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Orofacial and
Head Pain
Imaging Selection and Strategies
Ghabi
Gary D. Klasser
Editors
123
A. Kaspo
Orofacial and Head Pain
Ghabi A. Kaspo • Gary D. Klasser
Editors
Orofacial and Head Pain
Imaging Selection andStrategies
Editors
Ghabi A. Kaspo
Henry Ford Health Systrem
Henry Ford Hospital
Department of Otolaryngology
Royal Oak, Michigan, USA
Wayne State University
Department of Psychiatry
Detroit, Michigan, USA
Gary D. Klasser
School of Dentistry
Louisiana State University Health
Science
New Orleans, LA, USA
ISBN 978-3-032-08274-9 ISBN 978-3-032-08275-6 (eBook)
https://doi.org/10.1007/978-3-032-08275-6
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2025
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher,
whether the whole or part of the material is concerned, specically the rights of translation,
reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microlms or in any
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If disposing of this product, please recycle the paper.
Contents
1 Fundamentals of Orofacial Pain . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Gary D. Klasser and Steven D. Bender
2 Multidisciplinary Approach to Orofacial
Pain Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Steven D. Bender and Ghabi A. Kaspo
3 Overview of Radiographic Anatomy of Head, Face,
and Neck Structures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
John J. Frazier
4 Radiation Physics and Health Safety Concerns . . . . . . . . . . . . . . 35
Mel Mupparapu, Brad M. Hong, and Irene H. Kim
5 Imaging of Odontogenic Pain—Homotopic/Primary . . . . . . . . . 49
Carla Y. Falcon and Bassam M. Kinaia
6 Imaging of Odontogenic Pain—Heterotopic/Referred . . . . . . . . 71
Gary D. Klasser and Robert Utsman
7 Overview of Imaging Modalities for Temporomandibular
Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Gary D. Klasser and Ghabi A. Kaspo
8 Cone Beam Computed Tomography for
Temporomandibular Joint Disorders and Diseases . . . . . . . . . . . 85
Ghabi A. Kaspo and Christos Angelopoulos
9 MRI for Temporomandibular Joint Disorders
and Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Ghabi A. Kaspo and Mel Mupparapu
10 Otolaryngologic Causes of Orofacial Pain . . . . . . . . . . . . . . . . . . 115
Sandeep Uppal and Chew Lip Ng
11 Imaging for Osseous Pathology of the Maxillofacial
Skeleton: Osteomyelitis, Jaw Tumors, Osteoradionecrosis,
and Medicine- Related Osteonecrosis of the Jaw . . . . . . . . . . . . . 131
Cameron J. Szelesi, Benjamin T. Barbetta,
and Jerold E. Armstrong
v
vi
12 Imaging Neoplastic and Non- neoplastic Conditions
in Neck and Cervical Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Ghabi A. Kaspo and Gary D. Klasser
13 Imaging for Neurogenous Issues . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Iram F. Zaman, Ali Ghanem, Mohamed Ali Garada,
and Utkarsh Agarwal
14 Imaging for Central Nervous System Issues . . . . . . . . . . . . . . . . . 159
Mirela Cerghet and Zahid Iqbal
15 Imaging for Neurovascular Disorders Presenting
as Orofacial Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Dace Zvirbulis
16 Future Directions in Orofacial and Head Pain Imaging . . . . . . . 181
Kaan Orhan and Gurkan Unsal
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Contents
Contributors
UtkarshAgarwal Henry Ford Health– Henry Ford Hospital, Detroit, MI,
USA
Christos Angelopoulos Oral Diagnosis and Radiology, National &
Kapodistrian University, Athens, Greece
JeroldE.Armstrong Henry Ford Health– Henry Ford Hospital, Detroit,
MI, USA
Michigan State University, East Lansing, MI, USA
BenjaminT.Barbetta Henry Ford Health– Henry Ford Hospital, Detroit,
MI, USA
Michigan State University, East Lansing, MI, USA
StevenD.Bender Texas A&M College of Dentistry, Dallas, TX, USA
MirelaCerghet Henry Ford Health, Department of Neurology, Wayne State
University, Detroit, MI, USA
School of Medicine, Department of Neurology and Ophthalmology, Michigan
State University, East Lansing, MI, USA
CarlaY.Falcon, DMD, MDS Diplomate, American Board of Endodontics,
Department of Endodontics, Rutgers School of Dental Medicine, Newark,
NJ, USA
JohnJ.Frazier Department of Diagnostic Sciences, Oral and Maxillofacial
Radiology, Louisiana State University Health Sciences Center, School of
Dentistry, New Orleans, LA, USA
MohamedAliGarada Henry Ford Hospital, Detroit, MI, USA
