Botulinum toxin-A as a treatment option for refractory idiopathic trigeminal neuralgia of the ophthalmic branch: a case report and literature review.

Trigeminal neuralgia is one of the most common neurological pains affecting the head and neck and is associated with severe, lancinating, electrical pain episodes. The maxillary and mandibular branches are usually affected. The ophthalmic branch is rarely involved and, when present, it requires a comprehensive workup to rule out major conditions. Pharmacotherapy and surgery are the most common treatment options for this condition. Systemic medications may pose a wide range of side effects and effectiveness may decrease over time while surgery has inherent complications. Injectable onabotulinum toxins have been utilized for various applications in medicine and dentistry. There is, however, limited data on their use for the management of refractory trigeminal neuralgia of the ophthalmic branch. We present the case of a 58-year-old male diagnosed with refractory idiopathic trigeminal neuralgia affecting the ophthalmic branch, which was unresponsive to standard care and successfully managed with onabotulinum toxin type A. This treatment should be considered in cases of refractory trigeminal neuralgia prior to surgery. We reviewed the relevant literature concerning the application of Onabotulinum toxin A for managing trigeminal neuralgia of the ophthalmic branch. This case report and review aim to enlighten the application of Onabotulinum toxin A for managing refractory trigeminal neuralgia of the ophthalmic branch. Our case report and review show that Onabotulinum toxin A could be used for managing TN of the ophthalmic branch.

Granulomatosis with polyangiitis mistaken as a temporomandibular joint disorder: A case report.

INTRODUCTION: Granulomatosis with polyangiitis (GPA), is a rare systemic disease that if left untreated, it may lead to death within 6-12 months. This case report describes a 15-year-old female with a 14-month history of epiphora, nasal breathing difficulties, headaches, and jaw pain. The patient reported having various medical procedures attempted to address her symptoms. The classical presentation of strawberry gingivitis led to the diagnosis of GPA. Based on a multi-language search, this is the first reported case, that GPA is mistaken as Temporomandibular Joint Disorders (TMD). CASE PRESENTATION: A 15-year-old female with nearly 14 months of numerous complaints, including headaches and jaw pain, was referred for an orofacial pain (OFP) consultation. The patient had completed a dental examination and was prescribed chlorhexidine for gingivitis control. The OFP examination was not consistent with signs and symptoms of TMD. However, the gingival appearance of strawberry gingivitis was suggestive of GPA. A rheumatologist confirmed the diagnosis of GPA based on the clinical interview, serology testing, and dental findings. A course of rituximab and corticosteroids, and regular dental cleanings were recommended. A 4-month follow-up visit demonstrated complete resolution of her jaw pain and headaches. Gingival tissue appeared normal. CONCLUSION: This case emphasizes the need for familiarity with systemic diseases that can present oral manifestations. It also stresses the importance for dental professionals to be knowledgeable of differential diagnoses for TMD, headaches, and autoimmune disorders. Why is this case new information? This is believed to be the first published case mistaking GPA as TMD. This is a case in which a multidisciplinary approach and management were keys for a successful treatment outcome. What are the keys to successful management of this case? Obtain a thorough clinical history. Know the oral manifestation of systemic diseases. Know differential diagnosis of TMD and headaches. What are the primary limitations to success in this case? Having no access to the medical records during the OFP consultation. Having no awareness of differential diagnosis for gingivitis: strawberry, plaque-induced.

A Scoping Review of Physiotherapeutic Interventions for Trismus in Head and Neck Cancer: Where Is the Manual Therapy?

Purpose: Trismus, or restricted mouth opening, is a common side effect of treatment for head and neck cancer. This scoping review examined the characteristics, extent, and nature of existing research on manual therapy and jaw-mobilizing devices to prevent and manage trismus related to head and neck cancer. Method: Six electronic databases were searched using the terms trismus, head and neck cancer, and physical therapy and the associated MeSH terms. The review focused on the factors related to intervention delivery: timing, adherence, completion rates, and adverse events. Results: Nine studies were included. Eight examined the use of a jaw-mobilizing device, and one explored the benefit of remote telephone support. Two studies involved cancer survivors at risk of trismus, five involved survivors with trismus, and two included survivors both with and at risk of trismus. No studies were found examining physiotherapist provision of manual therapy. Within-group comparisons supported the benefit of using a jaw-mobilizing device to manage trismus, whereas significant between-groups differences were found only in non-randomized controlled trials. Survivor symptoms and intervention burden were reported reasons for poor adherence and completion rates. Conclusions: No benefit was found for the use of jaw-mobilizing devices for the prevention of trismus. Given the potential of manual therapy to enhance outcomes, physical therapist-led research is warranted.

