Limited Mouth Opening Research Articles

Is temporomandibular joint involvement more frequent in patients with epilepsy? A clinical study

Statement of problemEpileptic seizures may affect the stomatognathic system via transmission of an increased load to the dentition and the temporomandibular joint (TMJ), resulting in temporomandibular joint dysfunction (TMD). PurposeThe purpose of this clinical study was to assess whether TMD was more prevalent in patients with epilepsy than in those without epilepsy. Material and methodsA total of 107 participants diagnosed with epilepsy and 100 healthy controls were enrolled in the study. Those with epilepsy were divided according to their dental manageability into 3 subgroups: mild group, moderate group, and severe group. Following general, dental, and TMJ-related history, the range of maximal mouth opening (MMO), laterotrusion, possible deviation and deflection, and presence of crepitation and clicking was recorded, as suggested by the diagnostic criteria for temporomandibular diseases (DC/TMD). Pressure pain threshold (PPT) was also measured by using a pressure algometer on 3 points bilaterally. ResultsIncidence of TMJ complaints was not significantly different between the control (30%) and the group diagnosed with epilepsy (33%); however, the number of complaints experienced was significantly higher in the epilepsy group (C: 3%, E: 16% had 3 or more complaints; P<.001). Joint clicking was significantly more prevalent in the entire epilepsy group (P=.012) and in the mild group (P=.004) than in controls. Crepitation and joint pain were not significantly more common in the epilepsy group. Maximal mouth opening, laterotrusion, and the ratio of restricted mouth opening did not differ significantly in the epilepsy group. Deflection occurred significantly more often in the epilepsy subgroups (mild and moderate groups; P<.001), and the extent of deflection was also significantly higher in all the epilepsy subgroups (P<.001) than in controls. Regarding the pressure pain threshold, significant difference was observed in the severe group at the left masseter muscle points M1 (P=.046) and M2 (P=.028) compared with controls. ConclusionsAll parameters typical of TMD could be found frequently in patients with epilepsy. Because of the seizures and the consequent joint overload, the TMJ involvement was more common or more serious in those diagnosed with epilepsy. Outcomes of this study support the assumption that epilepsy is a risk factor for the development of TMD.

Contribution of anatomical criteria to surgical approach for treatment of bilateral coronoid hyperplasia

IntroductionBilateral coronoid hyperplasia is a rare condition characterized by a progressive and painless limitation of mouth opening. The treatment consists of coronoidectomy by intraoral or coronal approach. There is no recommendation in the literature on the choice of the surgical approach according to the importance of the hypertrophy. The objective of our study is to search for predictive anatomical criteria of each approach. Material and methodsThese anatomical criteria were evaluated from 3D CT facial reconstructions of 4 male patients aged 4 to 30 years retrospectively after their surgery. A single intraoral approach was used for cases 1 and 2 (group A), a double approach for cases 3 and 4 (group B). Same measurements were performed on 10 male case controls (group C). We performed a descriptive analysis of our results due to an insufficient number of patients. ResultsThe average width of the coronal processes was much greater in group B, when a double approach was necessary, than in groups A and C. In groups A and B, the average height of the coronoid notch is low compared to group C when there is a need for a coronal approach. The width/TZS ratio is increased in group B compared to group C. DiscussionIn our study, 3 criteria could be informative for the choice of the surgical approach: the width at the superior end of the coronoid process, the width/TZS ratio and the height of the coronoid notch but additional data are needed to confirm our therapeutic options.

Malocclusion Complexity in Patients with Myofascial Pain with or without Mouth-Opening Limitation: A Case-Control Study.

