Head and Neck Pain
Edwin A. Ernest III, DMD
Chronic headache and pain of the temporal tendon has been recognized since the early 1980s by a relatively small number of clinicians. However, much of the prescribed therapy has only been anecdotal because evidence of histopathology for temporal tendonitis has been lacking. This article presents physical evidence of pathology that helps to explain the reason for the refractory, migraine-like pain that is experienced by patients with temporal tendonitis.
Pain of the abnormal mandibular coronoid process and the temporal tendon attachment was described in 1980 and named coronoid impingement.1 The condition was described as lateral flaring of the coronoid process with subsequent pain. The pain experienced was attributed to physical impingement of the coronoid process and temporal tendon on the maxillary process tuberosity or zygomatic arch. Farrar and McCarty1 also reported hypertrophy of the entire temporal muscle, zygoma, and coronoid, and believed this to be another etiology of temporal pain.
The frequent regeneration of the coronoid process after coronoidectomy and reattachment of the temporal tendon has been observed by various clinicians.2-4 Our experience has not revealed hypertrophy or physical impingement of the coronoid process to be a common finding. Clinical studies indicate that this is a rare etiology in pain of the temporal tendon. Rather, we found that most patients who suffer headache pain of the temporal tendons have an insertion tendonosis of the tendon fibers at the coronoid process.
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