Limitation Of Mandibular Movement Research Articles

Analysis of clinical changes and magnetic resonance imaging features of 37 patients with temporomandibular joint disc condylar complex with anterior disc displacement without reduction.

This study aims to investigate clinical outcomes, imaging changes, and age differences with regard to temporomandibular joint disc condylar complex with anterior disc displacement without reduction (ADDWoR). A total of 37 patients (45 lateral joints) with ADDWoR who were admitted to The First Affiliated Hospital of Zheng Zhou University from January 2016 to June 2023 were selected. The patients were composed of 4 males and 33 females and had an average age of 23.5 years. The average course of the disease was 14.4 months. Clinical and magnetic resonance imaging (MRI) data were collected at the end of initial diagnosis and follow-up, and the length and thickness of the articular disc, the angle of the disc condyle, and the height of the condyle were measured. The statistical significance of the changes was assessed using SPSS 25.0 software package. At the end of follow-up, disc displacement in three patients (three lateral joints) was healed. Approximately 48.4% of the patients felt that limitation of mandibular movement was not alleviated; 58.3% of patients reported that pain during mouth opening was not reduced; 54.5% reported pain while chewing; 33.3% of the patients showed facial deviation, and only one showed remission. The mean disk-condyle angle increased from 61.63° to 67.81°. The average length of articular disc shortened from 8.20 mm to 7.27 mm, and the height of the condyle significantly decreased from 23.17 mm to 22.76 mm (P<0.05). The absorption ratio of the condyle increased, and no significant differences in the changes of joint soft and hard tissues between the adolescent and adult groups (P>0.05). In different age groups of patients with ADDWoR, clinical symptoms cannot be completely relieved. The disc is anteriorly displaced and shortens, condylar height decreases, and secondary facial asymmetry and mandibular retraction occur.

A Bibliometric Analysis of Research on Temporomandibular Joint Disc Displacement from 1992 to 2022.

The temporomandibular joint (TMJ) disc displacement is the most common temporomandibular disorders (TMD) condition. It causes clicking, pain, limited mandibular movements, and even masticatory difficulties in many people. The aim of this study is showcasing hotspots and frontiers in the field and providing a reference for the future research by a bibliometric analysis. Studies published from 1992 to 2022 were retrieved from Web of Science Core Collection on 23 April 2023. A total of 1882 studies (1739 articles and 143 reviews) were included in the bibliometric analysis. From 1992 to 2022, the annual number of publications and citations greatly increased. The United States of America (USA) contributed the most publications about TMJ disc displacement. Shanghai Jiao Tong University was the most productive institution; meanwhile, Yang, C. from this institution was the most prolific author. The University of Washington was the most influential institution, and Brooks, S. was the most influential author. Diagnostic criteria and management of TMJ disc displacement, as well as TMJ disc displacement-associated conditions, might be a hotspot for current global research. We provided an objective and valuable reference for future research on TMJ disc displacement.

Osteoma in the temporomandibular joint (Case report)

Osteomas are benign slow growing osteogenic tumors mostly arising in the craniofacial region and characterized by the deposition of differentiated and mature either or both cancellous and compact bone. Osteoma accounts for 2-3% of all bone primary tumors with an incidence of 10-12% among all benign skeletal neoplasms. Objective: The objective of this work is to describe a clinical case of an osteoma in the temporomandibular joint diagnosed in the maxillofacial surgery service of the General Hospital of Pachuca in the State of Hidalgo, Mexico. Clinical Case: A 39-year-old female patient who comes to the General Hospital Pachuca, Mexico due to pain and noises in the right preauricular region of 6 years of evolution, with facial asymmetry, mandibular deviation to the left and limited mouth opening. Clinically, facial asymmetry, mandibular deviation to the left, right posterior crossbite, anterior open bite mainly on the affected side, preauricular pain, joint sounds, and limitation of mandibular movements were observed. Radiographic examination revealed a trapezoidal mass measuring 2.5 by 2.0 cm, with alteration of the condyle-mandible anatomy on the right side. An insertional biopsy is performed, reporting an osteoma, and surgical intervention is continued. Conclusion: The osteoma in the temporomandibular joint is a rare lesion, its timely value is essential for its treatment. Surgical resection is the gold standard treatment, which is based on a radical excision that extends to the altered normal bone, with the contextual objective of achieving an optimal aesthetic result by choosing the least invasive surgical treatment possible.

