I can see why other patients gush about their admiration for Dr. Nathan. He is indeed pleasant and respectful. Equally important: so is his staff. I arrived late and out of sorts because of a difficult journey to his office in what I consider to be a remote suburb. They handled both my mood and my lateness and put me in a much better frame of mind.
Questions & Answers
Temporomandibular Joint Disorder (TMJ)
What is the TMJ?
You may not have ever heard of it, but you use it hundreds of times every day. It is the Temporomandibular Joint, the joint where the mandible (the lower jaw) joins the temporal bone of the skull, immediately in front of the ear on each side of the head. Each time you chew you move it, but you also move it every time you swallow (every three minutes or so). it is, therefore, one of the most frequently used of all joints of the body.
You can locate that joint by putting your finger on the triangular structure in front of your ear. Then move your finger just slightly forward and press firmly while you open your jaw all the way open and shut. The motion you feel is in the TMJ. You can also feel the joint motion if you put your little finger down into your ear canal with the fingernail backwards. Then press forward as you open and close your jaw again.
These maneuvers can cause considerable discomfort to a patient who is having TMJ trouble, and doctors do this to patients for diagnosis.
TMJ Dysfunction or Disorder
TMJ Dysfunction or TMJ Disorder (also called simply TMJ) is a condition that occurs when the TM joint is misaligned or malfunctioning in some way that subjects it to excess pressure. The condition was first identified in 1934 by an otolaryngologist Dr. J B Costen.
Costen was the pioneer in altering the medical and dental professions to the fact that ear, head and neck pain could be eliminated by correcting an improper bite and removing excess pressure on the TMJ.
According to the American Dental Association, approximately 75 million people in the United States are affected by TMJ dysfunction. Most studies show at least 35% of the population as having TMJ disorders.
How does TMJ Dysfunction Feel?
There are 68 pairs of muscles above and below the jaws. Together these muscles are in 24 hour use in speaking, swallowing, eating, breathing and maintaining the head upright on the shoulders.
TMJ is not only felt in the joint itself but results in pain in many of these associated muscles. Headaches, ear pain, facial pain and neck pain are the common symptoms. Often there is difficulty in opening the mouth and clicking of the TMJ. It’s a bit like having a stone in your shoe, not only does your foot hurt, but your ankles, legs and back become painful as the body tries to keep off the painful spot. TMJ dysfunction causes widespread and variable pains. The Journal of the American Medical Association describes it as the “great impostor because it mimics many different diseases and has such a wide variety of symptoms”.
Causes of TMJ
TMJ Dysfunction can be caused by forces that overloads the joints (TMJ’s). This can be anything from an incorrect swallowing pattern from childhood, a bad bite from misaligned teeth, missing teeth, old dentures or a trauma such as a fall or car accident. (TMJ, very commonly occurs with whiplash injuries). Tension resulting in clenching and grinding of teeth is a common cause as it overloads the TMJ and the 68 pairs of muscles simultaneously.
Treatment of TMJ
Whatever the cause or severity of TMJ the most effective approach is to use initially a soft dental splint to “decompress the Temporomandibular joints”, decrease muscle tension and limit the effects of clenching and grinding of teeth. Adjunctive therapy on the muscles is very helpful. Following this, the causes need to be addressed if pain is not resolved.
Hard dental splints worn 24 hours a day, made to correctly align the bite, have shown to be most effective. It is important that they are constructed to the exact bite and adjusted regularly as structural changes take place. Professional therapy on the muscles and to align the spine is advisable. Stress reduction may be helpful. TMJ treatment using custom-made dental appliances has reportedly been effective; however, can be cost prohibitive to many patients. Permanent changes to the bite with orthodontics or crown and bridgework may be required for long term pain relief. TMJ dysfunction should be treated with regular consultation from your doctor or health care therapist.
The TMJ Appliance
Temporomandibular Joint Disorders affect a large number of Americans, causing symptoms in the head and neck area. TMJ Appliance™ is a similar inter-oral device. Its unique design features, combined with lower cost, make TMJ treatment less expensive.
Where do I get one?
Due to FDA guidelines, this device can only be prescribed by a qualified doctor.
Facial Nerve Disorders
Twitching, weakness, or paralysis of the face are symptoms of a disorder involving the facial nerve, not a disease in itself. Abnormal movement or paralysis of the face can result from infection, injury, or tumors, and an evaluation by your physician is needed to determine the cause. An otolaryngologist head and neck surgeon has special training and experience in managing facial nerve disorders.
What Is The Facial Nerve?
The facial nerve resembles a telephone cable and contains 7,000 individual nerve fibers. Each fiber carries electrical impulses to a specific facial muscle. Information passing along the fibers of this nerve allows us to laugh, cry, smile, or frown, hence the name, “the nerve of facial expression”.
When half or more of these individual nerve fibers are interrupted, facial weakness occurs. If these nerve fibers are irritated, then movements of the facial muscles appear as spasms or twitching. The facial nerve not only carries nerve impulses to the muscles of the face, but also to the tear glands, to the saliva glands, and to the muscle of the stirrup bone in the middle ear (the stapes). It also transmits taste from the front of the tongue. Since the function of the facial nerve is so complex, many symptoms may occur when the fibers nerve are disrupted.
A disorder of the facial nerve may result in twitching, weakness, or paralysis of the face, in dryness of the eye or the mouth, or in disturbance of taste.
How Does It Work?
