Mandibular Range Of Motion Research Articles

Efficacy of botulinum toxin type A in the management of masticatory myofascial pain: A retrospective clinical study

BackgroundMuscular pain is the main cause of disability worldwide. Myofascial pain of orofacial origin is a frequent condition, the treatment of which is not always accomplished with traditional treatment. Botulinum toxin type A (BTA) is being studied for the treatment of this type of pain with contradicting results. Thus, the objective of this study was to assess the efficacy of BTA in the therapeutic management of masticatory myofascial pain (MFP). Case DescriptionA retrospective study of 100 patients with a diagnosis of MFP was conducted. The control group (50 patients) received conventional treatment (prescription of a muscle relaxant and craniocervical physical therapy). The BTA group (50 patients) received this same treatment and the infiltration of 100 units of BTA in the masticatory musculature. Subjective and objective pain ratings and range of mandibular movements were recorded before and after the treatment. No differences were found between groups in the baseline values. Statistically significant improvements were found in both groups compared with baseline values in all studied parameters. Moreover, BTA improved the subjective pain ratings compared with the control group. The administration of BTA added to the conventional treatment does not seem to improve objective pain ratings and functional measurements, but it improves the subjective pain ratings. Practical ImplicationsThe addition of BTA could be beneficial in the treatment of MFP in addition to conventional treatment, but further studies are needed to elucidate the mechanisms underlying this positive effect.

1425 Surgical Management of a Long-Standing Temporomandibular Joint Dislocation: A Case Report

Abstract Background Temporomandibular joint (TMJ) dislocation is a common presentation to Oral & Maxillofacial Surgery. In most cases, the condylar head is displaced anterior to the articular eminence and can be relocated by closed reduction. Severe dislocation into the infratemporal fossa is uncommon. Long-standing dislocation is rare and makes closed reduction difficult to achieve. Presentation A 60-year-old female presented to the outpatient clinic with long-standing bilateral TMJ dislocation which onset months prior following a seizure. Both condylar heads could be palpated superior to the zygomatic arches and could not be reduced under local anaesthetic. Mandibular range of movement was severely limited and creating an oral seal was not possible, affecting speech function. There was a history of discomfort and declining oral intake. Computed tomography revealed both condyles were displaced into the infratemporal fossa. Management The patient and family expressed a desire to avoid risk of damage to the facial nerve and therefore surgery was limited to an intra-oral approach only. Closed reduction was impossible due to the degree of muscle fibrosis present. Bilateral coronoidectomies were performed under a short general anaesthetic which immediately improved range of movement. Full articulation and occlusion were achieved by performing bilateral condylotomies. Outcome The patient was reviewed by video consultation 2 weeks later and had recovered well. They reported good masticatory function and improved dietary intake. No additional physiotherapy or surgical input was required, and they have been discharged from further review.

Mandibular range of motion in children with juvenile idiopathic arthritis with and without clinically established temporomandibular joint involvement and in healthy children; a cross-sectional study

BackgroundRecognition of temporomandibular joint (TMJ) involvement in children with juvenile idiopathic arthritis (JIA) has gained increasing attention in the past decade. The clinical assessment of mandibular range of motion characteristics is part of the recommended variables to detect TMJ involvement in children with JIA.The aim of this study was to explore explanatory variables for mandibular range of motion outcomes in children with JIA, with and without clinically established TMJ involvement, and in healthy children.MethodsThis cross-sectional study included children with JIA and healthy children of age 6–18 years. Mandibular range of motion variables included active and passive maximum interincisal opening (AMIO and PMIO), protrusion, laterotrusion, dental midline shift in AMIO and in protrusion. Additionally, the TMJ screening protocol and palpation pain were assessed. Adjusted linear regression analyses of AMIO, PMIO, protrusion, and laterotrusion were performed to evaluate the explanatory factors. Two adjusted models were constructed: model 1 to compare children with JIA and healthy children, and model 2 to compare children with JIA with and without TMJ involvement.ResultsA total of 298 children with JIA and 169 healthy children were included. Length was an explanatory variable for the mandibular range of motion excursions. Each centimeter increase in length increased AMIO (0.14 mm), PMIO (0.14 mm), and protrusion (0.02 mm). Male gender increased AMIO by 1.35 mm. Having JIA negatively influenced AMIO (3.57 mm), PMIO (3.71 mm), and protrusion (1.03 mm) compared with healthy children, while the discrepancy between left and right laterotrusion raised 0.68 mm. Children with JIA and TMJ involvement had a 8.27 mm lower AMIO, 7.68 mm lower PMIO and 0.96 mm higher discrepancy in left and right laterotrusion compared to healthy children.ConclusionAll mandibular range of motion items were restricted in children with JIA compared with healthy children. In children with JIA and TMJ involvement, AMIO, PMIO and the discrepancy between left and right laterotrusion were impaired more severely. The limitation in protrusion and laterotrusion was hardly clinically relevant. Overall, AMIO is the mandibular range of motion variable with the highest restriction (in millimeters) in children with JIA and clinically established TMJ involvement compared to healthy children.

