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Painful Dysfunction of Temporomandibular Joint

JOHN R. WARD, MD; DAVID A. DOLOWITZ, MD; JOHN L. BAUKOL, MD; CARLISLE SMITH, MD; CLARENCE O. FINGERLE, MS
Arch Intern Med. 1963;112(5):693-698. doi:10.1001/archinte.1963.03860050080007.
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Pain in or about the ear, when associated with "clicking," "snapping," or "popping" sensations accompanying jaw movements, has been attributed to malfunctioning temporomandibular joints.1 However, there is considerable controversy concerning the symptoms which can be attributed to disturbed joint function. In 1920, Wright suggested that dysfunction of the joint could produce hearing loss.2 Subsequently, Costen popularized a syndrome which includes impaired hearing, a feeling of fullness in the ears, tinnitus, facial pain, earache, vertigo, nystagmus, occipital headache, burning sensations in the throat, tongue, and side of the nose, dry mouth, herpes of the external ear canal and buccal mucosa, and a snapping noise while chewing.3,4 In a careful reevaluation of the syndrome, Schwartz and co-workers defined two phases: (1) an incoordination phase consisting of clicking and subluxation of the temporomandibular joint and (2) a limitation phase resulting from painful muscle spasm associated with "earache" or poorly localized facial pain.1,5 Despite

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