Limited Mouth Opening Research Articles

Does salivary cortisol serve as a potential biomarker for temporomandibular disorders in adults?

BackgroundThe etiology of temporomandibular disorders (TMD) is multifactorial, involving a complex interplay of psychological and physiological factors. While salivary biomarkers, particularly cortisol, play an important role in TMD pathophysiology, evidence in the literature is still scarce and inconsistent. Hence, this study aims to evaluate the applicability of salivary cortisol as a potential biomarker for TMD in adults.MethodsThe Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) were used to accurately diagnose TMD patients. The study included adults, both male and female, aged 18–40 in the TMD group (n = 66) and non TMD participants (n = 66) matched for age and gender. Salivary samples were collected from participants at two time points: early and late morning. Cortisol levels in the samples were quantified using enzyme-linked immunosorbent assay (ELISA). Statistical analysis was performed using a one-way ANOVA to evaluate the correlations between cortisol levels and the study variables. Tukey’s post-hoc tests were applied to adjust for multiple comparisons.ResultsSalivary cortisol levels were significantly higher in the TMD group than in the corresponding controls (p = 0.034). In the TMD group, the mean cortisol levels early in the morning were 29.95 ± 75.05 (0-398.64), while the late morning levels were recorded as 4.87 ± 3.96 (0-17.13). In the control group, the mean cortisol levels early in the morning were 10.98 ± 16.83 (2.16–92.90), and late morning mean cortisol levels were 6.15 ± 6.13 (0-20.42). This indicates that the early morning levels of cortisol are higher in TMD patients (p = 0.046). In the subgroup analysis of the TMD, the mean salivary cortisol levels recorded were highest at 82.49 ± 124.34 (8.32-398.64) in patients having disc displacement without reduction with limited mouth opening. Furthermore, the mean salivary cortisol levels in the early morning were statistically higher (84.83 ± 132.80) in males compared to females (9.36 ± 9.01) (p = 0.008) with TMD.ConclusionThe result of this study suggests that salivary cortisol could be a potential biomarker for a specific TMD subtype (disc displacement without reduction with limited mouth opening). However, further studies are needed to better understand the role of cortisol biomarker in the underlying pathogenesis of TMD.

Clinical experience of the carboxytherapy method in the treatment of patients with temporomandibular joint pain dysfunction syndrome (К07.60)

Objective. Improving the effectiveness of treatment of patients with TMJ PDS myogenic origin. Material and methods. According to the purpose of the study, a group of 10 patients (8 women and 2 men aged 14 to 60 years) was formed with the coincidence of a triad of signs: pain during movements of the lower jaw, a feeling of heaviness and tension in the chewing and facial muscles, restriction of mouth opening. A set of diagnostic measures has been implemented in the following scope: clinical and radiological examination methods, TMJ MRI, ultrasound and surface EMG of the chewing muscles, digital axiography. In the treatment of patients in the study group, the method of invasive carboxytherapy was used, based on dosed injections of CO2 in the projection of trigger points of the masticatory muscles. The research examines the therapeutic value of using of CO2 in the protocol of functional rehabilitation of patients with TMJ diseases of myogenic origin. Results. The analysis of the effectiveness of treatment of patients in the study group was carried out to assess the dynamics of key parameters: the severity of the pain syndrome according to VAS, the magnitude of the IMPACT index values and the magnitude of mouth opening. The severity of pain in patients in the study group, according to average values, decreased by 86% from the initial values, an increase in the amplitude of mouth opening by 28.5%, a decrease in the IMPACT index values by 42.5% from the initial values of hypertonicity of the masticatory muscles, an increase in blood flow speed of superficial temporal artery at 52.5%. Conclusion. The results of the clinical application of the carboxytherapy method in the treatment of patients with TMJ PDS allow us to recommend this method for implementation in the rehabilitation protocols of patients with TMJ PDS of myogenic origin, trismus and hypertonus of the masticatory muscles. Carboxytherapy as a method of etiopathogenetic rehabilitation contributes to the early relief of pain syndrome, normalization of the bioelectric activity of the chewing muscles and restoration the physiological kinematics of the lower jaw’s movements.