Sternoclavicular Graft Versus Costochondral Graft For Reconstruction ankylosed Temporomandibular joint in a child (Clinical and radiographic comparative study)

Aim: To evaluate the feasibility of using sternoclavicular graft ( SCG) versus costochondral graft for TMJ reconstruction in TMJ ankylosis in child. Patients and methods: A total of 20 patients having unilateral bony TMJ ankylosis underwent gap arthroplasty then reconstruction of TMJ with SCG (Group I) or CCG (Group II). Pre-operative and post-operative clinical and radiographic evaluation were done to assess maximum mouth opening, range of mandibular movements, ramus height, donor and recipient sites complications for 24 month follow up at least . Results: Statistical analysis shows that postoperative measurements of different mouth movements increased comparing preoperative measurements in both groups without any significant difference between groups . While postoperative complications occurrence were higher in Group II than group I in pleural tear ,pain, overgrowth ,and facial asymmetry aspects with high statistical significant difference for pleural tear complication (p 0.05). Conclusion : The present study concludes SCG is a versatile and simple alternative graft to the traditional CCG for TMJ reconstruction with minimal complications in children with TMJ ankylosis.

Splint Therapy for treatment of Anterior Disc Displacement with reduction

The aim of the study is to assess the efficacy of the Lingual Ring Splint (LS), anterior repositioning splint (ARS) and stabilizing splint (SS) in management of anterior disc displacement with reduction (DDWR) for the relief of pain and improving mandibular movements. Thirty patients diagnosed with DDWR were included in this study. The participants were randomly assigned into one of three equal groups using a computer-generated randomization schedule receiving the assigned splint for each group, with specific instructions regarding the time of using it and exercises. Follow up was made after 1 and 6 months to test pain score and mandibular range of motion. Pain score improved in all 3 groups with statistical significance with better results is SS group than other two splints. Also, there was an increase in maximum mouth opening (MMO) with the highest measurements in SS group with statistical significance difference. There was no statistical difference regarding lateral excursion between all groups.

Inter Maxillary Fixation Versus Open Reduction for the Treatment of Mandibular Condyle Fractures: A Comparative Evaluation.

Background:The treatment for fractured mandibular condyles aims at restoring the masticatory ability, occlusion, symmetry, and function as the bit were before the trauma. The treatment of the mandibular condylar fracture can be done based on the two protocols.Aims:The present clinical trial was conducted to collate aftertreatment upshot of closed treatment and open surgical treatment for mandibular condyle fractures.Materials and Methods:Forty-two patients were divided into two groups (n = 12) which were treated with either the closed reduction using intermaxillary fixation or open reduction and internal fixation. The following clinical parameters were assessed at 1st and 3rd day and at 1, 3, and 6 weeks: lateral excursion and protrusion, occlusion; interincisal opening, mandibular ramus height, deviation/deflection during jaw opening, and pain assessment using visual analog score. The collected data were subjected to statistical evaluation.Results:Interincisal opening was found to be 8.125 ± 0.3467 mm and 6.016 ± 0.1528 mm, respectively, for Group I and Group II which was statistically significant (P < 0.00001). At the 3 months and 6th week postoperatively, it was increased in the surgical groups to 17.433 ± 0.3822 mm and 19.175 ± 0.3696 mm, respectively.Conclusion:The present trial suggests surgical open reduction and internal fixation treatment of the mandibular condylar fracture is better than the nonsurgical closed reduction in terms of interincisal opening, lateral excursion, and protrusive mandibular movement range.

