (-54.5%) and the masseter (-15.4%) muscle (P < 0.05) but not the temporalis (-12.1%) and trapezius muscles (-12.7%) (P > 0.05). Nerve growth factor injection into the temporalis tendon caused a significant increase in mechanical sensitivity in the tendon (+15.4%) and masseter muscle (+14.4%) (P < 0.05) but not the temporalis (+2.8%) or trapezius muscles (+3.1%) (P > 0.05). A significant increase was found for headache frequency in the first seven days (P < 0.05) after nerve growth factor injection compared to after isotonic saline injection, but not intensity (P > 0.05).

CONCLUSION

These findings suggest that the therapeutic effect of temporalis tendon anesthetic injections on facial pain and headaches are most likely not only due to a direct effect of the local anesthetic on the temporalis tendon but rather to a more generalized block of the nerves in the area. In addition, the temporal tendon may contribute to the pathophysiological processes of headache.

Temporal tendinosis: A cause of chronic orofacial pain

PURPOSE OF REVIEW

Diverse musculoskeletal disorders and neuropathic symptoms of the face pose significant diagnostic challenges. In particular, temporal tendinosis is generally overlooked in the medical and dental literature and is therefore a poorly understood topic and often problematic cause of chronic orofacial pain. In this article, we explore temporal tendinosis as a cause of unresolved orofacial pain by reviewing the complex anatomy of the temporalis muscle, common presentations of temporal tendinosis, possible etiologies for injury and place a strong emphasis on required diagnostic evaluation and clinical management.

RECENT FINDINGS

Temporal tendinosis remains under diagnosed due to a combination of anatomical complexity and incomplete description in the majority of general anatomy medical textbooks. The two main presentations are unilateral facial pain with or without temporal headache and pain radiating from the distal temporalis tendon to the temporalis muscle. Diagnosis should be made with a combination of focused history, physical examination and specialised imaging, preferably with ultrasound but with MRI an alternate option. While many management options are available, optimal treatment remains unclear. Temporal tendinosis is an under-recognised and under-treated condition. Despite the fact that orofacial pain is one of the single most common complaints of patients presenting to physicians or dentists, it is widely acknowledged that training for diagnosis and manage of temporal tendinopathy among primary care physicians in both medical and dental professions is inadequate. This may result in extensive workups, leading to suboptimal management and chronic pain syndromes.

Ultrasound-Guided Injection of the Temporalis Tendon: A Novel Technique

A novel technique, ultrasound-guided injection of the temporalis tendon in adults, is described. Ultrasound-guided injection of the temporalis tendon is based on visualization of the temporalis muscle, temporalis tendon, and coronoid process. A practical step-by-step guide to doing the procedure is given. This technique is effective and reproducible. Two patients successfully treated with this technique will be briefly discussed. The anatomic location and size of the temporalis tendon make it mandatory to use ultrasound to ensure precision.

The concurrency of temporal tendinitis with TMD

Temporomandibular disorder (TMD) is a type of orofacial pain that can originate from a number of craniofacial mandibular structures. These include the TM joints, the muscles of mastication, related nerves, tendons, ligaments, bones and teeth. Symptoms include impaired jaw function, TM joint noises and pain, limited opening, often with jaw deviations or deflections to the affected side. Temporal tendinitis is a disorder of the fibrous insertion of the temporalis muscle tendons on the coronoid process of the mandible that is characterized by both inflammation and degeneration. Sometimes, temporal tendinitis can be the primary disease entity, but the authors found that it frequently coexists with TMD. This retrospective study was undertaken to determine the prevalence of temporal tendinitis with TMD. The charts of 449 patients diagnosed with TMD were reviewed to determine the incidences of temporal tendinitis. The referred pain sites and their incidences were also determined.

Temporal tendinitis: a modified Levandoski panoramic analysis of 21 cases

In 1993, Levandoski published the details of a system to analyze panoramic radiographs and especially, the temporomandibular joints. Piedra expanded the work of Levandoski to analyze facial and dental asymmetries. In this brief treatise, the disorder of temporal tendinitis was explored. A modified Levandoski technique was used to compare the lengths of the coronoid and condylar processes in an attempt to demonstrate how the panoramic radiograph can be simply used in the diagnosis of temporal tendinitis in the retrospective study of 21 such cases.

CONCLUSIONS

a total of 18 of the 21 coronoid processes (85%) were equal to or longer than their condylar process counterparts, thus indicating that a panoramic radiograph may be useful in the diagnosis of temporal tendinitis.

Less known non-infectious and neuromusculoskeletal system-originated anterolateral neck and craniofacial pain disorders

Pain syndromes of neuromusculoskeletal origin are not well-known by most of the clinicians working on head and neck area. As a result, most of the patients with these syndromes are either overlooked without having any treatment or they inappropriately have antibiotic treatments or surgical interventions such as dental extractions and tonsillectomies. Better recognition of the pain syndromes of the neck and face region or entities related to neuromusculoskeletal system may result in more appropriate and effective management of such conditions while avoiding unnecessary medical and surgical treatments. In this review, causes, clinical characteristics, diagnostic and treatment modalities of relatively less known craniofacial and neck pain entities including Eagle syndrome, carotidynia, glossopharyngeal neuralgia, superior laryngeal neuralgia, hyoid bone syndrome, acute calcific retropharyngeal tendinitis, temporal tendinitis, thyroid and cricoid cartilage syndromes, and mastoid process syndrome are summarized.