Analysis of the characteristic of clinical symptoms and cone-beam CT imaging changes in temporomandibular joint osteoarthritis patients with chewing side preference

Objective: To investigate the clinical symptoms and cone-beam CT (CBCT) imaging characteristics of temporomandibular joint osteoarthritis (TMJOA) with chewing side preference (CSP). Methods: One hundred patients with TMJOA diagnosed in the Department of Stomatology, General Hospital of the Chinese PLA from January 2018 to December 2020 were enrolled, including 32 males and 68 females, with an median age of 27.5 years (16-71 years). According to the habit of CSP, 100 cases were divided into 71 cases of TMJOA with CSP group and 29 cases of TMJOA without CSP group. The clinical symptoms were observed, including pain, TMJ sounds, limited mouth opening as well as the radiograph imaging changes of condylar bone. When analyzing the radiograph imaging changes of condylar, the cases with bilateral TMJ symptoms were excluded and the remaining cases were divided into symptomatic sides and asymptomatic sides with CSP or without CSP according to the symptoms of the chief complaint. SPSS 25.0 was used to analyze the statistical data. Age data did not conform to normal distribution so that median and quartile spacing were used for description, and Mann-Whitney U test was used for nonparametric test. Qualitative data such as gender, clinical symptoms and condylar lesion types were described by composition ratio and Chi-Square test was performed. Results: There was no statistical significance in age and gender of TMJOA patients in the group with or without CSP (P>0.05). There incidence of pain in CSP group [83.1% (59/71)] was margina uy higher than that in non-CSP group but without statistical difference[65.5% (19/29)] (χ²=3.71, P=0.054). There was also no significant difference in TMJ sounds and limitation of mandibular movement between the two groups(χ²=0.11, P=0.742; χ²=0.48, P=0.489). Among all of joints, the most common types of TMJOA were articular flattening and shortening and erosion. CBCT showed that erosion [65.0% (130/200)], flattening and shortening [73.0% (146/200)], subcortical sclerosis [42.0% (84/200)], osteophyte [30.5% (61/200)] and subcortical cystic [15.5% (31/200)]. According to the different groups of chief complaint sides, intra-group comparisons show that the proportion of erosion in symptomatic sides of CSP group [80.0% (40/50)] was significantly higher than that in asymptomatic sides of CSP group [50.0% (25/50)] (χ²=9.89, P=0.002). Inter-group comparisons show that the proportion of condyle flattening and shortening in symptomatic sides of CSP group [84.0% (42/50)] was significantly higher than that in bilateral joint of non-CSP group (8/15) (χ²=8.81, P=0.032). There was no significant difference in the proportion of subcortical sclerosis, osteophyte and subcortical cystic between the group with or without CSP (P>0.05). Conclusions: TMJOA patients with CSP may be more prone to clinical symptoms of pain and CBCT imaging changes of condyle erosion as well as flattening and shortening. CSP may be a promoting factor for the development of TMJOA.

Therapeutic approach to patients with chronic orofacial pain with temporomandibular disturbed

Temporomandibular disorder (TMD) is a term that encompasses a series of dysfunctions and disorders that affect the temporomandibular joint (TMJ), masticatory muscles and associated structures. These disorders are characterized by a set of signs and symptoms that may include joint noises, such as clicking and crackling, tooth wear, limited mandibular movement, accompanied or not by facial, cranial and periauricular pain. Here, we reported the clinical conduct of a patient with muscle TMD. Patient with chronic pain complaint in the cervico-craniofacial region, signs of bruxism, mouth opening limitation and masseteric hypertonia. The diagnosis was TMD of bilateral masseteric muscle origin, without trigger points. Heat thermotherapy was prescribed, myofacial and myofunctional physiotherapy, rigid Michigan stabilizer plate making, postural correction, and cognitive-behavioral therapy. The patient presented a gradual evolution of the clinical condition and after 90 days reported remission of approximately 95% of the symptomatological complaints, such as an improvement in the quality of sleep at night, without medication assistance, reduction in pain crises, and full mouth opening (44mm). It is concluded that the correct diagnosis and full patient adherence to the treatment proposed in this study provided relief in painful symptoms and biopsychosocial aspects.