Condylar fracture in a paediatric patient undergoing conservative and functional treatment: Case report

Trauma to the jaw can lead to fracture of the mandibular condyle. Prevalence in children is low and treatment should focus on possible long-term effects on facial bone and soft tissue growth. Trauma can result in dysfunction, facial asymmetry, mandibular retraction, dysfunction and stiffness of the temporomandibular joint. Clinical examination and imaging tests are essential to obtain an accurate diagnosis and an effective treatment to avoid possible complications. Treatment can be surgical or non-surgical, but non-surgical treatment is the method of choice in most cases. The aim of this study is to report a case of mandibular condylar fracture in a pediatric patient who underwent conservative and functional care who, with adequate monitoring by the Maxillofacial Surgery and Traumatology team and family, showed complete remodeling of the fractured bone and total recovery of the dental occlusion. Treatment in pediatric patients through conservative management allows an adequate range of mandibular movement and remodeling at the fracture site, but patient and family adherence to treatment is very important to obtain good results.

Vertical dimension of occlusion related to mandibular movement during swallowing

BackgroundIncreasing the vertical dimension of occlusion (VDO) is a common procedure in complicated prosthodontic treatment. The swallowing technique had been verified as a functional method to determine the VDO. The purpose of this study was to investigate the association between increasing VDO and mandibular movement during swallowing. Methods26 females and 14 males were enrolled (age range: 21 to 30 year-old). Under different increased VDO (3, 5, and 8 mm), the mandibular trajectory during swallowing was measured by K7 Evaluation System (Myotronics®). When the subjects were instructed to salivary swallowing, the range of mandibular movement in vertical, anteroposterior and lateral directions were recorded. ResultsIncreasing VDO significantly impacted the range of mandibular movement in lateral direction during swallowing (p < 0.0001, F value = 40.09). The average variance of the mandibular movement distance in lateral direction during swallowing raise 1.58 (p = 0.001); 3.59 (p = 0.0001) and 2.01 (p = 0.001) when th VDO was raised from 3 mm to 5 mm; from 3 mm to 8 mm and from 5 to 8 mm respectively. The range of mandibular movement was significantly correlated to the increasing VDO (p ≤ 0.05) under the analysis of the Post Hoc test. ConclusionsVDO was closely correlated to the trajectory of mandibular motion during swallowing. The increase in VDO could change the extent of mandibular trajectory during swallowing if the increase was more than 3 mm. The range of mandibular motion when swallowing had positive correlative tendency as the VDO was increased.

Management of Internal Derangement of Temporomandibular Joint Disc Displacement with Reduction Using Two Different Lines of Treatment

Objetive: This study was to compare the effectiveness of arthrocentesis versus the insertion of anterior repositioning splint (ARS) in improving the mandibular range of motion (MRM) for patients with the temporomandibular joint (TMJ) anterior disc displacement with reduction (ADDwR). Methods: 36 patients diagnosed as ADDwR were recruited and divided randomly into two groups. The first group (G1) was treated by arthrocentesis, and the second (G2) was treated using ARS. All patients were reexamined after six months. Results: Except that for protrusive movement, there were significant differences between the two groups for the percentage changes of the MRM as measured by the amount of pain free opening, unassisted opening, maximum assisted opening, right lateral and left lateral movements (p &lt; 0.05). Conclusion: Within the context of the current study, the non-invasive, lower cost ARS, provided better results in improving the MRM when managing ADDwR cases. Keywords Arthrocentesis; Anterior repositioning splint; TMD; Internal derangement; Anterior disc displacement; Mandibular range of motion.

