Terapia fonoaudiológica nas disfunҫões temporomandibulares (DTM): uma revisão de literatura

Introdução: A Disfunção Temporomandibular (DTM) é reconhecida como um grupo de condições musculoesqueléticas e neuromusculares alteradas que abrangem as articulações temporomandibula­res (ATMs), os músculos mastigatórios e todos os tecidos associados, com etio­logias múltiplas e tratamentos específicos. Objetivo: O objetivo deste trabalho é revisar a literatura sobre as propostas terapêuticas das disfunções temporomandibulares (DTM’s) e verificar quais são os procedimentos terapêuticos utilizados na terapia fonoaudiológica. Métodos: Foram incluídos artigos que agregaram aos seus objetivos a descrição de propostas de intervenção fonoaudiológica, publicados em português e inglês, com os resumos disponíveis nas bases de dados LILACS, PUBMED e SCIELO e publicados entre 2008 e 2018. Os descritores utilizados foram: “síndrome da disfunção da articulação temporomandibular”, “tratamento”, “fonoaudiologia”, “transtornos da articulação temporomandibular’’, “temporomandibular joint dysfunction syndrome”, “treatment”, “speech therapy”. Resultados: Dos 83 artigos selecionados, 10 foram considerados para análise do estudo por atenderem aos critérios de inclusão. Destes, 3 se encontravam sem acesso disponível e 2 estavam repetidos, restando, assim 5 artigos para a análise. Foram encontrados artigos que abordaram técnicas com laser de baixa intensidade, terapia miofuncional orofacial tradicional e bandagem terapêutica. Conclusão: Conclui-se que nos estudos na área da Fonoaudiologia, os tratamentos trazem, além da diminuição da dor, a necessidade da reabilitação das funções orofaciais. Os estudos ainda são escassos dentro dessa patologia, sendo de muita importância novas pesquisas sobre a DTM, pois a fonoaudiologia pode trazer uma variação benéfica de tratamentos, visando o restabelecimento das funções estomatognáticas.

Implications of Distraction Osteogenesis in Ankylosis of Temporomandibular Joint

Studies with children and adult patients submitted to mandibular distraction osteogenesis surgery were analyzed, whose complication was ankylosis of the temporomandibular joint. In this study, the objective was to carry out a narrative review of the literature, seeking the prevalence of this complication after distraction osteogenesis. The literature review was carried out in the electronic databases, PubMed and Scopus, using mesh terms and their respective entry terms. The screening process consisted of two phases: Phase I - Select by titles and abstracts; Phase II - Complete reading article based on selected articles from phase I. It was observed after the data tabulation a lack of scientific evidence regarding this complication after distraction osteogenesis; as well as a very large variability in the case report studies or case series since there are no clinical trials on this subject. Thus, it can be concluded that there are few studies to state the relationship between ankylosis of the temporomandibular joint after distraction osteogenesis, requiring further clinical trial studies on the subject. Keywords: Temporomandibular Joint Dysfunction Syndrome. Temporomandibular Joint Disorders. Osteogenesis. Distraction. Callotasis; Bone Formation ResumoForam analisados estudos com pacientes crianças e adultos submetidos a cirurgia de distração osteogênica mandibular que tiveram como complicação a anquilose da articulação temporo-mandibular. Neste estudo o objetivo foi realizar uma revisão narrativa da literatura buscando a prevalência desta complicação após a distração osteogênica. A revisão de literatura foi realizada nas bases de dados eletrônicas, PubMed e Scopus, utilizando mesh terms e seus respectivos entry terms. O processo de triagem consistiu em duas fases: Fase I - Selecionar por títulos e resumos; Fase II- Artigo completo de leitura baseado em artigos selecionados da fase I. Observou-se após a tabulação dos dados a falta de evidência científica com relação a esta complicação após a distração osteogênica; bem como uma variabilidade muito grande nos trabalhos de relato de caso ou série de casos uma vez que não existem ensaios clínicos referente a este assunto. Desta forma pode-se concluir que há poucos estudos para afirmarmos a relação entre a anquilose da articulação temporo-mandibular após a distração osteogênica, sendo necessários mais estudos de ensaio clínico sobre o tema. Palavras-chave: Síndrome da Disfunção da Articulação Temporomandibular. Transtornos da Articulação Temporomandibular. Calotasia. Formação Óssea.

