Síntomas óticos y síndrome del dolor miofascial en musculatura temporomandibular y esternocleidomastoideo: Estudio de un caso / Otic symptoms and myofascial pain syndrome in temporomandibular and sternocleidomastoid musculature: A case study

Introducción El dolor de oído y la alteración de la audición son motivos de consulta muy frecuentes. El dolor de oído referido puede deberse a alteraciones temporomandibulares y puntos gatillo en la musculatura cervical. La hipoacusia se relaciona con la presencia de puntos gatillo en musculatura cervical y mandibular. Aunque se han observado efectos beneficiosos sobre esta musculatura tras la utilización de terapia manual y punción seca, la literatura al respecto sigue siendo escasa, motivo por que se realizó el actual estudio. Objetivo Conocer los efectos de un tratamiento basado en la técnica suiza y punción seca en la musculatura temporomandibular y esternocleidomastoideo a corto plazo sobre el dolor de oído e hipoacusia, en una paciente de 24 años. Material y métodos Estudio de un caso. Se realizó una valoración previa al tratamiento y otra al finalizar para valorar sus efectos, mediante audiometría y escala visual analógica. Se programó una sesión de 50 min, semanalmente, durante cuatro semanas. Durante el tratamiento se aplicó la técnica suiza y punción seca en cinco músculos de la región mandibular y cervical. Resultados Tras cuatro sesiones de tratamiento se observó una mejora del dolor de la paciente y se evidenció una recuperación de la audición. Conclusiones Una intervención basada en la técnica suiza y punción seca para el tratamiento del síndrome de dolor miofascial de la musculatura temporomandibular y esternocleidomastoideo puede ser útil para mejorar alteraciones de la audición. Se sugiere la realización de ensayos clínicos aleatorizados que evalúen esta técnica (AU)

Introduction Ear pain and hearing impairment is a frequent medical consultation. Referred ear pain may be due to temporomandibular disorders and the presence of trigger points in the cervical musculature. Hearing loss is related to the presence of trigger points in the cervical and mandibular muscles. Although beneficial effects have been observed on this musculature after the use of manual therapy and dry needling, the literature on the matter is still scarce, which is why the current study was carried out. Objective To know the short-term effects of a treatment based on the Swiss technique and dry needling on the temporomandibular and sternocleidomastoid muscles on ear pain and hearing loss, in a female 24-year-old patient. Material and methods Case study. An assessment was carried out before the treatment and another at the end to evaluate its effects. A 50-minute session was held weekly for 4 weeks. During treatment, the Swiss technique was applied to 5 muscles of the mandibular and cervical region. Results After 4 treatment sessions an improvement in the patient's pain was observed and a hearing recovery was evidenced. Conclusions An intervention based on the Swiss technique and dry needling in the treatment of myofascial pain syndrome of the temporomandibular and sternocleidomastoid muscles may be useful in improving hearing disorders and otalgia. Randomized clinical trials evaluating this technique are suggested (AU)

Effects of exercise therapy on painful temporomandibular disorders.

Temporomandibular disorders (TMD) are common chronic musculoskeletal pain conditions among orofacial pain. Painful TMD condition such as myalgia and arthralgia can be managed by exercise therapy. However, as it is hard to access actual effect of each modality that is included in an exercise therapy programme due to multiple choice of the management modality, their efficacy remains controversial. Therefore, this review focused on the effects of exercise therapy for the management of painful TMD. The aims of this review were to summarise the effects of exercise therapy for major symptoms of painful TMD and to establish a guideline for the management of painful TMD, resulting in higher quality and reliability of dental treatment. In this review, exercise modalities are clearly defined as follows: mobilisation exercise, muscle strengthening exercise (resistance training), coordination exercise and postural exercise. Furthermore, pain intensity and range of movements were focused as outcome parameters in this review. Mobilisation exercise including manual therapy, passive jaw mobilisation with oral appliances and voluntary jaw exercise appeared to be a promising option for painful TMD conditions such as myalgia and arthralgia. This review addressed not only the effects of exercise therapy on various clinical conditions of painful TMD shown in the past, but also an urgent need for consensus among dentists and clinicians in terms of the management of each condition, as well as terminology.

Effectiveness of mobilisation of the upper cervical region and craniocervical flexor training on orofacial pain, mandibular function and headache in women with TMD. A randomised, controlled trial.

