Main Article Content
Temperomandibular Joint, Temperomandibular Disorders, Adolescence, Maxillofacial Surgery, Anterior Disc Displacement
Objective: To discuss a pediatric patient with acute temporomandibular disorder due to a sports-related trauma requiring chiropractic and oral surgical co-management.
Clinical Features: A 12-year-old girl sought chiropractic care for temporomandibular joint dysfunction (TMD) resulting from a volleyball injury after referral from her oral surgeon. Severe trismus was seen, along with spasm of the masticatory muscles and evidence of joint effusion. Mouth opening was significantly restricted and painful limiting her diet, ability to sing, smile, yawn and brush her teeth. Though not complaining specifically of neck pain, findings consistent with upper-crossed syndrome were present along with indicators of vertebral subluxation. Cervical ROM was limited and in some planes aggravated her TMJ pain.
Intervention and Outcome: Treatment consisted of chiropractic adjustments to the cervical and thoracic spine using Diversified Technique along with instrument-assisted soft-tissue mobilization directed to the musculature of her cervical and thoracic regions and muscles of mastication. Therapeutic exercises were attempted. TENS and low-level laser was also administered to reduce TMJ pain. Improvement in pain, TMJ ROM, CROM along with reduced indicators for vertebral subluxation were initially reported; however, her progress plateaued leading to advanced imaging and subsequent surgical intervention.
Conclusion: This young athlete ultimately required treatment by an oral and maxillofacial surgeon. Her condition resolved only after TMJ arthrocentesis with manipulation of the mandible under anesthesia. Clinicians treating TMJ disorders should be aware of its various origins, treatment options and complications and be willing to consult with or refer to the appropriate specialist when needed. This case provides an argument for interdisciplinary collaboration for some temporomandibular joint disorders.
2. “Facial Pain.” National Institute of Dental and Craniofacial Research. 2018. www.nidcr.nih.gov/data-statistics/facial-pain. Accessed 11 Dec 2020.
3. Stowell A, Gatchel R, Wildentein L. Cost-effectiveness of treatments for temporomandibular disorders: biopsychosocial intervention versus treatment as usual. JADA 2007; 138(2):202-208
4. DeVocht J, Goertz C, Hondras M et al. A pilot study of a chiropractic intervention for management of chronic myofascial temporomandibular disorder. JADA 2013; 144(10):1154-1163
5. Vinjamury S, Singh B, Khorsan R et al. Chiropractic treatment of temporomandibular disorders. Altern Ther Health Med 2008; 14(4):60-63
6. DeVocht J, Long C, Zeitler D, Schaeffer W. Chiropractic treatment of temporomandibular disorders using the activator adjusting instrument: a prospective case series. J Manipulative Physiol Ther 2003; 26(7):421-425
7. Yuill E, Howitt S. Temporomandibular joint: conservative care of TMJ dysfunction in a competitive swimmer. J Can Chiropr Assoc 2009; 53(3):165-172
8. Christidis N, Lindström- Ndanshau E, Sandberg A, Tsilingaridis G. Prevalence and treatment strategies regarding temporomandibular disorders in children and adolescents – a systematic review. J Oral Rehabil 2018; 46(3):291-301
9. da Silva C, Pachêco-Pereira C, Poporatti A et al. Prevalence of clinical signs of intra-articular temporomandibular disorders in children and adolescents: a systematic review and meta-analysis. JADA 2016; 147(1):10-18
10. Fricton J, Schiffman E. Epidemiology of temporomandibular disorders. In: Fricton J, Dubner R, editors. Advances in orofacial pain temporomandibular disorders. New York: Raven Press; 1995. p. 1
11. Brotman S. Managed health care and orofacial pain. Dent Clin North Am 1997; 41(2):297-307
12. Raphael K, Klausner J, Nayak S, Marbach J. Complementary and alternative therapy use by patients with myofascial temporomandibular disorders. J Orofac Pain 2003; 17(1):36-41
13. DeBar L, Schneider J, Ritenbaugh C. Use of complementary and alternative medicine for temporomandibular disorders. J Orofac Pain 2003; 17(3):224-236
14. “Temporomandibular Joint & Muscle Disorders.” National Institute of Dental and Craniofacial Research. 2018. https://nidcr.nih.gov/health-info/tmj/more-info. Accessed 11 Dec 2020.
15. Malik A, Shah A. Efficacy of temporomandibular joint arthrocentesis on mouth opening and pain in the treatment of internal derangement of TMJ – a clinical study. J Maxillofac Oral Surg 2014; 13(3):244-248
16. Eriksson L, Westesson P. Clinical and radiologic study of patients with anterior disc displacement of the temporomandibular joint. Swed Dent J 1983; 7:55-64
17. Katzberg R, Westesson P, Tallents R, Drake C. Anatomic disorders of the temporomandibular joint disc in asymptomatic subjects. J Oral Maxillofac Surg 1996; 54(2):147-153
18. He D, Yang X, Wang F, Yang C, Dong M. Acute trauma induced disc displacement without reduction and its sequelae. Sci Rep 2016; 6, 32684. https://doi.org/10.1038/srep32684. Accessed 11 Dec 2020.