The Role of Coronoidectomy in Complex Mandibular Reconstruction With Free Fibular Flap

Introduction: Complex mandibular reconstruction is at risk of postoperative restricted mouth opening. Temporomandibular joint pseudoankylosis can cause significant disability, leading to restricted mouth opening and an inability to create a proper seal with the mouth. Treating this condition often requires aggressive surgical intervention, primarily restoring the structure and functionality of the mandible. Coronoidectomy plays a vital role in improving mouth opening capacity. Case Presentation: Four patients with temporomandibular joint pseudoankylosis were included in this case series. The patients reported being unable to move their remaining lower jaw, having a perpetually open mouth, and constant drooling. All patients had a history of reconstructive surgery due to tumor or malignancy and could only open the mouth less than 10 mm. They underwent coronoidectomy followed by free fibular flap reconstruction. Postoperatively, all 4 patients exhibited a movable mandible and achieved proper occlusion. The maximum mouth opening increased by 25 to 45 mm; all flaps appeared vital, sutures remained intact, and no active bleeding. Discussion: Coronoidectomy is crucial for enhancing the ability to open the mouth. All of the patients underwent a coronoidectomy surgery followed by free fibular flap reconstruction. Immediately after the surgery, the mandibular projection appears nearly symmetrical, the patient opens their mouth, and occlusion is achieved subjectively. From our presented cases, after coronoidectomy, all patients had movable mandibula, and mouth opening was achieved. Coronoid process resection frees the mandible from the temporalis. Coronoidectomy and separation of the temporalis muscle from the mandible have excellent clinical efficacy for improving mouth opening and movement. Conclusion: Coronoidectomy followed by a free fibular flap should be considered the best surgical option for patients with restricted mouth opening after complex mandibular reconstruction.

Oral and radiological features associated with systemic sclerosis: a literature review

This review aimed to determine the orofacial radiological features associated with systemic sclerosis (SSc) characterises the oral health complications experienced by SSc patients and identifies their potential oral health care needs. SSc has several orofacial manifestations, including fibrosis of the overlying skin, limited mouth opening, a dry mouth, and swallowing difficulties. SSc patients also have an increased risk of periodontal disease and tooth decay. By outlining the orofacial radiological features and related complications, this review hopes to enhance the dental services provided to this population by enabling the prediction of their oral healthcare needs while calling for increased awareness among dental healthcare providers.

Prevalence of tinnitus in temporomandibular joints disorder patients

BackgroundDisorders affecting the temporomandibular joint (TMJ), related structures, and the masticatory muscles are called temporomandibular disorders (TMD). The two most typical symptoms are mouth opening restriction and pain. Costen noted the connection between TMD and tinnitus in 1934. These conditions are brought about by the shared structures that connect the TMJ and the auditory apparatus (bones and muscles) through a shared innervation source and specific ligaments. Wright addresses Costen ideas, which suggest that otological symptoms of TMD could be caused by auriculotemporal nerve damage, Eustachian tube restriction, or other factors causing an incorrect intratympanic pressure adjustment.MethodsCross-sectional observation was regulated at Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University. The following are the inclusion criteria: patients with a TMD diagnosis and those older than 16 years old. The following conditions are excluded: neurological or oncological disorders, ear infection, and a history of face trauma.ResultsThe total number was 196 patients, 63.8% females and 36.2% males. A total of 76.5% had bilateral joint pain, and 21.9% had unilateral joint pain. While 70.4% had bilateral muscle pain, 18.9% had unilateral muscle pain. A total of 91.8% had mild tinnitus, while 8.2% had moderate tinnitus.ConclusionIn this study, 8.2% of patients complaining of tinnitus had severe tinnitus, while 91.8% had mild tinnitus.

