Mandibular Function Impairment Research Articles

Clinical observation on warming needle moxibustion combined with rehabilitation techniques in the treatment of anterior disc displacement without reduction.

To observe the effect of warming needle moxibustion combined with rehabilitation techniques on clinical symptoms and quality of life of patients with anterior disc displacement without reduction (ADDwoR). This randomized controlled trial included 66patients, with ADDwoR, attending the Hangzhou Hospital of Traditional Chinese Medicine. Patients were assigned to the Experimental (12 sessions of warming needle moxibustion combined with rehabilitation manipulation therapy) and Control (rehabilitation therapy only) group (n = 33, each). Duration of treatment was 4 weeks, with 3 times a week. Outcomes included VAS pain score, maximum mouth opening (MMO), mandibular function impairment score (MFIQ), oral health impact scale (OHIP-14 scale), and mandibular dysfunction index (Fricton score). Safety assessments during treatment included incidence of fainting, broken needle, bleeding, hematoma and scalding. After treatment, the VAS scores, mandibular function impairment scores, oral health impact degree scale, and the scores of Dysfunction index (DI), palpation index (PI) and craniomandibular index (CMI) in the two groups were significantly decreased compared with before. While the maximum mouth opening was increased in both groups, the clinical efficacy evaluation showed the total significant rate of the control group was 59%, and the total significant rate of the experimental group was 83%, demonstrating a significant clinical efficacy difference between the two groups. Compared to targeted rehabilitation exercises only, warming needle moxibustion combined with rehabilitation manipulation can not only improve the pain and maximum mouth opening, but also mandibular function impairment, mandibular joint disorder and oral health of patients with ADDwoR. http://www.chictr.org.cn/index.aspx , identififier: ChiCTR2200059039.

Natural History of Mandibular Function in Spinal Muscular Atrophy Types 2 and 3.

Hereditary proximal spinal muscular atrophy (SMA) is characterized by abnormal alpha motor neuron function in brainstem and spinal cord. Bulbar dysfunction, including limited mouth opening, is present in the majority of patients with SMA but it is unknown if and how these problems change during disease course. In this prospective, observational, longitudinal natural history study we aimed to study bulbar dysfunction in patients with SMA types 2 and 3. We included 44 patients with SMA types 2 and 3 (mean age was 33.6 (95% CI 28.4;38.9) and re-examined them after on average 4 years. None were treated with SMN-modulating treatments before or during the course of this study. Longitudinal assessments included a questionnaire on mandibular and bulbar function, the Mandibular Function Impairment Questionnaire (MFIQ), and a clinical examination of masticatory performance, maximum voluntary bite force, and mandibular movements including the active maximal mouth opening. We found significant higher MFIQ scores and a significant decrease of all mandibular movements in patients with SMA type 2 (p < 0.001), but not in SMA type 3. Masticatory performance and maximum voluntary bite force did not change significantly. Mean reduction of active maximal mouth opening at follow-up was 3.5 mm in SMA type 2 (95% CI: 2.3; 4.7, p < 0.001). SMA type 2 was an independent predictor for a more severe reduction of the mouth opening (β= -2.0 mm (95% CI: -3.8; -0.1, p = 0.043)). Bulbar functions such as mandibular mobility and active maximum mouth opening decrease significantly over the course of four years in patients with SMA type 2.

Effect of pain on cranio-cervico-mandibular function and postural stability in people with temporomandibular joint disorders.

