Dr. Shapira's Chicago Headache Blog

A mechanism for retro-orbital pain and TMD is presented in this anatomical dissection of the the temporal branch of the zygomatic nerve passing through an accessory canal in the sphenozygomatic suture. This anatomical placement of the nerve would allow temporal muscle tension to cause nerve irritation and retro-orbital pain. Utilization of a diagnostic neuromuscular orthotic could differentiate retro-orbital pain that is best treated by neuromuscular dentistry.

Surg Radiol Anat. 2002 May;24(2):113-6.
Nervous branch passing through an accessory canal in the sphenozygomatic suture: the temporal branch of the zygomatic nerve.
Akita K, Shimokawa T, Tsunoda A, Sato T.

Unit of Functional Anatomy, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan. akita.fana@tmd.ac.jp
A nervous branch which passes through a small canal in the sphenozygomatic suture is sometimes observed during dissection. To examine the origin, course and distribution of this nervous branch, 42 head halves of 21 Japanese cadavers (11 males, 10 females) and 142 head halves of 71 human dry skulls were used. The branch was observed in seven sides (16.7%); it originated from the communication between the lacrimal nerve and the zygomaticotemporal branch of the zygomatic nerve or from the trunk of the zygomatic nerve. In two head halves (4.8%), the branch pierced the anterior part of the temporalis muscle during its course to the skin of the anterior part of the temple. The small canal in the suture was observed in 31 head halves (21.8%) of the dry skulls. Although this nervous branch is inconstantly observed, it should be called the temporal branch of the zygomatic nerve according to the constant positional relationship to the sphenoid and zygomatic bones. According to its origin, course and distribution, this nervous branch may be considered to be influential in zygomatic and retro-orbital pain due to entrapment and tension from the temporalis muscle and/or the narrow bony canal. The French version of this article is available in the form of electronic supplementary material and can be obtained by using the Springer LINK server located at http://dx.doi.org/10.1007/s00276-002-0027-4.

PMID: 12197019 [PubMed - indexed for MEDLINE]

Labels: anatomical cause, CGRP neuromuscular dentistry, diagnostic orthotic, retro-orbital headache, retro-orbital pain

Chronic pain is frequently multifactorial in nature. Neuromuscular dentistry has been very successful in treating TMD, Migrines, Tension Type headaches and other disorders. Frequently it is not a total cure but 50-80% reduction in pain is usually attained within several visits. There are many disorders and symptoms associated with TMD including:
Ear Aches or Otalgia
Sinus Pain
TM Joint Clicking and Popping
Ear Stuffiness or Eustacian Tube Dysfunction
Dizziness
Vertigo
Temporal Pain
Occipital Headaches
Morning Headaches
Sleep Apnea
Snoring
Sore Throats
Neck pain or stiffness
Feelings of a foriegn object in the throat
Pain in or behind the eyes
Scalp pain or feeling like your hair hurts

Most of these symptoms are mediated by the Trigeminal nerve and the Trigeminovaqscular system. These Nerves also connect to facial nerves, occipital nerves, glossopharyngeal nerves and to the autonomic nervous system. What happens in these nerves cause biochemical changes in the brain. Recent stuies shown the neural plasticity can create permanent changes in the brain. If chronic pain is the stimulus it can lead to central sensitization.

Changes inthe brain can be reversed over time but the exact amount of recovery will vary with individual patients genotypes, how long the pain has been present , other comorbidities that the patient carries. Some patients experience immediate3 and almost miraculous pain relief while others have a slower longer version of recovery. I always tell my patients to work for 50 - 80% improvement in pain. That is then our new starting point and we again seek 50 - *0 % reduction in pain.

There is "no cure" for long term chronic pain because lives have been changed due to living with pain. A cure would require a do-over of the years you had pain. There are no do-overs therefore we look to improve your future quality of life to the maximum. Some patients still have to do exercises or watch diet or even continue different medications. Other patients have remarkably and incredible improvements as described by Dr Barry Cooper in Cranio where he talked about "overwhelming success". This is why we use a diagnostic orthotic as the first step of treatment. We try to avoid permanent changes until the patient feels substantially improved. This is not a judgement that any doctor can make for the patient. It is a subjective evaluation by the patient themselves. Only the patient knows how well or poorly they are doing. We may have objective data showing physical improvement but the final test is have we improved or dramatically improved the patients quality of life. If the answer is yes we can talk about long term stabilization. The diagnostic orthotic is the first phase of treatment for those patients.

