The efficacy of Osteopathic treatment on TMJ with disk displacement without reduction with limited mouth opening. A case study
Konstantinos VATHRAKOKOILIS, Torsten LIEM, Ioannis AETOPOULOS, Konstantinos ANTONIADIS, Ekaterini TRIANTAFYLLIDOU
Department of Oral and Maxillofacial Surgery, Dental School, Aristotle University of Thessaloniki (Head: Professor K. Antoniadis)
Hellenic Archives of Oral & Maxillofacial Surgery (2018) 1, 35-42
SUMMARY: Temporomandibular joint (TMJ) dysfunc- tion, which is very common in recent years, is a disorder of the jaw's motor system, characterized by a restriction of mobility, mandibular deviation in mouth opening, pe- riarticular pain that can extend to the face, arthritic sounds and headache. However, there is no research data on the application of the Osteopathic Approach to the treatment of conditions in which classical conservative therapy fails. This case study refers to a 50- year-old lady with intense chronic pain of the TMJ, and very limited mouth opening with anterior dislocation of the disc. A 4-week treatment protocol was applied by direct and indirect techniques. The evaluation was done with the DC / TMD (Schiffman et al. 2016), the SQ, the JFLS-20 functional assessment scale, the GROC scale, the NPRS pain rating scale, the DC / TMD Ex- amination Form and Wilkes (1989) diagnostic cate- gories. The results showed significant changes in the pa- rameters evaluated. This study argues that osteopathic therapy may be an alternative to the treatment of temporomandibular dysfunction.
KEY WORDS: Osteopathic treatment, temporomandibular joint, myofascial dysfunction
REFERENCES
Al-Moraissi E: Open versus arthroscopic surgery for the management of internal derangement of the temporomandibular joint: a meta- analysis of the literature. International Journal of Oral and Max- illofacial Surgery 44(6):763-770, 2015
Butts R, Dunning J, Perreault T, Maurad F, Grubb M: Peripheral and spinal mechanisms of pain and dry needling mediated analgesia: a clinical resource guide for Health care professionals. International Journal of Physical Medicine & Rehabilitation 4:2, 2016
Carnes D, Mars T, Mullinger B, Froud R, Underwood M: Adverse events and manual therapy: a systematic review. Manual Therapy 15(4):355-63, 2010
Chase C: Educational Council on Osteopathic Principles, American As- sociation of Colleges of Osteopathic Medicine. Glossary of Os- teopathic Terminology, 2011
Darby IA, Hewitson TD: Fibroblast differentiation in wound healing and fibrosis. International Review of Cytology 57:143-179, 2007 Dodd JG, Good MM, Nguyen TL, Grigg AI, Batia LM, Standley PR: In vitro biophysical strain model for understanding mechanisms of osteopathic manipulative treatment. Journal of American Osteopathic Association 106(3):157-166, 2006
Gerwin RD, Dommerholt J, Shah JP: An expansion of Simons' inte- grated hypothesis of trigger point formation. Current Pain and Headache Reports 8, 468-475, 2004
Hartman L. Indirect Technique. Handbook of Osteopathic Technique: Springer; 1997. p. 31-8.
Hiraba K, Hibino K, Hiranuma K, Negoro T: EMG activities of two heads of the human lateral pterygoid muscle in relation to mandibular condyle movement and biting force. Journal of Neu- rophysiology 83: 2120-2137, 2000
Jayaseelan DJ, Tow NS: Cervicothoracic junction thrust manipulation in the multimodal management of a patient with temporomandibular disorder. Journal of Manual and Manipulative Therapy 24: 90-97, 2016 Johnson SM, Kurtz ME: Osteopathic manipulative treatment techniques preferred by contemporary osteopathic physicians. Journal of
American Osteopathic Association 103(5):219-224, 2003 Langenau EE, Dowling DJ, Dyer C, Roberts WL: Frequency of specific
osteopathic manipulative treatment modalities used by candidates while taking COMLEX-USA Level 2-PE. Journal of American Os- teopathic Association 112(8):509-513, 2012
Mapelli A, Zanandrea Machado BC, Giglio LD, Sforza C, De Felicio CM: Reorganization of muscle activity in patients with chronic temporo- mandibular disorders. Archives of Oral Biology 72, 164-171, 2016 Meltzer KR, Standley PR: Modeled repetitive motion strain and indirect osteopathic manipulative techniques in regulation of human fi- broblast proliferation and interleukin secretion. Journal of Amer-ican Osteopathic Association 107(12):527-536, 2007
Minasny B: Understanding the process of fascial unwinding. International Journal of Therapeutic Massage and Bodywork 2(3):10-17, 2009
Mujakperuo HR, Watson M, Morrison R, Macfarlane TV: Pharmaco- logical interventions for pain in patients with temporomandibular disorders. Cochrane Database Systematic Reviews 10, 2010
Murray GM, Phanachet I, Uchida S, Whittle T: The human lateral ptery- goid muscle: a review of some experimental aspects and possible clinical relevance. Australian Dentistry Journal 49: 2-8, 2004