Mandibular third molar coronectomy in older adults and its effects on oral health-related quality of life.

The purpose of this study was to investigate the effect of coronectomy on postoperative quality of life in older adults. Coronectomy is an alternative to complete surgical removal of a mandibular third molar that lies close to the inferior alveolar nerve. This prospective study included patients >60 years old who had an indication for coronectomy of a mandibular third molar. Patients were asked to complete the Dutch version of the Oral Health Impact Profile-14 (OHIP-14) daily during the first postoperative week. Postoperative pain, swelling, limited mouth opening, chewing ability and infection were also recorded. Furthermore, the effect of the impaction pattern, state of eruption, presence of preoperative pathology, patient health status according to the American Society of Anaesthesiologists score, gender, smoking on the postoperative OHIP-14 and pain scores were investigated. Thirty patients (16 males, 14 females) with a mean age of 71.2 (SD 8.3, range 60-91) years were included in the study. OHIP-14 and pain scores were highest on the first postoperative day and gradually declined during the first postoperative week. Patients who underwent coronectomy of a fully impacted mandibular third molar had significantly higher OHIP-14 scores on the first postoperative day than those who underwent coronectomy on a (partially) erupted mandibular third molar. We did not observe any postoperative complications up to 1 year after the surgery. Mandibular third molar coronectomy seems to present a valid treatment option in older adults.

Multi-label dental disorder diagnosis based on MobileNetV2 and swin transformer using bagging ensemble classifier

Dental disorders are common worldwide, causing pain or infections and limiting mouth opening, so dental conditions impact productivity, work capability, and quality of life. Manual detection and classification of oral diseases is time-consuming and requires dentists’ evaluation and examination. The dental disease detection and classification system based on machine learning and deep learning will aid in early dental disease diagnosis. Hence, this paper proposes a new diagnosis system for dental diseases using X-ray imaging. The framework includes a robust pre-processing phase that uses image normalization and adaptive histogram equalization to improve image quality and reduce variation. A dual-stream approach is used for feature extraction, utilizing the advantages of Swin Transformer for capturing long-range dependencies and global context and MobileNetV2 for effective local feature extraction. A thorough representation of dental anomalies is produced by fusing the extracted features. To obtain reliable and broadly applicable classification results, a bagging ensemble classifier is utilized in the end. We evaluate our model on a benchmark dental radiography dataset. The experimental results and comparisons show the superiority of the proposed system with 95.7% for precision, 95.4% for sensitivity, 95.7% for specificity, 95.5% for Dice similarity coefficient, and 95.6% for accuracy. The results demonstrate the effectiveness of our hybrid model integrating MoileNetv2 and Swin Transformer architectures, outperforming state-of-the-art techniques in classifying dental diseases using dental panoramic X-ray imaging. This framework presents a promising method for robustly and accurately diagnosing dental diseases automatically, which may help dentists plan treatments and identify dental diseases early on.

Comparative analysis of myoelectric activity and mandibular movement in healthy and nonpainful articular temporomandibular disorder subjects.

Temporomandibular disorders (TMDs) are one of the leading causes of craniofacial pain, and a high incidence of TMDs in young adults has been reported. Previous studies have used surface electromyography (sEMG) and mandibular kinematic analysis for TMDs diagnosis. This study aimed to provide normal reference values of sEMG and mandibular kinematics in Han Chinese adults, compare the sex differences and assess their diagnosis value on pain-free articular TMDs. This observational study recruited healthy young adults with individual normal occlusion and nonpainful articular TMDs patients with disc displacement. The sEMG signals of the anterior temporalis (TA), masseter (MM), and sternocleidomastoid and digastric were recorded in the mandibular postural positions (MPP) and during maximal voluntary clenching (MVC) with K7 electromyograph. Mandibular kinematics, including maximum opening and opening/closing velocities, were assessed by K7 kinesiograph. The sEMG reference values ranged from 3.0 to 4.3 µV in the MPP (n = 90) in healthy subjects. The sEMG values during MVC, maximum opening, and opening velocity were significantly higher in males than in females. Also, these indices showed good diagnostic efficiency for pain-free articular TMDs (n = 26). Reference values and sex differences in sEMG and mandibular kinematics in healthy subjects were determined. Compared with them, articular TMDs patients showed significantly lower myoelectric activity during maximal biting and restricted mouth opening range and velocity, which may assist in TMDs diagnosis. By analyzing sEMG of masticatory muscle and mandibular kinematics data from healthy Han Chinese young adults and TMDs patients with disc displacement, this study evaluated the sex difference and their diagnosis value on nonpainful TMDs with disc displacement. NCT06372769.

