jaw pain

Costen's syndrome: The cause of your jaw pain?

Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine

Do you have temple pain? Pain or cracking in the jaw ? You may be suffering from costen's syndrome or algo-dysfunctional syndrome of themanducatory apparatus (SADAM). The costen's syndrome or algo-dysfunctional syndrome of thechewing device is an unrecognized but not less common pathology. This pathology causes various symptoms including pain, and is likely to be very bothersome.


This article therefore comes to provide answers to all your questions concerning the costen's syndrome by better explaining the mechanism of occurrence, the different causes, the symptoms, how to diagnose it as well as the remedies to cure it.

Definition and anatomy




Le costen's syndrome occurs when there is a malfunction of thetemporomandibular joint. As its name suggests, it is the joint that connects the temporal bone of the skull and the jaw lower (mandible). the costen's syndrome manifests itself, among other things, by pain in thetemporomandibular joint (ATM) or at a distance from it and the mechanical problems of the jaw.



Anatomy and function of the temporomandibular joint (TMJ)


The temporomandibular joints involved in the costen's syndrome are two in number. They are located on each side of the face, in front of the ears. They are very complex anatomical structures because they perform movements practically in all directions. In their normal operation, they must open, close, slide forwards and also laterally. All these mobilities must be carried out synchronously.


The temporomandibular joints are like all other joints in the human body, and are made up of similar anatomical structures. These are bones, muscles, blood vessels, nerves, ligaments and cartilage. Furthermore, a articular disc separates the mandible and temporal bone from the skull. The role of this disc is to avoid direct friction between these two bones during movements of the mandible.


anatomy of the temporomandibular joint and masseter


One of the most used muscles during chewing is the muscle masseter. It is very powerful and allows the elevation of the mandible during chewing. the articular disc then absorbs the great pressure produced during the movements of the mandible during mastication to distribute it in the joint space.


Overall, the appropriate use of jaw depends on the harmony between all the components of the two temporomandibular joints. We can therefore easily speak, yawn and chew food without discomfort.



Causes of Costen Syndrome


The causes of costen's syndrome ou SADAM relate to multiple factors mainly leading to hypercontraction of one or more masticatory muscles, and in particular the masseter.


Causes and risk factors of dysfunctional algo syndromemanducatory apparatus are :


– Hypercontraction of the muscles of the jaw

– Dental occlusion problem preventing correct interlocking of the teeth (misaligned or lost teeth, badly performed dental repairs)

– Post-traumatic fractures of the bones of the face, skull or vertebrae cervical can lead to a displacement of the articular disc (road accident, sports accident)

– Stress and anxiety often the cause of tension in the jaw

– Congenital developmental defect of thetemporomandibular joint

– Degenerative pathologies of the joints, arthritis

– Chronic nasal obstruction

– Sleep and alertness disorders

– Hormonal factors

- Digestive disorders



Symptoms of the disease


Le costen's syndrome is characterized by a highly variable set of clinical symptoms. These various symptoms are explained by the location in front of the ears of the temporomandibular joints, their complex musculature, their rich innervation and the presence of many vessels. Tensions at these joints will cause an imbalance between the head and the spine and therefore, on all the muscles responsible for the general posture of the body.



Local symptoms (located to the jaw and face)


The local symptoms in the costen's syndrome are marked mainly by pain.


– Pain or discomfort when closing and opening the mouth

– Pain in front of the ear

– Pain in the mouth, palate or gums

– Tooth sensitivity

– Burning sensations in the mouth

– Neuralgia in the jaw, face or neck

– Headaches, migraines


In addition, the following joint symptoms are added:


– Reduced mobility of the jaw or abnormal movements

– Difficulty chewing

– Articular noises (“crack”) when opening the mouth or chewing

– Squeals of the jaw

– Sometimes blockage of the jaw in open or closed position


All of these signs can cause teeth to wear or crumble, canker sores and hypersalivation.



