Efecto de la desprogramación neuromuscular en la calidad de vida y sueño en pacientes con disfunción temporomandibular / Effect of neuromuscular deprogramming on quality of life and sleep in patients with temporomandibular dysfunction

Introduction: Neuromuscular deprogramming reduces the main symptoms such as pain by 70 to 90 percent in patients with temporomandibular dysfunction, but little information is available on the effect on quality of life and sleep. Objective: Determine the effect of neuromuscular deprogramming on quality of life and sleep in patients with temporomandibular dysfunction. Methods: 55 patients with temporomandibular dysfunction were included who were neuromuscularly deprogrammed (29 women and 26 men), with an average age of 34.9 ± 16.5 years. At the beginning and end of neuromuscular deprogramming, surveys were applied to assess the level of chronic pain, perception of quality of life related to oral health, perceived stress, quantity and quality of life, anxiety and depression. Results: In 37 patients (68 percent) pain was identified on examination, and it was confirmed in the chronic pain survey. The quality of life perception score was correlated with low sleep quality (r = 0.39; p = 0.008); pain score (r = 0.48; p = 0.003); anxiety (r = 0.55; p = 0.003) and depression (r = 0.41; p = 0.006). Neuromuscular deprogramming reduced patient-reported pain levels from 9.9 to 2.9 (p = 0.001), the percentage of patients with poor sleep quality from 60 percent to 29 percent (p < 0.0001), the quality of life score from 40.7 to 23.8 (p = 0.03), and perceived stress levels from 22.1 to 19.1 (p = 0.002). Conclusions: In patients with temporomandibular dysfunction, neuromuscular deprogramming reduces the level of pain. It is related to better perception in quality of life, higher quality of sleep and decreases perceived stress.

Introducción: La desprogramación neuromuscular reduce los síntomas principales como el dolor de 70 a 90 por ciento en los pacientes con disfunción temporomandibular, pero se dispone de escasa información sobre el efecto en la calidad de vida y sueño. Objetivo: Determinar el efecto de la desprogramación neuromuscular en la calidad de vida y sueño en pacientes con disfunción temporomandibular. Métodos: Se incluyeron 55 pacientes con disfunción temporomandibular que fueron desprogramados neuromuscularmente (29 mujeres y 26 hombres), con edad promedio de 34,9 ± 16,5 años. Al inicio y final de la desprogramación neuromuscular, se aplicaron las encuestas para evaluar el nivel de dolor crónico, percepción de calidad de vida relacionada con la salud oral, estrés percibido, cantidad y calidad de vida, ansiedad y depresión. Resultados: En 37 pacientes (68 por ciento) se identificó dolor a la exploración confirmado en la encuesta de dolor crónico. El puntaje de percepción de calidad de vida se correlacionó con baja calidad de sueño (r = 0,39; p = 0,008); el puntaje de dolor (r = 0,48; p = 0,003); ansiedad (r = 0,55; p = 0,003) y depresión (r = 0,41; p = 0,006). La desprogramación neuromuscular redujo los niveles de dolor referidos por el paciente de 9,9 a 2,9 (p = 0,001), el porcentaje de pacientes con pobre calidad de sueño de 60 por ciento a 29 por ciento (p < 0,0001), el puntaje de la calidad de vida de 40,7 a 23,8 (p = 0,03) y los niveles de estrés percibido de 22,1 a 19,1 (p = 0,002). Conclusiones: En pacientes con disfunción temporomandibular, la desprogramación neuromuscular reduce el nivel de dolor, se relaciona con mejor percepción en la calidad de vida, mayor calidad de sueño y disminuye el estrés percibido(AU)

Stability of Class II corrections with removable and fixed functional appliances: A literature review.