Background This study is aimed at determining the association between myofascial pain with or without mouth-opening limitation and malocclusion complexity. Methods A prospective, cross-sectional, case-control study was conducted. The Research Diagnostic Criteria were used to evaluate the presence of myofascial pain, chronic pain, and depression. The Index of Complexity, Outcome, and Need (ICON) was applied to quantify malocclusion complexity. A total of 96 patients with myofascial pain were grouped into two: subjects without mouth-opening limitation (n = 76, group A) and subjects with mouth-opening limitation (group B, n = 20). Both groups were compared with 231 controls (group C). A Chi-squared test and a multinomial logistic regression (p ≤ 0.05) were used to identify associations between the variables. Results Statistically significant associations were found between myofascial pain and the variables gender, malocclusion complexity, and depression (p ≤ 0.05). Age was not significantly associated (p = 0.327). Concerning malocclusion complexity, 77.9% of the controls were distributed in the first three ICON levels; however, 76.5% of group A subjects and 90% of group B were in the last three (p < 0.001). The multinomial logistic regression showed a significant association between malocclusion complexity in group A (p < 0.05) and an association between depression and group B (p < 0.05). Group B had the highest grades of chronic pain. Conclusions Females had greater risk of myofascial pain without mouth-opening limitation. As the complexity of the malocclusion increases, so do the odds of presenting myofascial pain without mouth-opening limitation. Myofascial pain with mouth-opening limitation frequently coexists with depression and chronic pain.

Tied to the Top: A Case Report on an Isolated Ankyloglossia Superior

ABSTRACT Objective: To report a case of isolated ankyloglossia superior in a one-month-old boy. Methods: Design: Case Report Setting: Tertiary Government Training Hospital Patient: One Results: A one-month-old boy with failure to thrive, feeding difficulties and a palatoglossal band that limited mouth opening and anterior posturing of the tongue was diagnosed to have non-syndromic ankyloglossia superior and underwent surgical transection of the fibrous ankylosis under intravenous sedation due to difficulty of insinuating an endotracheal tube orally. Direct latch breastfeeding was successfully adapted from the second to tenth postoperative day before they were lost to follow up. Conclusion: Despite a complicated pediatric airway, coordinated surgical and anesthesia management successfully restored tongue function and mouth opening to allow effective feeding.

Randomized double blind comparison of ketamine – propofol and fentanyl – propofol for the insertion of laryngeal mask airway in children

The ideal combination that provides smooth insertion conditions with minimal side effects has not been identified, particularly in children. In this study, 70 children of age 3-12 years are divided randomly into 2 groups: Group 1-Group-F-Fentanyl (n=35) received Fentanyl 2μg/kg and Group 2-Group –K- Ketamine (n=35) received Ketamine 0.5mg/kg before induction of anaesthesia. Baseline heart rate and arterial blood pressure were measured. Vital parameters (Heart rate and Arterial Blood Pressure) were measured before induction, before LMA insertion and thereafter at 1, 3 and 5 minutes after LMA insertion. Ideal LMA insertion conditions were evaluated with six variables by blinded observer: mouth opening, gagging, head and limb movements, laryngospasm and resistance to insertion. Also the apnoea time was noted. The incidence of head/limb movements was statistically significant and Group Propofol – Ketamine showed 22% compared to Fentanyl-Propofol group (2.8%) Coughing/gagging was seen in 2.86% of both the groups. Resistance to insertion was statistically significant with p value of 0.0268 showing more in Propofol + Ketamine. There was no statistical significance in the occurrence of restricted mouth opening, restriction to LMA insertion and occurrence of swallowing between the two groups.

Difficult Laryngoscopy Prediction Score for Intubation in Emergency Departments: A Retrospective Cohort Study.

ObjectiveDifficult laryngoscopy is associated with difficult intubation, an increasing number of endotracheal intubation attempts, and adverse events. Clinical prediction of difficult airways in an emergency setting was limited in sensitivity and specificity. This study developed a new model for predicting difficult laryngoscopy in the emergency department.MethodsThis retrospective cohort study was conducted using an exploratory model at the Emergency Medicine of Ramathibodi Hospital. The study was conducted from June 2018 to July 2020. The eligibility criteria were an age of ≥15 years who undergo intubation in the emergency department. Difficult laryngoscopy was defined as a Cormack–Lehane grade 3 and above. The predictive model and score were developed by multivariable logistic regression analysis.ResultsA total of 617 patients met the eligibility criteria; 83 (13.45%) had difficult laryngoscopy. Five independent factors were predictive of difficult laryngoscopy. Significant factors were M: limited mouth opening, O: presence of obstructed airway, N: poor neck mobility, T: large tongue, and H: short hypo-mental distance. The difficult laryngoscopy score had an accuracy of 89%. A score of >4 increased the likelihood ratio of difficult laryngoscopy by 7.62 times.ConclusionThe MONTH Difficult Laryngoscopy Score of >4 was associated with difficult laryngoscopy.