If the patient has improvement, whether it is only 25-30% or if they are at 80-90% the decision that the diagnostic orthotic treatment is successful remains the patient's. If they do not feel sufficiently improved they should not feel pressured into continuing treatment or making permanent changes. You should treat the diagnostic orthotic like a CAT SCAN or MRI but instead of images we have improvement in the quality of life. If improvement is not sufficient then a diagnostic approach should continue.

While NEUROMUSCULAR DENTISTRY IS REMARKABLY EFFECTIVE AT TREATING MANY CONDITIONS THERE ARE OTHER CONDITIONS THAT ARE NOT RELATED TO THE TRIGEMINAL NERVOUS SYSTEM, MYOFASCIAL PAIN OR JAW JOINTS.

TMJ disorders are frequently called The Great Imposter ("SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTER" IS A MUST READ FOR ANY PATIENTS WITH MIGRAINES OR TMD http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor) but we must remember that other disorders can also masquerade or more frequently coexist with these problems. Many times a diagnostic orthotic relieves many of the symptoms but the remaining symptoms have a different cause. The expression that "you can't see the forest for the trees" applies. When the majority of symptoms are relieved you now find that you can identify a particular problem that was lost in a long and winding maze of symptoms. As NMD unravels the maze a specific problem can now be identified and treated.

Labels: chronic daily headaches, diagnostic orthotic, facial pain TMJ, Migraines, neuromuscular dentistry, neuromuscular dentistry tmd, neuromuscular orthotic, quality of life, TMJD

I have had an enormous respones from visitors to this website looking for a neuromuscular dentist and not finding one listed in their area. If you need help find a neuromuscular dentist we try our best to connect you with one.

I do ask for feedback on doctors because I do not know all of them personally. I am most happy when I can refer to an excellent clincian that I trust.

While I believe that neuromuscular dentistry is essential for a majority of patients it does not exclude many other varieties of treatment in conjunction with NMD.

Quality of Life is the name of the game. We want to help you on your journey to that better quality of life.

Labels: diagnostic orthotic, LVI, myotronics, neuromuscular dentistry, neuromuscular dentistry migraine, neuromuscular dentistry tmd, neuromuscular orthotic

I have received several e-mails from patients who tell me that there are no dentists listed in their area. We will help you find a Neuromuscular Dentist in your area. I practice in Gurnee, Illinois and see patients primarily from Northern Illinois and Southern Wisconsin. I can do some procedures and initial consults on TMJ disorders at the offices of Chicagoland Dental Sleep Medicine Associates in Skokie and Schaumburg but patients with difficult headaches usually need to come to Gurnee. My office is especially convenient for North Shore suburbs of Chicago as well as Northwest suburbs.

I teach a course in Dental Sleep Medicine to dentists from around the U.S. and my team can arrange for out of own patients who want to travel to Chicago for Neuromuscular Dental Treatment.

Neuromuscular Dentistry for Treatment of headaches involves at least two extended appointments at the start of treatment. Ideally out of town patients will spend three days to begin treatment. The first visit for local patients is usually a consultation we can start treatment for long distance patience if previous arrangements are made.

Following the consultation appointment, treatment begins at the first appointment with a comprehensive examination and neuromuscular work up. The diagnostic orthotic is deliverd at the second visit visit. Long distance patients actually have a full day of treatment (the equivlant of two appointments) with the appliance being delivered on the first day. The patient will be seen early the next day for correcting the diagnostic orthotic to rflect changes in posture as muscles continual to release and normalize. A second visit in the afternoon will often include nerve blocks or trigger points if there is still residual pain. Some patients will leave after the second day but I prefer to have their next appointment the morning of the third day before they go home. We will usually schedule the next vist for 2 weeks later but if pain is completely relieved we may postpone the next appointment.

All patients are different and bring unique challenges and treatment is adjusted to individual patients. Many patients bring their spouse to the first series of appointments though this is not necessary.

Diagnostic orthotics are used in phase I treatment. The diagnostic orthotic is meant for a few months of use decrese pain and stbilize posture. If the patient decides they are substantially improved we recommend a second phase of treatment for long term stabilization. Long term stanilization and permanent changes are usually avoided at the initial series of visits.

Long term stabilization can take many different forms but it is designed to maintain the relief afforded by the diagnostic orthotic.

Labels: Chicago, diagnostic orthotic, Headache treatment, il, phase 1, TMD, TMJ, Wi