BACKGROUND: Class II functional appliances have been used in orthodontics for over 100 years. Although the stability of corrections is one of the main goals of orthodontic treatment, there is a paucity of longitudinal studies on the long-term stability of treatment of Class II malocclusion based on functional appliances. METHODS: This narrative review attempts to summarize the limited related evidence available and discusses the clinical implications of important aspects related to occlusal and skeletal changes that arise after Class II malocclusion treatment with functional appliances. RESULTS: The occlusal changes obtained through Class II functional treatment do mostly exhibit long-term stability. While mild posttreatment changes occurred, they were most likely due to physiologic aging processes and not likely associated with actual treatment relapse. Long-term retention in the lower jaw would be particularly beneficial. A stable occlusion with good intercuspation in the posterior arches seems more likely to preserve a Class I occlusion after treatment through dentoalveolar compensatory mechanisms. After treatment, the maxilla and the mandible do grow anteriorly, with the mandible growing more than the maxilla. Patients treated with functional appliances are not likely to develop TMJ disorders over the long term. CONCLUSIONS: Long term skeletal corrections achieved with functional appliances seem to be overall stable. Class II molar and overjet relapses can be likely explained by a combination of tooth movement and an unfavorable posttreatment maxillomandibular growth pattern, especially when combined with unstable interdigitation of the posterior teeth. No specific intermaxillary retention approach has been assessed yet.

Upper body motor function and swallowing impairments and its association in survivors of head and neck cancer: A cross-sectional study.

BACKGROUND: Upper body motor function and swallowing may be affected after curative treatment for head and neck cancer. The aims of this study are to compare maximum mouth opening (MMO), temporomandibular dysfunction (TMD), cervical and shoulder active range of motion (AROM) and strength, and swallowing difficulty between survivors of head and neck cancer (sHNC) and healthy matched controls (HMC) and to examine the correlations between these outcomes in sHNC. METHODS: Thirty-two sHNC and 32 HMC participated on the study. MMO, TMD, cervical and shoulder AROM, cervical and shoulder strength, the SPADI shoulder pain and disability indices, the Eating Assessment Tool (EAT-10) score, swallowing difficulty as determined using a visual analogue scale (VAS), and the location of disturbances in swallowing, were recorded. RESULTS: MMO and cervical and shoulder AROM and strength were significantly lower in sHNC, whereas FAI, SPADI score, EAT-10 and VAS were higher. The MMO, TMD, cervical and shoulder AROM, and cervical shoulder strength values showed significant correlations (some direct, others inverse) with one another. Swallowing difficulty was inversely associated with the MMO, cervical AROM and shoulder strength. CONCLUSION: Compared with controls, sHNC present smaller MMO, lower cervical and shoulder AROM, lower cervical and shoulder strength and higher perception of TMD, shoulder pain and disability and swallowing difficulty. sHNC suffer impaired swallowing related to lower MMO, presence of TMD, cervical AROM and shoulder strength values. Improving these variables via physiotherapy may reduce the difficulty in swallowing experienced by some sHNC.

The effectiveness of stabilization appliance therapy among patients with myalgia.

BACKGROUND: The efficacy of stabilization appliance therapy for masticatory muscle pain is debated. Therefore, there are currently no clear usage standards. We analyzed patient factors influencing its efficacy and characterized masticatory muscle pain subtypes to determine appropriate therapy candidates. METHODS: This case series study recruited patients diagnosed with local myalgia or myofascial pain and used variables related to temporomandibular disorders in the analysis. We used temporary appliance to screen patients for sleep bruxism for 2 weeks. Afterwards, we initiated therapy with stabilization appliances. Efficacy was evaluated via tenderness intensity during muscle palpation and the treatment satisfaction score after 2 months of treatment. RESULTS: We analyzed 62 (91%) patients. Tenderness upon muscle palpation was mitigated in 27 patients. Mitigated tenderness odds ratios were 0.035 for myofascial pain, 0.804 for 15-item Patient Health Questionnaire scores, and 1.915 for facet length. Thirty-nine patients expressed satisfaction; satisfaction odds ratios were 0.855 for 9-item Patient Health Questionnaire scores, 1.606 for facet length, and 4.023 for awake bruxism awareness. CONCLUSIONS: Stabilization appliance therapy is most effective for patients with awake bruxism awareness, local myalgia, long facets, and no psychosocial risk factors.

Open Surgery Versus Closed Treatment of Unilateral Mandibular Condyle Fractures.

