Short-Term Morphological Changes in Asymptomatic Perimandibular Muscles after Dry Needling Assessed with Rehabilitative Ultrasound Imaging: A Proof-of-Concept Study.

Alice Botticchio,Alejandro Santodomingo Bueno,José Luis Arias-Buría,Massimiliano Gobbo,Samuel Fernández-Carnero,Juan Mesa Jiménez,Firas Mourad

doi:10.3390/jcm10020209

Abstract

Facial anatomical structures are not easily accessible to manual palpation. The aim of our study is to objectively assess temporomandibular joint and perimandibular muscles dimensions by means of sonographic measurements before and after dry needling (DN) in asymptomatic subjects. Seventeen subjects participated in this before-after study with a within-subject control. After random allocation, one side of the face was used for the intervention and the contralateral as control. DN was performed on the temporal, masseter, and sternocleidomastoid muscles. Each subject was examined bilaterally before, immediately after, and one month after the intervention through Rehabilitative Ultrasound Imaging (RUSI) of the temporomandibular articular disc and the three target muscles. Maximum mouth opening was measured at baseline and at one month. After a single DN session, articular disc thickness significantly decreased; muscles’ thicknesses (except for temporal thickness) significantly decreased immediately and at follow-up on the treated side; no significant changes resulted for the control side. The maximum mouth opening increased from 4.77 mm to 4.86 mm. RUSI may be useful to assess the dimensions and thickness of the temporomandibular disc and muscles before and after an intervention. DN influences muscle morphology, and it has a positive influence on mouth opening in the short term.

Highlights

Pain on the sternocleidomastoid muscle was significantly associated with myogenic Temporomandibular disorders (TMD) and increased electromyographic activity of this muscle [9,10]
Patients were excluded in case of pregnancy; medical history of systemic disease; current pharmacological therapy; history of recurrent headache and/or neck pain; presence of orofacial pain or temporomandibular symptoms assessed with the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) [1]; or bruxism
Smith et al found that dry needling (DN) was effective in increasing maximum mouth opening in patients suffering from TMD of myogenic origin [26]

Summary

Introduction

Orofacial pain and altered masticatory function are hallmarks of symptomatic TMD; individuals suffering from TMD commonly experience changes in multiple aspects of their biological and psychosocial functioning [3,4,5]. Ultrasonography and electromyography studies have found a relationship between increased thickness and contraction activity of the masseter, temporal and sternocleidomastoid muscles in patients with TMD. Pain on the sternocleidomastoid muscle was significantly associated with myogenic TMD and increased electromyographic activity of this muscle [9,10]. Hypertrophy of the masseter and temporal muscles has been shown to alter the shape and thickness of these structures, leading to aesthetic changes of the face and to functional issues of the temporomandibular joint (TMJ). Hypertrophy of the chewing muscles represents a physiological finding, in some individuals, it seems to be associated with pain [12]

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