AliGhanem Department of Neurology, Henry Ford Health System, Detroit,
MI, USA
Zahid Iqbal Henry Ford Health, Department of Neurology, Wayne State
University, Detroit, MI, USA
BradM.Hong Division of Oral and Maxillofacial Radiology, University of
Pennsylvania School of Dental Medicine, Philadelphia, USA
vii
viii
Ghabi A. Kaspo Henry Ford Health Systrem, Henry Ford Hospital,
Department of Otolaryngology, Royal Oak, Michigan, USA
Wayne State University, Department of Psychiatry, Detroit, Michigan, USA
Bassam M. Kinaia, DDS, MS Diplomate, American Board of
Periodontology, Diplomate, International Congress of Oral Implantology,
Graduate Periodontics Program, University of Detroit Mercy, Detroit,
MI, USA
GaryD.Klasser Louisiana State University Health Sciences Center, School
of Dentistry, Department of Diagnostic Sciences, New Orleans, LA, USA
IreneH.Kim Division of Oral and Maxillofacial Radiology, University of
Pennsylvania School of Dental Medicine, Philadelphia, USA
MelMupparapu Division of Oral and Maxillofacial Radiology, University
of Pennsylvania School of Dental Medicine, Philadelphia, USA
ChewLipNg Department of Otolaryngology-Head and Neck Surgery, Ng
Teng Fong General Hospital, National University Health System, Singapore,
Singapore
KaanOrhan Department of Oral and Maxillofacial Radiology, Faculty of
Dentistry, Ankara University, Ankara, Türkiye
Medical Design Application and Research Center (MEDITAM), Ankara
University, Ankara, Türkiye
Contributors
CameronJ.Szelesi Henry Ford Health– Henry Ford Hospital, Detroit, MI,
USA
GurkanUnsal Department of Oral and Maxillofacial Radiology, Schulich
School of Medicine & Dentistry, Western University, London, ON, Canada
SandeepUppal The ENT Clinic, Singapore, Singapore
Robert Utsman Department of Biomedical and Community Health
Sciences, Division of Diagnostic Sciences & Services, James B.Edwards
College of Dental Medicine, Medical University of South Carolina,
Charleston, SC, USA
Iram F. Zaman, DO Department of Neurology, Wayne State University
School of Medicine, Detroit, MI, USA
Department of Neurology & Ophthalmology, Michigan State University
College of Human Medicine, East Lansing, MI, USA
Department of Neurology, Henry Ford Health System, Detroit, MI, USA
DaceZvirbulis Wayne State University, Department of Psychiatry, Detroit,
Michigan, USA
Fundamentals ofOrofacial Pain
GaryD.Klasser andStevenD.Bender
1
1.1 Introduction
According to the American Academy of Orofacial
Pain (AAOP) “Orofacial Pain is the specialty of
dentistry that encompasses the diagnosis, management, and treatment of pain disorders of the
jaw, mouth, face, head, and neck” and “is dedicated to the evidenced-based understanding of the
underlying pathophysiology, etiology, prevention,
and treatment of these disorders and improving
access to interdisciplinary patient care” [1].
Orofacial pain (OFP) is a broad category encompassing a number of associated disorders which
include, but are not limited to, temporomandibular muscle and joint disorders, jaw movement disorders, neuropathic and neurovascular pain
disorders, and vascular and sleep disorders [1].
One of the most frequently encountered OFP conditions, although it is difcult to assess true prevalence given the broad diagnostic criteria, is
temporomandibular disorders (TMDs). TMD is a
subgroup of conditions within the broad classication of various OFP disorders. In essence, it is
also an umbrella term for a group of disorders that
result specically from pain and functional limi-
tation of the masticatory structures, including the
temporomandibular joint (TMJ), associated musculature, or a combination of the two. There are
more than 30 conditions that can be identied as a
TMD and may include, but are not limited to,
arthralgia, myalgia, local myalgia, myofascial
pain with or without referral, articular disc disorders, degenerative joint disease, subluxation, and
headache attributed to TMD [2, 3]. Furthermore,
TMDs have been identied as a major cause of
non-dental pain in the stomatognathic system
often associated with difculties involving mastication and speaking due to pain and/or dysfunction [4, 5]. TMD may also manifest or be comorbid
with several other health conditions such as bromyalgia, back pain, irritable bowel syndrome, and
headache [6]. TMD is most commonly observed
in individuals between the ages of 20 and 40years.