PURPOSE: The aim of this meta-analysis was to evaluate the efficacy of open surgery and closed treatment for unilateral moderately displaced mandibular condyle fractures. METHODS: PubMed, Embase, and Cochrane Library databases were searched according to PRISMA guidelines from inception to October, 2018. Inclusion criteria were based on humans randomized controlled trials in the English literature. Pertinent data were collected and the incidence of the complications was calculated. RESULTS: A total of 6 studies with 227 patients were included in the meta-analysis. The results showed that there were no significant differences in incidence of malocclusion (odds ratio [OR], 0.33; 95% confidence interval [CI]: 0.07-1.46; P = 0.14). However, open surgery group had a better maximal mouth opening (WMD = 3.82, 95% CI: 1.93-5.71, P < 0.01), protrusion (WMD = 1.16, 95% CI: 0.42-1.89, P < 0.01) and sum of both laterotrusions (WMD: 2.50, 95% CI: 1.77-3.22, P < 0.01). And the incidence of temporomandibular joint pain was lower than closed treatment group (OR: 0.15, 95% CI: 0.06-0.37, P < 0.01). CONCLUSIONS: Compared with closed treatment, open surgery has significant advantages in improving mouth opening and mandibular movement, and reducing the incidence of temporomandibular joint pain, provided that open surgery was a promising application in treatment of unilateral moderately displaced mandibular condyle fractures.

Temporomandibular joint dysfunction syndrome and police work stress: an integrative review. / Síndrome da disfunção da articulação temporomandibular e o estresse presente no trabalho policial: revisão integrativa.

This study aimed to investigate whether stress found in activities performed by Brazilian police workers is associated with the risk of developing a temporomandibular joint dysfunction syndrome (TMD), a disorder that is commonly associated with stressful conditions. An integrative literature review on stress, TMD and police work was carried out. We identified several stressors in the work of Brazilian police officers and observed that stress influences the development, aggravation and treatment of TMD symptoms. The quality of life and health of TMD carriers is compromised. The fact that studies have shown the association between stress and activities carried out by Brazilian police officers, as well as between stress and TMD, has led to the assumption of a possible relationship between stress caused by police work and the risk of these workers developing TMD. It is recommended that individuals be thoroughly examined before being treated and that such treatment be multidisciplinary. The literature on TMD in police workers is still incipient, which is why we recommend the development of further studies on the topic.

O estudo objetivou investigar se o estresse presente nas atividades dos trabalhadores da polícia brasileira pode ter relação com o desenvolvimento da síndrome da disfunção da articulação temporomandibular (DTM), uma doença comumente associada a condições estressantes. Realizou-se uma revisão integrativa de literatura sobre os temas estresse, DTM e atividade policial. Foram identificadas diversas fontes estressoras no trabalho do policial brasileiro e observou-se que o estresse influencia no desenvolvimento, agravamento e tratamento dos sintomas da síndrome. Há comprometimento na qualidade de vida e saúde dos portadores de DTM. O fato de estudos terem mostrado associação entre estresse e atividades desenvolvidas pelos policiais brasileiros, bem como relação entre estresse e DTM, levou à suposição de que é possível haver relação entre o estresse gerado pelo trabalho executado por policiais e o risco de desenvolvimento da DTM por essa classe de trabalhadores. É recomendado que o indivíduo portador da síndrome seja avaliado como um todo antes da execução do tratamento e que esse tratamento seja multidisciplinar. A literatura sobre DTM em policiais ainda é incipiente, motivo pelo qual sugere-se o desenvolvimento de estudos sobre o tema.

Síndrome da disfunção da articulação temporomandibular e o estresse presente no trabalho policial: revisão integrativa / Temporomandibular joint dysfunction syndrome and police work stress: an integrative review

Resumo O estudo objetivou investigar se o estresse presente nas atividades dos trabalhadores da polícia brasileira pode ter relação com o desenvolvimento da síndrome da disfunção da articulação temporomandibular (DTM), uma doença comumente associada a condições estressantes. Realizou-se uma revisão integrativa de literatura sobre os temas estresse, DTM e atividade policial. Foram identificadas diversas fontes estressoras no trabalho do policial brasileiro e observou-se que o estresse influencia no desenvolvimento, agravamento e tratamento dos sintomas da síndrome. Há comprometimento na qualidade de vida e saúde dos portadores de DTM. O fato de estudos terem mostrado associação entre estresse e atividades desenvolvidas pelos policiais brasileiros, bem como relação entre estresse e DTM, levou à suposição de que é possível haver relação entre o estresse gerado pelo trabalho executado por policiais e o risco de desenvolvimento da DTM por essa classe de trabalhadores. É recomendado que o indivíduo portador da síndrome seja avaliado como um todo antes da execução do tratamento e que esse tratamento seja multidisciplinar. A literatura sobre DTM em policiais ainda é incipiente, motivo pelo qual sugere-se o desenvolvimento de estudos sobre o tema.