THE PREVALENCE AND STRUCTURE OF CLINICAL MANIFESTATIONS OF TEMPOROMANDIBULAR JOINT DYSFUNCTION

Subject. The relevance of the study is associated with the widespread prevalence of diseases of the temporomandibular joint and masticatory muscles. The large amount and inconsistency of literature data, the lack of generally accepted terminology and diagnostic criteria, and the variety of treatment methods proposed by various authors lead to difficulties in the choice of treatment tactics encountered by the dentist in everyday practice in treating patients with temporomandibular joint pathology. The goal is to study the available literature data on the prevalence and structure of clinical manifestations of functional disorders of the temporomandibular joint. Methodology. The study was conducted on the basis of a search and study of scientific publications on the epidemiology of clinical manifestations of functional disorders of the temporomandibular joint in the databases PubMed, eLibrary, Scopus, Web of Sciens, Medline. The selection of materials was carried out by keywords. Results. The review presents the scientific data of various authors on the epidemiology of the clinical manifestations of dysfunctional disorders of the temporomandibular joint. The most characteristic objective signs of the temporomandibular joint dysfunction syndrome are: “noise” phenomena in the joint during movements of the lower jaw, pain during palpation of the masticatory muscles, restriction of opening of the mouth, deviation during opening of the mouth, bruxomania, displaced position of the lower jaw relative to the upper (transverse, medial distal), the presence of otological symptoms (pain and / or a feeling of stuffiness in the ears), a burning sensation, tingling, tingling, or pain in the tongue. Conclusions. A study of the literature over the past 15 years has revealed a wide variation in the prevalence of clinical manifestations of functional disorders of the temporomandibular joint, which does not allow an unambiguous conclusion about the epidemiology of its dysfunction.

Avaliação da efetividade de tratamentos conservadores para disfunções temporomandibulares miogênicas: revisão integrativa da literatura

Objetivo: revisão integrativa sobre os principais métodos de tratamento conservador para disfunção temporomandibular, sendo eles: placa oclusal, aconselhamento e farmacoterapia. Materiais e método: a busca foi feita nas bases de dados PubMed, SciELO, Lilacs e Google Acadêmico, utilizando os seguintes descritores: “counseling and temporomandibular joint”; “counseling and facial pain”; “counseling and temporomandibular joint dysfunction syndrome”; “counseling and temporomandibular joint and drug therapy”; e “counseling and drug therapy and facial pain”. Resultados: no total, foram encontrados 314 estudos nesta pesquisa, porém, somente 8 foram incluídos no estudo. Esses comprovam a eficácia desses métodos de tratamento, fazendo com que o paciente obtenha diminuição da sintomatologia dolorosa, melhora das funções mastigatórias, além de proporcionar um alívio na tensão muscular, devido ao relaxamento das estruturas relacionadas. A placa oclusal tende a diminuir as forças oclusais aplicadas, redistribuindo a carga mastigatória sobre as superfícies oclusais. Alguns fármacos (anti-inflamatórios, antidepressivos e relaxantes musculares) são capazes de minimizar a sintomatologia dolorosa, proporcionando uma melhora na qualidade do sono e a redução de episódios de dor intensa. Por sua vez, o aconselhamento orienta os pacientes para que possam evitar atitudes que piorem sua doença, educando-os e conscientizando-os sobre seus hábitos parafuncionais, além de reduzir os fatores causadores de sintomatologia dolorosa. Conclusão: conseguimos observar que esses tratamentos apresentam índices de sucesso relevantes, quando se referem à diminuição dos sintomas, especialmente o aconselhamento, que ainda é uma terapia conservadora pouco explorada. Faz-se necessária a realização de mais estudos neste campo, para que sejam obtidos resultados cada vez mais concretos e conclusivos.

