Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20180017
Brazilian Journal of Pain
Case Report

Orofacial myofunctional disorder, a possible complicating factor in the management of painful temporomandibular disorder. Case report

Distúrbio miofuncional orofacial, um possível fator complicador no manuseio da disfunção temporomandibular dolorosa. Relato de caso

Melissa de Oliveira Melchior; Laís Valencise Magri; Marcelo Oliveira Mazzetto

Downloads: 0
Views: 219

Abstract

BACKGROUND AND OBJECTIVES: The clinical association between painful temporomandibular disorder and orofacial myofunctional disorders is frequent and requires attention. The objective of this study was to describe a clinical case of painful temporomandibular disorder in association with orofacial myofunctional disorders that evidence the importance of dental and speech therapy approaches involving myofunctional orofacial limits, as well as to discuss whether the presence of orofacial myofunctional disorders can be a comorbidity that hinders the temporomandibular disorder management.

CASE REPORT: Female patient, 35 years old, complaining of pain in the orofacial region and joint noises during high amplitude mandibular movements for 17 years. She was diagnosed with myofascial pain and arthralgia (RDC/TMD) and orofacial myofunctional disorders (phonoarticulation with deviations and lingual interposition, atypical swallowing, oromandibular incoordination and mandibular hyperexcursion with eminence noise). Complementary tests (electromyography and electrovibratography) were performed in the pre- and post-treatment moments (1 year after). The treatment consisted of self-management and mindfulness orientations, stabilizing occlusal splint and speech therapy. After the treatment, there was an improvement in pain and mandibular range of motion, with consequent reduction of noise, better electromyographic balance and reduction of orofacial myofunctional disorders scores.

CONCLUSION: The case report has suggested that the presence of orofacial myofunctional disorders in association with painful temporomandibular disorder could interfere in the management of pain and the balance of the stomatognathic system because it seems to act as a worsening factor to the temporomandibular disorder signs and symptoms. In this sense, the importance of dental and speech therapy interventions in patients with orofacial myofunctional disorders as possible comorbidity to painful temporomandibular disorder is highlighted.

Keywords

Comorbidity, Speech therapy, Temporomandibular joint dysfunction syndrome

Resumo

JUSTIFICATIVA E OBJETIVOS: A associação clínica da disfunção temporomandibular dolorosa com distúrbios miofuncionais orofaciais é bastante frequente e requer atenção. O objetivo deste estudo foi mostrar um caso de disfunção temporomandibular dolorosa com associação de distúrbios miofuncionais orofaciais que evidenciou a importância do manuseio terapêutico odontológico e fonoaudiológico, com abordagens que envolveram limites miofuncionais orofaciais, bem como discutir se a presença de distúrbios miofuncionais orofaciais pode ser uma comorbidade que dificulta o manuseio da disfunção temporomandibular.

RELATO DO CASO: Paciente do sexo feminino, 35 anos, com queixa de dor na região orofacial e ruídos articulares durante movimentos mandibulares de grande amplitude há 17 anos. Diagnosticada com dor miofascial e artralgia (RDC/TMD) e distúrbios miofuncionais orofaciais (fonoarticulação com desvios e interposição lingual, deglutição atípica, descoordenação oromandibular e hiperexcursão mandibular com ruído de eminência). Foram realizados exames complementares (eletromiografia e eletrovibratografia) nos momentos pré e pós-tratamento (1 ano após). O tratamento consistiu de orientações de automanuseio e de atenção plena nas funções orofaciais (mindfulness), placa oclusal estabilizadora e terapia fonoaudiológica. Após o tratamento, houve melhora da dor e da amplitude dos movimentos mandibulares, com consequente redução dos ruídos, maior equilíbrio eletromiográfico dos músculos e redução dos escores dos distúrbios miofuncionais orofaciais.

CONCLUSÃO: O presente caso sugere que a presença dos distúrbios miofuncionais orofaciais em associação com a disfunção temporomandibular dolorosa pode interferir no manuseio da dor e no equilíbrio do sistema estomatognático, pois parece atuar como fator de piora dos sinais e sintomas da disfunção temporomandibular. Neste sentido, ressalta-se a importância de intervenções odontológicas e fonoaudiológicas em pacientes que apresentem os distúrbios miofuncionais orofaciais como possível comorbidade à disfunção temporomandibular dolorosa.

Palavras-chave

Comorbidade, Fonoaudiologia, Síndrome da disfunção da articulação temporomandibular

References

Slade GD, Ohrbach R, Greenspan JD, Fillingim RB, Bair E, Sanders AE. Painful temporomandibular disorder: decade of discovery from OPPERA studies. J Dent Res. 2016;95(10):1084-92.

