An Unusual Case of Temporomandibular Joint Disorder Resembling Migraine

Abstract

This article presents the case of a 32-year-old woman with two distinct temporomandibular joint pathologies: right temporomandibular joint arthralgia, headache, disc displacement with reduction and intermittent locking, and limited opening, whereas the left temporomandibular joint was showing arthralgia and subluxation. A neurologist was regularly consulted and treated the patient for migraine. A detailed clinical assessment was used in the therapeutic approach. Cone beam computed tomography (CBCT) was used in the paraclinical assessment to evaluate the temporomandibular joint (TMJ); CBCT imaging revealed condylar bone changes that were not correlated with the clinical symptoms. To alleviate TMJ symptoms, the treatment plan included anti-inflammatory drugs, physiotherapy and an occlusal splint with lateral guiding ramps. After three months of anti-inflammatory medication, physiotherapy and splint wear, an improvement in the migraine symptoms and enhanced life quality was reported. The variation in pathology between the right and left joints and the extended history of temporomandibular disorder onset with no definitive diagnosis or therapy make this case unique.

FIGURE 1. a.

CBCT oblique sagittal section of the right TMJ with closed mouth: flat condyle and osteophytes production

FIGURE 1. b.

CBCT oblique the glenoid fossa sagittal section of the right TMJ with open mouth (A-anterior, P-posterior). The condyle slides until the anterior tubercle of the temporal bone

FIGURE 2. a.

CBCT oblique coronal section of the right TMJ with closed mouth: cortical condylar erosion with uncentered, lateral positioned condyle in the glenoid fossa

FIGURE 2. b.

CBCT oblique coronal section of the right TMJ with open mouth (M-medial)

FIGURE 3. a.

CBCT oblique sagittal section of the left TMJ with closed mouth: condyle cortical osteophytes and no other notable changes

FIGURE 3. b.

CBCT oblique sagittal section of the left TMJ with open mouth (P-posterior). The condyle slides in front of the articular tubercle of the temporal bone (subluxation)

FIGURE 4. a.

CBCT oblique coronal section of the left TMJ with closed mouth: flat condyle, osteophytes production, and an uncentered, lateral positioned condyle in the glenoid fossa

FIGURE 4. b.

CBCT oblique coronal section of the left TMJ with open mouth (L-lateral). The condyle slides lateral out of the glenoid fossa