Objectif : le trismus, ou ouverture restreinte de la bouche, est un effet secondaire courant du traitement du cancer de la tête et du cou. La revue exploratoire a porté sur les caractéristiques, l'ampleur et la nature des recherches sur la thérapie manuelle et les dispositifs de mobilisation mandibulaire pour prévenir et traiter le trismus lié au cancer de la tête et du cou. Méthodologiee : les auteurs ont fouillé six bases de données électroniques à l'aide des termes trismus, head and neck cancer et physical therapy et des termes associés du MeSH. La revue a porté sur les facteurs liés à la prestation des interventions, le moment, le respect, le taux d'achèvement et les événements indésirables. Résultats : neuf études ont été retenues. Huit portaient sur l'utilisation d'un dispositif de mobilisation mandibulaire et un, sur les avantages d'un soutien téléphonique à distance. Deux études étaient consacrées à des survivants du cancer à risque de trismus, cinq sur des survivants atteints de trismus et deux, sur des survivants atteints du trismus ou à risque. Aucune étude n'abordait la thérapie manuelle effectuée par un physiothérapeute. Les comparaisons intragroupes confirment les avantages d'un dispositif de mobilisation mandibulaire pour traiter le trismus, et seules des études témoins non aléatoires ont décelé des différences importantes entre les groupes. Les symptômes des survivants et le fardeau de l'intervention étaient les raisons signalées pour le peu d'adhésion au traitement et le faible taux d'achèvement. Conclusion : l'utilisation de dispositifs de mobilisation mandibulaire pour prévenir le trismus ne comportait pas d'avantages. Puisque la thérapie manuelle a le potentiel d'améliorer les résultats cliniques, il est justifié de réaliser des recherches dirigées par physiothérapeutes.

Condylar positional changes in rapid maxillary expansion assessed with cone-beam computer tomography.

OBJECTIVES: The aim of this study was to determine the presence of condylar spatial changes in patients having rapid maxillary expansion treatments compared to a control group. METHODS: Thirty-seven patients with maxillary transverse deficiency (11-17 years old) were randomly allocated into two groups (one treatment group - tooth borne expander [hyrax] - and one control group). Cone-beam computer tomographies (CBCT) were obtained from each patient at two time points (initial T1 and at removal of appliance at 6 months T2). CBCTs were analyzed using AVIZO software and landmarks were placed on the upper first molars and premolars, cranial base, condyles and glenoid fossa. Descriptive statistics, intraclass correlation coefficients and one-way Anova analysis were used to determine if there was a change in condyle position with respect to the glenoid fossa and cranial base and if there was a statistically significant difference between groups. RESULTS: Descriptive statistics show that changes in the condyle position with respect to the glenoid fossa were minor in both groups (<1.9mm average for both groups). The largest difference in both groups was found when measuring the distance between the left and right condyle heads. When comparing changes between both groups, no statistically significant difference was found between changes in the condyles (P<0.05). CONCLUSION: Rapid maxillary expansion treatments present mild effects/changes on the condylar position. Nevertheless, these changes do not present a significant difference with controls, thus not constituting a limitation for applying this treatment.

Masticatory muscle reaction in simulated low-velocity rear-end impacts.