BACKGROUND: Studies exploring interventions targeting the cervical spine to improve symptoms in patients with temporomandibular disorders (TMD) are limited. OBJECTIVES: To determine whether mobilisation of the upper cervical region and craniocervical flexor training decreased orofacial pain, increased mandibular function and pressure pain thresholds (PPTs) of the masticatory muscles and decreased headache impact in women with TMD when compared to no intervention. METHODS: In a single-blind randomised controlled trial, 61 women with TMD were randomised into an intervention group (IG) and a control group (CG). The IG received upper cervical mobilisations and neck motor control and stabilisation exercises for 5 weeks. The CG received no treatment. Outcomes were collected by a blind rater at baseline and 5-week follow-up. Orofacial pain intensity was collected once a week. A mixed ANOVA and Cohen's d were used to determine differences within/between groups and effect sizes. RESULTS: Pain intensity showed significant time-by-group interaction (P < 0.05), with significant between-group differences at four and five weeks (P < 0.05), with large effect sizes (d > 0.8). The decrease in orofacial pain over time was clinically relevant only in the IG. Change in headache impact was significantly different between groups, and the IG showed a clinically relevant decrease after the treatment. No effects were found for PPT or mandibular function. CONCLUSION: Women with TMD reported a significant decrease in orofacial pain and headache impact after 5 weeks of treatment aimed at the upper cervical spine compared to a CG.

Difference in Response to a Motor Imagery Task: A Comparison between Individuals with and without Painful Temporomandibular Disorders.

The aim of the study was to investigate the difference in response to a motor imagery task between individuals with and without painful temporomandibular disorders (TMDs). The participants were 24 adults with and without TMD (TMD and control group, resp.). A set of photographic images of the profile view of a person's head and neck and a hand and a foot were presented in a random order. The set consisted of six different orientations with rotations of each image at 0, 60, 120, 180, 240, and 300 degrees and included left and right representations. The participants were required to view the image and make a decision as to whether it was a left or a right side presented, that is, mental rotation (MR) task. Data were collected on 48 tasks (including left and right) at each orientation for each body part. Reaction times (RTs) for correct answers and accuracy in making the left or right judgements were recorded. The RT was slower in the TMD group than in the control group. The RT for the profile image was slower than those for the hand and foot images. For images that were 180 degrees, the RT was slower and the accuracy was lower than those for five of the other image orientations. The judgements made about the 180-degree rotated image were more inaccurate compared to images of all other orientations among all types of stimuli.

Masticatory muscle stretching for the management of sleep bruxism: A randomised controlled trial.

BACKGROUND: Sleep bruxism is a phenomenon associated with masticatory muscle hyperactivity. While stretching of limb and trunk muscles has been extensively studied for musculoskeletal disorders, little is known about the effectiveness of stretching of masticatory muscles in the management of bruxism. OBJECTIVE: The aim of this study is to determine the effectiveness of stretching of the masticatory muscles for sleep bruxism. METHODS: Twenty four pain-free individuals with sleep bruxism were randomly assigned to either an intervention group or a control group. Both groups were given sleep hygiene advice and the intervention group additionally received muscle-stretching exercises for 10 days. Primary outcome measures, bruxism bursts and episodes per hour of sleep, were measured by ambulant polysomnography. Secondary outcome measures were among others pain-free active maximum mouth opening (MMO) and masseter pressure pain threshold (PPT). RESULTS: The number of bruxism episodes per hour of sleep increased more in the intervention group than in the control group (by 1.1 episodes, P = 0.066), as did the number of bruxism bursts per hour of sleep (by 8.6 bursts, P = 0.049). MMO and PPT increased significantly more in the intervention group (by 3.2 mm, P = 0.020; and by 1.0 kg/cm2 , P = 0.036, respectively). CONCLUSION: Static stretching of the masticatory muscles resulted in a minor increase in sleep bruxism episodes (not significant) and bursts (significant). It also led to a significant increase in MMO and PPT. Therefore, masticatory muscle stretching was not effective in reducing sleep bruxism in the absence of pain and/or dysfunction.

Comparison of device-supported sensorimotor training and splint intervention for myofascial temporomandibular disorder pain patients.