Neck and jaw pain is common and is associated with jaw functional limitations, postural stability, muscular endurance, and proprioception. This study aimed to investigate the effect of jaw and neck pain on craniocervico- mandibular functions and postural stability in patients with temporomandibular joint disorders (TMJDs). Fifty-two patients with TMJDs were included and assessed using Fonseca's Questionnaire and the Helkimo Clinical Dysfunction Index. An isometric strength test was performed for the TMJ depressor and cervical muscles. The TMJ position sense (TMJPS) test and cervical joint position error test (CJPET) were employed for proprioception. Total sway degree was obtained for the assessment of postural stability. Deep neck flexor endurance (DNFE) was assessed using the craniocervical flexion test. The mandibular function impairment questionnaire (MFIQ) was employed to assess mandibular function, and the craniovertebral angle (CVA) was measured for forward head posture. Jaw and neck pain negatively affected CVA (R2 = 0.130), TMJPS (R2 = 0.286), DNFE (R2 = 0.355), TMJ depressor (R2 = 0.145), cervical flexor (R2 = 0.144), and extensor (R2 = 0.148) muscle strength. Jaw and neck pain also positively affected CJPET for flexion (R2 = 0.116) and extension (R2 = 0.146), as well as total sway degree (R2 = 0.128) and MFIQ (R2 = 0.230). Patients with painful TMJDs, could have impaired muscle strength and proprioception of the TMJ and cervical region. The jaw and neck pain could also affect postural stability, and the endurance of deep neck flexors as well as mandibular functions in TMJDs.

Intra-Articular Injection of Adipose-Derived Stromal Vascular Fraction in Osteoarthritic Temporomandibular Joints: Study Design of a Randomized Controlled Clinical Trial.

Temporomandibular joint (TMJ) osteoarthritis is a degenerative disease of the TMJ. It is characterized by progressive degradation of the extracellular matrix components of articular cartilage, with secondary inflammatory components leading to pain in the temporomandibular region and reduced mouth opening. Current treatments do not halt disease progression, hence the need for new therapies to reduce inflammation and, consequently, improve symptoms. The aim of our randomized controlled clinical trial protocol is to investigate the efficacy of adjuvant intra-articular injections of autologous tissue-like stromal vascular fraction (tSVF), compared to arthrocentesis alone, in reducing pain and improving mouth opening in TMJ osteoarthritis patients. The primary endpoint analysis will consist of the visual analogue scale (VAS) for pain. The secondary endpoint analyses will include maximal interincisal mouth opening measurements; assessment of oral health and mandibular function based on the oral health impact profile (OHIP) questionnaire and mandibular functional impairment questionnaire (MFIQ); complications during the follow up; synovial cytokine analysis at baseline and after 26 weeks; and nucleated cells and tSVF (immuno)histochemistry analyses of the intervention group. Our randomized clinical trial protocol will be applied to evaluate the efficacy of a new promising tSVF injection therapy for TMJ osteoarthritis. The safety of intra-articular injections of tSVF has been proven for knee osteoarthritis. However, since a tSVF injection is considered a heterologous application of cell therapy, the regulatory requirements are strict, which makes medical ethical approval challenging.

Effectiveness of an 8-week neck exercise training on pain, jaw function, and oral health-related quality of life in women with chronic temporomandibular disorders: a randomized controlled trial

To test the effectiveness of an 8-week exercise program targeted to the neck muscles compared to manual therapy, and placebo treatments on orofacial pain intensity, jaw function, oral health-related quality of life (OHRQoL), and jaw range of motion (ROM) in women with Temporomandibular Disorders (TMD). In this randomized controlled trial, fifty-four women (between 18–45 years old) with a diagnosis of myofascial or mixed TMD according to the Research Diagnostic Criteria for TMD (RDC/TMD) were randomized into three groups: Neck motor control training (NTG), Manual Therapy Group (MTG), and Placebo Group (PG). All patients were evaluated with the Visual Analog Scale, Mandibular Function Impairment Questionnaire, Oral Health Impact Profile-14, and jaw Range of Motion (ROM) at baseline, immediately after treatment (after 8 weeks of treatment), one month, and three-month follow-up. For all outcomes, a mixed analysis of variance (ANOVA) with repeated measures was conducted with a Bonferroni post hoc test. NTG was significantly better than the PG group on pain and jaw function at the end of treatment, one- and three-month follow-up (Effect Size (ES) &gt;0.7). For OHRQoL, NTG was significantly better than MTG and PG at the end of treatment and at three-month follow-up (ES &gt;0.7). The results of this project are encouraging, and they could be used to guide clinical practice in this field. Exercises targeted to the neck (which require low therapeutic supervision) could be a simple and conservative way to improve pain and disability for women with TMD with neck involvement.