Abstract This study aimed to investigate whether stress found in activities performed by Brazilian police workers is associated with the risk of developing a temporomandibular joint dysfunction syndrome (TMD), a disorder that is commonly associated with stressful conditions. An integrative literature review on stress, TMD and police work was carried out. We identified several stressors in the work of Brazilian police officers and observed that stress influences the development, aggravation and treatment of TMD symptoms. The quality of life and health of TMD carriers is compromised. The fact that studies have shown the association between stress and activities carried out by Brazilian police officers, as well as between stress and TMD, has led to the assumption of a possible relationship between stress caused by police work and the risk of these workers developing TMD. It is recommended that individuals be thoroughly examined before being treated and that such treatment be multidisciplinary. The literature on TMD in police workers is still incipient, which is why we recommend the development of further studies on the topic.

The relationship between pathological wear of teeth and temporomandibular joint dysfunction.

OBJECTIVE: Temporomandibular joint dysfunction (TMJD) is quite frequent pathology in population. In scientific literature pathological tooth wear (PTW) is listed among the predisposing factors of it. MATERIAL AND METHODS: During the survey 189 primary patients of dental department in polyclinic of Panevezys city were examined. According to the tooth wear degree 2 groups have been formed: control group (grade 0-1) withouth TMJ dysfunction; and experimental group (grade 2-4) with presumable TMJD. RESULTS: In experimental group tooth wear of anterior and posterior region increases with age respectively (p<0.05). It was also found that centric occlusion (CO) and relative rest heights difference increases with age in the control group (p<0.05) as well as the experimental group (p=0.001). In patients with diagnosed TMJD the difference between heights in CO and relative rest was bigger than in patients without TMJD (p=0.039). In the experimental group TMJD was diagnosed the most of patients grade-4 in 90%. The most common symptom is joint sounds was observed in 72.2%. CONCLUSIONS: 35-50 and over 50 age groups of patients had a higher first molars degree of wear than the younger ones. In patients with diagnosed TMJD the difference between heights in CO and relative rest was bigger than in patients without TMJD. TMJD symptoms and of posterior teeth pathological wear interface hypothesis confirmed. In the experimental group TMJD was diagnosed the most common in 90% of patients grade-4. The most common symptom is "Nutcracker" of experimental group patients 77.2%.

Disfunciones temporomandibulares y su relación con trastornos de ansiedad en niños: un caso clínico / Temporomandibular joint dysfunctions and their relationship with anxiety disorders in children: report of a clinical case

La presencia de desórdenes temporomandibulares (TTM) en el niño es un tema controversial. Algunos autores sostienen su ausencia en la población infantil; sin embargo, otros han observado signos y síntomas de TTM en poblaciones pediátricas. Nosotros creemos que tales desórdenes pasan inadvertidos con frecuencia por la falta de un examen clínico completo y minucioso que incluya el estudio de la ATM como parte del sistema estomatognático y como revisión rutinaria en la clínica odontopediátrica. Ante las reiteradas consultas que recibimos en la asignatura Odontología Niños de la FOLP, surgió la inquietud de profundizar en el tema y decidimos realizar un trabajo de investigación denominado : "Disfunciones temporomandibulares y su relación con trastornos de ansiedad en una población infantil". El objetivo general de este trabajo fue determinar los signos y síntomas de los TTM y su relación con los distintos niveles de trastornos emocionales en una población infantil, con el propósito de brindar información a odontólogos y odontopediatras acerca de la importancia de realizar un correcto examen clínico de la ATM que nos alerte sobre la posibilidad de aparición de TTM en niños, sin dejar de estar atentos a los miedos o los diferentes grados de ansiedad que los niños pueden desarrollar y que contribuyen en buen grado a agravar o desencadenar el cuadro.