Application of auriculotemporal nerve block and dextrose prolotherapy in exercise therapy of TMJ closed lock in adolescents and young adults

BackgroundTemporomandibular joint (TMJ) ‘closed lock’ is a clinical condition causing TMJ pain and limited mouth opening (painful locking). Recent studies suggest an increasing prevalence of degenerative joint disease associated with the onset of TMJ closed lock in adolescents and young adults. Early interventions are recommended, but the curative effect of standard therapies remains controversial. In this retrospective study, an alternative method of non-surgical treatment of TMJ closed lock is presented, and its long-term efficacy has been observed.MethodsForty adolescents and young adults, aged 16 to 30 years old, with distinct combination of symptoms of TMJ closed lock, were enrolled. Patients received anesthetic blockages of the auriculotemporal nerve, then performed mandibular condylar movement exercise for 10 min, and subsequently received hypertonic dextrose prolotherapy in retro-discal area of TMJ. Clinical assessments at baseline and at follow-up (2 weeks, 2 months, 6 months, and 5 years) included intensity and frequency of TMJ pain, mandibular range of motion, TMJ sounds, and impairment of chewing.ResultsCone beam CT images of the TMJs revealed joint space changes in all patients and degenerative bone changes in 20% (8/40) of the patients. The patients were diagnosed as having disc displacement without reduction with limited opening. Successful reduction of displaced disc had been achieved in the treatment. And pain at rest and pain on mastication had substantially decreased in all patients and mandibular function and mouth opening had significantly improved since 2 weeks’ follow-up. The overall success rate kept at a high level of 97.5% (39/40) at 6 months and 5 years’ follow-up.ConclusionsThe technique combining mandibular condylar movement exercise with auriculotemporal nerve block and dextrose prolotherapy is straightforward to perform, inexpensive and satisfactory to young patients with TMJ closed lock.

Are occlusal splints effective in reducing myofascial pain in patients with muscle-related temporomandibular disorders? A randomized-controlled trial.

Objectives This study aims to evaluate the effectiveness of upper Michigan occlusal splint (OS) compared to mandibular OS in terms of pain, range of motion (ROM), and muscle activity as assessed by surface electromyography (sEMG) in patients affected by muscle-related temporomandibular disorders (TMD). Patients and methods In this randomized-controlled trial, a total of 40 adult patients (13 males, 27 females; mean age: 47.2±12.8 years; range, 22 to 56 years) with a diagnosis of myofascial pain, lasting from at least three months on at least one masseter muscle. The patients were randomly allocated into two groups: Group 1 (n=20) using upper Michigan OS and Group 2 (n=20) using mandibular OS. At baseline (T0), at one (T1), three (T2), and six months (T3), the following outcomes were assessed: myofascial pain by Visual Analog Scale (VAS) and ROM of mandible movements, activity of the main masticatory muscles through sEMG. Results There were no significant intra-group differences in the outcome measures assessed in both groups. However, Group 2 had a significantly higher right lateral mandibular ROM at T2 (7.1±3.1 vs. 9.8±2.3, respectively; p<0.05) and a significantly higher left lateral mandibular ROM at T3 (7.6±3.5 vs. 10.5±2.1, respectively; p<0.05). We found no significant difference in none of the sEMG parameters. Conclusion Our study results suggest that OS, independently from being built on the upper or lower arch, seems to not have significant effects in reducing pain over a six-month period in TMD patients.

Bite force measurement in maxillofacial trauma – A clinical prospective study

Introduction: Maxillofacial fractures not only cause a change in the skeletal architecture (anatomical) but also lead to changes in the masticatory apparatus (functional). Masticatory function refers to the ability to chew without any interference or pain. The major determinants of this is the range of mandibular motion, maximum occlusal forces, and the activity of the masticatory muscles. This function is affected in maxillofacial trauma and also pathological injuries to the jaws. Bite force measurements are an excellent criteria for the assessment of masticatory efficiency. The purpose of this study was to assess the effect of maxillofacial fractures on the bite forces of patients treated for such fractures. Materials and Methods: 65 patients divided into 7 groups based on the kind of maxillofacial fracture. All the cases underwent ORIF. Bite force were measured on the immediate post-operative period, 1st , 4th and 12th post-operative week. The bite force instrument (transducer) was positioned between the antagonizing cusps in the region of Left First Molar and Right First Molar. Results: At the end of the 3rd post-operative week, all the groups showed a statistically significant increase in the bite force measurement as compared to the immediate post-operative bite force recording. Conclusion: Thus we conclude by saying that our study provides a basis for similar studies with a longer follow up period and larger sample size in order to assess the different kinds of maxillofacial trauma and its effect on bite force. Keywords: Bite force, Bite force device, Occlusal load, Maxillofacial trauma, Lefort fractures, Restoration of bite force.

