Costen's Syndrome: A Review of a Combined Medical and Dental Problem

Abstract

A surprising number of patients seen by physicians have pain referable to the temporomandibular joint. Costen's syndrome (1 ), a symptom-complex associated with dysfunction of that joint, formerly was believed to be relatively rare and was described only in the dental literature. It is now recognized as being fairly common and should be considered in the differential diagnosis of facial pain or headache. Unfortunately, it is still being overlooked, and many patients go from doctor to doctor without obtaining relief.The purpose of this paper is to acquaint the physician, who is usually consulted first, with the symptoms and signs in Costen's syndrome so that an earlier diagnosis can be made and cases referred for proper therapy.A brief historical review of the reports on this syndrome and the controversies regarding etiology seems pertinent to the discussion. SYMPTOMATOLOGYCosten (1) presented his first treatise on the subject in 1934. He had studied 11 cases in which a disturbance of mandibular joint function was the chief etiologic factor in certain disorders of the ear and head. He described a group of patients complaining of: 1) impaired hearing associated with a "stuffy)) sensation in the ears, more marked a t meal times; 2) tinnitus of the "low buzz" type; 3) a snapping or clicking noise while chewing; 4) pain, dull in character, within or about the ears; 5) mild dizziness, 6) "sinus" symptoms; 7) headache, either intermittent or severe and constant, localized to the vertex and occiput or behind the ears; and 8 ) a burning sensation in the throat, tongue and side of the nose. The pain was either mild enough to be mistaken for a symptom of chronic neurosis, or so severe as to be misdiagnosed as tic douloureux. It involved the ear, temporomandibular joint, eyes, cheek, parotid region, tongue, pharynx, occiput, neck, and an area along the mandible, and was associated with part or all of the usual distribution of the fifth cranial nerve.About two years later, Costen (2) reported 125 cases of what he called the "mandibular joint syndrome.'' These cases had been referred to an Otolaryngology Department as possible sinus or ear disturbances. He cited evidence to show that ear symptoms predominate in patients with edentulous mouths, and that pain (with or without herpes of the external auditory canal and buccal mucosa) predominates in patients with either natural malocclusion or malocclusion from loss of molar support on one side. He explained that when molar teeth are missing, or the vertical dimension of the jaw (intermaxillary area) is reduced, either by shrinkage of the alveolar ridge beneath dental plates or by the grinding away * Chief, Department of Geriatrics. 703