Objective assessment of the factors affecting outcome of immediate management of mandibular fractures – A prospective study in a Level-I trauma care center

Background: Mandibular fractures lead to complications if improperly treated. The management of mandibular fractures includes open reduction and internal fixation (ORIF) or closed reduction. Associated complications include malocclusion, infection, hardware extrusion, and nerve injury. Aims and Objectives: The aims of this study were to evaluate the functional outcome of various treatment modalities of mandibular fracture and to identify the factors affecting the outcome. Materials and Methods:The study included patients admitted in the trauma care center, between 13 and 70 years of age, and having mandibular fracture. Patients underwent ORIF or closed reduction according to the type of fracture. Mandibular injury severity score (MISS), Mandibular functional impairment questionnaire (MFIQ) score, and pain visual analog score were used to assess the functional outcome of treatment and complications. Results: Majority of the patients were male and were in the age group 21–30 years. The most common cause of fracture was road traffic accident (RTA). Majority of the patients underwent ORIF. Patients having higher injury severity scores, severe MFIQ scores and pain visual analog scores had more complications. Overall, complications in open reduction cases were higher than closed reduction ones. However, weight loss and time to functional improvement were more in closed reduction cases. Conclusion:Young males are most commonly affected with fracture of mandibles and mostly due to RTAs. There should be minimal delay from presentation to operative intervention in case of patients who require ORIF. Scoring systems such as MISS, MFIQ, and pain visual analog scale scores may help in the early prognostication of injury and warn against imminent complications.

Anatomical position of the mandibular condyle after open versus closed treatment of unilateral fractures: A three-dimensional analysis

This study aimed to compare open and closed treatment for unilateral mandibular condyle neck and base fractures by final three-dimensional (3D) condylar position at 6 months follow-up. 3D position was associated with mandibular functioning and pain. A total of 21 patients received open (n = 11) or closed (n = 10) treatment. 3D positions were assessed on cone-beam computed tomography scans. Volume differences, root mean square, translations, and rotations were obtained related to the pursued anatomical position and compared between treatment groups by the Mann-Whitney U test. The 3D position parameters were associated with the maximum interincisal opening (MIO), mixing ability test (MAT), Mandibular Function Impairment Questionnaire (MFIQ), and pain based on Spearman correlation coefficients (rs). Translation in the medial-lateral direction was smaller after open treatment (P = 0.014). 3D position was not associated with the MAT; however, worse position was associated with a smaller MIO. A larger pitch rotation was associated with a worse MFIQ (rs = 0.499, P = 0.025). Volume reduction of the affected condyle was associated with more pain (rs = −0.503, P = 0.020). In conclusion, after unilateral condylar fractures, worse 3D position is associated with a smaller mouth opening and worse patient-reported outcomes. This is independent of the chosen treatment, despite a better anatomical reduction after open treatment.

Pilates versus Bruegger’s exercises for forward head posture associated with temporomandibular joint dysfunction

Abstract The aim of the trial was to determine and compare the effect of Pilates exercises and Bruegger’s exercises in conjunction with low level laser therapy (LLLT) in forward head posture (FHP) associated with temporomandibular joint dysfunction (TMD). The study was conducted on 30 participants diagnosed with TMD associated with forward head posture. Through randomisation, participants were divided into Pilates (n=15) and Bruegger’s (n=15) exercise groups. LLLT was a common intervention for both the groups. Intervention was given for 3 times a week for 3 weeks. Outcome measures were pain intensity using visual analogue scale (VAS), craniovertebral angle (CVA) using ‘ON Protractor’ software application, range of motion (ROM) of temporomandibular joint (TMJ) using ruler and functional impairment using mandibular function impairment questionnaire (MFIQ) assessed at baseline and 3rd-week post-intervention. A statistically significant difference was noted in pain intensity, ROM of TMJ, CVA and functional impairment with pre- and post-intervention comparison (P&lt;0.001). Between-group analysis showed that Pilates group was better than Bruegger’s exercise group in terms of improving CVA (P&lt;0.001), mouth opening (P&lt;0.01) and reducing functional impairment (P&lt;0.01). However, both the groups were equally effective in in reducing pain intensity (P&lt;0.01). Pilates was better compared to Bruegger’s exercises in reducing functional impairment, improved mouth opening and correcting FHP. Further both the groups were equally effective in reducing pain intensity. Clinical trial registry India: CTRI/2021/09/046969

Subjective Efficiency Evaluation after Maxillomandibular Advancement Surgery in Obstructive Sleep Apnea Patients.