CORRECTION OF THE SIGNS OF MYOFASCIAL DYSFUNCTION IN PERSONS WITH THE CONSEQUENCES OF FRACTURE OF THE JAW BY MEASURES OF PHYSICAL THERAPY

Purpose: to evaluate the effectiveness of the developed physical therapy program based on the dynamics of myofascial dysfunction parameters of the neck and orofacial area in patients with the consequences of a mandibular fracture. Methods. 77 people were examined. The control group consisted of 32 people without the consequences of injuries of the maxillofacial area and burdened dental status. Group 1 consisted of 24 people who underwent rehabilitation according to the general principles of rehabilitation of patients of the dental profile. Group 2 consisted of 21 people with the consequences of a fracture of the lower jaw, who underwent rehabilitation using therapeutic exercises for the muscles of mastication, face, neck, cervical collar zone, back , shoulder girdle; a course of massage (intraoral and classical) of the masticatory muscles, temporomandibular joint, neck, cervical collar zone; thermal procedures (dry heat) on the area of the temporomandibular joint; postisometric relaxation of masticatory muscles, neck muscles; kinesiological taping of the temporomandibular joint, masticatory muscles, neck; training (education) of the patient (reception of soft food, restriction of wide opening of the mouth, elimination of dental bad habits). Rehabilitation lasted three months. Effectiveness was assessed by complaints, examination results, palpation, measurement of chin-sternum distance, "Hamburg test", manual muscle test. Results. During the re-examination, no such complaints were found in people of group 2, such as complications in swallowing, sound phenomena and pain in the temporomandibular joint, pain in the masticatory muscles, complications in nasal breathing, and pain in the neck. Complications when chewing food were found only in 28.6%, restriction of mouth opening - 28.6%, "uncomfortable" position of the jaw - 9.5%. The psycho-emotional state and sleep improved; corresponding complaints were found in 14.3% and 23.8%. The expression of visual manifestations of dysfunction decreased in both main groups with an advantage in individuals of the group. Pathological palpable changes were not detected in the temporal, masticatory, bifidus and hypoglossal muscles in individuals of group 2. Other changes were detected in a small number of individuals - in the lateral pterygoid in 14.3%, medial pterygoid in 9.5%, sternoclavicular-mammoid in 14.3%, trapezoid in 28.6%. In people of group 2, the distance between the chin and sternum when the neck was bent decreased from 4.82±0.42 cm to 2.16±0.23 cm (p<0.05). The decrease in manifestations of dysfunction in the temporomandibular joint during the "Hamburg test" was 11.9% in group 1, 38.3% in group 2, p<0.05. There was an improvement in the strength of the masticatory muscles according to manual muscle test during the movements of raising and lowering the lower jaw, its deviation and protrusion. Group 1, which underwent rehabilitation with the use of independent classes and passive use of preformed physical factors, did not demonstrate an effect on indicators of myofascial dysfunction of the neck; the achieved improvement according to the studied parameters of the orofacial zone were statistically significantly worse than the parameters of group 2. Conclusions. The obtained result is a justification for the need to apply programs of active functional physical therapy for the correction of myofascial dysfunction of the orofacial zone and the neck area in patients with injuries of the jaw.