Beneficial role of customized intraoral stents in radiotherapy for nasopharyngeal carcinoma.

e18642 Background: The intraoral stent is a mouth-opening device which may be used in nasopharyngeal carcinoma (NPC) patients during radiotherapy with the intention of preventing unnecessary irradiation in normal adjacent tissue. The purpose of this study was to investigate the effects of individualized intraoral stent on the intensity modulated radiation therapy(IMRT) by evaluation dose distribution and consequent radiobiological derived outcomes for NPC patients. Methods: Sixteen patients with NPC who used intraoral stent and 17 patients without intraoral stent were enrolled in this study. All patients underwent Helical Tomotherapy (HT) in our center. For the planning target volume (PTV), the conformity index (CI) and homogeneity index (HI) were used to compare two groups of HT plans (with or without intraoral stent). The mean dose of normal tissues were recorded for the two groups. Oral mucositis, gustatory sense, mouth opening and salivary function of each patients were weekly assessed at the beginning, during and after radiotherapy by clinical examination. Results: The mean dose metrics of oral cavity, mandible, left and right parotid gland in patients with intraoral stent was significantly decreased by 11.6%, 12.2%, 15.4%, and 8.7% on average, respectively (P &lt; 0.05), while the conformity index (CI, P = 0.056) and homogeneity index (HI, P = 0.676) of the tumor target showed no statistically different. The rates of grade I，II, III of oral mucositis of patients with intraoral stent were 43.15%, 43.75%, 12.50% when radiotherapy was just over. While the rates of patients with intraoral stent were 23.53%, 17.65%, 58.82%. There were significantly different in two groups (p = 0.022). There was no significant difference in the decline of taste function among each groups. But the symptoms of xerostomia and mouth opening restriction in the group with intraoral stent had been relieved significantly compared the group without intraoral stent at 1 month and 6 months after radiation. Conclusions: The custom-made intraoral stents showed promising value at sparing normal tissue during radiotherapy for NPC without affecting target dose coverage or tumor control. Clinical trial information: No. NJSH-2021NL-041.

New Approach for Virtual Surgical Planning and Mandibular Reconstruction Utilizing the Occipital Crest as a Native Midline Landmark

Virtual surgical planning (VSP) using computer-aided design and manufacturing (CAD-CAM) has been reported to aid in craniofacial reconstruction. The reported improvements have been related mainly to operative performance, with limited evaluations of the position and function of the temporomandibular joint (TMJ). This study analyzed the radiographic details of postoperative outcomes of mandibular reconstruction related to the TMJ as well as the mandibular Gonion angles utilizing the external occipital crest of the cranial base as an alternative to the sagittal plane for mirror image purposes. The patient initially presented to us with massive disfigurement with a counter-clockwise rotation of the condyle bearing segment of the affected side apparently under the effect of the temporalis muscle with a limited mouth opening and deviation while opening. Post-operative (virtual planning) were analyzed to compare the condyle segment with the previous position as well as the angles of the mandible The virtual surgical planning utilizing the cranial base triangle gives a better position for both the condyle and the angle with a more symmetrical position and the condyle in more favorable position within the glenoid fossa. The external occipital crest is a native midline landmark that could be utilized as an alternative to the sagittal plane for a mirror image in mandibular reconstruction with all the hereditary errors that are sensitive to the position of the sagittal plane virtually. This case report shows a better condyle position with virtual surgical planning versus the traditional method of reconstruction.

Severe Post-Traumatic Trismus Unresponsive to Drug Therapy in a 12-Year-Old Patient Treated with a Capacitive-Resistive Electrical Transfer Therapy: A Case Report

