MANDIBULAR joint neuralgia (Costen's syndrome), first reported by Costen in 1934,1 is accepted by otorhinolaryngologists and members of the dental profession as a definite clinical entity. It should be considered in every differential diagnosis of recurring facial pain. Nevertheless, the literature usually perused by the internist contains very few references to this syndrome of vertex and occipital pain, otalgia, glossodynia, and pain about the nose and eyes associated with disturbed temporomandibular joint function.
The pathology is either malocclusion from any cause or destructive changes of one or both mandibular joints. The resultant abnormal pressure in the mandibular fossa causes partial or complete closure of the internal auditory canal, accounting for the "stuffy deaf" sensation so common to the syndrome. The diverse and seemingly unconnected neuralgic pains are due to either direct nerve compression within the abnormal joint or reflex irritation of the nerves lying in close association with the