Clinical features and differential diagnosis of orofacial pain

According to the literature, the most common orofacial pains whose origin are not in the structures of the stomatognathic system, but which are encountered in the offices of dentists are tension pain, trigeminal neuralgia and migraine. Therefore, our main task is to differentiate between facial pain of dental origin, which are in our competence to manage them and other painful orofacial pathologies, which require the cooperation of several specialists. Facial pain, whether muscular or joint origin, has the qualities of a deep somatic pain, always occurs after a recent event (trauma, dental fracture, dental treatment, occlusal changes), is accompanied by disruption of functions (mastication, phonation) and it often causes limited mandibular movements. The presence of muscular, articular, vascular and neurological structures in a restricted anatomical territory often makes difficult to establish the correct diagnosis, that’s why the interdisciplinary approach is inevitable and recommended.

Using Autoplasma in Treatment of Secondary Arthrosis, Developed from Dislocation of TMJ Disc

22 patients diseased with secondary arthrosis, developed from dislocation of TMJ disc, were observed by the authors of the article. Between these patients were 17 females and 5 males. The age of patients was from 21 to 60 years. In the clinical case, the leading symptom was constant or periodical pain, located at the injured joint, limitation of mandibular movement, aggravation of pain while moving jaw and was attached with clicking in joint. In the complex treatment of this problematical disease, successfully and for the first time was used autoplasmolifting. Authors injected autoplasma once in 5-6 days, 6 injections on one course of treatment. After noted treatment, 18 patients all the symptoms were released, 4 patients condition got better there was slight pain left, while moving jaw. In 1 patient's case, the neuralgia of III branch of the trigeminal nerve was diagnosed and he received suitable treatment. In 3 cases there was necessary to include orthopedic/orthodontic treatment.

Surgical Reduction of Symphysis Fracture and Spontaneous Repositioning of the Mandibular Condyle: A Case Report

The condylar process is a more fragile area, which is usually fractured by indirect trauma. The objective of this study is to report the case of a 10-year-old patient who presented to the Maxillofacial Surgery and Traumatology Service of the Regional Hospital of Vale do Paraíba, in Taubaté-SP, Brazil. Physical examination revealed limited mandibular movement with painful symptoms, crossbite, and upper incisor avulsion. A face tomography showed a fracture of the mandibular symphysis (right side) and a fracture of the left condyle. Surgical reduction of the mandibular symphysis fracture was performed. After exposure and reduction of bone segments, maxillomandibular block, rigid internal fixation and conservative treatment for condyle fracture were performed. A soft liquid diet and weekly outpatient follow-up was adopted for the first two months. After 15 days of surgery, the patient had mild edema, slight limitation in mouth opening, sutures without dehiscence and without signs of infection. In the first control tomography, the treated fracture was adequately reduced and the fractured condyle remained with medial displacement in the glenoid cavity. After one year, on physical examination, the patient presented satisfactory dental occlusion, preserved mandibular movements and no signs of nerve damage. The tomography showed the fracture consolidated, and the left mandibular condyle well positioned in the glenoid cavity. After two years, the third tomography was performed, showing remodelling of the left mandibular condyle.

Use of Kinesiography to Assess Mandibular Function Following Segmental Resection and Microvascular Reconstruction.