EXPERIENCE OF CLINICAL AND RADIOGRAPHIC CORRELATION IN PATIENTS WITH PAIN SYNDROME OF TMJ DYSFUNCTION IN ATRICULATION-OCCLUSIVE DISORDERS

This article examines the imaging anatomy of the temporomandibular joint (TMJ), describes the technique of calculating the gaps between the fossa and the head, their comparison based on TMJ computed tomography (CT) data, and their comparison with clinical signs of TMJ dysfunction. The aim was to determine CT diagnostic criteria for persistent functional displacement of the lower jaw in patients with TMJ functional disorders in occlusal-articulation disorders at the stage of orthopedic treatment planning. Research materials and methods. A clinical and radiological examination of 150 patients with functional disorders of the masticatory apparatus and occlusal disorders, who were included in the experimental group, and 30 practically healthy persons – the control group, was carried out. The results. The presence of a pain syndrome was primarily determined - 60 patients (40.00%) complained of pain in the TMJ area, masticatory muscles or headache, and in 19 (31.67%) of them, complaints of pain bothered more than half year TMJ pain was found in 30 (20.00%) patients, in masticatory muscles in 43 (28.67%), headache in 47 (31.33%). Hypertonus of the masticatory muscles was established - 94 - 62.67% with their hypertrophy - 46 - 30.67%, both unilateral and bilateral, which were observed simultaneously with the parafunction of the masticatory muscles (34 - 22.67%). Palpatory functional stable displacement of the lower jaw was determined in 135 (90.00%) patients of the research group, in 57 (42.22%) of them significant pain syndrome was present in 46 (80.70%). At the same time, deviation or deflexion was established in 74 (49.33%) patients of the experimental group, restriction of mouth opening in 52 (32.67%) patients; crunching and clicking in the TMJ - 112- 74.67%. The presence of bilateral posterior displacement of the heads of the lower jaw was established in 103 (68.67%) patients with TMJ dysfunction, of which 42 (40.77%) came to the doctor with complaints of orofacial pain, and in 22 (14.67%) significant displacement, 17 (77.27%) of them had a pain syndrome; unilateral posterior displacement of the heads of the lower jaw in 32 (21.33%) patients with TMJ dysfunction, 16 (50.00%) of them have a pain syndrome, and 11 of them have a significant displacement; in 16 (10.67%) one-sided posterior displacement with simultaneous anterior displacement in the contralateral joint was established with a subjective assessment of the absence of pain syndrome. Presence of a significant displacement in at least one joint was established in 72 (48.00%) patients with TMJ dysfunction, 63 (87.50%) of them had a pain syndrome. Conclusions. CT enables a comprehensive assessment of bone structures and their connection in the TMJ and is a valuable tool for planning orthopedic treatment and evaluating its effectiveness in dynamics.

Oral functions in adult persons with spinal muscular atrophy compared to a healthy control group: a prospective cross-sectional study with a multimodal approach

BackgroundOral function tests have been shown to reliably detect impaired bulbar function in adults with spinal muscular atrophy (SMA). Although not routinely recorded, it is known that persons with SMA are affected to varying degrees. Detecting differences in bite and tongue force, endurance, and maximum mouth opening has become particularly promising since the introduction of causal therapy for SMA. This study aimed to compare oral function among adult persons with SMA with different SMA types, walking abilities, and treatment status to a healthy control group.MethodsData from oral function tests conducted on 58 persons with SMA and 45 healthy individuals were analyzed. Differences in oral function between SMA subgroups were pairwise tested and compared to the healthy control group using Wilcoxon rank sum tests.ResultsIn an overall comparison, three out of five oral function tests revealed lower values for the SMA group compared to the control group. Subgroup analyses indicated lower scores for most oral function tests in non-ambulatory, untreated patients with SMA type 2 compared to controls. Ambulatory, treated patients with SMA type 3 achieved strength and endurance values comparable to those of healthy individuals.ConclusionsThe impairment of oral function varies across persons with SMA. Routine measurement of oral function is warranted to determine individual bulbar involvement stages. Further evaluation should be scheduled if indicators such as restricted maximum mouth opening arise.Trial registration DRKS, DRKS00015842. Registered 30 July 2019, https://drks.de/register/de/trial/DRKS00015842/preview.