Paanalahti K, Holm LW, Nordin M, Asker M, Lyander J, Skillgate E: Ad- verse events after manual therapy among patients seeking care for neck and/or back pain: a randomized controlled trial. BMC Musculoskeletal Disorders 15(77), 2014
Peck CC, Murray GM, Gerzina TM: How does pain affect jaw muscle activity? The Integrated Pain Adaptation Model. Australian Den- tistry Journal 53: 201-207, 2008
Pihut M, Ferendiuk E, Szewczyk M, Kasprzyk K, Wieckiewicz M: The efficiency of botulinum toxin type A for the treatment of masseter muscle pain in patients with temporomandibular joint dysfunction and tension-type headache. Journal Headache Pain 17: 29, 2016
Ritchlin C: Fibroblast biology. Effector signals released by the synovial fibroblast in arthritis. Arthritis Research 2(5):356-360, 2000
Roberts E, Delgado Nunes V, Buckner S, Latchem S, Constanti M, Miller P, Doherty M, Zhang W, Birrell F, Porcheret M, Dziedzic K, Bernstein I, Wise E, Conaghan PG: Paracetamol: not as safe as we thought? A systematic literature review of observational stud- ies. Annual Rheumatic Disorders 75(3):552-559, 2016
Schleip R: Fascial plasticity: a new neurobiological explanation. Part1. Journal of Bodywork and Movement Therapy 7:11–19, 2003 Schleip R: Fascial plasticity: a new neurobiological explanation. Part 2.Journal of Bodywork and Movement Therapy 7:104–116, 2003 Scully C: Oral and Maxillofacial Medicine: the Basis of Diagnosis andTreatment, third ed. Churchill Livingstone, Edinburgh, 2013 Schiffman E, Ohrbach R: Executive Summary of the Diagnostic Criteria
for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications. Journal of American Dental Association 147(6): 438–445, 2016
Tozzi P: Selected fascial aspects of osteopathic practice. Journal of Bodywork Movement Therapy 16(4):503-519, 2012
Wilkes C: Internal derangements of the temporomandibular joint. Archives of Otolaryngology Head Neck Surgery 115: 469–477, 1989 Wong CK: Strain counterstrain: current concepts and clinical evidence. Manual Therapy 17(1):2-8, 2012
Zein-Hammoud M, Standley P: Modeled Osteopathic Manipulative Treatments: A Review of Their in Vitro Effects on Fibroblast Tis- sue Preparations. Journal of American Osteopathic Association 115(8): 490-502, 2015 oooo.2017.09.014, 2017
Department of Oral and Maxillofacial Surgery, Dental School, Aristotle University of Thessaloniki (Head: Professor K. Antoniadis)
Hellenic Archives of Oral & Maxillofacial Surgery (2018) 1, 35-42
SUMMARY: Temporomandibular joint (TMJ) dysfunc- tion, which is very common in recent years, is a disorder of the jaw's motor system, characterized by a restriction of mobility, mandibular deviation in mouth opening, pe- riarticular pain that can extend to the face, arthritic sounds and headache. However, there is no research data on the application of the Osteopathic Approach to the treatment of conditions in which classical conservative therapy fails. This case study refers to a 50- year-old lady with intense chronic pain of the TMJ, and very limited mouth opening with anterior dislocation of the disc. A 4-week treatment protocol was applied by direct and indirect techniques. The evaluation was done with the DC / TMD (Schiffman et al. 2016), the SQ, the JFLS-20 functional assessment scale, the GROC scale, the NPRS pain rating scale, the DC / TMD Ex- amination Form and Wilkes (1989) diagnostic cate- gories. The results showed significant changes in the pa- rameters evaluated. This study argues that osteopathic therapy may be an alternative to the treatment of temporomandibular dysfunction.
KEY WORDS: Osteopathic treatment, temporomandibular joint, myofascial dysfunction
REFERENCES
Al-Moraissi E: Open versus arthroscopic surgery for the management of internal derangement of the temporomandibular joint: a meta- analysis of the literature. International Journal of Oral and Max- illofacial Surgery 44(6):763-770, 2015
Butts R, Dunning J, Perreault T, Maurad F, Grubb M: Peripheral and spinal mechanisms of pain and dry needling mediated analgesia: a clinical resource guide for Health care professionals. International Journal of Physical Medicine & Rehabilitation 4:2, 2016
Carnes D, Mars T, Mullinger B, Froud R, Underwood M: Adverse events and manual therapy: a systematic review. Manual Therapy 15(4):355-63, 2010
Chase C: Educational Council on Osteopathic Principles, American As- sociation of Colleges of Osteopathic Medicine. Glossary of Os- teopathic Terminology, 2011
Darby IA, Hewitson TD: Fibroblast differentiation in wound healing and fibrosis. International Review of Cytology 57:143-179, 2007 Dodd JG, Good MM, Nguyen TL, Grigg AI, Batia LM, Standley PR: In vitro biophysical strain model for understanding mechanisms of osteopathic manipulative treatment. Journal of American Osteopathic Association 106(3):157-166, 2006
Gerwin RD, Dommerholt J, Shah JP: An expansion of Simons' inte- grated hypothesis of trigger point formation. Current Pain and Headache Reports 8, 468-475, 2004
Hartman L. Indirect Technique. Handbook of Osteopathic Technique: Springer; 1997. p. 31-8.