AIMS: To evaluate the electromyographic (EMG) activity of masseter and temporalis muscles in relation to impact awareness, gender, impact magnitude, and kinematics of head movement in simulated low-velocity rear-end impacts. METHODS: Twenty-nine individuals (17 men and 12 women) were subjected in random order to 3 rear-end impacts: 2 unexpected impacts (chair accelerations of 4.5 m/s2 and 10.1 m/s2) and 1 expected impact (chair acceleration of 10.1 m/s2). The EMG activity of the deep and superficial masseter muscle was recorded bilaterally. EMG activity was also recorded for the left anterior temporalis muscle. Angular acceleration and angular displacement of the head were also recorded. The temporal relationship between onset of the masticatory muscle activity and maximum peak of the kinematics of head movement was determined. RESULTS: The magnitude of normalized masticatory EMG activity ranged from 1.4 to 1.8 times higher (P < .05) for fast unexpected impacts compared to slow unexpected impacts in all masticatory muscles. The magnitude of normalized anterior temporalis EMG peak response ranged from 1.8 to 2.5 times higher (P < .05) in female subjects than in male subjects for all impacts. No significant differences were identified for impact awareness in the magnitude of normalized EMG activity for any masticatory muscle. No significant differences were identified with respect to timing of masticatory muscle response (P > .05). CONCLUSION: EMG activity increased with increased impact magnitude. Temporal and amplitude awareness of a simulated impact did not produce a difference in the masticatory muscle response. Gender differences were identified in the anterior temporalis muscle response. The onset of the masticatory muscle response occurred after peak angular acceleration of the head but prior to peak angular displacement of the head.

The role of sternocleidomastoid muscle in simulated low velocity rear-end impacts.

The objectives of this study were to evaluate behavior of sternocleidomastoid muscle (SCM) electromyogram (EMG) related to impact velocity, gender, awareness and kinematics of head movement in simulated low velocity rear-end impacts. Twenty-nine healthy adults (17 male) were subjected in random order to three rear-end impacts: Two unexpected impacts causing chair accelerations of 4.5 m/s(2) (slow) and 10.1 m/s(2) (fast) and one 10.1 m/s(2) expected impact. Normalized left and right SCM EMG, linear head acceleration, angular head acceleration and maximum angular head displacement were recorded. The magnitude of normalized SCM EMG peak response ranged 2-3 times higher (P< 0.001) in female subjects than their counterpart male subjects. SCM EMG magnitude was 3-4 times higher (P< 0.001) for the fast unexpected than slow unexpected impacts, but there was no significant difference (P> 0.05) for the fast expected compared to the fast unexpected impacts. The onset time of SCM peak EMG ranged from 78 ms to 114 ms later than peak of linear head acceleration for all groups. Onset time of peak SCM EMG was not significantly different (P> 0.05) than onset of angular acceleration for the slow and fast-unexpected impacts, but onset peak SCM EMG was significantly earlier than peak angular head acceleration (30 ms) (P

Kinematics of head movement in simulated low velocity rear-end impacts.

OBJECTIVES: To evaluate kinematics of head movement related to impact velocity, gender and awareness in simulated low velocity rear-end impacts. METHODS: Thirty individuals were subjected in random order to three rear-end impacts: two unexpected impacts causing chair acceleration of 4.5m/s2 (slow) and 10.0m/s2 (fast) and one 10.0m/s2 expected impact. Rearward head displacement, and linear and angular head accelerations were recorded. RESULTS: Angular head displacement was almost two times higher for the fast than the slow unexpected-impacts (P=0.04). Rearward and forward angular head accelerations increased two to three times with increased impact magnitude (P<0.05). Rearward and forward linear head accelerations were two and a half to three and a half times higher for the fast than for the slow unexpected impacts (P<0.05). Males presented two times higher upward linear head acceleration than females in the unexpected fast impact. No significant magnitude differences were identified for impact awareness in kinematics of head movement (P>0.05). Rearward angular head acceleration reached the peak between 62 and 84 ms later than the rearward linear head acceleration (P<0.05) in all impacts. No significant differences were identified for timing of kinematics of head movement (P>0.05) with increased impact magnitude; however, statistical powers were low. INTERPRETATION: Kinematics of head movement increases with increased impact magnitude. Gender differences exist for vertical linear head acceleration only. Temporal and amplitude awareness do not change the magnitude in kinematics of head movement. There are temporal differences between angular and linear head accelerations.