Musculoskeletal Approach to Maxillofacial Pain.

Rocabado M, Iglarsh ZA. Philadelphia, PA 19105, JB Lippincott Co, 1990, hardback, 244 pp, illus, $55.

The authors state that the purpose of this book is to provide health care practitioners, whether they be dentists, physical therapists, or physicians, with a knowledge base of the developmental characteristics, dysfunctional states, and treatment of the maxillofacial region. They accomplish this through a well-written and comprehensive text that will be invaluable for clinical practice. Many of the concepts in this text are derived from Rocabado's teachings, and familiarity with his work would be beneficial to the reader. This text is written using a multidisciplinary approach and is divided into four parts. Part 1 encompasses the basic concepts of biological growth and development and the growth and development of the cranium, maxillary bones, and temporomandibular joint (TMJ). The last chapter of part 1 deals with the interaction between the developing craniofacial skeleton and the maturing neuromuscular system and their influences on the development of oral function.

Part 2 begins with a review of synovial joint physiology, which provides an excellent overview of the general physiology of soft tissue and bone. Anatomy of the TMJ is then described, together with an overview of the stomatognathic system and the functional anatomy of the orofacial musculature. Etiological factors leading to TMJ disorders are discussed, and the differential diagnosis of specific disorders is addressed as an attempt to avoid the blanket "TMJ dysfunction" diagnosis. A wide range of syndromes are covered, including occlusal alterations, abnormal para-oral habits, and capsular dysfunctions. Functional pathology of the muscles of the stomatognathic system is covered only briefly; this chapter would have benefited from expansion, with the inclusion of all upper-quarter musculature, as well as more basic etiology and treatment. The psychophysiologic component of head, neck, and TMJ pain is also covered rather briefly, considering the amount of research that has been undertaken in this area.

Part 3 covers evaluation of the maxillofacial, craniofacial, and related regions. This part is divided into three components consisting of maxillofacial anatomical evaluation, neuromuscular evaluation of the maxinofacial region, and evaluation of functional activities. These components closely follow Rocabado's concepts on evaluation. They are described and illustrated well, but would have benefited from a few case studies.

Part 4 again follows Rocabado's concepts, covering physical therapy of the tongue and oral environment, physical modalities, and manual techniques, including joint mobilization. The application of dental appliances to patients with maxillofacial dysfunction and the relation between the appliance and physical therapy intervention are covered. Physical therapy for the patient following TMJ surgery is also addressed, and treatment protocols are included. An appendix includes both a brief summary of marketing in this area and evaluation forms for the patient with maxillofacial dysfunction that follow the approach of the book.

This text is most appropriate for physical therapists and dentists. Physicians, physical therapist assistants, dental assistants, and other health care practitioners may also find this book useful if their practice involves maxillofacial disorders. It would be utilized best by the clinician who has completed some advanced courses or training in this area. Entry-level students or those with little background in this field may find the book difficult, as it is written using fairly scientific terminology and assumes at least some background knowledge of the subject. The book also would have benefited from an introductory chapter that included basic definitions and explanations of terminology relating to physical therapy and dentistry. The illustrations and photographs are especially helpful and are abundant. Overall, the text is well-organized with sound, accurate information and is an important addition to the professional literature in this field.

David Levine, PT

The Univ of Tennessee at Chattanooga

Chattanooga, Tenn