Is playing string or wind musical instruments a risk factor for temporomandibular dysfunction? a systematic review

AIM. medical problems specifically affecting professional musicians are commonly mentioned in the literature. the present study is aimed to evaluate, through a systematic review, the possible association between the practice of string with bow and wind musical instruments and the occurrence of temporomandibular dysfunction (TMD). METHODS. the search for articles was conducted in PubMed/ Medline, Web of Science, Scopus, Lilacs, Cochrane Library, and Open Gray databases, and there was no restriction on language or date of publication. the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. the MeSH terms used were: "music"; "temporomandibular joint"; "temporomandibular joint disorders"; "temporomandibular joint dysfunction syndrome"; and "occupational diseases". cross-sectional studies, case-control, cohort and clinical trials were included that involved the practice of string with bow and wind musical instruments and the occurrence of temporomandibular dysfunction (TMD). articles were previously selected by title and abstract. qualitative evaluation was done through the Newcastle-Ottawa scale. RESULTS. the literature search identified 732 studies, of which 10 met the inclusion criteria, nine of them cross-sectional studies and one a clinical intervention study. the TMD prevalence ranged from 47.0 percent to 89.0 percent. recruitment of participants took place in professional schools and orchestras, and in bands of professional musicians. all studies reported associations between TMD and the practice of musical instruments, and violinists presented higher prevalence rates when compared to other instrument groups. CONCLUSION. all studies pointed to a possible association between TMD and the practice of string and wind musical instruments. more longitudinal and clinical trials studies are needed to verify any possible interrelationship.

A Modified External Fixator System in Treatment of Mandibular Condylar Fractures.

The purpose of this study is to evaluate patient's outcomes after condylar fractures treated with the modified external fixation system from 2008 to 2012.A group of 58 patients with unilateral and bilateral fractures of mandibular condyle was admitted in the authors' study.The final sample included a total of 44 patients, 24 males (54.6%) and 20 females (45.4%).The remaining 14 (24%) patients were excluded because they did not fulfill all the criteria requested.After 12 months from surgery, the functional-clinical evaluation of mouth's maximum opening and mostly extent of lateral excursion and of protrusion showed the following results: 8% of the sample showed a maximum mouth opening <30 mm, 72% of the sample showed a maximum mouth opening between 30 and 40 mm, 20% of the sample showed a maximum mouth opening >40 mm lateral excursion (contralateral to fracture) and protrusion was respectively of 9.5 and 3.9 mm.Only 2 (4.5%) of the 44 evaluated patients reported headaches. 86.5% of the patients showed no postoperative temporomandibular joint dysfunction; 9% of them reported occasional clicking, while 4.5% reported recurrent disorders. The average satisfaction score of surgery outcome reported by patients was 94.5/100, and it ranged between 50/100 and 100/100.

[Intra-articular injections of hyaluronic acid for anterior disc displacement of temporomandibular joint].

Anterior disc displacement (ADD) of temporomandibular joint (TMJ) is regarded as one of the major findings in temporomandibular disorders (TMD). It is related to joint noise, pain, mandibular dysfunction, degenerative change and osteoarthritis. In the mean time, the pathological changes were found in synovial membrane and synovial fluid. Hyaluronic acid is a principal component of the synovial fluid which plays an important role in nutrition, lubrication, anti-inflammation and cartilage repair. The synthesis, molecule weight, and concentration of hyaluronic acid are decreased during TMD and cause TMJ degenerative changes. The clinical conditions, pathological changes, the mechanism of action for hyaluronic acid and the treatment of anterior disc displacement of TMJ are discussed in this article.

[Temporomandibular joint, occlusion and bruxism]. / Articulation temporo-mandibulaire, occlusion et bruxisme.

Temporomandibular joint and dental occlusion are joined for better and worse. TMJ has its own weaknesses, sometimes indicated by bad functional habits and occlusal disorders. Occlusal analysis needs to be addressed simply and clearly. The term "malocclusion" is not reliable to build epidemiological studies, etiologic mechanisms or therapeutic advice on this "diagnosis". Understanding the impact of pathogenic malocclusion is not just about occlusal relationships that are more or less defective, it requires to locate them within the skeletal framework, the articular and behavioural context of the patient, and above all to assess their impact on the functions of the masticatory system. The TMJ-occlusion couple is often symbiotic, developing together in relation to its environment, compensating for its own shortcomings. However, a third partner may alter this relationship, such as bruxism, or more generally oral parafunctions, trauma or an interventionist practitioner.

