A syndrome of ear and sinus symptoms dependent upon disturbed function of the temporomandibular joint. 1934.
- J B Costen
- The Annals of otology, rhinology, and laryngology
Since Costen described a syndrome that involved temporomandibular joint (TMJ) symptoms and neurologic as well as otolaryngologic problems, 1 there has been much confusion about the terminology of etiology of temporomandibular joint diseases. Today, TMJ diseases are generally referred to as craniomandibular disorders (CMD) and their etiology is considered to be multifactorial. 2-5 It is evident that females are predisposed to CMD.6-9 This seems to be due to endocrine factors and to the generally weaker structure of the female skeleton. Harinstein et a110 stress that there is a correlation between CMD and generalized joint hypermobility. Our own examinations have shown that more women exhibit increased flexibility of the joints than men.11 The role of occlusion in CMD pathogenesis has been discussed controversially and emotionally in the literature. Many authors consider. as first described by Costen, that the posterior bite collapse, which may be due to tooth loss, abrasion, or iatrogenic/prosthetic causes, is a decisive mechanism for development of a compression joint with CM pain symptoms.1· 12-15 According to Ricketts, 13 congenital deep bite results in a functional bite collapse and increased tenderness of the masticatory muscles. Contrary to Ricketts, Pullinger et al16 observed no correlation between deep bite and CMD. Diedrichs and Bockholt 17 even found that the incidence of CMD increases with the number of teeth present in the posterior supporting zone because there is a higher probability of myoarthropathies. Slavicek15 and Pullinger et al16 stated that the Class 11/1 occlusion can cause condylar dislocation, leading to CMD. Posterior prematurities as well as balance and hyperbalance contacts are regarded