Dissertação
Mobilização articular em pacientes com disfunção temporomandibular: estudo controlado randomizado
Fecha
2016-08-03Autor
Silva, Muriel Priebe e
Institución
Resumen
Temporomandibular disorder (TMD) is a condition that affects the masticatory muscles, and
associated structures. The physiotherapy approach in TMD includes modalities, which can
be applied individually or combined, such as: ultrasound, laser therapy, mobilization of
temporomandibular joint (TMJ) and cervical spine and cervical manipulation. These
interventions still need to be better investigated regarding their effects and with quantitative
tools for evaluating the craniocervicomandibular system structures. Thus, this research aims
to verify the effect of TMJ and hyoid bone mobilization on the pain threshold and
electromyographic activity of masticatory and cervical muscles, in women with severe TMD.
Furthermore, it proposed to evaluate the response of this technique on cervical dysfunction.
The participants were 26 women, mean age of 27.92 (± 6.06) years, with diagnosis of TMD,
assessed by Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD)
and classified as severe, according to the Temporomandibular Index score (TMI > 0.5). All
participants were divided randomly into two groups: control group (CG, n = 13) and treatment
group (TG, n = 13). They were evaluated, as the cervical dysfunction, through the
Craniocervical Dysfunction Index (CCDI); pain threshold, by algometry of masticatory and
cervical muscles and surface electromyography of these muscles, at rest and maximum
intercuspal (MI) situations. The evaluations were performed at the beginning (A1) and, after
five weeks (A2) in both groups. The participants of the TG were submitted to 10
physiotherapy sessions, consisted by TMJ and hyoid bone mobilization techniques. The
participants of CG waited to be treated after this period. In the evaluation of the diagnostic
subgroups of TMD, there was a reduction of mixed dysfunction from 92.3% to 15.4%,
respectively, at A1 and A2, in the TG. Furthermore, TMD diagnosis present in all patients at
A1, was suppressed in 69,25% of TG patients at A2. Houve um aumento de 27,40% no
limiar de dor no músculo temporal anterior e 8,57% de diminuição na região inferior do
masseter no GT, na comparação entre A1 e A2.In both groups, there was an increase in the
pain threshold in the middle region of the masseter ( 10 and 7,98 % in GC and GT ,
respectively) . Furthermore, increased pain threshold was observed in subocciptal muscles,
1,42% and 6,23 % in the CG and TG , respectively and in 30,18% in scalene in GT. The
electrical activity of the sternocleidomastoid , during MI, increased 6,97% in the control group
and 6,32% in GT. Masticatory muscles showed no difference between groups and between
assessments (A1 and A2 ) in both groups. These findings show that the joint mobilization
was effective in suppressing TMD diagnosis, improving cervical dysfunction and painful
sensitivity of anterior temporal muscle. The technique does not interfere in the muscle
activity, which showed little altered in the study participants, although they presented severe
TMD.