Hábitos do sono em pacientes com disfunção temporomandibular / Sleep habits in patients with temporomandibular disorders

This study aims to evaluate the association between habitual body posture during sleep, sleep disturbances, and TMD severity. One hundred and fifty patients with complaints of TMD signs and symptoms were considered for this study. However, sixty-seven patients were diagnosed with TMD through the Research Diagnostic Criteria for Temporomandibular Dysfunction (RDC-TMD) and were evaluated in the study. The sleep habits were assessed using specific questionnaires answered individually. It was use a self-report questionnaire with questions relating to different sleep habits: sleep with hand under the chin, wake up with face discomfort, read or watch TV on bed, take drug or alcohol to sleep; and questions relating to sleep disorders based on General Health Questionnaire (GHQ): difficulty to keeping sleep, wake up early and get no sleep. The level of TMD was obtained with FonsecaÆs anamnestic index. A database was created and the statistical analysis used in this study was the chi-square test, with a significance level of 95% (p < 0.05). There was a statistical association between the TMD severity and patients who sleep with hand under the chin (p=0.004), wake up with face discomfort (0=0.004), and read or watch TV on bed (p=0.009). It can be concluded that patients with TMD require special consideration with respect to usual body posture during sleep...

Este estudo tem como objetivo avaliar a associação entre a postura corporal habitual durante o sono, distúrbios do sono e severidade da DTM. Cento e cinquenta pacientes com queixas de sinais e sintomas de DTM foram considerados para este estudo. Sessenta e sete pacientes foram diagnosticados com DTM através dos critérios diagnósticos de pesquisa em disfunção temporomandibular (RDC - TMD) e incluídos neste trabalho. Os hábitos de sono foram avaliados por meio de questionários específicos. Foi usado um questionário de autorrelato com as questões relativas a diferentes hábitos de sono: dormir com a mão sob o queixo, acordar com desconforto no rosto, ler ou assistir TV na cama, usar drogas ou álcool para dormir; e as questões relacionadas aos distúrbios do sono baseadas no Questionário de Saúde Geral (General Health Questionnaire - GHQ): dificuldade em manter o sono, acordar cedo e ficar sem dormir. O grau de DTM foi obtido com o índice de Fonseca. Um banco de dados foi criado e a análise estatística utilizada neste estudo foi o teste do qui-quadrado, com um nível de significância de 95% (p <0,05). Houve uma associação estatisticamente significativa entre a severidade da DTM e os pacientes que dormem com a mão sob o queixo (p = 0,004), acordam com desconforto na face (0 = 0,004) e leem ou assistem TV na cama (p = 0,009). Pode-se concluir que os pacientes com DTM requerem uma análise especial com relação à postura corporal habitual durante o sono...

Complicaciones en cirugía ortognática: conceptos actuales y revisión de la literatura / Complications in orthognathic surgery: current concepts and review of the literature

La cirugía ortognática es el tratamiento de elección para corregir deformidades dentofaciales congénitas o adquiridas en menor cantidad de casos, estas técnicas pueden ser aplicadas en la resección de tumores y apnea del sueño. Usualmente se lleva a cabo entre la segunda y tercera década de vida. Dentro de los benefi cios que se obtienen se incluyen una mejor función masticatoria, resultados estables en discrepancias dentofaciales severas y un mejor aspecto estético facial. Sin embargo, aun el cirujano más experimentado puede enfrentar complicaciones, entre las que destacan las vasculares, técnicas, nerviosas, periodontales, infecciosas, oftálmicas, de oclusión, psicológicas y necrosis ósea. Algu-nas de estas complicaciones pueden discutirse en detalle con el paciente antes del procedimiento. A pesar de lo anterior, el tratamiento de cirugía ortognática puede ser considerado como un procedimiento seguro. Las complicaciones se pueden dividir en preoperatorias, transoperatorias y postoperatorias, teniendo en las dos últimas una mayor incidencia.

Orthognathic surgery is the treatment of choice for the correction of congenital or acquired dentofacial deformities; in a minority of cases, the techniques involved can be applied to tumor resection and to treat sleep apnea. This type of surgery is usually performed between the second and third decades of life. The benefi ts obtained include a better chewing function, stable results in severe dentofacial anomalies, and improved facial aesthetics. However, even the most experienced surgeon can encounter a range of issues, most notably vascular, technical, ner-vous, periodontal, infectious, ophthalmic, psychological, those related to occlusion, and bone necrosis. Some of these can be discussed in detail with the patient prior to the procedure. Nevertheless, orthognathic surgery treatment can be considered a safe procedure. Complications can be classifi ed into three types: preoperative, intraoperative, and postoperative, the latter two being the most common.

