Month: June 2021

What is the Temporomandibular Joint? 

It is a joint which connects the jaw bone with the base of the skull. It has a hinge-shaped action, which allows the mouth to be opened and closed just in front of the ear (See Image).

What is the Temporomandibular Joint Dysfunction?

Currently, there is scientific evidence which shows that this condition is more common in female patients between the ages of 20 and 40. It manifests itself when there is inflammation or wear of the structures within the joint which limits or impairs the opening and closing of the mouth when speaking, yawning, chewing or swallowing. Temporomandibular joint dysfunction can affect one or both sides, as well as nearby muscles, causing pain, tension, and inflammation. 

The most common cause of this condition is constant grinding, gnashing, or clenching of the teeth (also known as bruxism). Bruxism may happen unconsciously, when you are awake, or when you sleep. The constant movement of the joint not only inflames or erodes the structures of the joint, it also produces a noticeable wear of the teeth (see image).

What are the symptoms?

The most common symptoms are:

• Pain in the affected jaw or in the joint area (just in front of the ear) at rest or movement (eating, speaking, yawning, etc). 
• Pain on one side of the face or in the jaw in front of the ear or on the affected side. 
• Headache (particularly in the morning)
• Pain or limitation when opening the mouth. 
• Ear pain
• 'Click' when opening and closing the mouth. 
• Pain on one side of the face or neck. 
• Feeling of blocked ear or dizziness. 

How is Temporomandibular Joint Dysfunction diagnosed and treated?

It is important to see a specialist (otolaryngologist) when having discomfort or pain in the jaw or in the joint area (just in front of the ear) at rest or movement (eating, speaking, yawning, etc.), which it does not improve with conventional analgesic treatment. 

During the consultation, the specialist doctor will not only take note of your important medical history, he will also examine your ear and jaw region in order to diagnose the cause of your condition. It is important to emphasize the importance of going to a specialist doctor since due to pain in the ear region caused by an inflamed temporomandibular joint, it is common for it to be misdiagnosed and treated as an ear infection. 

Treatment can vary depending on the severity of symptoms and damage to the temporomandibular joint. It is advisable to start with conservative treatment:

• Application of local heat with a towel moistened in warm / hot water and massage in the affected temporomandibular region several times a day.
• Avoid hard foods that put additional pressure on the joint, opt for foods with a soft consistency. 
• Restrict the opening of the mouth when biting food, chewing, talking or yawning.
• Reduce stress (meditation, yoga, deep breaths, improve sleep habits, aerobic exercise, etc.), as well as be aware of when we clench or grind our teeth and avoid it whenever possible. 
• In severe cases, it will also be necessary to take anti-inflammatory drugs with or without a muscle relaxant.

Your doctor may also assess the need to treat your case together with a:

• Psychologist or psychiatrist to improve stress or anxiety management. 
• Dentist to assess the condition of your teeth and evaluate the use of a dental guard to control involuntary movements of the teeth during sleep. 

If you have noticeable improvement from medical treatment, your doctor may suggest surgical treatment. There are several techniques and they vary depending on the cause and severity of the temporomandibular dysfunction; your doctor will recommend the best treatment for you. 

The decision to have any surgical procedure should be after the surgeon knows all the patient’s medical history and has fully explained as well as discussed the surgical procedure, possible complications and risks.

* This information does not take the place of your doctor's advice. Please consult your healthcare provider for information about a specific medical condition.

References

Cope, G., & Cope, A. (2011). Diagnosis, treatment and management of TMJ disorders. Dental Nursing, 7(12), 682–686. https://doi.org/10.12968/denn.2011.7.12.682 

Flint, P. W., Flint, P. W., & Cummings, C. W. (2020). Cummings otolaryngology: head and neck surgery; Chapter 89: Temporomandibular Joint Disorders (7th ed., Vol. 2). Elsevier. 

What is TMJ? Mountain Ear Nose and Throat Associates. (n.d.). https://mountainent.com/blog/what-is-tmj. 

What are turbinates?

The turbinates are structures on the sides of the nose responsible for directing, filtering and humidifying the air we breathe through the nose (see image). We generally have three pairs in each nostril, named for their location: inferior turbinates, middle turbinates, and superior turbinates. 

Each turbinate is made up of bone surrounded by mucosa, which is lined with blood vessels and nerve endings. In turn, the mucosa surrounding the turbinates contain immune receptors, which help to perceive and block the inhalation of irritants or possible causes of infection.

Can turbinates cause nasal obstruction?

The growth or inflammation of the turbinates may prevent you from breathing properly through one or both nostrils. The turbinates can become inflamed by exposure to an allergic agent (such as dust, pollen, mites, etc.), by inhaling irritants, changes in temperature, or due to infection in the nose or sinuses. Most of these cases are temporary conditions, and the turbinates return to their normal size.

However, continued exposure to irritants or allergens can cause persistent inflammation of the turbinates, particularly the lower turbinates (see image). This, depending on the severity, can cause us to breathe through the mouth most of the time which can limit physical activity, cause bad breath, hoarseness or sleep-related breathing disorders, headaches, runny nose and, in the childhood can affect the development of certain structures in the face.