(1) Background: Trismus clinically manifests as a reduction of the buccal opening and restricted mouth opening due to different etiologies, but it is often associated with traumatic phenomena. Several treatments have been proposed such as physiotherapy exercises, cryotherapy, laser therapy, hyaluronic acid and platelet-rich fibrin infiltration, but the gold standard is represented by drug therapy based on corticosteroids and NSAIDs, currently the most documented in the scientific literature. Capacitive-resistive electric transfer (Cret) therapy is used to treat musculoskeletal injuries. Cret is a non-invasive electrothermal treatment classified as deep thermo-therapy. (2) Patient: We would like to document a case of particularly traumatic trismus in a 12-year-old patient, not responsive to previous pharmacological therapy and treated with a radiofrequency device called Velvet temporomandibular joint (TMJ). Five capacitive and resistive diathermy sessions with the device were performed. The first four sessions were performed every 4 days and the fifth after 5 days. (3) Result: The maximum opening of the mouth was 10 mm at the initial stage and 38 mm at the end of the six sessions. Pain regressed after the second appointment. (4) Conclusions: Clinical studies with a good number of samples need to be conducted to evaluate the effectiveness of this device which has proved to be an excellent treatment for this refractory case to conventional therapies. Finally, it may be useful to define precise and replicable protocols to make this therapy suitable for patients with TMJ disorders.

Can TMJ morphological alterations impede TMJ agony?

Introduction: The relation between temporomandibular joint morphology and its incoordination is an arena which is not ventured in much even though many researches have been done but still it is a drop in the ocean of such a vast and complicated structure of the human TMJ anatomy. Objective: To evaluate morphological variations of temporomandibular joint in healthy and disorder patients using computed tomography. Study Design: A total of 20 temporomandibular joint disorder patients and 10 patients with normal TMJs and Class I occlusion were studied. The study was conducted at SUM Hospital and Oral Medicine and Radiology department, IDS Bhubaneswar with TMJ as chief complaint during a period from September 2016 to November 2016. Symptomatic group and asymptomatic group based on according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/ TMD) were selected. The present research on TMJ morphology has been designed to investigate parameters like shape of condyle, glenoid fossa and articular eminence in relation to various temporomandibular disorders (TMD).The patients were enrolled with symptoms or signs such as pain, restricted mouth opening, deviation, clicking. A series of morphological parameters with teeth in maximum intercusspation were studied in CT scan. &#x0D;

Dual-Echo magnetic resonance imaging pulse sequence in diagnosis of temporomandibular disorders

Objective: This study was conducted to assess the diagnostic accuracy of different MRI pulse sequence dual-echo-PD in the diagnosis of temporomandibular disorders. Subjects and methods: Twenty seven patients (54 Temporomandibular joints) with painful joints or limited mouth opening or unexplained longstanding headache were enrolled in the study to examine the diagnostic accuracy of magnetic resonance imaging sequence dual-echo in delineation of the articular disc position, the disc morphology, and the cortical bone in comparison to the gold standard of MRI scanning sequence: proton density weighted images. Results: Dual-echo-PD weighted image showed 94.7% sensitivity and 96.3% diagnostic accuracy in identifying articular disc position. Dual-echo-PD showed no statistically significant difference than proton-density in delineation of disc morphology or cortical bone. Conclusions: The dual-echo imaging sequence can be used instead of using PD to delineate disc position, morphology, and cortical bone.

The effect of intraarticular botulinum toxin-A injection on symptoms of temporomandibular joint disorder

IntroductionApplication of arthrocentesis in temporomandibular joint disorders preferred and suggested therapeutic treatment option in recent years. This study was designed to investigate and compare the effect of intra-articular injection of botulinum toxin-A (Btx-A) on pain and mouth opening after arthrocentesis in nonreduction disc displacement. Materials and methodsThis restrospective study was conducted on 30 patients with a visual analogue scale is higher than five and limited mouth opening. Patients were divided into 2 groups as conventional arthrocentesis group (group A) and intra-articular Btx-A injection following arthrocentesis group (group B). Maximum mouth openining and temporomandibular joint pain were measured in preoperative (t0) and at postoperative 1st-week (t1), 1st-month (t2) and 6th-month (t3). ResultsWhen VAS scores of group A and group B were examined, no statistical difference was observed at t0 and t1 time intervals; an increased in mouth opening values and decreased VAS score values were observed in both groups in the 1st month (t2) and 6th (t3) months, mostly in group A. Conclusionİntra-articular injection of Btx-A following arthrocentesis can induce mouth opening and reduce the pain and dysfunction in patients with anterior disc displacement.