Results of orthodontic treatment of a child with asymmetrical micrognathia and the congenital mandibular condylar hyperplasia

Aim. To analyze the results of orthodontic treatment of a child with asymmetrical micrognathia and mandiblar condylar hyperplasia.&#x0D; Methods. The configuration of a face in the photos was evaluated and diagnostic models of the jaws were analyzed by using the Ponts and Korkhaus methods in treatment dynamics. The physiological status of bone tissue, temporomandibular joints and teeth was studied by using orthopantomography and computed tomography. Functional disorders were detected by using special tests, including EschlerBittner's test and Ilyina-Markosyans test. Orthodontic treatment and stimulation of mandibular growth in the mixed dentition stage were undertaken with the single jaw removable appliances and the appliance improved by us for correction of the distal occlusion. The Damon Q bracket system with archwires was used in permanent dentition period.&#x0D; Results. The child's convex facial profile was typical for distal occlusion and micrognathia. The facial asymmetry, increasing with mouth opening, and a decrease in mandibular range of motion indicated lesion of the right temporomandibular joint. The right condyle was enlarged on the orthopantomogram. The computed tomography showed that it was asymmetrically enlarged and had a cellular structure. There was detected asymmetric micrognathia. The comprehensive rehabilitation plan included orthodontic treatment, myotherapy, speech therapy, mechanotherapy. The use of removable orthodontic appliances led to the normal size of the dentition and their relation, significantly reduced functional disorders and improved facial aesthetics. Five years after completion of orthodontic treatment, the physiological occlusion and amplitude of the mandibular movements remained, but the right mandibular angle was flattened.&#x0D; Conclusion. The comprehensive rehabilitation of a child with asymmetrical micrognathia and mandibular condylar hyperplasia started in mixed dentition stage provided conditions for the formation of normal permanent dentition and the improvement of functional disorders and facial aesthetics; our results allow us to suggest the positive effect of our tactics for treatment of the patient.

Craniofacial morphology/phenotypes influence on mandibular range of movement in the design of a mandibular advancement device

BackgroundThe mandibular opening path movements have different directions according to the craniofacial morphology of the patient but always downward and backward, therefore increasing the collapse of the upper airway. The aim of this work is to determine if there is a relationship between the craniofacial morphology and the mandibular movement to help understand the impact on the mandibular position.Methods52 students with full permanent dentition aged 19 to 23 years (mean 21.3 SD 1.7; 29 females and 23 males), participated in the study. Each subject had a lateral cephalometric radiograph taken. The opening angle was determined for two levels of vertical openings at 5 and 10 mm.ResultsThe opening angle showed a greater variability between subjects ranging from 63.15 to 77.08 for 5 mm angle and from for 61.65 to 75.72 for the 10 mm angle. Differences of facial phenotypes was evident when comparing the individual dissoccluding angle of the low angle horizontal pattern and high angle vertical pattern.ConclusionsThe opening angle is related to craniofacial morphology with higher vertical anterior and shorter anteroposterior faces having a more horizontal path of mandibular movement than shorter vertical anterior and longer anteroposterior subjects who have a more vertical path.

Loose intra-articular body in the temporomandibular joint: case report of a successful conservative management

Loose intra-articular bodies are a rare finding in the temporomandibular joint. Surgical removal of the loose bodies isoften described as the only treatment option; however, it presents possible postoperative complications. The aim of thispaper is to report the successful conservative management of a temporomandibular disorder associated with a singleloose intra-articular body. A 62-year-old woman presented with pain in the right temporomandibular joint andpre-auricular region, limited mouth opening and open-lock episodes. Panoramic radiography and cone-beam computedtomography exams revealed the presence of a single loose body located anterior to the right condyle. Magnetic resonanceimages showed bilateral anterior disc displacement without reduction. A non-invasive approach consisting of an occlusalsplint and low-level laser therapy associated with home-based physical therapy was performed for management ofclinical signs and symptoms. The patient was followed up for 2 years and presented significant pain reduction andimprovement in the range of mandibular movements. The combination of conservative therapies may be an alternativefor surgical intervention to control pain and improve mandibular function in patients with temporomandibulardysfunction associated with a loose body in the temporomandibular joint.