19. Holt K, Russell D, Cooperstein R et al. Interexaminer reliability of a multidimensional battery of tests used to assess vertebral subluxation. Chiropr J Aust 2018; 6(1):100-117
20. Moore M. Upper crossed syndrome and its relationship to cervicogenic headache. J Manipulative Physiol Ther 2004; 27(6):414-420
21. Neff S, Schielke A. Chiropractic management of a patient with chronic post-surgical neck pain: a case report. J Acad Chiropr Orthopedists 2016; 13(1):2-7
22. Lambert M, Hitchcock R, Lavallee K et al. The effects of instrument-assisted soft tissue mobilization compared to other interventions on pain and function: a systematic review. Phys Ther Rev 2017; 22(1):76-85
23. Aggarwal A, Gadekar J, Kakodkar P. Role of myofascial release technique on mobility and function in temporomandibular joint disorder patients with neck pain. J Dent Res Rev 2020; 7:84-87
24. Kato M, Kogawa E, Santos C, Conti P. TENS and low-level laser therapy in the management of temporomandibular disorders. J Appl Oral Sci 2006; 14(2):130-35
25. Singh H, Sunil M, Kumar R, Singla N et al. Evaluation of TENS therapy and placebo drug therapy in the management of TMJ pain disorders: a comparative study. J Indian Acad Oral Med Radiol 2014; 26:139-44
26. Rodrigues D, Siriani A, Bérzin F. Effect of conventional TENS on pain and electromyographic activity of masticatory muscles in TMD patients. Braz Oral Res 2004; 18(4):290-95
27. Bronfort G, Evans R, Nelson B et al. A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain. Spine 2001; 26(7):788797
28. Kumari S, Reddy D, Paul S. The normal range of maximal incisal opening in pediatric population and its association with physical variables. Ann Afr Med 2019; 18(3):153-157
29. Klasser G, Epstein J. How to manage closed lock disc displacement without reduction with limited opening. J Can Dent Assoc 2014; 80:e60
30. Rehman K, Hall T. Single needle arthrocentesis. Br J Oral Maxillofac Surg 2008; 47(5):403-404
31. Kalamir A, Pollard H, Vitiello A, Bonello R. Manual therapy for temporomandibular disorders: a review of the literature. J Bodyw Mov Ther 2007; 11:84-90
32. Blum C. SOT and the treatment of TMJ: why dentists and chiropractors need to work together. J Calif Chiropr Assoc 2007; 32(3):12-13
33. Walczy?ska-Dragon K, Baron S, Nitecka-Buchta A, Tkacz E. Correlation between TMD and cervical spine pain and mobility: is the whole body balance TMJ related? BioMed Research International 2014; Article ID 582414, 7 pages. https://doi.org/10.1155/2014/582414. Accessed 11 Dec 2020.
34. Silveira A, Gadotti I, Armijo-Olivo S et al. Jaw dysfunction is associated with neck disability and muscle tenderness in subjects with and without chronic temporomandibular disorders. BioMed Research International 2015; Article ID 512792, 7 pages. https://doi.org/10.1155/2015/512792. Accessed 11 Dec 2020.
35. Jaeger J, Oakley P, Moore R et al. Resolution of temporomandibular joint dysfunction (TMJD) by correcting a lateral head translation posture following previous failed traditional chiropractic therapy: a CBP® case report. J Phys Ther Sci 2018; 30(1):103-107
36. Alacantra J, Plaugher G, Klemp D, Salem C. Chiropractic care of a patient with temporomandibular disorder and atlas subluxation. J Manipulative Physiol Ther 2002; 25(1):63-70
37. Rubis L, Rubis D, Winchester B. A collaborative approach between chiropractic and dentistry to address temporomandibular dysfunction: a case report. J Chiropr Med 2014; 12:55-61
38. Chinappi A, Getzoff H. The dental-chiropractic cotreatment of structural disorders of the jaw and temporomandibular joint dysfunction. J Manipulative Physiol Ther 1995; 18(7):476-481
39. Jagger R. Mandibular manipulation of anterior disc displacement without reduction. J Oral Rehabil 1991; 18(6):497-500
40. Foster M, Gray R, Davies S, Macfarlane T. Therapeutic manipulation of the temporomandibular joint. Br J Oral Maxillofac Surg 2000; 38(6):641-644
41. Saghafi D, Curl D. Chiropractic manipulation of anteriorly displaced temporomandibular disc with adhesion. J Manipulative Physiol Ther 1995; 18(2):98-104
42. Zhang Y, He D. Clinical investigation of early post-traumatic temporomandibular joint ankylosis and the role of repositioning discs in treatment. Int J Oral Maxillofac Surg 2006; 35:1096-1101
43. Merril R. Discussion. The arthroscopic appearance of acute temporomandibular joint trauma. J Oral Maxillofac Surg 1990; 48:784
44. Lei J, Han J, Liu M et al. Degenerative temporomandibular joint changes associated with recent –onset disc displacement without reduction in adolescents and young adults. J Craniomaxillofac Surg 2017; 45(3):408-413
45. Moncada G, Cortés D, Millas P, Marholz C. Relationship between disk position and degenerative bone changes in temporomandibular joints of young subjects with TMD. An MRI study. J Clin Pediatr Dent 2014; 38(3):269-276
46. Stein J. TMJ arthrocentesis. A conservative surgical alternative. NY State Dent J 1995; 61(9):68-76
47. Nitzan D, Dolwick M. An alternative explanation for the genesis of closed-lock symptoms in the internal derangement process. J Oral Maxillofac Surg 1991; 49(8):810-815
48. Nitzan D, Dolwick M, Martinez. Temporomandibular joint arthrocentesis: a simplified treatment for severe, limited mouth opening. J Oral Maxillofac Surg 1991; 49(11):1163-1167.
49. Dimitroulis G, Dolwick M, Martinez A. Temporomandibular joint arthrocentesis and lavage for the treatment of closed lock: a follow up study. Br J Oral Maxillofac Surg 1995; 33(1):23-27
50. Brennan P, Ilankovan V. Arthrocentesis for temporomandibular joint pain dysfunction syndrome. J Oral Maxillofac Surg 2006; 64(6):949-951