TEMPOROMANDIBULAR DISORDERS

DEPARTMENT OF OROFACIAL PAIN AND TEMPOROMANDIBULAR DISORDERS

The Orofacial Pain and Temporomandibular Disorders department at Instituto Português da Face is dedicated to the prevention, diagnosis, education, treatment and rehabilitation of the pathology associated with facial pain.

OROFACIAL PAIN ("FACIAL PAIN") CAN HAVE DIFFERENT ETIOLOGY:

Temporomandibular Joint Pathology
Myalgia
Neurovascular Pain
Neuropathic Pain
Headaches
Migraines
Intra-oral Pathology

Since this pain can have different etiology, a multidisciplinary approach is essential - specialists in temporomandibular disorders, maxillofacial surgery, stomatology, neurology, otolaryngology, physical medicine and rehabilitation, oral medicine, physiotherapy, and speech therapy work together to find the best medical solutions.

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TEMPOROMANDIBULAR JOINT DISORDERS

WHAT IS TEMPOROMANDIBULAR JOINT?

The temporomandibular joint (TMJ) is located near the ear and is frequently used to perform essential activities of our daily lives such as eating, talking, smiling, and yawning. It is the most commonly used joint in the human body on a daily basis, about 2000x per day.

When this joint presents pathology, we can say that we have temporomandibular disorder(TMD).

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WHAT ARE THE MOST COMMON SIGNS AND SYMPTOMS IN A TEMPOROMANDIBULAR DISORDER?

The most common signs and symptoms of this disorder include :

Facial and or/joint pain (often confused with ear pain)
Joint popping/clicking
Blocking or limitation of mouth opening
Sensation of disarticulation of the jaws
Muscle or neck tension/pressure
Feeling "gritty" in the joint
Headaches

WHAT ARE THE MAIN CAUSES OF TEMPOROMANDIBULAR DISORDERS (TMD)?

TMD is a multifactorial disease, meaning that there are different causes associated with this problem. These can be highlighted:

Acute trauma
Chronic traum
Autoimmune pathology
Tumors
Bruxism (teeth grinding)
Tooth clenching

HOW IS THE DIAGNOSIS OF TEMPOROMANDIBULAR DISORDER (TMD) MADE?

To make the diagnosis of TMD, in a first step, it is essential to listen to the patient's clinical history and perform the appropriate objective examination in order to obtain some diagnostic hypotheses.

In the medical history we will ask you some questions, such as: (1) when did you start having complaints; (2) how has the disease progressed; (3) have you had previous treatments; (4) the level of pain you have experienced in the last six months; (5) do you feel any limitation in opening your mouth.

After the first consultation, there may be a need for our Orofacial Pain and Temporomandibular Disorder specialists to ask you to perform:

Magnetic resonance imaging of the temporomandibular joints and/or;
Computed Tomography of temporomandibular joints and/or;
Orthopantomography and/or;
Frontal X-ray.

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The two most important muscles in chewing are the masseter muscle and the temporal muscle

TREATMENTS FOR TEMPOROMANDIBULAR DISORDERS

Temporomandibular disorders can envolve the muscle and/or the temporomandibular joint and for that reason there are different therapeutic approaches, according to the diagnosis, which must be assertive and meticulous. Thus, for a given diagnosis, there may be a conservative and/or surgical treatment.

NON-SURGICAL TREATMENTS

PHARMACOLOGICAL TREATMENT

The medical team specialized in Orofacial Pain and Temporomandibular Disorder at Instituto Português da Face may prescribe medication to control some of the symptoms - anti-inflammatories, muscle relaxants, antidepressants, and/or antiepileptics.

CONSERVATIVE NON-PHARMACOLOGICAL TREATMENT

We may prescribe relaxing drips/plates, physical therapy, or acupuncture to control your symptoms.