The anatomy of the facial nerve is very complex. The facial nerve passes through the base of the skull in transit from the brain to the muscles of facial expression. After leaving the brain, the facial nerve enters the bone of the ear (temporal bone) through a small bony tube (the internal auditory canal) in very close association with the hearing and balance nerves. Along its inch-and-a-half course through a small canal within the temporal bone, the facial nerve winds around the three middle ear bones, in back of the eardrum, and then through the mastoid (the bony area behind the part of the ear that is visible). After the facial nerve leaves the mastoid, it passes through the salivary gland in the face (parotid gland) and divides into many branches, which supply the various facial muscles. The facial nerve gives off many branches as it courses through the temporal bone: to the tear gland, to the stapes muscle, to the tongue (for taste sensation), and to the saliva glands.
Head & Neck Cancer
Did you know:
More than 55,000 Americans will develop cancer of the head and neck this year – nearly 13,000 of them will die.
Most of this is preventable.
Tobacco is the most preventable cause of these deaths. In the United States, up to 200,000 people die each year from smoking-related illnesses. The good news is that this figure has decreased due to an increasing number of Americans who have quit smoking. The bad news is that some of these smokers switched to smokeless or spit tobacco, assuming it is a safe alternative. This is untrue – they are merely changing the site of the cancer risk from their lungs to their mouth. While lung cancer cases are down, cancers in the head and neck appear to be increasing.
Cancer of the head and neck is curable if caught early. Fortunately, most head and neck cancers produce early symptoms.
You should know the possible warning signs so you can alert your doctor to your symptoms as soon as possible.
Remember – successful treatment of head and neck cancer can depend on early detection. Knowing and recognizing the signs of head and neck cancer can save your life.
Here’s what you should watch for…
A lump in the neck…
Cancers that begin in the head or neck usually spread to lymph nodes in the neck before they spread elsewhere. A lump in the neck that lasts more than two weeks should be seen by a physician as soon as possible. Of course, not all lumps are cancer. But a lump (or lumps) in the neck can be the first sign of cancer of the mouth, throat, voicebox (larynx), thyroid gland, or of certain lymphomas or blood cancers. Such lumps are generally painless and continue to enlarge steadily.
Change in the voice…
Most cancers in the larynx cause some change in the voice. Any hoarseness or other voice change lasting more than two weeks should alert you to see your physician. An otolaryngologist is a head and neck specialist who can examine your vocal cords easily and painlessly. While most voice changes are not caused by cancer, you shouldn’t take chances. If you are hoarse more than two weeks, make sure you don’t have cancer of the larynx. See your doctor.
A growth in the mouth…
Most cancers of the mouth or tongue cause a sore or swelling that doesn’t go away. These sores and swellings may be painless unless they become infected. Bleeding may occur, but often not until late in the disease. If an ulcer or swelling is accompanied by lumps in the neck, be very concerned. Your dentist or doctor can determine if a biopsy (tissue sample test) is needed and can refer you to a head and neck surgeon to perform this procedure.
Bringing up blood…
This is often caused by something other than cancer. However, tumors in the nose, mouth, throat or lungs can cause bleeding. If blood appears in your saliva or phlegm for more than a few days, you should see a physician.
Cancer of the throat or esophagus (swallowing tube) may make swallowing solid foods difficult. Sometimes liquids can also be troublesome. The food may “stick” at a certain point and then either go through to the stomach or come back up. If you have trouble almost every time you try to swallow something, you should be examined by a physician. Usually a barium swallow x-ray or an esophagoscopy (direct examination of the swallowing tube with a telescope) will be performed to find the cause.
Changes in the skin…
The most common head and neck cancer is basal cell cancer of the skin. Fortunately, this is rarely a major problem if treated early. Basal cell cancers appear most often on sun-exposed areas like the forehead, face, and ears, although they can occur almost anywhere on the skin. Basal cell cancer often begins as a small, pale patch that enlarges slowly, producing a central “dimple” and eventually an ulcer. Parts of the ulcer may heal, but the major portion remains ulcerated. some basal cell cancers show color changes.
Other kinds of cancer, including squamous call cancer and malignant melanoma, also occur on the skin of the head and neck. Most squamous cell cancers occur on the lower lip and ear. They may look like basal cell cancers and, if caught early and properly treated, usually are not much more dangerous. If there is a sore on the lip, lower face, or ear that does not heal, consult a physician.
Malignant melanoma classically produces dense blue-black or black discoloration’s of the skin. However, any mole that changes size, color, or begins to bleed may be trouble. A black or blue-black spot on the face or neck, particularly if it changes size or shape, should be seen as soon as possible by a dermatologist or other physician.
Constant pain in or around the ear when you swallow can be a sign of infection or tumor growth in the throat. This is particularly serious if it is associated with difficulty in swallowing, hoarseness or a lump in the neck. These symptoms are best evaluated by an otolaryngologist.
What you should do…
All of the symptoms and signs described here can occur with no cancer present. In fact, many times complaints of this type will be due to some other condition. But you can’t tell without an examination. So, if they occur, see your doctor – and be sure.
Remember: When found early, most cancers in the head and neck can be cured with relatively little difficulty. Cure rates for these cancers could be greatly improved if people would seek medical advice as soon as possible. So play it safe. If you think you have one of the warning signs of head and neck cancer, see your doctor right away.
Information provided by the American Academy of Otolaryngology – Head and Neck Surgery, Inc.