Hyoid bone insertion tendinitis: clinicopathologic correlation

Hyoid bone insertion tendinitis is often not taken into consideration in clinical practice and neglected in the differential diagnosis while evaluating patients with chronic neck pain. One of the main important reasons why physicians do not bear this entity in mind is that it has not been well described histopathologically. Two patients, who had been diagnosed and treated surgically for hyoid bone insertion tendinitis, were presented in this study. Microscopically, degenerative changes in the striated muscle tissue, which are characterized by myocyte necrosis, atrophy along with fibrosis and calcification in some foci, were observed. These findings provide evidence for the clinical picture of hyoid bone insertion tendinitis.

The course of the buccal nerve: relationships with the temporalis muscle during the prenatal period

The aim of this study was to describe the course of the buccal nerve and its relationships with the temporalis muscle during the prenatal period. Serial sections of 90 human fetal specimens ranging from 9 to 17 wk development were studied by light microscopy. Each fetal specimen was studied on both right and left sides, making a total of 180 cases for study. A 3-D reconstruction of the region analysed in one of the specimens was made. In 89 cases the buccal nerve was located medial to the temporalis muscle; in 73 cases it penetrated the muscle; in 15 cases it lay in a canal formed by the muscle fibres and was covered by fascia, and finally, in 3 cases it was a branch of the inferior alveolar nerve. The study has revealed that in a large number of cases the buccal nerve maintains an intimate association with the temporalis muscle.

Tendon and ligament insertions--a possible source of musculoskeletal pain

In many cases of musculoskeletal pain, the source of the pain is still elusive as indicated by the number of acceptable, but different types of treatments that are available. Within the musculoskeletal system, the tendino-periosteal attachment of the muscles (enthesis) appears to be an area that is especially susceptible to injury as a result of trauma. Because it is a structurally flawed, richly innervated, and metabolically active area, it may be the "weakest link" and most reactive site in the musculoskeletal system. Following episodes of trauma, lesions at the enthesis may result in a wide range of symptoms. Treatment of these lesions may be crucial to the success of post-traumatic pain management.

Anatomical observation of a craniomandibular muscle originating from the skull base: the sphenomandibularis

This study describes a hitherto unreported, functionally distinct craniomandibular muscle as observed in 25 cadaveric specimens and MRI scans of clinical patients. The muscle was consistently observed as originating from the maxillary surface of the sphenoid bone and inserting on the temporal crest (internal oblique line) of the mandible. This anatomic observation should broaden our understanding of craniomandibular function and may have clinical implications regarding retro-orbital pain.

The "pre-anterior belly" of the temporalis muscle: a preliminary study of a newly described muscle

Gross anatomical structures of the human body have been known and taught to students for centuries. However, at times, anomalies or even previously undescribed structures are discovered and subsequently reported. This preliminary report discusses the discovery of either a previously undescribed belly of the temporalis muscle, a previously undescribed muscle of mastication, or simply an anomaly of the temporalis. The somatosensory innervation of this structure was identified and will be presented. Preliminary measurements of this structure will also be provided. Finally, clinical implications of these findings, which may aid in the diagnosis and treatment of temporal and facial pain, will be discussed.

Surgical management of refractory craniomandibular pain using radiofrequency thermolysis: a report of thirty patients

Radiofrequency thermolysis has traditionally been used to treat pain disorders of differing etiologies primarily in the low back and cervical areas. This paper describes the use and results of a different and simplified approach to surgical management of extracapsular disorders, namely, temporal tendinitis, Ernest Syndrome, and occipital myalgia-neuralgia where conservative attempts have failed. A brief discussion of the pain disorders are addressed along with the methods of differential diagnosis, conservative therapy, and traditional surgical treatment. Finally, surgical management using radiofrequency thermolysis is described with results of treatment in 30 patients showing a 96% success rate.

Therapeutic effects of the plane occlusal splint on signs and symptoms of craniomandibular disorders in patients with nocturnal bruxism

The long-term effects were studied of a full arch maxillary plane occlusal splint on chronic signs and symptoms of craniomandibular disorders (CMD) in 31 patients with nocturnal bruxism. The results revealed that the score and intensity of signs and symptoms in this type of patient fluctuate from day to day and even within a single day. In spite of continuation of nocturnal bruxism, the symptoms of CMD were cured or improved with the long-term use of the occlusal splint. However, in general, the symptoms recurred after discontinuation of splint therapy. The therapeutic mechanisms of the splint during sleep are discussed.

Hyoid bone syndrome: a degenerative injury of the middle pharyngeal constrictor muscle with photomicroscopic evidence of insertion tendinosis

This article describes the condition known as hyoid bone syndrome, its diagnosis by exclusion, and the histopathologic evidence of focal, degenerative muscle injury. The injury involves the origin fibers of the middle pharyngeal constrictor muscle on the greater cornu of the hyoid bone. The importance of the dentist and physician in recognizing the condition is emphasized, because dental and nondental pain reference sites make up the syndrome.