To investigate subjective efficiency outcomes after maxillomandibular advancement (MMA) surgery in obstructive sleep apnea (OSA) patients. A prospective cohort study was carried out between December 2016 and May 2021, including 30 severe or treatment-refractory OSA patients treated by MMA surgery. All patients answered four validated questionnaires: the Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), Mandibular Function Impairment Questionnaire (MFIQ), and EQ-5D-3L (i.e., EQ-5D and EQ-VAS). They also answered one custom-made questionnaire (AMCSQ). Questionnaires were requested to be filled out 1 week before surgery and at least 6 months after surgery. The total preoperative and postoperative scores on the questionnaires were compared. The mean total ESS (p < 0.01), FOSQ (p < 0.01), EQ-5D (p < 0.05), and EQ-VAS (p < 0.01) scores showed significant improvement, which was in accordance with an improvement in the mean postoperative apnea/hypopnea index score (p < 0.01). In contrast, the mean total MFIQ score (p < 0.01) indicated a decline in mandibular function. This study confirms the hypothesis that MMA surgery in OSA patients improves outcomes, both objectively and subjectively, with the exception of postoperative mandibular function.

Further Validity and Reliability of Turkish Version of the Mandibular Functional Impairment Questionnaire in Patients with Temporomandibular Dysfunction

Purpose: &#x0D; The aim of this study is to develop a new Turkish version of MFIQ (MFIQ-T-N) by adding the cut off value and improving the validation to the Turkish version of the Mandibular Functional Impairment Questionnaire (MFIQ-T) in patinets with Temporomandibular dysfunction.&#x0D; Methods: The psychometric properties of the MFIQ were examined in 242 participants diagnosed with TMD and 81 healthy participants. The internal construct validity was assessed with both exploratory and confirmatory factor analysis. External construct validity of the MFIQ-Tr-N was established by The Fonseca Anamnestic index (FAI), The Oral Health Impact Profile-14 (OHIP-14), and The patient health questionnaire-9 (PHQ-9). Predictive validity was examined using the receiver operating characteristic (ROC) to validate the cut-off value of the MFIQ-T-N for diagnosis of TMD. For the determination of reliability internal consistency, test-retest reliability and smallest real difference (SRD95) were investigated. &#x0D; Results: Factor analysis indicated that the MFIQ-T-N had three factors as masticatory, non-masticatory 1, and 2. The MFIQ-T-N was moderately correlated with the FAI (Spearman’s rho = 0.553, p &lt; .001) and OHIP-14 (rho = 0.534, p &lt; .001). The cut-off point for MFIQ-T-N was set at &gt;5 with 84% sensitivity and 87% specificity. The ICC and Cronbach’s α values were found as 0.913 and 0. 916, respectively. The SRD95 for Test-retest reliability was 7.004. &#x0D; Conclusions: The MFIQ-T-N had sufficient psychometric features and was appropriate to use for participants with TMD. In addition, this new version provides researchers with greater opportunities to evaluate mandibular functions in the TMD patient group.