This study was to compare the short-term therapeutic efficacy of device-supported sensorimotor training with that of standard splint therapy for patients with myofascial temporomandibular disorder (TMD) pain over a treatment period of 3 months. We tested the hypothesis that both types of intervention are equally effective for pain reduction. In addition, the electromyographic (EMG) activity of the temporal and masseter muscles was recorded under conditions of force-controlled submaximum and maximum biting in intercuspation. Of consecutive patients seeking treatment for non-odontogenic oro-facial pain, 45 patients with myofascial TMD pain (graded chronic pain status, GCPS, I and II) were randomly assigned to 2 treatment groups (sensorimotor training and conventional splint treatment). Patients were evaluated 4 times (initial examination, 2, 6 and 12 weeks later) by use of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Electromyographic activity was recorded at the initial session and after 3 months. Ease-of-use of the treatment options was also evaluated. Significant (P < .0001) pain reduction (sensorimotor training 53%, splint therapy 40%) was achieved for both groups, with no significant differences (P > .05) between the groups. Force-controlled sub-maximum normalized electromyographic activity was significantly different between T0 and T3 for group A (sensorimotor training, P < .05) but was not significantly different for group B (splint, P > .05). For normalized maximum-biting EMG activity in intercuspation, however, a significant increase in EMG activity was observed for group A for the masseter and temporal muscles (P < .001) and for group B for the masseter muscle only (P < .001). Moreover, sensorimotor training was significantly (P < .05) less easy to use than the splint. The results of this study confirm the pain-reducing effect of sensorimotor training for patients with myofascial TMD pain (GCPS I and II). This innovative active treatment might be a promising option for TMD pain patients.

Effect of the Pilates method on women with temporomandibular disorders: A study protocol for a randomized controlled trial.

BACKGROUND: There is no consensus regarding the influence of temporomandibular disorders (TMD) on postural changes, but it is believed that an imbalance in one may influence the other. The aim of this study is to evaluate changes in the level of pain, the severity of TMD, the EMG activity of masticatory muscles and posture of young women undergoing training in Pilates, as well as correlating postural changes, pain level, severity of TMD and EMG activity of masticatory muscles. METHODS/DESIGN: A randomized clinical trial with blinded assessors will be held. 40 patients divided randomly into two groups will be assessed. The control group will receive conventional treatment with occlusal splint while the intervention group, in addition to conventional treatment will participate in Pilates sessions. Both groups will consist of women aged 18-35 years with TMD and pain. The research follow-up period will be 15 weeks.

Effect of temporomandibular disorder therapy on otologic signs and symptoms: a systematic review.

The most common temporomandibular disorders (TMD) signs and symptoms are related to muscle sensitivity through palpation, restricted mouth opening, asymmetric mandibular movements, joint sounds, pain and otologic signs and symptoms. To date, counselling, occlusal splints, exercises, biofeedback and acupuncture are examples of conservative modalities proposed for TMD therapy. The aim of this systematic review was to investigate the effect of these conservative therapies for TMD on otologic signs and symptoms. The authors searched the following electronic databases published up to 1st May 2015: PubMed, LILACS, Scopus, Web of Science and Science Direct with no time or language limitations. Using a two-phase selection process, the authors identified 08 articles and used them to conduct a qualitative analysis. Methodological quality of each article was performed with the aid of 'Quality Assessment of a Cohort Study' and 'Quality Assessment of a Randomized Clinical Trial', developed by the Dutch Cochrane Centre, a centre of the Cochrane Collaboration. This systematic review showed in seven of the eight studies included that a total or partial resolution of otologic complains occurred after counselling, exercise therapies and occlusal splint therapy. Upon the limitations of the studies included in this systematic review, the present outcomes suggested that there is insufficient evidence in favour or against the conservative therapies for TMD on changes in otologic signs and symptoms. Thus, further studies with a higher level of evidence and more representative samples should be conducted to better understand the relationship of TMD therapy changes on otologic complains.

Headache attributed to masticatory myofascial pain: impact on facial pain and pressure pain threshold.