Comparison of unilateral rostral, middle and caudal segmental mandibulectomies as an alternative treatment for unilateral temporomandibular joint ankylosis in cats: an ex vivo study.

Temporomandibular joint ankylosis (TMJA) is the partial or complete inability to open the mouth due to intra- or extra-articular fibrous, bony or fibro-osseous tissue proliferation. Surgical procedures such as gap arthroplasty, condylectomy or wide extra-articular osteotomy have been recommended to treat this condition; these techniques are challenging, time-consuming and have been occasionally associated with postoperative recurrence, severe periarticular neurovascular iatrogenic trauma and death. Segmental mandibulectomy had previously been recommended as an alternative option for unilateral TMJA, but the location of mandibulectomy and extent of bone removal from the mandible region have not been mentioned in the literature. This study aimed to validate the area of the mandibular body (rostral, middle or caudal) and amount of bony tissue that should be osteotomized during a segmental mandibulectomy for treatment of unilateral TMJA in cats. In this block study, 30 cadaver heads of domestic shorthair cats were randomly divided into three groups of 10 specimens each based on the mandibular region that would undergo segmental mandibulectomy (rostral, middle and caudal). The size of the removed mandibular segment and pre- and postoperative vertical range of mandibular motion were compared for statistical purposes. A significant statistical difference was observed between the pre- and postoperative vertical range of mandibular motion between the rostral, middle and caudal segmental mandibulectomies (P <0.001). The mean postoperative recovered range of mandibular motion for the rostral, middle and caudal segmental mandibulectomies was 50.4%, 81.9% and 90.4%, respectively. The caudal segmental mandibulectomy showed the highest postoperative vertical range of mandibular motion. The removal of a minimum of 1.2 cm of the caudal mandibular body was required to achieve nearly full recovery of presurgical mouth opening in the specimens of this study. The caudal segmental mandibulectomy may eliminate the risk of iatrogenic periarticular neurovascular damage inherent to more invasive surgeries performed at the temporomandibular joint area. When performed unilaterally, the caudal segmental mandibulectomy is a viable surgical alternative that may show a similar outcome to other surgical techniques.

Mandibular orthognathic surgery does not alter temporomandibular joint symptoms – A single centre prospective study

AbstractAimMandibular orthognathic surgery has been considered a risk factor for developing temporomandibular dysfunction (TMD). A prospective follow‐up study was initiated to examine the correlation between two surgical techniques for mandibular advancement and setback on mandibular range of movement and temporomandibular joint symptoms.Materials and methodsThirty‐four patients who underwent mandibular orthognathic surgery were included. Twenty patients were operated with the intraoral vertical ramus osteotomy (IVRO) technique and subsequent rigid maxillomandibular fixation (MMF) for 6 weeks; 14 were operated with the bilateral sagittal split osteotomy (BSSO) with internal osteosynthesis. The patients completed a questionnaire regarding subjective symptoms and were examined 1 day before, and 1 year after surgery. Evaluations of tenderness upon muscular and articular palpation, assessment of mandibular mobility and calculation of the Helkimo index were performed.ResultsMean maximum mouth opening was reduced one year after surgery for both experimental groups. The BSSO‐group also experienced reduced laterotrusive and protrusive movements. No statistically significant differences within or between the groups were found for the Helkimo clinical dysfunction score. Both groups reported no differences in TMD‐related symptoms before and after surgery, and no differences were found between the groups.ConclusionsMaximum mandibular movement was slightly reduced for both surgical techniques. Assisted mouth opening, laterotrusive and protrusive mandibular movements were reduced after BSSO, and maximum mouth opening was reduced after IVRO. However, the differences were small and both groups were well within the normal range. None of the groups experienced changes in TMD‐related symptoms.