Mandibular reconstruction has attained adequate morphological outcomes. However, some patients encounter difficulties in oral function and limited mandibular movements. An objective: evaluation has seldom featured actual kinetic measurements after mandibular reconstruction.Thirty patients who underwent mandibular reconstruction using bony free flap were enrolled in the study. Twenty-two patients were recruited after surgery and compared to a control group of 8 healthy subjects; 8 patients underwent both pre and postoperative evaluations. For each patient, a kinesiographic scan was obtained, recording maximum mouth opening, maximal laterality, and maximal protrusion.All postoperative kinesiographic evaluations were performed at least 6 months after surgery to ensure complete healing. In the first group of 22 patients, all measured movements were less than those of healthy controls, in particular maximum mouth opening. In the second study group (pre and postoperative evaluation), the postsurgical values did not achieve the control ones, but were no less than the preoperative values, granting adequate functional outcomes.The kinesiograph appears useful for objectively recording the functional outcomes in patients who have undergone mandibular reconstruction. The postoperative jaw movements were acceptable, ensuring a sufficient functional recovery.

Several Variables Response to 2.2% Intra-Articular Injections of Hyaluronic Acid

Objectives of the research: to assess the effects of TMJ 2.2 hyaluronic acid injection on following TMJ pain, TMJ clicking, maximum opening capacity and lateral mandibular movements. This study include one hundred patients (77females and 23males) whom complain from clicking and pain at their TMJ with or without limitation of mandibular movements. The age ranged between 9-65 years old. Hyaluronic acid 2.2% were used for intra- articular injection unilaterally at the upper compartment of the most painful TMJ. Assessment of pain was done by using the visual analogue scale (0-10), the intensity of clicking was evaluated by stethoscope using basser clicking score, lateral movements were calculated by using ruler and recorded into special case sheet, and any complications that reported by the patients were recorded. These data were recorded before treatment and one, two, three weeks post injections, also one month after the last injection. SPSS (statistical package of social science) window 11.5 version was used for statistical investigation with chi square and paired T tests with P ≤ 0.001 as a significant value. The outcome of this study reveals that age cluster between (21-30) years was the most prevailing age, it signify (29%) of the entire trial, whereas the age group over 50 years was the least represented age group, it signify 7%, Female were presented in this study more often than males at a ratio of (3.3 -1). Regarding TMJ pain, there were significant differences (P≤ 0.001) before and after intra-articular drug administration. Significant differences P≤ 0.001were found in clicking scores means before and after intra-articular HA injections there were significant differences P≤ 0.001 in maximum opening capacity means before and after TMJ injections. There were significant differences in both lateral left and right movements means P ≤ 0.001 before and after TMJ injections of hyaluronic acid. This study conclude that HA 2.2% TMJ injection is an effective method in treating different TMJ diseases including temoporomandibular disorders, it reduce pain, clicking and improve mandibular motion, their effect persist even one month beyond last injection, it is effective, safe, painless, not costly, with no side effects like steroid, with no complications, usually no need to another drugs following injections like antibiotic and analgesic. We recommend that this modalities as the best treatment for TMDs. Also we conclude that females seek treatment more often than males at a ratio 3.3:1.

Comparison of immediate response to four conservative treatment modalities for management of masticatory myalgia with limited mandibular movement: a retrospective study.

