Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.63231/2595-0118.202668-en
Brazilian Journal of Pain
Relato de Caso

Minimally invasive approach to temporomandibular disorders in a patient with congenital muscular torticollis. Case report

Abordagem minimamente invasiva de disfunções temporomandibulares articulares em paciente com torcicolo muscular congênito. Relato de caso

Jean Soares Miranda; Leticia Lima Morais Carvalho; Peter França Dutra; Bianca dos Santos Ferraz; Larissa de Oliveira Reis; Ricardo de Souza Tesch

http://dx.doi.org/10.63231/2595-0118.202668-en BrJP, vol.9, e202668, 2026
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Abstract

BACKGROUND AND OBJECTIVES: Temporomandibular disorders (TMD) are often associated with biomechanical and postural factors such as congenital muscular torticollis (CMT). This report describes a minimally invasive therapeutic approach in a patient with TMD and CMT, highlighting the efficacy of arthrocentesis combined with viscosupplementation.

CASE REPORT: The 31-year-old female patient with a previous diagnosis of CMT and TMD symptoms (joint pain, crepitation, and limited mouth opening) underwent clinical evaluation according to the Diagnostic Criteria for TMDs (DC/TMD) and imaging tests (computed tomography and magnetic resonance imaging). After unsatisfactory response to conservative treatment (occlusal splint, physical therapy, and dry needling), a minimally invasive approach was adopted, consisting of ultrasound-guided arthrocentesis and viscosupplementation with 1% sodium hyaluronate. Significant improvement was observed after the minimally invasive protocol, with increased mouth opening (from 28 mm to 42 mm), pain reduction, and bone recorticalization in the right temporomandibular joint. The integrated approach demonstrated efficacy in functional restoration and symptom relief.

CONCLUSION: The combined use of arthrocentesis and viscosupplementation was associated with clinical and functional improvement in a patient with refractory temporomandibular disorder and congenital muscular torticollis, suggesting a potential role for minimally invasive approaches in complex TMD cases.

Keywords

Minimally invasive surgical procedures; Temporomandibular joint disorders; Temporomandibular joint; Torticollis

Resumo

JUSTIFICATIVA E OBJETIVOS: As disfunções temporomandibulares (DTM) são frequentemente associadas a fatores biomecânicos e posturais, como o torcicolo muscular congênito (TMC). O objetivo deste estudo foi descrever a abordagem terapêutica minimamente invasiva em uma paciente com DTM e TMC, destacando a eficácia da artrocentese associada à viscossuplementação.

RELATO DO CASO: Paciente do sexo feminino, 31 anos, com diagnóstico prévio de TMC e sintomas de DTM (dor articular, crepitação e limitação da abertura bucal), foi submetida a avaliação clínica conforme os Critérios Diagnósticos para DTM (DC/TMD) e exames de imagem (tomografia e ressonância magnética). Após resposta insatisfatória ao tratamento conservador (placa oclusal, fisioterapia e agulhamento seco), optou-se por um tratamento minimamente invasivo com artrocentese guiada por ultrassom e viscossuplementação com hialuronato de sódio 1% na ATM direita. Observou-se melhora significativa após o protocolo minimamente invasivo, com aumento da abertura bucal (de 28 mm para 42 mm), redução da dor e recorticalização óssea na articulação temporomandibular direita. A abordagem integrada demonstrou eficácia na restauração funcional e no alívio sintomático.

CONCLUSÃO: O uso combinado da artrocentese e da viscossuplementação foi associado à melhora clínica e funcional em uma paciente com disfunção temporomandibular refratária e torcicolo muscular congênito, sugerindo um papel potencial das abordagens minimamente invasivas em casos complexos de DTM.

Palavras-chave

Procedimentos cirúrgicos minimamente invasivos, Transtornos da articulação temporomandibular, Articulação temporomandibular, Torcicolo

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Submetido em:
26/09/2025

Aceito em:
07/02/2026

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