Case report of refractory temporomandibular joint disorder: the importance of a multidisciplinary approach
DOI:
https://doi.org/10.33448/rsd-v9i11.10516Keywords:
Temporomandibular joint; Temporomandibular joint disorders; Combined modality therapy.Abstract
Temporomandibular disorder (TMD) occurs when there is involvement of the temporomandibular joint (TMJ), masticatory muscles and associated structures. These disorders can result from pain and limitations of mandibular movements, difficulty in chewing, speaking and swallowing. Viscosupplementation of the TMJ with hyaluronic acid (HA) is a minimally invasive method and a therapeutic alternative in cases of pain and mandibular limitation. The aim of this study is to report the evolution of a clinical case of joint TMD refractory to conservative treatment, in a patient with bilateral TMJ pain during mandibular function, tinnitus and crepitation with difficulty opening the mouth. Multidisciplinary follow-up was performed, along with viscosupplementation therapy with hyaluronic acid (VAH) and oral motricity therapy based on mandibular strengthening. They were evaluated after 7 days, 30 days and 60 days, showing satisfactory improvement in 2 months. In conclusion, viscosupplementation associated with exercise-based therapy can be evaluated as effective therapeutic measures for the functional restoration of TMJ and pain reduction. Multidisciplinary treatment in refractory cases of TMD is of paramount importance for the control of signs and symptoms in the long term.
References
Alpaslan, G. H., & Alpaslan, C. (2001). Efficacy of temporomandibular joint arthrocentesis with and without injection of sodium hyaluronate in treatment of internal derangements. J Oral Maxillofac Surg, 59(1), 613–618.
Altman, R. D., Manjoo, A., Fierlinger, A., Niazi, F. & Nicholls, M. (2015). The mechanism of action for hyaluronic acid treatment in the osteoarthritic knee: a systematic review. BMC Musculoskelet Disord, 26(1), 321–8.
Avivi-Arber, L., Martin, R., Lee, J. C. & Sessle, B.J. (2011). Face sensorimotor cortex and its neuroplasticity related to orofacial sensorimotor functions. Arch Oral Biol, 56(1), 1440–1465.
Bjornland, T., Gjaerum, A. A. & Moystad, A. (2007). Osteoarthritis of the temporomandibular joint: na evaluation of the effects and complications of corticosteroid injection compared with injection with sodium hyaluronate. J Oral Rehabil, 34(1),583–9.
Bonotto, D., Custódio, L. G. & Cunali, P. A. (2011). Viscossuplementação como tratamento das alterações internas da articulação temporomandibular: relato de casos. Rev. Dor, 12(3), 274-278.
Boudreau, S. A., Farina, D. & Falla, D. (2010). The role of motor learning and neuroplasticity in designing rehabilitation approaches for musculoskeletal pain disorders. Man Ther, 15(1), 410–414.
Bouloux, G. F., Chou, J., Krishnan, D., Aghaloo, T., Kahenasa, N. & Smith, J.A. (2017). Is Hyaluronic Acid or Corticosteroid Superior to Lactated Ringer Solution in the Short-Term Reduction of Temporomandibular Joint Pain After Arthrocentesis? Part 1. J Oral Maxillofac Surg, 75, 52–62.ª
Bouloux, G. F., Chou, J., Krishnan, D., Aghaloo, T., Kahenasa, N. & Smith, J.A. (2017). Is Hyaluronic Acid or Corticosteroid Superior to Lactated Ringer Solution in the Short Term for Improving Function and Quality of Life After Arthrocentesis? Part 2. J Oral Maxillofac Surg, 75,63–7.b
Escoda-Francoli, J., Vazquez-Delgado, E. & Gay-Escoda, C. (2010). Scientific evidence on the usefulness of intraarticular hyaluronic acid injection in the management of temporomandibular dysfunction. Med Oral Patol Oral Cir Bucal, 15, 644–8.
Ferreira, C. L., Machado, B. C., Borges, C.G., Da Silva, M. A. M., Sforza, C. & De Felício, C. M. (2014). Impaired orofacial motor functions on chronic temporomandibular disorders. J Electromyogr Kinesiol, 24(4), 565-71.