Volumetric outcomes of treatment for unilateral condylar fractures: A pilot study

BackgroundThree-dimensional (3D) imaging allows assessment of changes in condylar volume and morphology. The association between the morphology of the condyle and post-treatment functional impairment is still unclear. PurposeTo analyse the volume of both condyles after a unilateral condylar fracture and to evaluate the relationship between condylar volume and mandibular function. MethodsA pilot study was performed in which data from a recently published cross-sectional study were used. In a previously published cross-sectional study a cone beam computed tomography scan was acquired of patients with a unilateral condyle fracture. These scans were analysed, and the condylar volumes were measured and related to the outcomes of the Mandibular Functional Impairment Questionnaire and the Mixing Ability Test. ResultsPatients with larger condyles have a better recovery regarding function than patient with smaller condyles, independent of the received treatment. This study showed a significant positive correlation between masticatory function and the post-treatment volume of the fractured condyle. Men tended to have larger condyle volumes than women and seem to have a better outcome in function. A larger condyle volume was associated with an increase of the mouth opening. ConclusionGiven that the volume of the condyle is associated with the function of the temporomandibular joint, imaging may be helpful to stratify the pathophysiological adaptation mechanisms and to improve our ability to plan individualized treatment.

Factors associated with mandibular function impairment in people with Parkinson’s disease during social isolation due to COVID-19

Factors associated with mandibular function impairment in people with Parkinson’s disease during social isolation due to COVID-19

Effect of Oral Exercise on Trismus after Oral Cancer Radiotherapy: A Quasi-Experimental Study.

Trismus is a severe complication of oral cancer treatment. Oral exercise is a potentially helpful approach for preventing or improving trismus. The study aimed to test the efficacy of an oral exercise for enhancing the maximum inter-incisal opening (MIO) in patients undergoing surgery and radiotherapy for oral cancer. This is a quasi-experimental study. A sample of 69 oral cancer patients completed the study, with 35 in the control group and 34 in the intervention group. Intervention subjects were asked to perform three 20-min oral exercise sessions per day for six months. Data on oral exercise practicing time, MIO, and mandibular function impairment were collected at the last radiotherapy exposure (T1), three months (T2), and six months (T3) after the radiotherapy. At T3, the intervention group exercised 217.1 min (95%CI: 107.4~326.7) more than the control group. The generalized estimation equations showed a statistically significant group-by-time interaction in MIO. The change in MIO score from T1 to T3, as indicated by the regression slope, was 2.5 mm (95%CI: 0.4~4.6) greater in the intervention group than in the control group. The results support the efficacy of the study intervention for improving patient exercise adherence and MIO.

Self-Reported Mandibular Impairment and Cervical Pain Comorbidity in Undergraduate Dental Students

The aim of this study was to evaluate the frequency of co-existence of self-reported mandibular functional impairment and cervical pain in the same individuals. Participants answered a validated Mandibular Functional Impairment Questionnaire (MFIQ) and also indicated in a schematic map the region of cervical pain when it was reported. The frequency of cervical pain in participants with or without mandibular functional was compared with Chi-squared test. The final evaluated population consisted of 80 participants, 28 men (35%) and 52 women (65%), with ages ranging between 18 and 55 years (median = 20). It was found that 43.75% (n = 35) reported cervical pain, 15% of participants reported some degree of mandibular impairment, and 11.25% presented the comorbidity. In conclusion, participants with mandibular impairment presented significantly more frequent cervical pain than participants without mandibular impairment.

Review of Various Clinical Assessment Indices and Orthodontic Management for Temporomandibular Joint Disorders.

The term "temporomandibular disorders" (TMDs) refers to a variety of problems involving the muscles of the masticatory system and the jaw. The most common symptoms of TMD are pain in the face, headaches, clicking or popping in the joints, and difficulties with jaw function. The severity of TMD can be measured with a number of different scales, including the Helkimo, Craniomandibular Index (CMI), Mandibular Functional Impairment Questionnaire (MFIQ), Fonseca scale and Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) scales. The former focuses on the patient's chief complaint, while the latter takes into account secondary symptoms such as limited mobility, impaired temporomandibular joint (TMJ) function, muscle pain, and discomfort during mandibular motion. According to the severity of the issue, the results can be used to categorise the situation. To effectively treat TMD, one must first determine their index score and then formulate a treatment strategy based on that score.