POSITION OF THE TEMPOROMANDIBULAR JOINT DYSFUNCTION SYNDROME AMONG FACIAL PAIN SYNDROMES

At the present time, the actual problem of dentistry is the study of the issues of the syndrome of pain dysfunction (SPD) of the temporomandibular joint (TMJ), which is found in 14-20% of teenagers and significantly increases with age (Siemkin V.A, Rabukhina N.A., 2000 ; Khavatova VA, 2005). The pathology of TMJ dysfunction was detected in 80% of the examined patients (Bezrukov V.M, 2002). Separately allocated dysfunction of TMJ in dysplastic-dependent form of joint pathology, thereby emphasizing that dysfunction is a characteristic manifestation of dysplasia of connective tissue in the maxillofacial area (Statovskaia Ye.Ye, 2005; Kozlov D.L., Viazmin A.Y., 2007). According to observations of A.I Mirza, I.V. Mikheieva, V.M. Novikov and according to our data, in more than 90% of people, pathological phenomena in the area of the temporomandibular joint have nothing to do with the inflammatory processes of this combination. At the same time, various dysfunctions and pain spasm of separate areas of chewing muscles occupy the main place. The aim of the work was to analyze the causes and clinical symptoms of patients with SPD. In this regard, as it turned out from the anamnesis, many patients had been undergoing inappropriate treatment for a long time. The cavity of the temporomandibular joint was repeatedly injected emulsion hydrocortisone acetate, antibiotics and other medications, which do not work in case of SPD of the temporomandibular joint. In some cases, after such therapy, dysfunction of the mandible occurred, leading to an even greater disruption of the joint function and increased pain. A number of patients with SPD of the temporomandibular joint due to a false diagnosis for a long time received treatment for neuralgia of the trigeminal nerve by drugs, Novocain blockade or alcoholization of sensitive branches of the trigeminal nerve. These patients often had neuritis, which greatly worsened the patient’s condition and the prognosis of the disease. The clinical picture of the SPD of the temporomandibular joint and a number of such diseases (syndromes of Slider, Sikara, etc.) is often so obscure and confusing that a large clinical experience is needed to evaluate individual symptoms. In addition, it should be noted that dysfunction of the mandible occurs with lesions of any part of the temporomandibular complex. Thus, limitation of the mobility of the mandible usually develops with arthritis of the temporomandibular joint, abscesses and phlegmons of the parotideomasseterica, temporal regions, pterygomandibulare, parapharingenal space, jaw-tongue groove and osteomyelitis of the branches of the mandible. Diagnostic difficulties often increase due to the fact that it is not always possible to find out the atypical etiological origin of the SPD of the temporomandibular joint. Against the background of the listed objective adverse factors, the presence of diagnostic errors largely contributes to insufficient knowledge of dentists who have clinical questions and questions on treatment of the SPD TMJ due to the difficulty in differential diagnosis, which is not fully covered in textbooks on dentistry. Control of correctness of the established diagnosis is the blockade of the motor branches of the trigeminal nerve subcutaneously using the Yehorov's method, which results in the removal of muscle spasm, stops pain and improves the mobility of the mandible. Conducting additional paraclinical examination methods such as dynamic MRT, 3-D MRT, CT and electromyography should be done.

Management of Temporomandibular Joint Dysfunction Syndrome: An Overview

Temporomandibular joint dysfunction is a complex and multifactorial disorder of oro-facial region. It is one of the most common disorders in maxillofacial region. The usual complain of the patients with this syndrome are pain in the area of the jaw and associated muscles, eating problem, chewing and locking of the jaw. It is more common in female than male. It’s etiology is not yet well established. However it’s successful management depends on identification and controlling of the etiological factors.J Bangladesh Coll Phys Surg 2017; 35(3): 133-141