Awake Intubation with i-Scope Videolaryngoscope in a Case of Limited Mouth Opening

Awake Intubation with i-Scope Videolaryngoscope in a Case of Limited Mouth Opening

Pattern of Temporomandibular Pain Dysfunction Syndrome

Aim: The aim of this analysis was to understand the pattern of temporomandibular pain dysfunction syndrome among patients with TMPDS. Study Design: A descriptive cross-sectional study. Place and Duration: In the department of Oral and Maxillofacial Surgery, PIMS Hospital, Islamabad and Punjab Dental Hospital, Lahore for duration of Four months from 16th January 2021 to 15th May 2021. Methods: A total of 46 patients with a clinical demonstration of TMPDS were enrolled in the analysis. Data was collected on demographic characteristics, major ailments, etiology, history of stress and depression. Results: In this study, 18 (39.1%) of the 46 patients were male and 28 (68.9%) females. 17 to 70 years was the age range of patients with 24.3 ± 12.9 years mean age and 20 (43.5%) subjects in the 10-19 age group and then 9 (19.6%) patients in the 20-29 age group and 3 (6.5%) was observed in the 60-69 age group. Regarding the main complaint, pain was the most prevalent complain noticed in 34(73.9%) subjects. 7 (15.2%) patients reported click, limited mouth opening was observed in 5 patients (10.9%). Etiology was caused by facial trauma in 8 (17.4%) of 46 subjects and only 3 person (6.4%) reported Bruxism. Twelve patients (26.1%) have stress as the only etiology. Collectively stress was testified in 21 subjects (45.6%). The etiology could not be established in 14 (30.4%) patients. Nine stressed people used psychiatric medications for clinical depression (19.6%). Conclusions: In our analysis, TMPD was common in women with 25 years mean age. The most common underlying complaint was pain. Stress was the communal primary etiology. Also 23% have Clinical depression in stressed people. Keywords: Temporomandibular pain dysfunction syndrome, Stress, Pain.

Effects of Low-Level Laser Therapy on Osseous Defects Distal to Mandibular Second Molar after Extraction of Impacted Third Molar.

Objective To evaluate the efficiency of low-level laser therapy on the distal osseous defects of the mandibular second molar (M2) after the adjacent impacted third molar (M3) extraction. Methods A total of 59 clinic cases were screened out, whose M3 were impacted and the distal alveolar bone of M2 had been destroyed horizontally. They were randomly divided into 2 groups based on whether they would have laser irradiation or not after M3 extraction. Then, postoperative complications of the 2 groups were compared. The alveolar bone level distal to M2 was established before and 3 to 6 months after M3 extraction by radiographic evaluation, which was compared between two groups. Results The incidence of severe pain and mouth-opening limitation was significantly lower in the LLLT group than that in the control group. The amount of bone formation in the LLLT group was higher than that in the control group 3 months after the operation, and the difference was statistically significant. But the difference was not statistically significant 6 months after surgery. Conclusion LLLT may alleviate postoperative complications and improve early osteogenesis. It is a viable option for use in the treatment of osseous defects distal to mandibular second molars following extraction of impacted third molars.

Effects of Radial Extracorporeal Shock Wave Therapy in Reducing Pain in Patients with Temporomandibular Disorders: A Pilot Randomized Controlled Trial

Temporomandibular disorders (TMD) are primarily characterized by pain as well as issues concerning the proper functioning of individual elements of the stomatognathic system. The aim of the study was to assess the safety and efficacy of physical exercise, with or without radial Extracorporeal Shock Wave Therapy (rESWT), in patients with TMD. Eligible patients were adults (≥18 years) with diagnosed myofascial pain with or without mouth opening limitation (Group Ia, Ib) based on the Diagnostic Criteria for TMD (DC/TMD). Enrolled patients (n = 15) were randomly assigned 1:1 to receive physical exercise combined with rESWT (n = 8) or sham rESWT (n = 7) for four weeks. The primary endpoint was the pain intensity measured by a visual analogue scale (VAS). The secondary endpoints were muscle activity and function assessed through the surface electromyography evaluation of the anterior temporalis and the masseter muscles. The rESWT group (mean age: 28.50 ± 8.85 years) showed a statistically significant pain reduction (VAS Right side: ΔT0-T1 MD = −3.00; p = 0.023, Left side: ΔT0-T1, MD = 3.57, p = 0.021), whereas patients in the sham WBV group (mean age: 30.71 ± 8.98 years), did not reach statistical significance (VAS: Right side: ΔT0-T1 MD = 1.00, p = 0.155; Left side: ΔT0-T1 MD = 1.25 SE = 0.25, p = 0.094). Concurrently, muscle activity and performance significantly improved in the active rESWT group, with an improvement in the percentage of the overlapping coefficient (POC) compared to the control group. No dropouts and no side effects were recorded. Taken together, the findings of this pilot RCT suggested that rESWT combined with physical therapy could be effective in relieving pain and improving function in muscle-related TMD patients.