• BOTULINUM TOXIN PROTOCOL FOR TEMPOROMANDIBULAR JOINT DEVELOPED BY IPFACE

We have developed an exclusive protocol for the treatment of muscular Temporomandibular Disorder, with botulinum toxin associated with post-treatment physiotherapy. This protocol allows the control of muscle pain, relaxation of all cervicofacial muscles and muscle re-education. At this moment Instituto Português da Face team has more than 500 patients treated with this protocol, with a complication rate of less than 0.13%, and an overall success rate close to 83%. The overall satisfaction rate of patients who have undergone this treatment is 7.05 ± 2.90 (1-10) in 22 randomized patients.

• PSYCOTHERAPY

According to the holistic view of modern medicine, it is essential to treat patients as a whole - body, mind, and spirit - so in some cases psychotherapy sessions may be recommended.

• PHYSIOTHERAPY

Special kinesiotherapy techniques, manual massage and muscle strengthening, specific to the Temporomandibular Joint.

• SPEECH THERAPY

Functional rehabilitation of the stomagmatic system.

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SURGICAL TREATMENTS

ARTHROCENTESIS OF THE TEMPOROMANDIBULAR JOINT

It is a minimally invasive technique, performed most of the time under local anesthesia. Its main objective is to eliminate the inflammatory mediators responsible for the pain, reduce the intra-articular pressure, release intra-articular fibrous adhesions and hydrate/lubricate the TMJ. In the early stages of temporomandibular joint problems there is an inflammatory process responsible for the pain, which can be treated with this technique. In very early and particular cases, arthrocentesis can improve the position of the articular disc. A study carried out at Instituto Português da Face on 216 arthrocentesis of the temporomandibular joint with Prof. Dr. David Ângelo shows an overall success rate of 86.11% and an overall satisfaction index of 9.09 ± 0.971 (0-10).

TEMPOROMANDIBULAR JOINT ARTHROCENTESIS PROTOCOL WITH SUPER PRP

Instituto Português da Face has developed a specific protocol for arthrocentesis of the temporomandibular joint with super PRP:

Anesthesia	Duration	Recovery	Scar
Local	30 minutes	2-5 days	No scar

WHAT IS THIS PROTOCOL?

ARTHROSCOPY OF THE TEMPOROMANDIBULAR JOINT

Arthroscopy is a widely used technique in medicine. It allows minimally invasive surgical interventions to be performed on various joints of the human body such as the knee, hip or shoulder. However, this technique can also be used on the temporomandibular joint.

This procedure allows a very small camera to be introduced into the joint and a thorough diagnosis and treatment to be made. It also allows for minor interventions to reposition the disc, treat areas of inflammation, and remove adhesions from the joint.

A study conducted at Instituto Português da Face on 140 arthroscopies of the temporomandibular joint with Prof. Dr. David Ângelo shows an overall success rate of 84.9% and an overall satisfaction index of 9.03 ± 1.13 (scale of 0-10). A study published in an American journal by Instituto Português da Face group showed that it is a safe technique with very few associated complications. Recently, this group published a modification of the original surgical technique that allows for better results.

Anesthesia	Duration	Recovery	Scar
General	2h	2 weeks	Imperceptible

OPEN SURGERY OF THE TEMPOROMANDIBULAR JOINT

Open surgery is reserved for more complex cases. There are several techniques within open surgery that you can discuss with your doctor. Our group has a lot of experience in open surgery with excellent results. In one of the most recent scientific papers, we obtained an 89% success rate in cases of advanced pathology of the temporomandibular joint. Recently, our group published a technique that allows for an invisible scar, associated with fewer surgical complications and excellent functional results. The overall satisfaction rate of patients who underwent open surgery was 8.38 ± 1.84 (0-10).

Anesthesia	Duration	Recovery	Scar
General	2h	weeks3 weeks	Invisible (RHIITNI)

Overall, the scientific literature supports that early diagnosis and treatment are associated with better outcomes for patients with temporomandibular joint pathology.

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