Ferreira, N., Masterson, D., De Lima, R. L., Moura, B. S, Oliveira, A. T., Fidalgo, K. S., Carvalho A. C. P., Dos Santos, M. F., & Grossmann, E. (2018). Efficacy of viscosupplementation with hyaluronic acid in temporomandibular disorders: A systematic review. J Craniomaxillofac Surg, 46(11), 1943-1952.
Gencer, Z. K., Özkiriş, M., Okur, A., Korkmaz, M., & Saydam, L. (2014). A comparative study on the impact of intra-articular injections of hyaluronic acid, tenoxicam and betametazon on the relief of temporomandibular joint disorder complaints. J Craniomaxillofac Surg, 42, 1117–21.
Guarda-Nardini, L., Tito. R., & Staffieri A. (2002). Treatment of patients with arthrosis of the temporomandibular joint by infiltration of sodium hyaluronate: a preliminary study. Eur Arch Otorhinolaryngol, 259(5), 279-84.
Guarda-Nardini, L., Masiero, S., & Marioni, G. (2005). Conservative treatment of temporomandibular joint osteoarthrosis: intra-articular injection of sodium hyaluronate. J Oral Rehabil, 32, 729–34.
Hepguler, S., Akkoc, Y., Pehlivan, M., Ozturk, C., Celebi, G., & Saracoglu, A. (2002). The efficacy of intraarticular sodium hyaluronate in patients with reducing displaced disc of the temporomandibular joint. J Oral Rehabil, 29(1), 80–6.
Machado, B. C., Mazzetto, M. O., Da Silva, M. A. M. R., & de Felício, C. M. (2016). Effects of oral motor exercises and laser therapy on chronic temporomandibular disorders: a randomized study with follow-up. Lasers Med Sci, 31(5), 945-54.
Maffei, C., Garcia, P., de Biase, N. G., de Souza, C. E., Vianna-lara, M. S., & Grégio, A. M. (2014). Orthodontic intervention combined with myofunctional therapy increases electromyographic activity of masticatory muscles in patients with skeletal unilateral posterior crossbite. Acta Odontol Scand, 72, 298–303.
Melchior, M. O., Machado, B. C., Magri, L. V., & Mazzetto, M.O. (2016). Effect of speech-language therapy after low-level laser therapy in patients with TMD: a descriptive study. Codas, 28(6), 818-22.
Melchior, M. O., Magri, L. V., & Mazzetto, M. O. (2018). Distúrbio miofuncional orofacial, um possível fator complicador no manuseio da disfunção temporomandibular dolorosa. Relato de caso. BrJP, 1(1), 80-86.
Okeson, J. P., & de Leeuw, R. (2011). Differential diagnosis of temporomandibular disorders and other orofacial pain disorders. Dent Clin North Am, 5(1), 105–20.
Pereira A. S. et al. (2018). Metodologia da pesquisa científica. [e-book]. Santa Maria. Ed. UAB/NTE/UFSM. Recuperado de https://repositorio.ufsm.br/bitstream/han dle/1/15824/Lic_Computacao_Metodologia-Pesquisa-Cientifica.pdf?sequence=1
Quinn, J. N., & Bazan, N. G. (1990). Identifi cation of protaglandin E2 and leukotriene B4 in the sinovial fl uid of painful, dysfunctional temporomandibular joints. J Oral Ma- xillofac Surg 48(9),968-71.
Schiffman, E., Ohrbach, R., Truelove, E., & et al. (2014). Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache, 28(1), 6–27.
Sharma, A., Rana, A. S., Jain, G., Kalra, P., Gupta, D., & Sharma, S. (2013). Evaluation of efficacy of arthrocentesis (with normal saline) with or without sodium hyaluronate in treatment of internal derangement of TMJ – A prospective randomized study in 20 patients. J Oral Biol Craniofac Res, 3(1), 112–9.
Souza, R. F., da Silva, C. H. L., Nasser, M., Fedorowicz, Z., & Al-Muharraq, M. A. (2012). Interventions for the management of temporomandibular joint osteoarthritis. Cochrane Database Syst Rev. 4:CD007261.
Swann, D. A., Radin, E. L., Nazimiec, M., & et al. (1974). Role of hyaluronic acid in joint lubrication. Ann Rheum Dis, 33(4), 318-26.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2020 Pablo Leal Teixeira Santos; Fernanda Ferruzzi Lima; Marcelo Oliveira Mazzetto; Melissa de Oliveira Melchior; Lais Valencise Magri; Aline Akemi Mori
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
