Influência do tratamento das desordens temporomandibulares na dor e na postura global / Influence of temporomandibular disorders management on pain and global posture

JUSTIFICATIVA E OBJETIVOS: A disfunção temporomandibular é uma síndrome clínica que acomete principalmente músculos mastigatórios e articulações temporomandibulares. Como a articulação temporomandibular está diretamente relacionada à região cervical e escapular por meio de cadeias musculares, alterações posturais da coluna podem acarretar distúrbios de articulação temporomandibular, e vice-versa. A relação entre a postura corporal e a disfunção temporomandibular pode estabelecer uma forma de prevenção e reabilitação. Sendo assim o objetivo deste trabalho foi avaliar a influência do tratamento da disfunção temporomandibular muscular na postura global de indivíduos diagnosticados por meio do Research Diagnostic Criteria for Temporomandibular Disorders. MÉTODOS: Trinta pacientes foram classificados em grupo controle (n=12) (sem diagnóstico clínico de disfunção temporomandibular) e tratamento (n=17) (com diagnóstico de disfunção temporomandibular). Esses pacientes passaram por avaliação postural através da fotogrametria e análise pelo Software de Avaliação Postural. O tratamento consistiu em aconselhamento, fisioterapia caseira e uso do dispositivo interoclusal, monitorado por dois meses. Os pacientes do grupo controle apenas utilizaram o dispositivo interoclusal pelo mesmo período. Após o tratamento, uma nova avaliação foi feita pela fisioterapia. RESULTADOS: Nos pacientes do grupo controle, não ocorreram alterações nas medidas correspondentes ao inicio da intervenção comparado ao pós-tratamento. Já no grupo tratamento, apenas o ângulo de alinhamento vertical da cabeça exibiu resultado estatisticamente significativo (p<0,05). Para análise da melhora da dor foi comparado antes e após o tratamento e obtiveram-se resultados positivos para remissão de sintomas dolorosos. CONCLUSÃO: Pode-se concluir que desvios posturais globais causam adaptações e realinhamento corporal que podem interferir na função e organização da articulação temporomandibular. O tratamento foi efetivo para melhora da dor.

BACKGROUND AND OBJECTIVES: Temporomandibular disorder is a clinical syndrome affecting primarily masticatory muscles and temporomandibular joints. Since temporomandibular joint is directly related to cervical and scapular region by means of muscle chains, postural spinal changes may induce temporomandibular joint disorders and vice-versa. The relationship between body posture and temporomandibular disorder may determine prevention and rehabilitation. So, this study aimed at evaluating the influence of temporomandibular joint disorder management on global posture of individuals diagnosed by the Research Diagnostic Criteria for Temporomandibular Disorders. METHODS: Thirty patients were classified in control group (n=12) (without clinical diagnosis of temporomandibular disorder) and treatment group (n=17) (with diagnosis of temporomandibular disorder). These patients went through postural evaluation by photogrammetry and analysis with the Postural Evaluation Software. Treatment consisted of counseling, home physiotherapy and interocclusal device, monitored for 2 months. Control group patients have only used interocclusal device for the same period. After treatment a new evaluation was performed by the physiotherapy department. RESULTS: Control group patients have shown no changes in measurements corresponding to beginning of intervention as compared to after treatment. In the treatment group, only the vertical alignment angle of the head has shown statistically significant results (p<0.05). To analyze pain relieve pre and post treatment data were compared with positive results for painful symptoms remission. CONCLUSION: It is possible to conclude that global postural changes cause body adaptations and realignment, and may interfere with temporomandibular joint function and organization. Treatment was effective to relieve pain.

Joint disorder: nonreducing disc displacement with mouth opening limitation - report of a case.

The internal derangement of the temporomandibular joint (TMJ) represents 8% of all cases of temporomandibular disorders (TMD) posing difficulties to establish an accurate diagnosis and treatment because of its low prevalence. This article presents the case of an 18-year-old Caucasian female patient who came to our Orofacial Pain and TMD Outpatient Service with complaints of intense pain on the right TMJ and limitation of mouth opening (maximum interincisal opening of 29 mm) with deviation to right, which she had been experiencing for the past 3 years. After a detailed clinical interview, a diagnosis hypothesis of nonreducing disc displacement with mouth opening limitation was established. The proposed treatment consisted of intra-joint infiltration with anesthetic in the right TMJ followed by jaw manipulation to recapture the articular disc, which was impeding the complete translation movement of the affected TMJ. After jaw manipulation, a new evaluation was done and showed the re-establishment of jaw dynamics with mouth opening and closing without deviation to the right side, clicking, opening limitation or pain. The patient was followed up at 6 months intervals. Two years after treatment, the patient was reevaluated and her mandibular range of motion without aid increased to 54 mm with no clicking, deviation to right, trismus or pain on the TMJ, indicating success of the treatment approach without recurrence of the pathology.

Joint disorder: nonreducing disc displacement with mouth opening limitation - report of a case

The internal derangement of the temporomandibular joint (TMJ) represents 8 percent of all cases of temporomandibular disorders (TMD) posing difficulties to establish an accurate diagnosis and treatment because of its low prevalence. This article presents the case of an 18-year-old Caucasian female patient who came to our Orofacial Pain and TMD Outpatient Service with complaints of intense pain on the right TMJ and limitation of mouth opening (maximum interincisal opening of 29 mm) with deviation to right, which she had been experiencing for the past 3 years. After a detailed clinical interview, a diagnosis hypothesis of nonreducing disc displacement with mouth opening limitation was established. The proposed treatment consisted of intra-joint infiltration with anesthetic in the right TMJ followed by jaw manipulation to recapture the articular disc, which was impeding the complete translation movement of the affected TMJ. After jaw manipulation, a new evaluation was done and showed the re-establishment of jaw dynamics with mouth opening and closing without deviation to the right side, clicking, opening limitation or pain. The patient was followed up at 6 months intervals. Two years after treatment, the patient was reevaluated and her mandibular range of motion without aid increased to 54 mm with no clicking, deviation to right, trismus or pain on the TMJ, indicating success of the treatment approach without recurrence of the pathology.