Arthrocentesis versus non-surgical intervention as initial treatment for temporomandibular joint arthralgia: a randomized controlled trial with long-term follow-up

Arthrocentesis for arthralgia of the temporomandibular joint (TMJ) is often only indicated when conservative, non-surgical interventions have failed. However, performing arthrocentesis as initial therapy may facilitate earlier and better recuperation of the joint. The aim of this study was to assess the efficacy of this therapy with a long-term follow-up. Eighty-four patients were randomly allocated to receive either arthrocentesis as initial treatment (n = 41) or non-surgical intervention (n = 43). Pain (100-mm visual analogue scale, VAS) and mandibular function impairment questionnaire scores (MFIQ, 0–100) were recorded at 3, 12, and 26 weeks, and ≥ 5 years (median 6.2, interquartile range 5.6–7.4 years). Univariable analyses were performed and linear mixed-effect models were constructed. Patients in the arthrocentesis group experienced significantly lower TMJ arthralgia compared to those treated non-surgically (pain during movement: −10.23 mm (95% confidence interval −17.86; −2.60); pain at rest: − 8.39 mm (95% confidence interval −13.70; −3.08)), while mandibular function remained similar in the two groups (MFIQ −2.41 (95% confidence interval −8.61; 3.78)). Of the final sample, 10 patients (10/39, 26%) in the non-surgical intervention group and two patients (2/34, 6%) in the arthrocentesis group received additional treatment during follow-up. Thus, initial treatment with arthrocentesis reduced TMJ arthralgia more efficaciously than non-surgical intervention in the long term, while maintaining similar mandibular function.

Evaluation of the effect of T-Scan™ as an adjunct to stabilization splint in the treatment of temporomandibular joint disorders

ABSTRACT Objective To assess the effectiveness of the stabilization splint (SS) combined with the T-Scan™ III system in the treatment of temporomandibular joint disorder (TMD) with myofascial pain. Methods Forty-eight enrolled patients were randomly assigned to the SS group or T-Scan™-guided SS group. Mandibular Function Impairment Questionnaire (MFIQ), Maximum Comfortable Opening (MCO), Visual Analog Scale (VAS), and Patient Health Questionnaire-9 (PHQ-9) were used as the outcome variables. Results The occlusal contacts of patients in the SS plus T-Scan™ group showed lower Occlusal Time (OT), Disocclusion Time (DT), and Asymmetry Index of Occlusal Force (AOF) after occlusal adjustment under the guidance of the T-Scan™. Importantly, the TMD symptoms were alleviated more obviously in SS plus T-Scan™ group, with better scores for MCO and MFIQ. Conclusion T-Scan™-guided occlusal adjustment of SS can obtain better OT, DT, and AOF, which furthers improvement of the therapeutic effects on TMD with myofascial pain.

Adult Cleft Patients: An Exploration of Functional Needs and Treatment Barriers.

Management of cleft lip and palate has been well characterized in pediatric patients, but limited data exist regarding the long-term functional outcomes of cleft patients once they reach adulthood. An institutional, cross-sectional survey of adult patients with a history of cleft lip and/or palate was performed. The survey recorded patient characteristics, concerns, and barriers to care. Patient-reported outcome measures were assessed using the Nasal Obstruction Symptom Evaluation Scale, Epworth Sleepiness Scale, Mandibular Function Impairment Questionnaire, and the CLEFT-Q Speech Modules. A total of 63 patients (18.2%) participated in the survey. The mean patient age was 43.7 years (median: 41y, range: 19-93y), and the most common diagnosis was cleft lip and palate (51%) followed by isolated cleft palate (35%) and isolated cleft lip (14%). A subset of patients scored with moderate to severe dysfunction on each outcome measure including the Nasal Obstruction Symptom Evaluation Instrument (59%), Epworth Sleepiness Scale (7%), and Mandibular Function Impairment Questionnaire (13%). Respondent scores on the CLEFT-Q Speech modules demonstrated a bimodal distribution with lower scores in a significant subset of patients with cleft palate and cleft lip and palate. Many respondents (41%) were interested in clinical evaluation but cited barriers to seeking treatment including financial barriers (35%) or lack awareness of clinical options (27%). Many cleft patients have persistent needs or concerns in adulthood, especially regarding speech and nasal breathing. Systemic barriers pose challenges to these patients undergoing clinical evaluation.