Ohrbach R, Dworkin SF. The evolution of TMD diagnosis: past, present, future. J Dent Res. 2016;95(10):1093-101.

Manfredini D, Winocur E, Ahlberg J, Guarda-Nardini L, Lobbezoo F. Psychosocial impairment in temporomandibular disorders patients. RDC/TMD axis II findings from a multicentre study. J Dent. 2010;38(10):765-72.

Scrivani SJ, Keith DA, Kaban LB. Temporomandibular disorders. N Engl J Med. 2008;359(25):2693-705.

Campi LB, Jordani PC, Tenan HL, Camparis CM, Gonçalves DA. Painful temporomandibular disorders and central sensitization: implications for management-a pilot study. Int J Oral Maxillofac Surg. 2017;46(1):104-10.

Costa YM, Conti PC, de Faria FA, Bonjardim LR. Temporomandibular disorders and painful comorbidities: clinical association and underlying mechanisms. Oral Surg Oral Med Oral Pathol Oral Radiol. 2017;123(3):288-97.

Pereira CC, De Felício CM. Os distúrbios miofuncionais orofaciais na literatura odontológica: revisão crítica. Rev Dent Press Ortodon Ortop Facial. 2005;10(4):134-42.

de Felício CM, de Oliveira MM, da Silva MA. Effects of orofacial myofunctional therapy on temporomandibular disorders. Cranio. 2010;28(4):249-59.

Ferreira CL, Machado BC, Borges CG, Rodrigues Da Silva MA, Sforza C, De Felício CM. Impaired orofacial motor functions on chronic temporomandibular disorders. J Electromyogr Kinesiol. 2014;24(4):565-71.

Look JO, Schiffman EL, Truelove EL, Ahmad M. Reliability and validity of Axis I of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) with proposed revisions. J Oral Rehabil. 2010;37(10):744-59.

de Felício CM, Medeiros AP, Melchior MO. Validity of the 'protocol of oro-facial myofunctional evaluation with scores' for young and adult subjects. J Oral Rehabil. 2012;39(10):744-53.

Melchior MO, Machado BC, Magri LV, Mazzetto MO. Effect of speech-language therapy after low-level laser therapy in patients with TMD: a descriptive study. Codas. 2016;28(6):818-22.

Slade GD, Fillingim RB, Sanders AE, Bair E, Greenspan JD, Ohrbach R. Summary of findings from the OPPERA prospective cohort study of incidence of first-onset temporomandibular disorder: implications and future directions. J Pain. 2013;14(12 Suppl):T116-24.

Michelotti A, Iodice G, Vollaro S, Steenks MH, Farella M. Evaluation of the short-term effectiveness of education versus an occlusal splint for the treatment of myofascial pain of the jaw muscles. J Am Dent Assoc. 2012;143(1):47-53.

Costa YM, Porporatti AL, Stuginski-Barbosa J, Bonjardim LR, Conti PC. Additional effect of occlusal splints on the improvement of psychological aspects in temporomandibular disorder subjects. A randomized controlled trial. Arch Oral Biol. 2015;60(5):738-44.

Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP. International RDC/TMD Consortium Network, International Association for Dental Research; Orofacial Pain Special Interest Group, International Association for the Study of Pain. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of theInternational RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†. J Oral Facial Pain Headache. 2014;28(1):6-27.

Kabat-Zinn J. An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. Gen Hosp Psychiatry. 1982;4(1):33-47.

de Felicio CM, Melchior Mde O, Da Silva MA. Clinical validity of the protocol for multi-professional centers for the determination of signs and symptoms of temporomandibular disorders. Part II. Cranio. 2009;27(1):62-7.

Machado BC, Mazzetto MO, Da Silva MA, de Felício CM. Effects of oral motor exercises and laser therapy on chronic temporomandibular disorders: a randomized study with follow-up. Lasers Med Sci. 2016;31(5):945-54.

Visscher CM, Van Wesemael-Suijkerbuijk EA, Lobbezoo F. Is the experience of pain in patients with temporomandibular disorder associated with the presence of comorbidity?. Eur J Oral Sci. 2016;124(5):459-64.

Manfredini D, Ahlberg J, Winocur E, Guarda-Nardini L, Lobbezoo F. Correlation of RDC/TMD axis I diagnoses and axis II pain-related disability. A multicenter study. Clin Oral Investig. 2011;15(5):749-56.


Submitted date:
10/27/2017

Accepted date:
01/29/2018

5f160e240e8825185c9517e2 brjp Articles

BrJP

Share this page
Page Sections