There is no clear evidence on how a headache attributed to temporomandibular disorder (TMD) can hinder the improvement of facial pain and masticatory muscle pain. The aim of this study was to measure the impact of a TMD-attributed headache on masticatory myofascial (MMF) pain management. The sample was comprised of adults with MMF pain measured according to the revised research diagnostic criteria for temporomandibular disorders (RDC/TMD) and additionally diagnosed with (Group 1, n = 17) or without (Group 2, n = 20) a TMD-attributed headache. Both groups received instructions on how to implement behavioural changes and use a stabilisation appliance for 5 months. The reported facial pain intensity (visual analogue scale--VAS) and pressure pain threshold (PPT--kgf cm(-2)) of the anterior temporalis, masseter and right forearm were measured at three assessment time points. Two-way anova was applied to the data, considering a 5% significance level. All groups had a reduction in their reported facial pain intensity (P < 0·001). Mean and standard deviation (SD) PPT values, from 1·33 (0·54) to 1·96 (1·06) kgf cm(-2) for the anterior temporalis in Group 1 (P = 0·016), and from 1·27 (0·35) to 1·72 (0·60) kgf cm(-2) for the masseter in Group 2 (P = 0·013), had significant improvement considering baseline versus the 5th-month assessment. However, no differences between the groups were found (P > 0·100). A TMD-attributed headache in patients with MMF pain does not negatively impact pain management, but does change the pattern for muscle pain improvement.

[Chronic myofacial pain. Reduced pain through psychoeducation and physiotherapy]. / Chronische Kiefer- und Gesichtsschmerzen. Verringerte Schmerzen durch Psychoedukation und Physiotherapie.

BACKGROUND: Psychological factors are associated with the emergence and persistence of pain perception. The aim of this pilot study was to assess the psychological factors relating to pain perception in patients with chronic myofacial pain and to investigate the influence of patient information, education and physiotherapy on pain perception and functional jaw opening examined over a 6-month period. PATIENTS AND METHODS: In accordance with the research diagnostic criteria for temporomandibular disorders (RDC/TMD), 40 patients (31 females and 9 males, mean age 38.6 years) with chronic myofacial pain were assessed at 3 time points: on admission (T1), after 3 months (T2) and 6 months (T3). The study included a structured interview and five psychological questionnaires. At all time points patients were informed about the development of pain and the relationship between chronification of pain and psychological risk factors. RESULTS: After 6 months significant improvements in jaw function and quality of life, as well as a decrease in psychological parameters, such as fear and depression were found. Improvement was related to the severity of pain chronification. CONCLUSION: The results show the necessity of early identification of patients with severe pain chronification and the need for psychological pain therapy.

Questionable effect of lavage for treatment of painful jaw movements at disc displacement without reduction: a 3-year randomised controlled follow-up.

The present randomised controlled study compared the 3-year outcome of local anaesthetics with anaesthetics and lavage in patients suffering from painful temporomandibular joint (TMJ) locking. The study included 45 patients referred for treatment of temporomandibular disorders (TMD) to the Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden. All patients received a history questionnaire and clinical examination according to the Research Diagnostic Criteria for TMD, panoramic radiographs and magnetic resonance imaging at baseline. Twenty-five patients were randomised to anaesthetics alone and 20 patients to anaesthetics and lavage. Three years after treatment, we sent the 37 patients who were available for follow-up a questionnaire that evaluated pain intensity, physical and emotional functioning, and global improvement. Thirty-four patients responded. The primary outcome was defined as ≥ 30% pain relief. In an intention-to-treat analysis, 28 of 45 patients (62%) reported ≥ 30% pain relief at the follow-up. At 3 years, improvement in pain relief, physical functioning, emotional functioning and global improvement differed non-significantly between local anaesthetics and anaesthetics and lavage. Compared with baseline, significant improvements (P < 0.05) in pain intensity, physical functioning, emotional functioning and global changes had occurred in both groups after 3 years. Because outcome measurements in the local anaesthetics and lavage and the local anaesthetics groups differed non-significantly 3 years after treatment of painful TMJ disc displacement without reduction, use of lavage (50 mL saline) has an equivalent effect as local anaesthetics.

Differential diagnosis and treatment of bilateral facial pain after whiplash: a case report.

STUDY DESIGN: Clinical case report. BACKGROUND: Symptoms in the face and jaw are common after whiplash. Few studies have reported cervicogenic headache in a trigeminal nerve distribution, and no published studies could be found describing such symptoms experienced bilaterally after whiplash. The objective of the current case report was to detail the clinical reasoning and management of an uncommon patient presentation. CASE DESCRIPTION: The 41-year-old female patient of the current case complained of shooting pain in the jaw, cheek and forehead beginning 7 days after her accident. No imaging was performed, and examination ruled out serious pathology. The patient was treated primarily with deep neck flexor (DNF) and proprioceptive training for 10 visits over an 8-week period. OUTCOMES: The Numeric Pain Rating Scale improved from 2/10 to 0/10, the Neck Disability Index improved from 17/50 to 1/50, and the Neck Flexor Muscle Endurance Test improved from 13 to 30 s. The patient remained symptom-free at 4-month follow-up. DISCUSSION: The current case report describes a patient presentation unique to the literature. Significant changes were seen by week 3 with DNF and proprioceptive training. Additional research is required to determine the effectiveness of this intervention in similar presentations.