Ultrasound assessment of the structure of the masticatory muscles against the background of relief of myofascial pain syndrome

INTRODUCTION. Restricted mouth opening, parafunctional activity of the chewing muscles are a symptom of the development of many dental diseases caused by intra- and extra-articular causes. To verify the diagnosis, it is necessary to conduct an ultrasound examination, according to the assessment of the dynamics of qualitative and semi-quantitative parameters, it is possible to analyze the results of the treatment according to the BOS principle, which was the purpose of this study.AIM. The aim of the study was to conduct an ultrasound assessment of the structure of the masticatory muscles against the background of relief of myofascial pain syndrome.MATERIALS AND METHODS. 104 people were examined and treated, the relief of myofascial pain syndrome was carried out using combined treatment – injections of botulinum toxin type A, cross-taping and ozonation of the chewing muscle. Clinical criteria were evaluated – the intensity and duration of pain, the degree of mouth opening. According to the developed ultrasound criteria, the features of the structure of the masticatory muscles, the presence or absence of trigger points with diameter determination were studied. Using qualitative indicators, the length, width and depth of muscle tissue were studied.RESULTS AND CONCLUSIONS. In patients with myofascial pain syndrome, starting at 14 days and for 6 months, stable positive dynamics was achieved, as evidenced by a statistically significant change in the studied parameters. A correlation was revealed between the degree of mouth opening and changes in the width of the chewing muscles according to the ultrasound method of investigation. The inclusion of this method makes it possible to timely, accurately and non-invasively assess the condition of the chewing muscles, while studying the size changes of which it is possible to adjust the treatment.

IMPLANT PLACEMENT IN ORAL SUBMUCOUS FIBROSIS (OSMF) AND TRISMUS PATIENTS WITH RESTRICTED MOUTH OPENING

IMPLANT PLACEMENT IN ORAL SUBMUCOUS FIBROSIS (OSMF) AND TRISMUS PATIENTS WITH RESTRICTED MOUTH OPENING

Anesthetic management of a rare case of mobile vocal cord polyp causing dynamic airway obstruction: A case report

We report the anesthetic management of a patient presenting with a mobile vocal cord lesion in combination with restricted mouth opening. Fiber-optic laryngoscopy revealed a highly mobile vocal cord lesion, moving in and out of the vocal cords with respiration. A very small tracheal lumen was visible posteriorly during expiration. ASA difficult airway algorithm was applied, and the patient was successfully intubated awake with a # 5 microlaryngeal tube loaded over a pediatric bronchoscope. We aim to highlight the importance of detailed preoperative evaluation, adopting difficult airway algorithms and utilization of devices, with which we have maximum expertise with some modification as the key to avoid airway-related adverse events in such patients.

Evaluating the reproducibility and validity of maximal mouth opening measurement techniques

