Management of myofascial pain: low-level laser therapy versus occlusal splints.

The present study was designed to compare the effects of low-level laser with occlusal splints in patients with signs and symptoms of myofascial pain (MP) dysfunction syndrome. A total of 40 (34 women and 6 men, with a mean age of 32.84 [SD, 10.70] years) were selected after the diagnosis of MP according to the Research Diagnostic Criteria for Temporomandibular Disorder. The patients were randomly divided into 2 groups: study group (n = 20) and control group (n = 20). Low-level laser was applied to patients in the study group 2 times per week, for a total of 10 sessions. Patients in the control group were instructed to wear occlusal splints 24 h/d for 3 months. The functional examination was based on Research Diagnostic Criteria for Temporomandibular Disorder and pressure pain threshold values were obtained with the aid of an algometer in both groups. Patients' self-report of pain was evaluated with visual analog scale. Comparisons were made within and between the groups before and after treatment. Vertical movements showed statistically significant improvements after the treatments in both groups (P < 0.01), but when the groups were compared with each other, there were no significant difference between the groups. In both groups, tenderness to palpation of the muscles decreased significantly. Pressure pain threshold evaluations and visual analog scale scores revealed similar results, too. This particular type of low-level laser therapy (820 nm, 3 J/cm2, 300-mW output power) is as effective as occlusal splint in pain release and mandibular movement improvement in MP.

[Predictive significance of reflex otalgia in local radical radiotherapy of oropharyngeal carcinomas]. / Prädiktive Bedeutung der Reflexotalgie in der lokal radikalen Radiotherapie von Oropharynxkarzinomen.

BACKGROUND: Patients with carcinomas of the upper aero-digestive tract often suffer from ear pain as a tumor associated syndrome. This prospective study examines the predictive and prognostic value of this symptom. PATIENTS AND METHODS: Ninety-six consecutive patients who completed a locally radiotherapy of a carcinoma of the oropharynx were prospectively evaluated and followed. Forty-nine out of 96 patients stated the symptom, either spontaneously or after questioning. The 2 groups showed no difference regarding TNM-classification, histology and total dose. Overall survival, local control and disease specific survival were calculated according to Kaplan-Meier and compared by the log-rank test. RESULTS: A clinically complete remission was obtained in significantly fewer patients with reflex-otalgia as compared to patients without reflex-otalgia, 61.2% versus 89.3%, p < 0.002. Local control of patients with reflex-otalgia was significantly less with 49%, mean follow-up 564 days, in comparison to local control in patients without reflex-otalgia, mean follow-up 613 days, p = 0.01. Disease specific survival was significantly worse for patients with reflex-otalgia, p < 0.012. The probability of local control of T1/T2 tumors with reflex-otalgia was similar to T3/T4 tumors without reflex-otalgia. Local control for all tumor categories combined is 74% for patients without reflex-otalgia versus 49% for patients with reflex-otalgia. CONCLUSION: In our patients, reflex-otalgia is a new and statistically significant parameter for the probability of local control and disease specific survival.