Conservative treatment modalities are recommended for managing masticatory myalgia in individuals with temporomandibular disorders. The aim of this study was to retrospectively review and compare the effectiveness of four conservative treatments: counseling and occlusal splint therapy, counseling and manipulation integrated with electrophysiotherapy, the combination of the two treatments, and counseling only. One hundred and sixty-eight patients who had myalgia with limited jaw movement were retrospectively observed in this study. Between January 2015 and December 2017, 63 patients received counseling and stabilization occlusal splint therapy (Group 1), 35 patients received counseling and manipulation integrated with electrophysiotherapy (Group 2), 33 patients received the combination of counseling, splint therapy, and manipulation integrated with electrophysiotherapy (Group 3), and 37 patients received counseling only (Group 4). All subjects were followed up for 12 weeks. The intensity of spontaneous pain, palpation pain, chewing pain in the masticatory muscles, and range of pain-free maximal mouth opening were recorded in the clinical assessments. Intragroup and intergroup differences were examined by using analysis of variance (ANOVA) and the Kruskal-Wallis test. Spontaneous pain in the masticatory muscles was relieved significantly in all groups at the 6-week visit (P < .05), and no significant difference was found among the groups (P > .05). Palpation pain was relieved significantly at the 9-week visit in the counseling + occlusal splint therapy group, counseling + manipulation + electrophysiotherapy group, and counseling + occlusal splint + manipulation + electrophysiotherapy group (P < .05). In the treatment group with counseling alone, significant palpation pain relief occurred at 12 weeks. Chewing pain was relieved significantly at the 6-week visit in the counseling + occlusal splint therapy group, counseling + manipulation + electrophysiotherapy group, and counseling + occlusal splint + manipulation + electrophysiotherapy group (P < .05), yet no significant difference compared to the baseline was observed in the counseling-only group (P > .05). A significant increase in the maximal range of pain-free mouth opening was observed at the 9-week visit in the counseling + occlusal splint therapy group, and at the 3-week visit in the counseling + manipulation + electrophysiotherapy group and counseling + occlusal splint + manipulation + electrophysiotherapy group (P < .05). Nevertheless, no significant change in the range of mouth opening was found throughout the follow-up period in the counseling-only group (P > .05). Each of the included treatment modalities relieved spontaneous pain and tenderness to palpation of the masticatory muscles during the follow-up intervals. Counseling alone did not help patients with chewing pain and limited mouth opening in the short term. Treatment protocols including counseling, occlusal splint therapy, and manipulation, integrated with electrophysiotherapy showed the best short-term outcomes for symptomatic improvement.

Sagittal fracture of mandibular condyle: a review of 151 cases

Objective: A retrospective research was made to summarize the clinical characteristics, treatment methods, results of the adult cases with sagittal fracture of mandibular condyle (SFMC). Methods: One hundred and fifty-one cases of hospitalized patients were enrolled. The age, sex, etiology, level of fracture, degree of displacement, associated facial fractures, treatment methods and results were retrospectively analyzed. Results: The patient's age ranged from 16 to 81 years old, with a median age of 38.5 years. The male to female ratio was 2.97∶1. The most involved age group was 20-29 years old [35.1% (53/151)]. Falls [53.6% (81/151)] were the most common cause. According to the classification of He (2009) and Duan (2011), the most common type of SFMC was type A [60.5% (130/215)] and the displacement type [80.9% (174/215)]. Eighty-six point zero percent (185/215) of SFMC were treated by surgery. The surgical rates of type A, B and M fractures were 91.5% (119/130), 79.6% (43/54) and 88.5% (23/26), with significant differences between the groups (P<0.05). The surgical rates of the displacement and dislocation type were 89.7% and 100%, with significant differences. The differences between the fixations of type A, type B and type M fractures were statistically significant. The follow-up results showed that, 78.7% (59/75) of patients treated with surgery had normal occlusion, no joint symptoms and no limited mandibular movement. Patients treated with conservative therapy had good occlusion and an average maximum mouth opening of 36.25 mm with malunion occurred in 5/6 of the condyles. Conclusions: Under appropriate surgical indications, surgical treatment of SFMCs could achieve significantly better outcomes than conservative treatment.

Prolotherapy with 12.5% dextrose to treat temporomandibular joint dysfunction (TMD)

Introduction: Temporomandibular joint dysfunction (TMD) is a collective term used to describe a complex and multifactorial disorders of the orofacial region. Symptoms commonly associated with TMD include TMJ pain, limited mandibular movement or locking and painful clicking or popping sounds. Most of patients diagnosed with TMD are initially treated conservatively. Failure of such conservatism poses a great challenge for the treating physician. Prolotherapy has been used successfully in many joints in the body by orthopedics and spinal surgeons. Injection prolotherapy has also been used in management of weakening tendons or ligaments in head and neck. Aim of the study: To evaluate the efficacy of dextrose prolotherapy with 12.5% concentration in the treatment of intractable temporomandibular joint dysfunction.

Clinical and sociodemographic characterization of patients with temporomandibular dysfunction of the University Hospital of Maracaibo.

