THE PSYCHOSOMATICS OF NOCTURNAL ORAL TRAUMA
References
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Figure 1
The haematoma over the ascending ramus of the mandible cannot be reconciled by the suggestion that the tissue was bitten. When the mandible is moved laterally the haematoma fits the distal cusp of the maxillary third molar. Such trauma suggests violent injury. Often hyperkeratosis is located in this area. Even without overt surface evidence of trauma this area is often tender to palpation in patients with craniomandibular disorders. Photograph from Every et. al. (10); used with permission.
Truama to the ascending ramus of the mandible at the limit of the thegotic stroke. Figure 1a
Juxtaposition of the distal cusp of the maxillary third molar with the location of the haematoma in Fig.1. is more easily demonstrated on a dry skull . In this photograph the mandible has been positioned to the limit of the thegotic stroke. Facets match on the mandibular and maxillary teeth in this position. Photograph from Every et. al. (10); used with permission.
Figure 1a
Juxtaposition of the distal cusp of the maxillary third molar with the location of the haematoma in Fig.1. is more easily demonstrated on a dry skull . In this photograph the mandible has been positioned to the limit of the thegotic stroke. Facets match on the mandibular and maxillary teeth in this position. Photograph from Every et. al. (10); used with permission.
Figure 2
Combining the clinical evidence from thegosis-facet matching during simulated thegotic jaw movements and CAT Scans it is possible to plot the movement of the coronid process and the head of the condyle. This evidence supports the hypothesis for the possibility of a traumatic relationship between the coronoid process and the zygomatic arch at the limit of the thegotic stroke. Traumatic relationships of deeper structures suggest the possibility of other trauma.
For example, the relationship of the middle meningeal artery to the medial pole of the condyle at the limit of the thegotic stroke (as determined by facet-matching positions) suggests pressure on this artery when it is lateral to the spine of the sphenoid (a common anatomical variation). This relationships was proposed by Every where he suggested that this nocturnal trauma was a principal etiological factor in classic migraine (3). Such a view is supported by Blau ‘s contention where he argues that classical migraine is caused by sterile inflammation of the meningies (13). Thegotic trauma to the middle meningeal artery could account for this sterile inflammation.
Angle A is determined by facet matching the anterior teeth through a simulated thegotic stroke.
Often jaw clicks coincide with tooth cusp impediments during the stroke.
The distance moved from centric occlusion to this conscious stroke limit is about 15 mm. It is possible to determine the end position of both the ipsilateral and contralateral coronoid process and assess their relationship to the zygomatic arch illustrated here for a left thegotic excursion.