Primary care-based facial pain unit in Vantaa: the first experiences 2003­2009.

As an attempt to tackle the challenge in serving facial pain patients, the first primary care-based facial pain unit was founded in 2003 as part of public dental primary care of Vantaa, Finland. Data were collected, consisting of sex, age, sources of referrals, reasons for seeking care, diagnoses made, therapeutic procedures, and numbers of visits to dentists and phone consultations. To describe the development of the present pain management system, we divided the observation periods into two parts: 2003-2006 and 2007-2009 and compared frequencies of the studied parameters between the two follow-up periods. During 2003-2006, 370 patients were examined and the number of visits was 659, corresponding patients' number was 437 and visits' number 960 during 2007-2009. Referrals to the primary care facial pain unit came from primary care dentists (80%), respective primary care pain unit GPs (6%), oral hygienists (3%) and ordinary GPs (2%). Four percentage of the patients' referrals came from secondary and tertiary care clinics of various types and 5% from private sector dentists and specialists. The average number of telephone consultations per year increased from 51 to 300 between study periods. During the follow-up period, the main reason for seeking care from our unit was temporomandibular disorders. Education in self-care, oral appliance therapy and physiotherapy were mostly used as management for these pain problems. The facial pain management unit in primary health care could be a useful model to serve increasing numbers of chronic facial pain patients.

Counselling and self-management therapies for temporomandibular disorders: a systematic review.

The aim of this review was to investigate the effectiveness of counselling and other self-management-based therapies on muscle and temporomandibular joint (TMJ) pain relief and increasing the functional abilities of patients with temporomandibular disorders (TMD). A systematic literature review was conducted by three independent reviewers and included articles published up to 2012. PubMed and Cochrane Library electronic databases were used in addition to hand-searching to assess clinical outcomes for counselling and self-management approaches for TMD treatment. The review yielded 581 records that were narrowed down to 7. All included studies were classified as blind-randomized controlled clinical trials. The selected articles analysed revealed that counselling was able to improve tenderness upon masticatory muscle palpation and maximum mouth opening with and without pain in patients with TMD, with similar results to those of interocclusal appliances approaches. Thus, counselling- and self-management-based therapies could be considered a conservative low-cost and beneficial treatment alternative for treating TMD to potentially improve psychological domains and remove harmful behaviours for the control of the signs and symptoms of TMD.

Somatosensory sensitivity in patients with persistent idiopathic orofacial pain is associated with pain relief from hypnosis and relaxation.

OBJECTIVES: In a recent study hypnosis has been found to relieve persistent idiopathic orofacial pain. Quantitative sensory testing (QST) is widely used to evaluate somatosensory sensitivity, which has been suggested as a possible predictor of management outcome. The objectives of this study were to examine: (1) possible associations between clinical pain relief and baseline somatosensory sensitivity and (2) the effect of hypnosis management on QST parameters. METHODS: Forty-one patients with persistent idiopathic orofacial pain completed this randomized controlled study in 1 of 2 groups: hypnosis (hypnotic analgesia suggestions) or control (relaxation). QST at 2 intraoral (pain region and contralateral mirror image region) and 3 extraoral (hand and both cheeks) sites was performed at baseline and after the hypnosis/control management, together with pressure pain thresholds and pressure pain tolerance thresholds determined bilaterally at the masseter and temporalis muscles, the temporomandibular joints, and the third finger. RESULTS: Degree of pain relief was negatively correlated with a summary statistic of baseline somatosensory sensitivity (summed z-score), that is, high baseline somatosensory sensitivity was associated with low pain relief (r=-0.372, P=0.020). Hypnosis had no major effect on any QST measure compared with relaxation (P>0.063). CONCLUSIONS: High pain sensitivity at baseline may predict poor pain management outcome. In addition, despite clear clinical pain relief, hypnosis did not significantly or specifically influence somatosensory sensitivity. Future studies should further explore QST measures as possible predictors of different management response in orofacial pain conditions.

Impact of rehabilitation with metal-ceramic restorations on oral health-related quality of life.