Hiraba K, Hibino K, Hiranuma K, Negoro T: EMG activities of two heads of the human lateral pterygoid muscle in relation to mandibular condyle movement and biting force. Journal of Neu- rophysiology 83: 2120-2137, 2000
Jayaseelan DJ, Tow NS: Cervicothoracic junction thrust manipulation in the multimodal management of a patient with temporomandibular disorder. Journal of Manual and Manipulative Therapy 24: 90-97, 2016 Johnson SM, Kurtz ME: Osteopathic manipulative treatment techniques preferred by contemporary osteopathic physicians. Journal of
American Osteopathic Association 103(5):219-224, 2003 Langenau EE, Dowling DJ, Dyer C, Roberts WL: Frequency of specific
osteopathic manipulative treatment modalities used by candidates while taking COMLEX-USA Level 2-PE. Journal of American Os- teopathic Association 112(8):509-513, 2012
Mapelli A, Zanandrea Machado BC, Giglio LD, Sforza C, De Felicio CM: Reorganization of muscle activity in patients with chronic temporo- mandibular disorders. Archives of Oral Biology 72, 164-171, 2016 Meltzer KR, Standley PR: Modeled repetitive motion strain and indirect osteopathic manipulative techniques in regulation of human fi- broblast proliferation and interleukin secretion. Journal of Amer-ican Osteopathic Association 107(12):527-536, 2007
Minasny B: Understanding the process of fascial unwinding. International Journal of Therapeutic Massage and Bodywork 2(3):10-17, 2009
Mujakperuo HR, Watson M, Morrison R, Macfarlane TV: Pharmaco- logical interventions for pain in patients with temporomandibular disorders. Cochrane Database Systematic Reviews 10, 2010
Murray GM, Phanachet I, Uchida S, Whittle T: The human lateral ptery- goid muscle: a review of some experimental aspects and possible clinical relevance. Australian Dentistry Journal 49: 2-8, 2004
Paanalahti K, Holm LW, Nordin M, Asker M, Lyander J, Skillgate E: Ad- verse events after manual therapy among patients seeking care for neck and/or back pain: a randomized controlled trial. BMC Musculoskeletal Disorders 15(77), 2014
Peck CC, Murray GM, Gerzina TM: How does pain affect jaw muscle activity? The Integrated Pain Adaptation Model. Australian Den- tistry Journal 53: 201-207, 2008
Pihut M, Ferendiuk E, Szewczyk M, Kasprzyk K, Wieckiewicz M: The efficiency of botulinum toxin type A for the treatment of masseter muscle pain in patients with temporomandibular joint dysfunction and tension-type headache. Journal Headache Pain 17: 29, 2016
Ritchlin C: Fibroblast biology. Effector signals released by the synovial fibroblast in arthritis. Arthritis Research 2(5):356-360, 2000
Roberts E, Delgado Nunes V, Buckner S, Latchem S, Constanti M, Miller P, Doherty M, Zhang W, Birrell F, Porcheret M, Dziedzic K, Bernstein I, Wise E, Conaghan PG: Paracetamol: not as safe as we thought? A systematic literature review of observational stud- ies. Annual Rheumatic Disorders 75(3):552-559, 2016
Schleip R: Fascial plasticity: a new neurobiological explanation. Part1. Journal of Bodywork and Movement Therapy 7:11–19, 2003 Schleip R: Fascial plasticity: a new neurobiological explanation. Part 2.Journal of Bodywork and Movement Therapy 7:104–116, 2003 Scully C: Oral and Maxillofacial Medicine: the Basis of Diagnosis andTreatment, third ed. Churchill Livingstone, Edinburgh, 2013 Schiffman E, Ohrbach R: Executive Summary of the Diagnostic Criteria
for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications. Journal of American Dental Association 147(6): 438–445, 2016
Tozzi P: Selected fascial aspects of osteopathic practice. Journal of Bodywork Movement Therapy 16(4):503-519, 2012
Wilkes C: Internal derangements of the temporomandibular joint. Archives of Otolaryngology Head Neck Surgery 115: 469–477, 1989 Wong CK: Strain counterstrain: current concepts and clinical evidence. Manual Therapy 17(1):2-8, 2012
Zein-Hammoud M, Standley P: Modeled Osteopathic Manipulative Treatments: A Review of Their in Vitro Effects on Fibroblast Tis- sue Preparations. Journal of American Osteopathic Association 115(8): 490-502, 2015 oooo.2017.09.014, 2017
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