A efIcácia dos recursos fIsioterapêuticos no ganho da amplitude de abertura bucal em pacientes com disfunções craniomandibulares / The effectiveness of the physiotherapeutic resources in the gain of the amplitude of bucal opening in patients with craniomandibular dysfunctions

Introdução: A Articulação Temporomandibular (ATM) é um dos componentes do sistema estomatognático e vem sendo estudada por diversas áreas das ciências da saúde. Qualquer alteração em um dos constituintes articulares e musculares da ATM predispõe ao aparecimento das Disfunções Craniomandibulares (DCMs). A DCM caracteriza-se por diversos sinais e sintomas, como a limitação dos movimentos mandibulares, sendo classificada em musculares, articulares e musculoarticulares. A limitação dos movimentos da mandíbula pode estar associada à dor e aos desarranjos internos da ATM. Com isso, a fisioterapia é uma alternativa de tratamento das DCMs, melhorando os sinais e sintomas que as envolvem. Objetivo: Identificar a eficácia dos recursos fisioterapêuticos no ganho da amplitude de abertura bucal em pacientes com DCM, por meio de uma revisão de literatura. Metodologia: Foi realizado um levantamento bibliográfico nas seguintes bases de dados: PUBMED, SciELO, PEDro, HighWire Press e PERIÓDICOS CAPES no período de 1998 a 2008. Além disso, foram utilizados livros atualizados referentes ao tema abordado. Resultado: Dezessete artigos foram analisados, sendo cinco constatando a limitação de abertura bucal; os demais descreveram e sugeriram tratamentos para melhorar a amplitude de abertura bucal em pacientes com DCM. Conclusão: Foi observada melhora na amplitude de abertura da boca em pacientes com DCM, mediante os tratamentos propostos nos artigos revisados.

Introduction: The Temporomandibular joint (TMJ) is one of the components of the stomatognathic system and has been studied by several areas of health sciences. Any change in one of the constituents of the TMJ joint and muscle predisposes to the appearance of Craniomandibular disfunction (CMD). The CMD is characterized for several signs and symptoms, among them the limitation of the mandibular movements, being classified as muscle, to articulate and muscle to articulate. The limitation of movements of the jaw can be associated to the pain and to the internal disorders of the TMJ. With that, the physiotherapy is an alternative of treatment of the CMDs, improving the signs and symptoms that involve them. Objective: To identify the effectiveness of physiotherapy in the gain range of mouth opening in patients with DCM by means of a literature review. Methodology: A survey in the following bibliographic databases: PUBMED, SciELO, PEDro, and HighWire Press PERIODIC CAPES during 1998 to 2008. Furthermore, we used updated books on the subject addressed. Result: Seventeen articles were reviewed, with 5 noting the limitation of mouth opening, the other described and suggested treatments to improve the range of mouth opening in patients with DCM. Conclusion: There was improvement in range of mouth opening in patients with DCM, the treatments offered by the reviewed articles.

A eficácia dos recursos fisioterapêuticos no ganho da amplitude de abertura bucal em pacientes com disfunções craniomandibulares / The effectiveness of the physiotherapeutic resources in the gain of the amplitude of bucal opening in patients with craniomandibular dysfunctions

Introdução: A Articulação Temporomandibular (ATM) é um dos componentes do sistema estomatognático e vem sendo estudada por diversas áreas das ciências da saúde. Qualquer alteração em um dos constituintes articulares e musculares da ATM predispõe ao aparecimento das Disfunções Craniomandibulares (DCMs). A DCM caracteriza-se por diversos sinais e sintomas, como a limitação dos movimentos mandibulares, sendo classificada em musculares, articulares e musculoarticulares. A limitação dos movimentos da mandíbula pode estar associada à dor e aos desarranjos internos da ATM. Com isso, a fisioterapia é uma alternativa de tratamento das DCMs, melhorando os sinais e sintomas que as envolvem. Objetivo: Identificar a eficácia dos recursos fisioterapêuticos no ganho da amplitude de abertura bucal em pacientes com DCM, por meio de uma revisão de literatura. Metodologia: Foi realizado um levantamento bibliográfico nas seguintes bases de dados: PUBMED, SciELO, PEDro, HighWire Press e PERIÓDICOS CAPES no período de 1998 a 2008. Além disso, foram utilizados livros atualizados referentes ao tema abordado. Resultado: Dezessete artigos foram analisados, sendo cinco constatando a limitação de abertura bucal; os demais descreveram e sugeriram tratamentos para melhorar a amplitude de abertura bucal em pacientes com DCM. Conclusão: Foi observada melhora na amplitude de abertura da boca em pacientes com DCM, mediante os tratamentos propostos nos artigos revisados.

Introduction: The Temporomandibular joint (TMJ) is one of the components of the stomatognathic system and has been studied by several areas of health sciences. Any change in one of the constituents of the TMJ joint and muscle predisposes to the appearance of Craniomandibular disfunction (CMD). The CMD is characterized for several signs and symptoms, among them the limitation of the mandibular movements, being classified as muscle, to articulate and muscle to articulate. The limitation of movements of the jaw can be associated to the pain and to the internal disorders of the TMJ. With that, the physiotherapy is an alternative of treatment of the CMDs, improving the signs and symptoms that involve them. Objective: To identify the effectiveness of physiotherapy in the gain range of mouth opening in patients with DCM by means of a literature review. Methodology: A survey in the following bibliographic databases: PUBMED, SciELO, PEDro, and HighWire Press PERIODIC CAPES during 1998 to 2008. Furthermore, we used updated books on the subject addressed. Result: Seventeen articles were reviewed, with 5 noting the limitation of mouth opening, the other described and suggested treatments to improve the range of mouth opening in patients with DCM. Conclusion: There was improvement in range of mouth opening in patients with DCM, the treatments offered by the reviewed articles.

