gms | German Medical Science

Objective: The aim of this study was to point out the complex structure of temporomandibular joint, to show one of the causes of temporomandibular disfunction as well as the possibilities and outcome of the physical therapy in reducing subjective symptoms and improving the functional status. Temporomandibular disfunction includes a series of pathological conditions with similar symptoms which in their basis have disfunction of temporomandibular joint. One of the most often listed TMD classifications in literature is the one of Oksen J.P, accepted by the American Academy of Orofacial Pain. The TMJ is a small, but complex joint whose function is of vital importance. The injuries of the joint are caused by a direct impact of force which is, through the joint, transferred to the base of skull. Concerning the fact that the mandible is the strongest facial bone, the most common type of injury is a one sided luxation of the TM joint. The joint consists of: convex joint body – head of mandible, concave joint bodytemporal bone socket, and in between these two joint bodies – the articular disc. The joint capsule is reinforced with ligaments ( lateral, sphenomandibular, stylomandibular ligaments). The range of movement in this joint includes opening and closing of mouth and rotations. In the act of opening the mouth, the force of gravity takes part, as well as platisma muscle, digastric muscle and lateral pterygoid muscle.

Material/Methods: Case study: Patient XX, 54 years old, suffered a subluxation of TM joint during a chiropractic class where he/she took part as a demonstration model. Clinical picture was dramatic (strong pain in TM joint, local swelling, hypersalivation, lowered angle of the mouth, movement restriction). Apart from clinical findings, in diagnosis we used X-ray, OPT, CT/MR scan of what we gain insight into the joint and bone structure and numerous soft tissue structures of articular region. After diagnosis, treatment implied the reposition, immobilization of joint for 48 hours, pureed food through a straw and application of physical proceedings afterwards (criotherapy, laser therapy, sonophoresis, electrotherapy-electrophoresis with medicaments, magnetic therapy, IR light) and local infiltration of glucocorticoids. By reducing local swelling and signs of inflammation inorder to reduce the pain we conducted acupuncture as well. During the 6 months period of treatment we observed the following parameters: pain by VAS (0-10cm) patient subjective evaluation method for 2 weeks. Size of maximal mouth opening was measured in cm (the distance between the upper and lower teeth) for 4 weeks. The quality of chewing was observed every 4 weeks at the control examination of the patient by the answers to the given questions, the ability of chewing the soft, semisolid and solid food (answers: without difficulties -1, with partial difficulties -2, impossible to chew -3)

Results: After 6 months of treatment pain in the joint at the phase of rest was significantly reduced (p<0,025), there was no statistically significant reduction in pain when chewing, the size of maximal mouth opening was increased (p<0.002), while analyzing the answers to the solid food chewing ability was no statistically significant improvement.

Conclusion: The comlex structure of TM joint, including its vital function (food chewing) requires timely diagnosis, reposition measures, resting phase, gradual transition from pureed food on a solid while results of applied physical therapy have an important place in reducing pain and increasing joint mobility