CASE STUDY Fig. 6 and its semilunar ganglion receive a threshold level of nociceptive input for a suffi-cient amount of time, a regional vasoconstriction of various major cerebral arter-ies including the cerebral vision center vessels (Brod-mann area #17) occurs. The patient may begin to experi-ence sensory, visual, motor and autonomic focal neuro-logical phenomenon (FNP) known as “aura”. The area of the brain served by the vasoconstricted arter-ies, in an effort to receive more blood, affects vasodila-tion of the vessels. Massive pain, some of which may be heterotopic, may ensue. The pain may manifest above or behind the eyes. ᕢ Neural sensitization is a host’s response over time to repeated stimuli. Nociceptors transmit pain signals to the brain. The neurotransmitter events that originate within the nocicep-tors enhance the perception of pain. Sensitization makes nociceptors in any kind of damaged tissue neurologically “hot”. The good news is that once the tissue is fully healed, this process goes away. Neural sensitization is nature’s way of protecting damaged tissues while healing occurs. ᕣ Hilton’s Law: the muscles acting on a joint have the same nerve supply as the joint. The distension-induced nociceptive signal in the TMD patient’s cerebral arteries then goes to the brain and right through an already neurologi-cally sensitized pain transmis-sion system, (the trigeminal). This is because those nerves have already been altered by things like chronic compres-sion-type nerve damage in the TMJ’s bilaminar zone (auricu-lotemporal neurovascular Fig. 7 bundle off the mandibular division of the trigeminal nerve, and the receptive signals from hypertonic jaw muscles, a consequence of Hilton’s Law). The result then can be any kind of headache, including, in more extreme cases, “the vascular migraine!” 5 What are the FACT and Bionator appliances and what is their purpose? The FACT (Functional, Advancing, Condylar, Translation) appliance5 (Figs. 4 and 5) is a daytime anterior repositioning splint. It is to be worn Fig. 8 34 Winter 2022 JAOS
Journal of the American Orthodontic Society Winter 2022: Page 34