Abstract: Objective: To describe the clinical and sociodemographic characteristics of patients with temporomandibular joint (TMJ) dysfunction at the University Hospital of Maracaibo. Methods: A retrospective study was conducted by assessing the clinical history of patients with TMJ dysfunction who underwent orthopedic treatment in the Oral Surgery Unit of the Dentistry Service of the University Hospital of Maracaibo. Information was collected on socio-demographic characteristics (age, gender, origin, and occupation) and clinical findings related to the presence, location, area, beginning, frequency, cause, and duration of pain, and signs present during mandibular dynamics; additionally, a structural and functional diagnosis was made. The data were processed and analyzed using SPSS v.9. Results: 221 patients were included, with only 10% of the disorders observed in males. Regarding occupation, 39.1% worked at home and 28.3% were students. 97.2% of patients presented pain, and of these, pain was localized in 75%. During mandibular movement with maximum opening, 47.4% showed some difficulty, which was more significant in males. TMJ noises were noted in 74.9%, more often in females. In addition, the previous partial displacement of a disk with recapture presented an incidence of 66.4%. Conclusion: The prevalence of TMJ dysfunction was higher in female patients and in adulthood. Noises were present with a high frequency, as was limited mandibular movement.

Effect of educational and self-care therapies on masticatory performance of women with painful temporomandibular disorder

Abstract Introduction Temporomandibular disorders (TMD) can compromise masticatory performance due to the presence of pain, muscular dysfunction and limitation of mandibular movements. Substantial improvements in TMD pain can be achieved through therapeutic approaches including education and self-care. Objective The aim of the present study was to investigate the impact of these treatment modalities in the masticatory performance of women with painful TMD. Material and method Fifty-two women were randomly divided into three groups: Control Group (CG); Education Group (received education about TMD) (EG); Self-Care and Education Group (received education about TMD and instructions self-care therapies) (SEG). The education instructions about TMD and self-care therapies were transmitted through a video and printed illustrative material. The masticatory performance was evaluated through the sieves method with natural tested foods in the evaluation periods: baseline evaluation, 30 days after and 60 days of follow-up. Data were analyzed and used with a one-way ANOVA parametric test for mean comparison of CG, EG and SEG groups (α = 0.05). Result The masticatory performance of the participants was similar, irrespective of the proposed treatments, at baseline (p=.604), 30 days (p=.450) and 60 days (p=.669). Conclusions The results indicated that treatment with educational and self-care therapies over a period of 60 days had no impact on the masticatory performance of women with painful TMD.

Correlations between the Helkimo indices and the maximal mandibular excursion capacities of patients with temporomandibular joint disorders

Temporomandibular disorders (TMD) may present with diverse signs and symptoms, and one very significant is the limitation of mandibular movements. Additionally, the Helkimo indices allow for the reliable quantification of the signs and symptoms of TMD. The purpose of this study was to ascertain whether there are any correlations between the Helkimo indices and the maximal mandibular excursion capacity in a group of patients with TMD. Eighty patients (72 women and 8 men, mean age 33.6 years) with diagnosis of TMD according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were evaluated to obtain the Helkimo indices and their maximal mandibular excursion capacities. Normal or decreased maximum mandibular movements, i.e., opening, lateral and protrusion were compared with the anamnestic index, muscular pain symptoms, joint pain symptoms and the dysfunction index. Chi-squared analysis was used to compare normal and decreased movement capacities in terms of the Helkimo indices, and the muscle and temporomandibular joint (TMJ) pain. The statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) version 19.0. There were statistically significant differences in the clinical dysfunction index with the maximum opening (p = .011) and lateral movements (p = .024) but not with the maximum protrusion. There were no significant differences in the anamnestic index or the muscle pain and TMJ pain items of the clinical dysfunction index according to the mandibular excursions. The occurrences of limitations in the maximum opening and lateral movements are indications of greater TMD intensity.

