A multidisciplinary approach to treating musculoarticular dysfunction of the temporomandibular joint with obvious pain syndrome

Abstract

Objective: to investigate the efficiency of an integrated approach to treating craniomandibular dysfunction, by changing the biomechanical tempomandibular joint (TMJ) movement pattern via botulinum toxin type A injection into the masticatory muscles.Patients and methods. The investigation enrolled 20 patients aged 18-45 years with clinical signs of muscular-articular dysfunction of the TMJ. Before and after treatment, all the patients underwent magnetic resonance imaging of the TMJ and masticatory muscles, as well as ultrasonography and surface electromyography (EMG) of the masticatory muscles.Results. There was a significant reduction in pain syndrome, an improvement in the relationship of intra-articular TMJ elements, and a change in the structure of the masticatory muscles. The EMG indices were near-normal. Four-six months after treatment, the majority of patients showed an increase in the amplitude of mouth opening (95%), reductions in resting pain (85%) and in the frequency of TMJ clicking (90%).Conclusion. The management of patients with severe chronic pain syndrome in the presence of muscular-articular dysfunction of the TMJ requires the participation of an orthodontist to correct malocclusion and a neurologist to treat local myofascial pain syndrome.

Keywords

• craniomandibular dysfunction
• musculoarticular dysfunction of the temporomandibular joints
• muscular prosopalgia
• botulinum toxin type a
• masticatory muscle ultrasonography
• magnetic resonance imaging
• surface electromyography