ObjectivesA limitation of the maximal mouth opening (MMO) is a frequent complication of oral (cancer) surgery. The measurement between the right central incisors is considered the golden standard for assessing MMO, although it has been noted to overestimate MMO in edentulous patients. This study aims to evaluate the reproducibility and validity of four MMO techniques and to determine the extent to which they are dependent on the remaining dentition. Materials and MethodsFour methods for capturing the MMO were recorded in consecutive patients with mixed dentition. The degree of agreement between the different measurement methods was compared using Bland-Altman plots. To investigate the reproducibility of each method, intersession, interobserver and intraobserver reliability were calculated for measurements performed by two clinicians across two sessions. Two subgroups were created based on dentition: (A) cases missing at least one right central incisor, and (B) patients with both right central incisors present. ResultsAll but one intraclass correlation coefficient (ICC) demonstrated excellent reproducibility (ICC > 0.9). The highest ICC values were found for the intraoral MMO(iMMO) and corrected intraoral MMO(ciMMO) method. A significant relationship between the MMO in both subgroups was identified only for the intraoral Range of Motion (iROM) method (p=.010*). ConclusionThe findings suggest that the current golden standard for measuring MMO does not adequately account for the absence of the right central incisor(s). Two of the proposed methods, which include corrections for missing incisors, should be incorporated into future clinical trials on MMO.

An exploratory data-driven approach to classify subgroups of patients with temporomandibular disorders based on pain mechanisms

Temporomandibular disorders (TMDs) are a common musculoskeletal condition, presenting treatment challenges due to their non-specific nature. Categorizing patients with TMDs into clusters based on neurobiological pain mechanisms could provide a promising approach to facilitate targeted treatments. This observational study (1) used a network analysis (NA) to explore the complexity of TMDs by investigating relationships among biopsychosocial variables, and (2) validated potential TMD subgroups based on mechanism-specific pain categories. One hundred and two patients with TMD were included. Biopsychosocial variables covered: general health, psychosocial features, TMD pain, and TMD characteristics. A NA evaluated the associations between variables and determined the role of each feature within the network. Hierarchical clustering was used to identify TMD subgroups. The NA revealed significant correlations primarily within the same feature domains, indicating a strong interplay between symptoms and psychological factors. Cluster analysis identified two subgroups driven by nociceptive and nociplastic pain mechanisms; the nociplastic group exhibited higher levels of anxiety, depression, pain catastrophization, central sensitization, pain duration, and more pain locations, along with poorer sleep quality, quality of life, and health status. In contrast, the nociceptive group exhibited restricted maximal mouth opening (MMO), heightened pain during TMJ palpation and mouth opening, and a greater positive response to manual therapy. Across all features, psychological factors, pain locations, and MMO primarily contributed to the separation of subgroups. By adopting a data-driven approach, these results support the significant role of considering the neurobiological basis of pain to improve patient classification. This knowledge may facilitate clinical reasoning and personalized treatments. PerspectiveThis study used a network analysis to explore the complex biopsychosocial interactions present in people with TMDs, identifying important variables such as the Central Sensitization Inventory and pain-free maximal mouth opening. The findings distinguish potential nociceptive and nociplastic pain subgroups, offering important insights for targeted therapeutic strategies.

Elastic Bands Improve Oral Appliance Treatment Effect on Obstructive Sleep Apnoea: A Randomised Crossover Trial.

Oral appliances (OAs) that limit mouth opening during sleep, such as monobloc appliances, have shown superior treatment effects in subgroups of patients with obstructive sleep apnoea. The application of elastic bands on bibloc appliances may resemble these benefits. The primary objective was to investigate if application of elastic bands to bibloc appliances improves treatment success (> 50% reduction of respiratory event index (REI)), in addition to other subjective variables. Furthermore, we aimed to identify variables predicting the need for elastic bands in OA treatment. Included patients (n = 69) were randomly assigned to OA treatment with or without elastic bands. After 3 weeks, treatment effect was investigated with home respiratory polygraphy and questionnaires. Thereafter, patients changed treatment modality, with identical follow-up regime. Statistical analyses were performed using Student's t-test and Pearson's chi-squared test to investigate differences between the two treatment modalities, and logistic regression analysis was conducted to investigate variables tentatively associated with treatment success. Based on REI, the success rate with OA treatment was in favour of elastic bands (53.9% vs. 34.6%, p = 0.002). Male sex and larger maximum mouth opening were identified as predictors for increased treatment success with elastic bands. The main benefit with elastic bands seemed to be greater reduction of REI when supine. However, patients seem to prefer OA without elastic bands. Elastic bands improved OA treatment effect by reducing the REI in supine position. Patient groups that seemed to benefit from elastic bands in OA treatment were men with large maximum mouth openings.