The use of noninvasive neuromodulation in the treatment of chronic pain in individuals with temporomandibular dysfunction

ABSTRACT BACKGROUND AND OBJECTIVES: Faced with mechanisms of maladaptive neuroplasticity that can generate a memorization of pain sensation in individuals with temporomandibular dysfunction, the transcranial direct current stimulation emerges as a possible treatment strategy for chronic pain. However, further studies are needed to demonstrate the efficacy of this therapeutic modality and its long-term effect. Thus, the present study aims to discuss the use of transcranial direct current stimulation in the treatment of temporomandibular dysfunction in individuals with chronic pain. CONTENTS: The present review encompasses 40 articles, published between the years 2000 and 2016. The temporomandibular dysfunction is a disease characterized by a set of signs and symptoms that may include joint noise, pain in the muscles of mastication, limitation of mandibular movements, facial pain, joint pain and/or dental wear. Pain appears as a very present and striking symptom, with a tendency to chronicity, a condition that is difficult to treat and often associated with psychological factors such as anxiety and depression. Studies using transcranial direct current stimulation in patients with chronic pain symptomatology have been showing good results through neuromodulation of neuronal excitability. It is worth noting that it corresponds to a non-invasive technique, low cost, easy and quick to apply, besides having minimal adverse effects. CONCLUSION: The transcranial direct current stimulation has shown promising results in the treatment of temporomandibular dysfunction pain, with the possibility of becoming a complementary technique to the existing treatments, and thus, providing a professional assistance of better quality and resolution to the patient with this disorder.

Disfunción de la articulación temporomandibular en pacientes con artritis reumatoide

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease characterised by a pathogenic immune response that causes joint damage that can be disabling and even cause premature death. The temporomandibular joint (TMJ) can also be affected, causing pain, crepitus, swelling, and limitation of mandibular movements. TMJ dysfunction is a very common condition, thus the aim of this study was to determine to what extent patients with RA have TMJ dysfunction compared with healthy patients and to identify the main differences in the clinical presentation. A case-control study was performed with the objective of identifying the main differences in the clinical presentation. A total of 37 patients were included in each group. In the group of patients with RA it was found that 75% of patients (28 cases) had TMJ dysfunction, while in the control group there were only 13.5% (5 cases). The findings identified in the group of patients with RA and TMJ dysfunction were mainly: mandibular deviation, joint sounds, tooth loss, joint pain, and limitation of the opening. This study was able to identify that there is an increased risk of 82% (OR 19.9, 95% CI=0.71-0.89) in developing TMJ dysfunction in patients with RA compared with healthy patients. It is concluded that it is important to perform periodic TMJ exploration to be able to identify early signs and symptoms of dysfunction to avoid progression. This would be reflected in better nutrition and quality of life of the patient.

Limitation of Mandibular Movement: A Rare Case Report of Unilateral Zygomatico-Coronoid Interference

Introduction:Zygomatico-coronoid interference is a rare type of mandibular extracapsular ankylosis. There is a lack of information on the treatment of these cases in the literature. Condylectomy and coronoidectomy are not always the best options for the treatment of limitations in mandibular movement.Case Presentation:A 51-year-old woman presented with mouth-opening limitation due to zygomatic bone displacement and interference with the coronoid process. The treatment plan was bilateral coronoidectomy through an intraoral approach and osteotomy of the right zygomatic arch through an extraoral incision. The patient was able to open her mouth to approximately 40 mm after surgery. The patient underwent physiotherapy during follow-up appointments. There was no relapse after three months of follow-up.Conclusions:This study shows that simultaneous arch osteotomy and coronoidectomy may be an appropriate treatment procedure for zygomatico-coronoid interference.

Evaluation of using botulinum toxin (A) in the treatment of myofacial pain syndrome

Myofacial pain syndrome (MPS) is a disorder which has become a topic over the past two decades and nowadays .10 patients (9 female & 1 male) complaining of unilateral MPS were injected with botulinum toxin type A(BTX-A) in masseter and temporalis muscles extra orally under electromyographic guidance (EMG) since they are the primary muscles responsible for pain in ear region and temporal headache respectively, which cause limitation of mandibular movement and development of MPS. EMG evaluation of the results together with clinical one were taken at baseline before injection, after 1, 2, 3 and 6 months following the last injection. The study revealed that BTX-A reduced the severity of symptoms and improve functional abilities for patients with MPS and these extend beyond its muscle - relaxing effects.