Giant Osteochondroma of the mandibular condyle and temporomandibular joint - A case report

Osteochondroma is one of the common bone tumours but is rarely seen in the head and neck region. Osteochondroma of the mandibular condyle, extending to the temporomandibular joint (TMJ) is an infrequent occurrence. Patients commonly present with restricted mouth opening and malocclusion. Due to the significant overlap in features between chondromas and condylar hyperplasia, it is very likely to be misdiagnosed, resulting in treatment errors. In this report, an interesting case of a large osteochondroma of the mandibular condyle extending into the zygomatic and petrous part of the temporal bone involving the left TMJ in a 35-year-old female patient is described who presented with facial asymmetry and restricted mouth opening. This paper outlines the clinico-radiographic and histopathological features for diagnosis and appropriate treatment of osteochondroma.

A case of monosomy 21 presented with difficult tracheal intubation

BackgroundMonosomy 21 is a rare chromosomal abnormality. It is mainly associated with mental retardation, intellectual disability, growth retardation, microcephaly, and characteristic facial features. General anesthesia in adults with this disease has not been reported. We report difficult airway management of an adult patient with monosomy 21.Case descriptionA 30-year-old female was scheduled for laparoscopic gynecological surgery. She was diagnosed with monosomy 21 at birth and accompanied with mental retardation. Preoperative examination revealed limited mouth opening with Mallampati score of IV, but no abnormal laboratory test or chest X-P. Anesthesia was performed using general anesthesia with epidural analgesia. Although bag-mask ventilation was improved by a muscle relaxant, mouth opening was further restricted, and laryngoscope insertion was impossible. Tracheal intubation was achieved using a bronchofiberscope. The operation procedure was completed, and the patient was discharged from the hospital without any major postoperative complications.ConclusionsIn this patient, mouth opening was further reduced after induction of general anesthesia with a muscle relaxant. Preoperative evaluation and adequate preparation of airway management are important for general anesthesia in an adult patient with monosomy 21.

Clinical study for the characteristics and treatment of masticatory muscle tendon-aponeurosis hyperplasia

Masticatory muscle tendon-aponeurosis hyperplasia (MMTAH) is a new disease entity that is characterised by hard severely limited mouth opening without pain. Additionally, MMTAH may be frequently misdiagnosed as bilateral fibrous ankylosis of the temporomandibular joint (TMJ) by clinicians. This study aimed to identify the characteristics and treatment of MMTAH. We selected 22 patients who presented with limited mouth opening and underwent bilateral aponeurectomy and coronoidectomy and 10 healthy participants without limitations in mouth opening. All participants underwent mouth opening training following surgery, and follow-up assessments were performed every 3 months. Mandibular movements were recorded during maximal opening and excursion. Moreover, we conducted surface electromyography (EMG) of the masseter and anterior temporalis muscles during maximum voluntary teeth clenching and used a pressure-sensitive film to assess the occlusal load in the intercuspal position. There were no significant differences in the lateral and protrusive movements of the mandible between patients with MMTAH and their healthy counterparts. Both occlusal force and EMG activity were considerably higher in patients with MMTAH than in healthy participants. In addition, the EMG activity of the anterior temporalis muscle was significantly higher than that of the masseter muscle in these patients. Furthermore, the maximal opening increased markedly and the occlusal force decreased significantly after surgery. MMTAH is characterised by the large occlusal force and EMG activity of the masseter muscles and anterior temporalis, and surgery is a useful treatment for this disorder.

Therapeutic approach to patients with chronic orofacial pain with temporomandibular disturbed

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