Application of mouth gag and temporomandibular joint pain and trismus in tonsillectomy.

OBJECTIVE: To determine the effect of duration of application of mouth gag on Temporomandibular (TM) joint pain and trismus after tonsillectomy. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of ENT and Head and Neck Surgery, Combined Military Hospital, Nowshera, from February to July 2012. METHODOLOGY: A total of 40 patients undergoing tonsillectomy, in mouth opening prior to surgery was measured as inter incisor distance in cms. A stop watch was used to calculate the time of application of mouth gag. Mouth opening was again measured 06 hours after the surgery. Difference between the two readings was considered as trismus score and categorized as mild (1 cm), moderate (2 cm) and severe (3 cm). Patient was asked to score pain on a visual analogue scale (0 - 9). Score 0 was categorized as no pain; 1 - 3 as mild pain; 4 - 6 as moderate pain; 7 - 9 as severe pain. Spearman's rank correlation was used for finding correlation between time of mouth gag application and study outcome (pain and trismus). RESULTS: Trismus as observed by difference in inter incisor distance was mild in 11 patients; moderate in 15 patients and severe in 14 patients 06 hours after the surgery. Eleven (27.5%) had mild pain over temporomandibular joint, 15 (37.5%) had moderate and 14 (35%) had severe pain 06 hours after the surgery. Direct relationship was observed between duration of application of mouth gag with postoperative pain and trismus. Significant strong correlation was observed between length of mouth opening to severity of pain and trismus (rs = 0.738; p < 0.001). CONCLUSION: Duration of mouth gag application should be reduced to cause less TM joint pain and trismus in early postoperative period in tonsillectomy.

[The peculiarities of petrotympanic fissure topography in Costen syndrome and possible causes of its development].

A complex study of morphometric characteristics of the articular surfaces of the temporomandibular joint and the examination of the peculiarities of the petrotympanic fissure topography were performed on 138 samples of skulls of adult individuals with intact occlusion, complete anodontia and different forms of cranial skull (dolicho-, meso- and brachicranial). No distinct differences in studied parameters were found between the studied groups. However, in the hypsicranial group the petrotympanic fissure was found to pass more often through the medial third of the mandibular fossa, which may be a predisposing anatomical factor for Costen syndrome. Due to the fact that in anodontia the parameters characterizing the articular surfaces of the temporomandibular joint, are significantly changed, the immediate cause of the Costen syndrome are the changes of the articular surfaces of the temporomandibular joint, primarily the reduction in the size of mandibular condyle, which is accompanied by its pathological displacement and compression of the chorda tympani.

Risk of headache, temporomandibular dysfunction, and local sensitization in male professional boxers: a case-control study.

OBJECTIVE: To evaluate differences in the incidence of headache, trigeminal nerve mechanosensitivity, and temporomandibular functionality in professional male boxers (exposed to repetitive craniofacial trauma) who were actively training and without severe previous injuries compared with handball players. DESIGN: Case-control study. SETTING: University-based physical therapy research clinic. PARTICIPANTS: Eighteen boxers (mean age, 23±4.61y) as the cases group, and 20 handball players as the comparison group (mean age, ±2y, and sex matched), were included. All participants (N=38) completed the assessment protocol. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Measurements were taken of the headache impact (Headache Impact Test-6) and the pressure pain threshold over the trigeminal nerve sensory branches, the masseter muscle, and the tibialis anterior muscle. The secondary outcome measure included the temporomandibular function (Helkimo Clinic Index). RESULTS: The boxers showed slight mandibular function impairment, local muscular and neural sensitization, and a higher impact from headaches than did the handball players. The between-group comparison found significant differences in all outcome measures (P<.05), except in the tibialis anterior muscle pressure pain threshold on the dominant (P=.958) and the nondominant (P=.453) sides. CONCLUSIONS: Professional male boxers seem to suffer a greater headache impact and local sensitization of the craniomandibular region than do professional handball players. It cannot be determined whether these findings are short-lasting, as a result of the training activity, or long-lasting.