Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20240062-en
Brazilian Journal of Pain
Review Article

Is the use of manual therapy in the craniomandibular and cervical regions beneficial for reducing orofacial pain and increasing mandibular mobility? Systematic review

O uso de terapia manual na região craniomandibular e cervical é benéfico para redução da dor orofacial e aumento da mobilidade mandibular? Revisão sistemática

Rita de Cassia das Neves Martins; Lais Silva Ferreira; Nathalia Rodrigues de Mello Rosa; Juliana Leite da Silva; Fabiano Politti; Daniela Aparecida Biasotto-Gonzalez

http://dx.doi.org/10.5935/2595-0118.20240062-en BrJP, vol.7, e20240062, 2024
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Abstract

BACKGROUND AND OBJECTIVES: The use of manual therapy in the craniomandibular and cervical regions in the treatment of patients with temporomandibular disorders (TMD) has become common practice, and the literature supports the use of these techniques to relieve pain and improve the range of mandibular movement. Therefore, the organization of scientific findings can help clinicians make informed decisions. Thus, the objective of this systematic review was to evaluate the effectiveness of manual therapy in the craniomandibular region in patients with TMD and to compare it with manual therapy in the cervical region in terms of pain intensity and range of mandibular movement.

CONTENTS: Following PRISMA guidelines, Randomized Clinical Trials were included with a population of adults of both genders with signs and symptoms of TMD. Case reports, pilot studies, case series, editorials, opinion letters, letters to the editor, literature reviews, cohort studies, and case-control studies were excluded. The search strategy was created using MESH and synonyms for TMD, cervical treatment, manual therapy, physiotherapy, exercise, pain, and mandibular range of motion. The databases Medline, Embase, Pubmed, Cochrane Library, Virtual Health Library, PEDro, Scielo, LILACS and Central were used. The Cochrane ROB2 risk of bias and the PEDro scale were used to assess the methodological quality of the included studies. Eight studies were eligible, published between 2013 and 2022, totaling 339 individuals with TMD aged between 18 and 65 years. The results of the present review showed that patients undergoing manual therapy in the craniomandibular and cervical regions, with or without the addition of exercises and/or patient education, present a progressive reduction in the intensity of orofacial pain and gains in mandibular range of motion.

CONCLUSION: The results expand the data reported by other systematic reviews that investigated different aspects of the application of manual therapy in individuals with TMD. Manual therapy in the craniomandibular and cervical regions, whether associated with exercises and/or patient education, presents a clinically relevant improvement in the intensity of orofacial pain and mandibular range of motion.

Keywords

Cervical vertebrae; Musculoskeletal manipulations; Pain; Rehabilitation; Temporomandibular joint dysfunction syndrome

Resumo

JUSTIFICATIVA E OBJETIVOS: O uso de terapia manual nas regiões craniomandibular e cervical no tratamento de pacientes com disfunção temporomandibular (DTM) tornou-se uma prática comum, sendo que a literatura apoia o uso dessas técnicas para alívio de dor e melhora da amplitude de movimento mandibular. Portanto, a organização dos achados científicos pode auxiliar o clínico na tomada de decisão. Assim sendo, o objetivo deste estudo foi avaliar a eficácia da terapia manual na região craniomandibular em pacientes com DTM e compará-la com a terapia manual na região cervical em desfechos de intensidade de dor e amplitude de movimento mandibular.

CONTEÚDO: Seguindo as diretrizes do PRISMA, foram incluídos Ensaios Clínicos Randomizados com uma população de adultos, de ambos os sexos, com sinais e sintomas de DTM. Foram excluídos relatos de casos, estudos-piloto, séries de casos, editoriais, cartas de opinião, cartas ao editor, revisões de literatura, estudos de coorte e estudos de caso-controle. A estratégia de busca foi criada utilizando MESH e sinônimos para DTM, tratamento cervical, terapia manual, fisioterapia, exercício, dor e amplitude de movimento mandibular. Foram utilizadas as bases Medline, Embase, Pubmed, Cochrane Library, Biblioteca Virtual da Saúde, PEDro, Scielo, LILACS e Central. Foi utilizado o risco de viés da Cochrane ROB2 e a escala PEDro para avaliar a qualidade metodológica dos estudos incluídos. Oito estudos publicados entre 2013 e 2022 foram elegíveis, totalizando 339 indivíduos com DTM, com idade entre 18 e 65 anos. Os resultados da presente revisão mostraram que pacientes submetidos à terapia manual na região craniomandibular e região cervical, com ou sem adição de exercícios e/ou educação ao paciente, apresentaram redução progressiva na intensidade da dor orofacial e ganho na amplitude de movimento mandibular.

CONCLUSÃO: Os resultados ampliam os dados reportados por outras revisões sistemáticas que investigaram diferentes aspectos da aplicação da terapia manual em indivíduos com DTM. A terapia manual na região craniomandibular e a terapia manual na região cervical, associada ou não a exercícios e/ou educação do paciente, contribui para uma melhora clínica em relação à intensidade da dor orofacial e amplitude de movimento mandibular.

Palavras-chave

Dor; Manipulações musculoesqueléticas; Reabilitação; Síndrome da disfunção da articulação temporomandibular; Vértebras cervicais

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Submitted date:
04/17/2024

Accepted date:
09/05/2024

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