TMJ disorders were first described in current terms by Costen a St. Louis Otolaryngologist (ENT) who describes the biomechanical and muscular aspects of abnormal jaw function.  This was then and always has been a medical disorder of joints, muscles, tendons and ligaments affected by oral functions including talking, eating, swallowing as well as multiple directly related ear dysfunctions and syndromes.

ENTs were the original care givers due to the frequent ear syndromes of ear aches, stuffiness in the ears, ear pain, eustacian tube dysfunction and many others.  Unfortunately most medical treatments failed and dentists evolved and became experts in the biomechanics of jaw function surplanting otolaryngologists as  the primary caretakers of TMJ Dysfunction.

Turning the clock back prior to Dr Costen’s description of TMJ disorders can take us back to 1908 when another Otolaryngologist Dr Greenfield Sluder described a syndrome of severe head, ear, eye, neck and jaw pain that became known as Sluder’s Neuralgia.  Today, we know that Sluder’s Neuralgia is often considered the original description of Temporomandibular Disorders or possibly Migraine, Cluster Headache or other Trigeminal Autonomic Cephalgia.  The syndrome still contained a wide variety of ear, nose, sinus and jaw dysfunctions.  Dr Sluder considered this problem to be a primary neurological disorders centered on the nerves in the otolaryngology scope of practice.  This was considered a medical problem and medical physicians, primariily otolaryngologists treated it.

Dr Sluder went on to write numerous scientific papers and 2 books based on this neurological approach.  The first book “Concerning Some Headaches and Eye Disorders of Nasal Origin” was published in 1918 and a second medical testbook that became the “Bible” for treating head and neck pain called “Nasal Neurology:  Headaches and Eye Disorders”  published in 1927.  Dr Greenfield Sluder later became Chairman of Otolaryngology at Washington University School of Medicine in St Louis.

Dr Sluder dedicated that textbook to Dr Gustav Baumgarten a Professor of Physiology at St Louis College of Medicine.  Dr Baumgrtner later became a Professor of Special Therapeutics and Pathology and finally a Professor of Medicine.  In his dedication Sluder wrote “Whose infinite kindness and personal help with advanced subjects not then in the curriculum has been a help throughout my life”.

Sluder wrote in his prefix  that the title was specifically designed to attract the attention of neurologists, internists, and opthamologists than would a customary treatise on Rhinology.  He felt that this material was relevant to all medical practice.

A great deal of the material focused on the Pterygopalatine Ganglion or the Sphenopalatine Ganglion (Nasal Ganglion, Meckel’s Ganglion).  Due to Sluders work with Sluder’s neuralgia many called the ganglion, Sluder’s  Gangliion.  The use of anesthetic blocks to this ganglion had miraculous results in treating an amazing amount of medical issues.  This amazing block seemed almost miraculous in how various symptoms responded.

In 1930 Hiram Byrd published his paper “Sphenopalatinre Phenomena” and stated  “That the pain of all eye lesions may be stopped by cocaine to the nasal ganglion….is a fact that has been repeatedly observed.”  This old article  in the “Annals of Internal Medicine” (JAMA) was published in 1930 and looked at 2000 patients who received a total of 10,000 blocks also stated that the Nasal Ganglion (SPG, Sphenopalatine Ganglion, Pterygopalatine Ganglion) Blocks were effective for treating the pain of Iritis, the pain of keratitis, the pain of interstitial keratitis associated with syphilis, the pain of conjunctivitis, the pain of optic neuritis from methyl alcohol poisening, the pain of traumatic ulcer to the cornea, blepharospasm, functional hyperesthesia of the ciliary muscle, pain in the eyes associated with errors in refraction, photophobia (excewssive sensitivity to light) , excessive lacrimation, intra-ocular tension and pain of glaucoma, pain of phylctenula (an inflammatory syndrome caused by a delayed hypersensitivity reaction) , the pain of Chalazion (a cyst in eyelid hardened oils blocking the gland).

The work of these doctors showed the clearly overlapping diagnosis between TMJ Disorders and these neurological and biomechanical disorders commonly called Temporomadibular Dysfunction or TMD.  The Tension-Type Headache is almost always the Myofascial Pain and Dysfunction syndrome.  MPD is part of Temporomandibular dysfunction (TMD).  The classification system  ignore the fact that all Tension-type headaches represent the muscular components of TMD,  the abscence of TM Joint pain or sounds does not matter in the diagnosis.

This material and much more is covered in multiple blogs on this site.   This is the most comprehensive information available anywhere and includes many pubmed abstracts and full articles with commentaries.

Below are a few examples of the many uses of Sphenopalatine Ganglion Blocks:


This link discusses use of SPG Block for Trigeminal Neuralgia:

This link discusses use of SPG Block for intactable/ refractory migraines:

Sphenopalatine ganglion block for treating head and neck cancer pain:

SPG Blocks as a pain Management tool:

Byrd H, Byrd W (1930) Sphenopalatine phenomena: present status of knowledge. Archives of Internal Medicine 46(6): 1026-1038.