Dental ceramics present excellent ability to reproduce the natural teeth regarding esthetic and biomechanics. Recently, due to the advancement of ceramic technology, metal-free restorations were developed. However, the traditional metal-ceramic restorations still present the requirements of high strength, long survival in the oral environment and favorable aesthetics. In this context, it is essential to know the specificity of each ceramic system available in order to apply it properly to various clinical situations. This report describes an integrated rehabilitation using metal-ceramic restorations of a patient at 50 years of age, who presented edentulous spaces, and previous unsatisfactory composite and amalgam restorations, and indirect metallic restorations, leading to compromised quality of life in both functional and psychosocial aspects. The impact on quality of life was measured using a generic instrument, OHIP-14, validated for the World Health Organization, which covers both the biological and the psychosocial dimensions. This instrument was applied to the patient before and after treatment. The patient had an overall OHIP-14 score of 28 before the treatment and after treatment the score decreased to 0, showing that dental and oral health conditions are factors that do impact on the quality of life. Rehabilitation has provided functional and aesthetic restorations, harmony of the stomatognathic system and improvement of life quality.

Impact of rehabilitation with metal-ceramic restorations on oral health-related quality of life

Dental ceramics present excellent ability to reproduce the natural teeth regarding esthetic and biomechanics. Recently, due to the advancement of ceramic technology, metal-free restorations were developed. However, the traditional metal-ceramic restorations still present the requirements of high strength, long survival in the oral environment and favorable aesthetics. In this context, it is essential to know the specificity of each ceramic system available in order to apply it properly to various clinical situations. This report describes an integrated rehabilitation using metal-ceramic restorations of a patient at 50 years of age, who presented edentulous spaces, and previous unsatisfactory composite and amalgam restorations, and indirect metallic restorations, leading to compromised quality of life in both functional and psychosocial aspects. The impact on quality of life was measured using a generic instrument, OHIP-14, validated for the World Health Organization, which covers both the biological and the psychosocial dimensions. This instrument was applied to the patient before and after treatment. The patient had an overall OHIP-14 score of 28 before the treatment and after treatment the score decreased to 0, showing that dental and oral health conditions are factors that do impact on the quality of life. Rehabilitation has provided functional and aesthetic restorations, harmony of the stomatognathic system and improvement of life quality.

As cerâmicas dentais são conhecidas pela excelência em reproduzir artificialmente dentes naturais. Recentemente, devido ao aprimoramento da tecnologia cerâmica, surgiram as restaurações livres de metal. Entretanto, as tradicionais metalocerâmicas ainda preenchem adequadamente os requisitos de alta resistência, longa sobrevida em meio bucal e estética favorável. Neste contexto, é fundamental conhecer a especificidade de cada sistema cerâmico a fim de indicá-lo adequadamente às diversas situações clínicas. Este artigo relata um caso de reabilitação integral e integrada de paciente de 50 anos de idade, portador de espaços edêntulos, restaurações protéticas posteriores e restaurações diretas anteriores insatisfatórias, resultando em comprometimento da qualidade de vida nos âmbitos funcional e psicossocial, utilizando coroas metalocerâmicas. O impacto na qualidade de vida foi mensurado utilizando um instrumento genérico, OHIP-14, validado pela Organização Mundial de Saúde, que abrange tanto a dimensão biológica, como a dimensão psicossocial. Este instrumento foi aplicado à paciente antes e após o tratamento, obtendo pontuação total de 28 e 0 respectivamente, o que mostra que a condição de saúde oral representa fator de grande impacto sobre a qualidade de vida. A reabilitação oral proporcionou restabelecimento funcional e estético, harmonia do sistema estomatognático e melhoria da qualidade de vida da paciente.

Toxina botulínica A (Dysport ®) asociada a rehabilitación, en pacientes con dolor miofascial cervical o dorsal primario: un estudio piloto multicéntrico aleatorizado / Botulinum toxin type A associated to rehabilitation in patients with primary myofascial pain of cervical or dorsal localization: a randomized multicenter pilot study