A direct anatomical study of the morphology and functionality of disco-malleolar and anterior malleolar ligaments / Estudio anatómico directo de la morfología y funcionalidad de los ligamentos disco-maleolar y maleolar anterior

The disco-malleolar and anterior malleolar ligaments are common to the middle ear, the temporomandibular joint and the jaw, all of them sharing a common embryological origin; these ligaments' morphometric and functional aspects were studied in 23 temporal bones. Experimental design: The epitympanum roof and the temporomandibular joint roof were elevated by micro-dissection of the middle cranial fossa, exposing both disco-malleolar and anterior malleolar ligaments and their association with the malleus, the temporomandibular joint disc and the mandibular lingula. Principal observations: Both ligaments start in the malleus and take anterior and divergent routes towards the temporomandibular joint and lingula, passing through Huguier's canal. The disco-malleolar and anterior malleolar ligaments' mean lengths were 6.88 mm (SD 0.81) and 4.22mm (SD 1.17), respectively, no statistically significant difference being revealed between the sides. Temporomandibular joint disc traction was applied for verifying malleus mobility; malleus movement was observed when applying disco-malleolar traction in 30.5% of the samples. Correlation was observed between malleus movement and disco-malleolar length (R2=-0.499, p<0.05). Both ligaments common to the stomatognathic system and middle ear were present in all specimens. Conclusions: There was an anatomical and functional relationship between human TMJ and the middle ear.

Los ligamentos disco-maleolar y maleolar anterior son comunes en el oído medio, la articulación temporomandibular y la mandíbula, todas ellos comparten un origen embriológico común. Los aspectos morfométricos y funcionales de estos ligamentos fueron estudiados en 23 huesos temporales. Diseño experimental: el techo del epitímpano y el techo de la articulación temporomandibular fue elevada mediante micro-disección de la fosa craneal media, exponiendo ambos ligamentos disco-maleolar y maleolar anterior y su asociación con el maleus, el disco de la articulación temporomandibular y língula mandibular. Principales observaciones: Ambos ligamentos comienzan en el maleus y toman una ruta anterior y divergente hacia la articulación temporomandibular y língula, pasando a través del canal de Huguier. Las longitudes medias del ligamento disco-maleolar y maleolar anterior fueron 6,88 mm (DS 0,81) y 4,2mm (DS 1,17), respectivamente, no fueron reveladas diferencias estadísticamente significativas entre las partes. La tracción del disco de la articulación temporomandibular fue aplicada para verificar la movilidad del maleus; el movimiento del maleus fue observado cuando se aplicó tracción del ligamento disco-maleolar en el 30,5% de las muestras. Se observó correlación entre el movimiento del maleus y la longitud disco-maleolar (R2 = -0,499, p <0,05). Ambos ligamentos comunes al sistema estomatognático y el oído medio estaban presentes en todos los especímenes. Conclusiones: Existe una relación anatómica y funcional entre la ATM humana y el oído medio.

The effect of occlusal adjustment in the treatment of TMD evaluated with T-San II system / 实用口腔医学杂志

Objective:To investigate the effects of occlusal adjustment in the treatment of TMD . Methods: 7 cases of TMD were treated by occlusal adjusment and occlusal contact points were measured with T-scan II system before and after treatment . VAS pain analysis table was used to evaluate the pain control effect of occlusal adjustment method. Results:The number of occlusal contact points increased obviously after occlusal adjustment,and distribution of contact on two sides tended to be balanced.Pain release was indicated by VAS table . Conclusion: Occlusal ajustment method is necessary for the treatment of TMD

A RETROSPECTIVE STUDY ON THE RELATIONSHIP BETWEEN MRI EVIDENCE OF TEMPOROMANDIBULAR JOINT EFFUSION AND CLINICO-SURGICAL FINDINGS

PURPOSE: Although joint effusion caused by the inflammatory changes of synovium has been known to be associated with joint pain, it is still controversial. This study is to clarify the relationship between the evidence of joint effusion seen high signal intensity in T2-weighted magnetic resonance imaging and clinico-surgical findings. MATERIALS AND METHODS: All of the patients were diagnosed as temporomandibular joint internal derangement and received unilateral open surgery. The authors classified the joint effusion as four categories by size and shape: degree 0-no evidence; degree 1a-a line of high signal along articular surface in unfolded disc; degree 1b-high signal spot in the folded disc; degree 2-pooling in the anterior recess and folded disc; degree 3-pooling in the glenoid fossa and along articular eminence. The authors evaluated clinical and surgical findings. RESULTS: Two-hundred eighty-nine patients(242 females) with mean age of 30.2 years(range: 14 to 74) were included. High signal intensity was seen in 166 joints(57.4%): degree 1 in 82 joints, degree 2 in 69 joints(23.9%), degree 3 in 15 joints(5.2%). Maximal mouth opening of degree 0 group was 38.07mm, degree 1: 36.34mm, degree 3: 33.47mm. Mean TMJ pain score of the joint effusion groups was 1.58, no evidence group was 1.41. Click of degree 0 group was 44.7%, degree 3 was 43.4%. Crepitus of degree 0 group was 17.1%, degree 3 was 26.7%. Mean pain score of headache of degree 0 group was 1.80, degree 2 was 1.22. Neck and shoulder pain of degree 0 group was 50.4%, degree 1 was 39.0%. Perforation, adhesion, hyperemia of degree 0 was 27.6%, 35.8%, 18.7%, degree 2: 23.2%, 29.0%, 29.3%(degree 1). CONCLUSIONS: TMJ pain, TMJ sound and surgical findings did not relate significantly to the joint effusion of TMJ, but referred symptoms such as headache, neck and shoulder pain were less severe in the joint effusion groups.