Movimentos mandibulares durante a fala antes e depois da frenectomia lingual

O objetivo desse estudo foi analisar a velocidade e a amplitude dos movimentos mandibulares durante a fala, antes e depois da frenectomia lingual, em uma amostra composta por 10 sujeitos entre 15 e 21 anos, com diagnóstico de anquiloglossia. Inicialmente foi realizada a aferição da abertura máxima de boca com paquímetro, bem como, da velocidade de abertura e fechamento de boca e da amplitude dos movimentos mandibulares durante a fala, com eletrognatógrafo- BioEGN. Os sujeitos diagnosticados com anquiloglossia foram encaminhados para realização da frenectomia lingual. Após 30 dias do procedimento cirúrgico, novos registros foram obtidos. Para análise dos dados foram aplicados os testes Shapiro-Wilk e o teste t-Student. Quando comparados os movimentos mandibulares antes e depois da frenectomia lingual, a análise das variáveis mostrou que os sujeitos apresentaram diferença estatistica­mente significante dos movimentos mandibulares durante a fala, mostrando que a anquiloglossia interfere na realização desses movimentos. O presente estudo mostra que a velocidade e amplitude dos movimentos mandibulares durante a fala foram melhoradas após frenectomia lingual em pacientes com anquiloglossia.

Orofacial rehabilitation after severe orofacial and neck burn: Experience in a Brazilian burn reference centre

ObjectiveTo quantify the benefits of a functional oral rehabilitation program for impairment caused by full thickness orofacial and neck burns, comparing the effects of early and late intervention. MethodsAn observational cross-sectional study was conducted in a burn reference center over a two-year period. Patients with full thickness orofacial and neck burns were divided in two groups: Group 1 was composed by 14 patients who began the rehabilitation program 3–12 months after the burn injury; Group 2 was composed by 15 patients who began the rehabilitation program more than 12 months after the burn injury. Treatment was based on current strategies of non-surgical exercises for orofacial contracture management. Outcome measurements included an oral motor clinical evaluation and the assessment of the mandibular range of movement. ResultsThe functional rehabilitation program was effective in reestablishing the oral motor functions (i.e deficits reduced to approximately 15% when compared to the optimal possible scores) and in restoring horizontal mouth opening dimensions, with more than 70% of the patients presenting measurements within the expected normal limits at the end of treatment. Our results did not indicate differences in performance between the group of patients in neither set of assessments, i.e. pre and post treatment (p > 0.05). ConclusionThe results of this study indicate that non-invasive orofacial contracture management is effective for patients with orofacial and neck burns, including those with long term sequelae.

Association between convergence insufficiency and temporomandibular disorder cross-sectional study.

Evaluate whether there is an association between convergence insufficiency and temporomandibular disorder (TMD) and whether there is an association between pain and range of motion in different degrees of TMD. We evaluated 138 individuals with TMD and 46 without TMD using the Research Diagnostic Criteria for temporomandibular disorders, the Fonseca Anamnestic Index (FAI), Numeric Pain Rating Scale, and the measurement of mandibular range of motion (ROM). Convergence insufficiency was diagnosed using the convergence test and Convergence Insufficiency Symptom Survey. Analysis of variance was used to compare age and mandibular ROM. The Kruskal-Wallis was used to compare mandibular ROM and pain between groups. The chi-square test was used to evaluate associations between TMD subgroups and the FAI, sex, and ocular convergence. The majority of individuals without TMD did not exhibit convergence insufficiency. The frequency convergence insufficiency was significantly higher among individuals with severe TMD (p < 0.003). Mean pain severity differed between individuals with and without TMD. Mandibular ROM diminished with the increase in TMD severity. Convergence insufficiency, age, the increase in pain, and the reduction in mandibular range of motion were associated with the degrees of TMD severity. Despite the significant associations between convergence insufficiency and both pain and TMD severity, these variables cannot be indicated as predictive factors due to the low variability in the linear regression analysis. The present findings can assist in decision making regarding the treatment of severe TMD and the evaluation of ocular convergence.