Approximately 33% of the population has at least
one TMD symptom and 3.6% to 7% of the population has TMD with sufcient severity to cause
them to seek treatment [7–9].
1.2 Classication ofOrofacial
Pain (Including TMD)
G. D. Klasser (*)
Louisiana State University Health Sciences Center,
School of Dentistry, Department of Diagnostic
Sciences, New Orleans, LA, USA
e-mail: gklass@lsuhsc.edu
S. D. Bender
Texas A&M College of Dentistry, Dallas, TX, USA
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2025
G. A. Kaspo, G. D. Klasser (eds.), Orofacial and Head Pain,
https://doi.org/10.1007/978-3-032-08275-6_1
Classication systems for OFP conditions are an
important undertaking since they assist clinicians
to pinpoint the specic entity regarding the condition’s etiology, pathophysiology,
symptomatology, diagnosis, and therapeutic
1
2
G. D. Klasser and S. D. Bender
approaches. The denition and terminology
employed also serve to facilitate communication
with the patient, who then may feel more comfortable belonging to a specic group that is recognized and for which a diagnostic and
therapeutic process is available. Terminology and
classication are also extremely helpful instruments in providing correct communication for
researchers when discussing or comparing their
data. The ultimate goals for an ideal classication
system are to organize objects and group them
together, establish a link between the objects,
provide an overview and maximize understanding, highlight similarities and differences, draw
attention to the grouping and contrasting of
objects, and encourage reection on what direction collections should take. In other words, an
ideal classication system ensures that the information is coherent and homogenous.
Over the years, OFP classication systems
have been presented by several organizations
such as the International Headache Society,
International Association for the Study of Pain,
American Academy of Craniofacial Pain, and
American Academy of Orofacial Pain in the form
of guidelines or criteria. Furthermore, individual
articles from various individuals or groups of
authors have also been published on this very
same topic. Despite not yet developing a universal and uniform consensually agreed upon and
evidence-based classication system for OFP,
each contributes its own unique denitions and
diagnostic criteria albeit with various inherent
advantages, strengths and limitations. A discussion of such is beyond the scope of this chapter.
The rst classication system to implement a
dual-axis diagnostic framework for the provision
of operationalized diagnostic algorithms for the
most common TMD was the Research Diagnostic
Criteria for Temporomandibular Disorders
(RDC/TMD) published in 1992 [10]. The aim
was to utilize this empirically derived approach
for clinical and epidemiological research purposes while incorporating and accounting for
psychosocial and behavioral considerations. In
an evolutionary progression, the Diagnostic
Criteria for Temporomandibular Disorders (DC/
TMD) was published in 2014 [3]. The DC/TMD
provides reliable and validated evidence-based
diagnostic criteria for the most common pain and
non-pain-related TMDs. Similar to the RDC/
TMD, the DC/TMD follows a dual-axis assessment, by employing both a physical and psychosocial diagnosis. The expanded DC/TMD was
also published in 2014 [11]. The purpose for the
development of this international expert
consensus- based classication system was to
standardize the diagnostic algorithms for the less
common TMDs not addressed in the DC/TMD
for clinical and research applications. Despite the
global acceptance and adoption of the DC/TMD,
this classication system is only focused on
adults. Therefore, in 2023, the DC/TMD for adolescents and children was developed [12, 13].
The purpose of this initiative was to adapt the
pre-existing DC/TMD for adults and revise it to
be more applicable to the adolescent and child
populations for implementation in clinical and
research settings. In 2024, due to the complexity
and excessively time-consuming physical exam,
as well as the difculty of implementing psychosocial diagnosis associated with the DC/TMD
[14, 15], the brief DC/TMD (bDC/TMD) was
developed [16]. Although the validity, reliability,
and utility of the bDC-TMD has not yet been
tested, the aim is to have this classication system expedite clinical diagnosis and initial management in non-specialist clinical settings to the
benet of patients by earlier recognition of TMD,
thereby improving prognosis [16].
1.3 Evolution ofOrofacial Pain
In 1975, the AAOP was formed as the professional membership organization representing the
eld of OFP.AAOP is an organization of dentists
and other health professionals dedicated to alleviating pain and suffering through the promotion
of excellence in education, research, and patient
care in the eld of OFP and associated disorders.
One of the goals of this organization was to have
the discipline of OFP recognized as a specialty.
Unfortunately, despite several attempts in achieving this goal, all efforts for being recognized as a
specialty were rejected. However, in March 2020,