A case report of arthrocentesis in temporomandibular joint internal derangement

In this case report, a 56-year-old male presented to our department of oral and maxillofacial surgery with a chief complaint of pain during mouth opening on the left joint region. The patient also complained of limited mouth opening and temporomandibular joint (TMJ) pain. Arthrocentesis was performed under aseptic conditions. Clinical evaluation of the patients was done before the procedure, 1 week, 1 month, and 4 months postoperatively. Intensity of TMJ pain and maximal mouth opening were recorded at each follow-up visit. There was a significant improvement in mouth opening and a reduction in pain scores in the postoperative period. Arthrocentesis is a simple and safe procedure for patients with internal derangement with a closed lock for improving mouth opening and decreasing pain.

Multidisciplinary treatment of a patient with TMJ ankylosis and a severe dentofacial discrepancy: A case report.

Temporomandibular joint (TMJ) ankylosis is a debilitating condition characterised by the fusion of bony or fibrous tissues in the TMJ, resulting in restricted mouth opening, functional challenges and facial deformities. This report highlights the complexity and multifaceted nature of TMJ ankylosis and emphasises the significance of early intervention and a multidisciplinary approach. Distraction osteogenesis has emerged as a successful method for managing TMJ ankylosis and associated facial asymmetry. Post-distraction orthodontic management is essential to address occlusal changes, including posterior open bite and crossbite. A 17-year-old boy with unilateral right-sided TMJ ankylosis presented with restricted mouth opening, facial asymmetry and functional difficulties. Multidisciplinary treatment planning involved distraction osteogenesis, condylectomy, coronoidectomy and orthodontic correction to achieve proper occlusion and facial aesthetics. The treatment significantly improved facial aesthetics, mouth opening, occlusion and the patient's confidence and self-esteem. This case report underscores the complexity of TMJ ankylosis and the need for a comprehensive approach, including surgical and orthodontic interventions. Collaboration among healthcare professionals and ongoing research is vital to refine treatment approaches and improve the quality of life for patients with TMJ ankylosis.

C-MAC Video Stylet Assisted Endotracheal Intubation in Sedated but Spontaneously Breathing Patients Using Remimazolam and Trachospray Device: A Report of Two Cases

The C-MAC video stylet (Karl Storz KG, Tuttlingen, Germany) is proposed as a successor to the familiar retromolar intubation endoscope. With its flexible tip, it may be especially useful for patients with a limited mouth opening. An awake or sedated airway management technique is often preferred when a difficult airway is anticipated. Due to the challenges in preparation, sedation, topical airway anesthesia and the execution of such an airway management technique itself, these techniques are often clinically underused. The C-MAC video stylet seems to be well suited for an awake or sedated airway approach, as its handling is easier and faster than a flexible fiberscope. It does not exert pressure on the tongue as direct laryngoscopy or video laryngoscopy do. We report two cases of a difficult airway in which intubation was performed by using the C-MAC video stylet in sedated, spontaneously breathing patients. After a low dose of 3 mg midazolam IV, remimazolam was administered continuously (0.46–0.92 mg/kg/h). This was supplemented with a low dose of remifentanil (0.04–0.05 µg/kg/min). The Trachospray device (MedSpray Anesthesia BV, Enschede, The Netherlands) was used for topicalization of the upper airway by means of 4 mL of lidocaine 5%. In addition, a further 5 mL of lidocaine 5% was sprayed via an epidural catheter advanced through the oxygenation port of the C-MAC video stylet for further topicalization of the vocal cords and proximal part of the trachea. The well-coordinated steps described in these two cases may represent a blueprint and a good starting point for future studies with a larger number of patients.