Costen's syndrome

Definition and clinical essence

Costen's syndrome is a pathological condition of the maxillofacial region defined in propaedeutic dentistry as painful temporomandibular joint (TMJ) dysfunction. In modern medical nomenclature, the term "craniomandibular dysfunction" is also used to refer to this pathology. The primary clinical manifestation, embedded in the definition of the syndrome itself, is a pain syndrome accompanied by impaired normal joint function.

Characteristics of pain syndrome

Since the chief complaint of patients with Costen's syndrome is pain, the physician must perform a detailed analysis of it. Proper pain analysis makes it possible to establish a preliminary diagnosis and formulate a further examination plan. Pain in TMJ dysfunction is assessed according to the following key criteria:

• By duration: it is determined whether the pain is constant or occurs intermittently.
• By character: the patient's subjective sensations are divided into sharp and dull.
• By localization: it is determined whether the pain is strictly localized to the joint area or has a diffuse character.
• By onset: it is extremely important to establish whether the pain appears spontaneously or is triggered by various stimuli (e.g., touching facial tissues, jaws, or movements of the mandible).

The acuity, specificity, and periodicity of pain serve as the basis for differential diagnosis. The physician must take into account that pathologies of the maxillofacial region most often present signs of inflammation of odontogenic origin (e.g., acute, diffuse, nocturnal pain with radiation is typical for pulpitis), so joint pain must be clearly differentiated from them.

Differential diagnosis and associated symptoms

When examining the temporomandibular joint, it is important to distinguish craniomandibular dysfunction from other joint pathologies based on specific clinical signs:

• «Clicking joint» symptom. The presence of a characteristic click during jaw movements is a sign of the initial stage of chronic arthritis and arthro-arthritis of the TMJ.
• Chronic TMJ subluxation. This condition may be detected in systemic diseases. In particular, it is characteristic of Ehlers-Danlos syndrome — a pathology associated with congenital anomalies of the musculoskeletal system and connective tissue (accompanied by increased skin elasticity, hypertelorism, abnormal tooth root shape, and pulp stones).

Methods of clinical examination

A comprehensive approach is used to confirm Costen's syndrome. The goal of the examination is to establish an accurate diagnosis based on a thorough analysis of complaints, taking a medical history, and physical examination. The physician must assess the patient's general condition, identify etiological and pathogenetic factors, and strictly follow the sequence of examination methods.

Subjective methods: The examination always begins with questioning. The physician identifies primary and secondary complaints, collects the history of the present illness (including information on previously administered treatment and its efficacy), personal history, and data on past and comorbid pathologies. To adequately analyze complaints of joint pain, it is necessary to assess the patient's neuropsychiatric status and intellect, establish a trusting rapport, and assist with leading questions while observing the rules of medical deontology.

Objective methods: After questioning, the physician proceeds to the objective examination:

1. An external examination of the patient's face and neck is performed.
2. Palpation of the peri-jaw soft tissues, as well as the bones of the facial and neurocranium, is carried out.
3. Targeted assessment of mouth opening and closing functions is performed.
4. The range and character of movements directly in the temporomandibular joint (TMJ) are assessed.
5. The stage concludes with inspection, palpation, percussion, and probing of the oral cavity organs.

If necessary, additional instrumental and laboratory tests are prescribed to clarify the nature of the dysfunction.

Class and exam questions

What else to study on this topic

• «Clicking joint» symptom in TMJ arthritis and arthro-arthritis
• Ehlers-Danlos syndrome and its dental manifestations
• Differential diagnosis of odontogenic pain (using pulpitis as an example)
• Primary and additional examination methods for dental patients
• Assessment of neuropsychiatric status during dental history taking

Other topics in "Chapter 15. Semiotics in Dentistry"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.