Regional symptoms (ENT sphere, eyes)


Symptoms in the ENT sphere (ear, nose and throat) are also possible:


- Vertigo

– Tinnitus (noise in the ears)

– Clogged ear sensation

– Swallowing problem


There may be an association of these signs with eye problems.



Remote symptoms


Remote symptoms related to costen's syndrome are irradiations of pain in the neck or at the level of the cervical spine can even lead to lumbago.


Digestive disorders occur because of difficulty in eating due to poor chewing.



Diagnosis: How to know that we are in front of a SADAM


The diagnosis of costen's syndrome ou SADAM can be difficult because of the wide variability of symptoms that the patient may present with. The specialist will then be able to orient himself by carrying out a detailed questioning and a meticulous clinical examination. This examination will then consist in assessing the mouth opening, the masticatory musculature, the articulation of the mandible without forgetting to check the dental occlusion.


With regard to the paraclinical examinations, the dental panoramic X-ray will be requested in order to detect a possible dental anomaly or the jaw responsible for pain. The scanner of thetemporomandibular joint open and closed mouth will provide information on the state of the articular disc.


x-ray of the temporomandibular joint


In addition, these examinations will allow the specialist to make the differential diagnosis between the costen's syndrome and other pathologies of the face (fractures, tumors, neuralgia) which can also cause pain in the jaw.



Treatment: What are the remedies to cure?


Behavioral rehabilitation


Behavioral rehabilitation is the first treatment to be offered in the costen's syndrome when the pain and discomfort are moderate and not very disabling. This treatment consists of:


– Avoid foods that are hard to chew

– Check the posture of the jaw and that of the body through exercises

– Relax and know how to manage stress in order to avoid tension on the jaw



Physical means


– Pain management by applying ice or a warm, wet towel to sore muscles

– Make massages

– Mandibular physiotherapy and osteopathy for the correction of joint dysfunctions

– Transcutaneous electrical neurostimulation (TENS) to soothe muscle tension



Medical treatment


This treatment involves the use of painkillers, non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants.



Dental brace or gutter


The dental gutter is prescribed by the specialist when the aforementioned treatments have not been conclusive, with the aim of:


– Correct dental occlusion anomalies

– Reposition the mandible

– Relieve contractions in the jaw



Orthodontics and surgery


The specialist resorts to orthodontics or a more invasive surgical treatment depending on the case and when all previous treatments have failed.





The goal of osteopathic treatment in the costen's syndrome ou SADAM is to release the tensions of the masticatory muscles in particular the masseter, which unbalance thetemporomandibular joint. The osteopath uses local techniques of compression and stretching of the muscles, traction and articular compression in order to allow the relaxation of the dysfunction. It is also brought to act on the cervical spine, the neck, the temporal bone of the skull or even the pelvis if necessary.


costen syndrome treatment in osteopathy


Costen syndrome prevention


Prevention of the algo-dysfunctional syndrome of themanducatory apparatus goes through good hygiene and good dental care. It is also necessary to avoid the abuse of chewing gums and hard foods to chew in order to prevent the tension of the masticatory muscles and to promote the relaxation of the jaw.





Le costen's syndrome ou SADAM is a disease of jaw and more precisely of the articulation which connects the temporal bone of the skull and the mandible. The abnormalities found in this pathology can affect all the anatomical elements of themanducatory apparatus. However, the various factors favoring the SADAM all lead to hypercontraction of the main masticatory muscle called masseter.


Le SADAM is therefore revealed by pain in the joint or at a distance from it, as well as mechanical discomfort in the jaw.


Despite the complexity of this pathology, a well-done history and a well-performed clinical examination will guide the specialist in the diagnosis. Among the possible paraclinical assessments, the scanner will help to visualize the elements of thetemporomandibular joint.


The treatment successively involves behavioral rehabilitation, physical means, medication, orthodontics and surgery. Finally, prevention of costen's syndrome remains the best choice to make.


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