How is persistent turbinate inflammation diagnosed and treated?

It is important to see a specialist in the nose and paranasal sinuses (otolaryngologist) if you suspect or have a persistent nasal obstruction for more than three weeks. 

During the consultation, the specialist doctor will not only take note of your important medical history, he will also examine your nose in order to diagnose the cause of your condition either manually or with the help of a small camera called an endoscope. 

Initial treatment for inflamed turbinates can vary depending on the doctor or medical condition and is focused on reducing inflammation and improving nose breathing. Anti-inflammatories or antihistamines are usually prescribed either as a spray applied directly to the nose or orally. 

If you do not have noticeable improvement with medical treatment, your doctor may suggest a simple surgical procedure to reduce the size of the turbinates called a turbinoplasty. There are several surgical techniques to reduce the size of the turbinates; your doctor will recommend the best treatment for you. In general, most procedures do not require incisions in the skin, and do not change the shape or size of the nose. 

The decision to have any surgical procedure should be after the surgeon knows all the patient’s medical history and has fully explained as well as discussed the surgical procedure, possible complications and risks.

* This information does not take the place of your doctor's advice. Please consult your healthcare provider for information about a specific medical condition.

References

Abdullah, B., & Singh, S. (2021). Surgical Interventions for Inferior Turbinate Hypertrophy: A Comprehensive Review of Current Techniques and Technologies. International Journal of Environmental Research and Public Health, 18(7), 3441.

https://doi.org/10.3390/ijerph18073441 Becker, D. (2003). Septoplasty and turbinate surgery. Aesthetic Surgery Journal, 23(5), 393–403. https://doi.org/10.1016/s1090-820x(03)00208-5

What is the septum or nasal septum?

The septum or nasal septum is located in the middle of the two nostrils or nostrils; It is lined by mucosa which produces mucus, and is made up of cartilage and bone. This structure divides the nose in two, directs the air we breathe into the airway, and provides support and structure to the nose (see image). 

What causes a deviated septum and what are the symptoms?

The septum can be twisted or deviated as we grow during childhood, or when we suffer a blow to the nose (see image).

The most common symptom is the inability to breathe properly through one or both nostrils. This, depending on the severity, can cause a deformity in the nose or that we breathe through the mouth most of the time which can limit physical activity, cause bad breath, hoarseness or sleep-related breathing disorders, recurrent nosebleeds, headaches, runny nose and, in childhood it can affect the development of certain structures in the face.

In severe cases the deformity of the nasal septum can obstruct the drainage of the paranasal sinuses causing recurrent infections or sinusitis (click here to read what it is sinusitis), alterations in smell, pressure or pain in the face, fever and a feeling of blocked ears.

How is a septal deviation diagnosed and how is it corrected?

It is important to see a specialist in the nose and paranasal sinuses (otolaryngologist) if you suspect or have symptoms caused by a deviated nasal septum. 

During the consultation, the specialist doctor will not only take note of your important medical history, he will also examine your nose in order to diagnose the cause of your condition either manually or with the help of a small camera called an endoscope. 

En caso de tener una desviación septal, el médico podrá solicitar una tomografía computarizada de nariz y senos paranasales, el cual brinda imágenes detalladas del interior de tu nariz y senos paranasales para lograr visualizar detalladamente el grado  y localización de desviación del septum, o si existen algún otra condición médica asociada (ver imagen).

In turn, if surgical treatment is required, this study also helps the surgeon to plan the surgery in order to provide you with the best possible results. 

By going to an otolaryngologist, you will be given a diagnosis and treatment. Commonly a deviation of the nasal septum which causes symptoms and does not improve with medical treatment, requires a surgical correction called rhinoseptumplastia or septumplastia. There are several surgical techniques to correct a septal deviation, such as: closed, open or endoscopic approach. Your doctor will recommend the best treatment for you. 

The decision to have any surgical procedure should be after the surgeon knows all the patient’s medical history and has fully explained as well as discussed the surgical procedure, possible complications and risks.

* This information does not take the place of your doctor's advice. Please consult your healthcare provider for information about a specific medical condition.

References 

Becker, D. (2003). Septoplasty and turbinate surgery. Aesthetic Surgery Journal, 23(5), 393–403. https://doi.org/10.1016/s1090-820x(03)00208-5 

Grover, N. (2017). Septoplasty and Nasal Airway Surgery. Otorhinolaryngology: Head and Neck Surgery (2 Volumes), 1894–1894. https://doi.org/10.5005/jp/books/13036_130 

Nedev, P. (2010). Rhinoseptoplasty – complications, mistakes or unpredictable deformities. International Bulletin of Otorhinolaryngology, 6(1), 23. https://doi.org/10.14748/orl.v6i1.7058 

U.S. National Library of Medicine. (n.d.). Septoplastia – Serie-Indicaciones: MedlinePlus enciclopedia médica. MedlinePlus. https://medlineplus.gov/spanish/ency/esp_presentations/100038_2.htm.