Teamwork Approach in Management of Zygomaticomaxillary Complex (ZMC) Fracture with Globe Rupture: A Case Report

Introduction : Zygomaticomaxillary complex (ZMC) fractures are one of the most common fractures of the facial skeleton. Zygomatic fractures can cause ocular and mandibular functional impairment, along with cosmetic defects. The characteristic clinical signs of zygomatic bone fracture include diplopia, infraorbital nerve paraesthesia, flattening of the cheek, and trismus, whereas maxillary fracture may typically cause flattening of the midface and malocclusion. Therefore, surgical reconstruction is required to restore the function and appearance.Case Report : A 31-year-old man with ZMC fracture and globe rupture underwent open reduction and internal fixation using plate and orbital mesh. We collaborated with an ophthalmologist who performed enucleation and tarsorrhaphy.Discussion : The reconstruction improved functional and physical aspects and therefore psychological wellbeing. The main goal of the ZMC fracture treatment is to reconstruct the face in terms of functions and aesthetic. Furthermore, reconstruction of the left orbit (orbital rims and walls) as a secondary objective despite the blind eye, improved his appearance enabling formation of a pocket into which an eye implant was inserted. Satisfying functional and aesthetic outcome was achieved in this patient.Conclusion: A teamwork approach in surgical reconstruction for this case with ZMC fracture which always has an orbital component, was recommended to obtain an effective and optimal result. Both plastic surgeon and ophthalmologist can elaborate patient needs for facial reconstruction especially orbital region with good result.

CLINICAL APPLICATION OF THE MANDIBULAR FUNCTION IMPAIRMENT QUESTIONNAIRE

<h3>Objectives</h3> The Mandibular Functional Impairment Questionnaire (MFIQ) was developed in 1993 for clinical assessment of functional impairment in patients with temporomandibular disorder (TMD). The MFIQ contains 17 items, rated on a 5-point Likert scale, and covers 10 items relating to mastication, 5 items on interpersonal contact, and 2 items on nonmasticatory function. <h3>Study Design</h3> A preliminary retrospective study was conducted at a private oral medicine/orofacial pain clinic to examine the clinical application of the MFIQ. Thirty-eight patients were randomly selected. All patients had filled out the MFIQ at the initial appointment before diagnosis. <h3>Results</h3> Of the 38 patients reporting orofacial pain at presentation, 2 were diagnosed with headache pain (HA), 13 had oral issues (OC) including sensory change or lichen planus, 21 had TMD, and 2 had trigeminal neuralgia (TN). Patients with OC were significantly older (65.8 ± 10.1 years) than patients with HA (35.0 ± 11.3 years, <i>P</i> = .036) and TMD (41.4 ± 16.3 years, <i>P</i> < .001). The categories that were rated to be more difficult in TMD compared with HA, OC, and TN are "taking a large bite" (2.1 ± 1.3; 0 ± 0, <i>P</i> = .003; 0.5 ± 1.1, <i>P</i> = .029; 2 ± 3.5, <i>P</i> = .013), "chewing resistant food" (2.0 ± 1.3, OC 0.8 ± 1.5, <i>P</i> = .50), "yawning" (1.5 ± 1.1; 0 ± 0, <i>P</i> < .001; 0.2 ± 0.6, <i>P</i> = .001; 0 ± 0, <i>P</i> <0.001), and "kissing" (1.2 ± 1.4; 0 ± 0, <i>P</i> = .007; <i>P</i> = .007; <i>P</i> = .007). Other items on the MFIQ did not return significance on analysis between groups. No difference in calculated level of function impairment (<i>P</i> = .086) or qualitative level of functional impairment score (<i>P</i> = .197) was found between groups. <h3>Conclusions</h3> Calculated level of function impairment and impairment score do not appear to be effective in differentiating TMD from other patients with orofacial pain. However, items associated with masticatory function (taking a large bite, chewing resistant food) and yawning and kissing are reported to be more difficult in TMD. Certain items on the MFIQ appear to have more application in differentiating TMD from other causes of orofacial pain.