Head and Neck Pain
Interventional blockade of the major sensory nerve to the TMJ can be a valuable diagnostic tool for the pain practitioner. The block is not unduly difficult, carries no risk of morbidity, and the resulting diagnostic information gain can be of paramount benefit. The complex pain patient who presents with TMJ symptoms and cervical pain not affected by previous therapies may benefit from this diagnostic block. We hope the revisiting of this subject updated from an article by this author that was first published in The Journal of Neurological & Orthopaedic Medicine & Surgery. 1988. 9(2)is stimulating and of tutorial benefit for our readers.
Edwin A. Ernest III, DMD
Head and Neck Pain Department Head
While this paper describes one method of resolving temporomandibular joint neuralgic pain, not all TMJ pain cases can be treated in this manner due to the various reasons for pain associated with the temporomandibular joint. It has been this authors experience that neuralgic pain of the temporomandibular joint can be divided into three basic types:
(1) Posterior Compartment Pain,
(2) Anterior Compartment Pain, and
(3) Posterior/Anterior Compartment Pain combination.
The posterior compartment pain cases in this study were effectively treated with radio-frequency generator thermoneurolysis, which denervates the posterior articular nerve, a branch of the auriculotemporal nerve. The anterior compartment, as well as posterior/anterior compartment, pain cases were not resolved by the radio-frequency generator therapy. Differentiation of patient case type is critical for successful application of radio-frequency generator thermoneurolysis.
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