Introducción. Se postula que la toxina botulínica A (TBA) es eficaz en el tratamiento del síndrome de dolor miofascial (SDM), pero estudios previos muestran resultados contradictorios. Nuestro objetivo es evaluar la eficacia y la seguridad de una dosis única de TBA (Dysport®) en el SDM primario de localización cervicodorsal. Material y métodos. Estudio piloto multicéntrico, aleatorizado, a doble ciego, paralelo y controlado con placebo. Se aleatorizó a los participantes (n=24, pauta 1:1) para recibir una dosis intramuscular de Dysport® (dosis máxima, 500 U) o de placebo, con seguimiento durante 12 semanas. Se midieron la intensidad del dolor mediante escala visual analógica (EVA) y los umbrales de dolor a la presión mediante algometría. A todos ellos se les indicó estiramientos musculares. Resultados. Los pacientes tratados con placebo mostraron una disminución inicial de la intensidad del dolor seguida de un aumento gradual, mientras que los que recibieron Dysport® mostraron una mejoría más lenta, pero más continua. Después de 12 semanas, las reducciones medias de las puntuaciones EVA fueron del 26 y el 44,6% respectivamente; la reducción en los pacientes a quienes se trataba con Dysport® fue clínicamente relevante, aunque la diferencia entre grupos no fue estadísticamente significativa. A las 12 semanas, el umbral de dolor a la presión había aumentado en ambos grupos (el 36% con placebo y el 58% con Dysport®; p = 0,748 entre tratamientos). Se apreciaron tendencias similares en todos los puntos gatillo. El tratamiento con Dysport® se toleró bien. Conclusiones. Estos resultados indican que Dysport® es beneficioso en el tratamiento del SDM cervicodorsal(AU)

Introduction. It is postulated that botulinum toxin type A (BTA) is effective in the treatment of the myofascial pain syndrome (MPS). However, previous studies have shown contradictory results. Our objective has been to evaluate the efficacy and safety of a single dose of BTA (Dysport®) in primary MPS of cervical-dorsal localization. Material and methods. A multicenter, randomized, double blind, parallel and placebo-controlled pilot study was performed. The participants (n=24, 1:1 regime) were randomized to receive an intramuscular dose of Dysport® (maximum dose: 500 U) or placebo, with follow-up for 12 weeks. Pain intensity using the visual analogue scale (VAS) and pressure pain threshold with the algometry were measured. All of the participants were told to perform muscle stretchings. Results. The patients treated with placebo showed an initial decrease in pain intensity followed by a gradual increase of it while those who received Dysport® show a slower, but more continued improvement. After 12 weeks, the mean reductions on the VAS were 26% and 44.6%, respectively. The reduction in the patients who were treated with Dysport® was clinically relevant, although the difference between groups was not statistically significant. At 12 weeks, the pressure pain threshold had increased in both groups (36% placebo and 58% Dysport®; P=.748 between treatments). Similar tendencies were seen in all the trigger points. Treatment with Dysport® was well tolerated. Conclusions. These results suggest that Dysport® is beneficial in the treatment of cervical-dorsal MPS(AU)

Sensory retraining: a cognitive behavioral therapy for altered sensation.

Sensory retraining teaches the patient to ignore or blot out postinjury unpleasant orofacial sensations to optimally tune into and decipher the weakened and damaged signals from the tissues. Sensory retraining is a simple, inexpensive, noninvasive exercise program, which initiated shortly after injury, can lessen the objectionable impression of orofacial altered sensations. Sensory retraining exercises are most effective on decreasing the perceived burden associated with hypoesthetic orofacial altered sensations.

A abordagem fisioterapêutica na disfunção da articulaçãotemporomandibular. Revisão da literatura / The physical therapy approach in temporomandibular joint disorder. Review

A disfunção da articulação temporomandibular é uma das principais causas de dor orofacial. Há alguns anos estudos vem mostrando a atuação da fisioterapia através de diversas abordagens no tratamentoda disfunção temporomandibular (DTM). O objetivo desse trabalho émostrar uma revisão da literatura sobre as técnicas abordagem da fisioterapia na DTM. Conclusão: A literatura mostra a importância da fisioterapia no tratamento da DTM, através de estudos utilizandorecursos da eletroterapia, exercícios, técnicas de liberação miofacial, mobilização e manipulação articular. Algumas técnicas e recursos carecem de maiores estudos para comprovar sua eficácia notratamento da DTM.

The temporomandibular joint dysfunction is major cause orofacial pain.A few years research has shown the performance of physical therapy through various approaches in the treatment of temporomandibular disorders (TMD).The aim of this study is to present aliterature review of the technical approach to therapy in TMD. Conclusion:The literature shows the importanceof physical therapy in the treatment ofTMD, through studies using resourcesof electrotherapy, exercises, myofascialrelease techniques, joint mobilizationand manipulation. Some techniques and resources need more studies to prove its effectiveness in the treatment of TMD.