A long-term clinical evaluation of comprehensive physiotherapy for patients with chronic anterior disc displacement of the temporomandibular joint without reduction

doi:10.19439/j.sjos.2018.03.015

Abstract

Abstract: PURPOSE: To observe the long-term clinical efficacy of comprehensive physiotherapy for patients with chronic anterior disc displacement of the temporomandibular joint (TMJ) without reduction (ADDWoR). METHODS: A total of 256 patients with chronic ADDwoR (the course of disease was 8.4±9.6 months) who completed the treatment in our hospital from January 2014 to December 2015 were followed up. Symptoms and function pre-treatment, post-treatment and during follow-up including the maximum active mouth opening (mm), visual analog scale(VAS), mandibular function impairment questionnaire (MFIQ) score were recorded and compared; recurrent frequency and symptoms were recorded and compared, too. SPSS 17.0 software package was used for analysis of variance of repeated measurement. RESULTS: The follow-up period was 30.5±4.6 months, the patients' maximum mouth opening: pre-treatment post-treatment> follow-up (P<0.05); the patients' MFIQ: pre-treatment>post-treatment> follow-up (P<0.05). 82.8% patients didn't have recurrent symptoms, 14.5% had recurrence and the symptoms were not improved in 2.7% of patients. Among 37 patients with symptomatic recurrent disease, 70.3% had pain, 13.5% had mouth opening limitation, and 13.6% had pain with mouth opening limitation. CONCLUSIONS: Comprehensive physical therapy can significantly relieve pain and improve mouth limitation in patients with chronic ADDwoR of TMJ, and long-term efficacy was good. The causes of recurrence in some patients need further study.

Key words: Temporomandibular joint disorders, Modality therapy, Manual therapy, Movement therapy

CLC Number:

R782.6

FANG Zhong-yi, FAN Shuai, CAI Bin, XU Li-li, JIANG Xin, LIU Li-kun, HE Ying.. A long-term clinical evaluation of comprehensive physiotherapy for patients with chronic anterior disc displacement of the temporomandibular joint without reduction[J]. Shanghai Journal of Stomatology, 2018, 27(3): 289-292.

References

[1] Brown DT, Gaudet EL Jr. Temporomandibular disorder treatment outcomes: second report of a large-scale prospective clinical study [J]. Cranio, 2002, 20(4): 244-253.
[2] Sato S, Kawamura H, Nagasaka H, et al. The natural course of anterior disc displacement without reduction in the temporomandibular joint: follow-up at 6, 12 and 18 months [J]. J Oral Maxillofac Surg, 1997, 55(3): 234-238.
[3] 傅开元, 张寒冰, 赵燕平. 急性和慢性不可复性盘前移位临床对比研究 [J]. 中华口腔医学杂志, 2004, 39(6): 471-474.
[4] 马绪臣. 再谈颞下颌关节紊乱病的治疗理念-从AADR关于颞下颌关节紊乱病的政策声明谈起[J]. 口腔颌面修复学杂志, 2016, 17(1): 3-7.
[5] 蔡斌. 颞下颌关节不可复性盘前移位的物理治疗 [J] 中华口腔医学杂志, 2017, 52(3): 166-170.
[6] 张顺喜, 陈钰杰, 张瑾. 关节松动术联合运动疗法对颞下颌关节慢性不可复性盘前移位的疗效观察 [J]. 广州医药, 2015, 46(3): 22-25.
[7] 李飞, 肖红雨, 李圣节. 手法结合运动疗法治疗颞下颌关节紊乱病的疗效观察 [J]. 解放军医学院学报, 2015, 36(9): 920-922.
[8] 徐丽丽, 蔡斌, 方仲毅, 等. 个体化综合物理疗法治疗颞下颌关节紊乱病的疗效观察 [J]. 中华物理医学与康复杂志, 2014, 36(5): 329-332.
[9] 方仲毅, 范帅, 徐丽丽, 等. 软组织牵伸配合物理因子改善第三磨牙拔除后的张口受限及下颌功能[J]. 中国组织工程研究, 2015, 19(2): 252-256.
[10] Xu L, Cai B, Fang Z. Translation and validation of a chinese version of the mandibular function impairment questionnaire [J]. J Oral Rehabil, 2016, 43(8): 608-614.
[11] Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the international RDC/TMD consortium network and orofacial pain special interest group [J]. J Oral Facial Pain Headache, 2014, 28(1): 6-27.
[12] 张震康, 马绪臣. 颞下颌关节紊乱病保守治疗-手术治疗-保守治疗的循环历程 [J]. 中华口腔医学杂志, 2005, 40(5): 365-367.
[13] Slade GD, Ohrbach R, Greenspan JD, et al. Painful temporomandibular disorder: decade of discovery from OPPERA studies [J]. J Dent Res, 2016, 95(10): 1084-1092.
[14] Schiffman EL, Velly AM, Look JO, et al. Effects of four treatment strategies for temporomandibular joint closed lock [J]. Int J Oral Maxillofac Surg, 2014, 43(2): 217-226.
[15] 姜鑫, 范帅, 蔡斌, 等. 手法复位配合运动与牙合垫治疗急性颞下颌关节盘不可复性前移位的近期疗效评价[J]. 上海口腔医学, 2016, 25(5): 570-573.
[16] 姜鑫, 刘丽琨, 蔡斌, 等. 应用运动训练维持颞下颌关节盘手法复位后的盘-髁关系[J]. 中国口腔颌面外科杂志, 2016, 14(5): 435-439.
[17] Steed PA. The longevity of temporomandibular disorder improvements after active treatment modalities [J]. Cranio, 2004, 22(2): 110-114.
[18] Armijo-Olivo S, Pitance L, Singh V, et al. Effectiveness of manual therapy and therapeutic exercise for temporomandibular disorders: systematic review and meta-analysis [J]. Phys Ther, 2016, 96(1): 9-25.
[19] Al-Baghdadi M, Durham J, Araujo-Soares V, et al. TMJ disc displacement without reduction management: a systematic review [J]. J Dent Res, 2014, 93(7 Suppl): 37S-51S.
[20] Ucar M, Sarp ü, Koca I, et al. Effectiveness of a home exercise program in combination with ultrasound therapy for temporomandibular joint disorders[J]. J Phys Ther Sci, 2014, 26(12): 1847-1849.
[21] Sato S, Kawamura H. Changes in condylar mobility and radiographic alterations after treatment in patients with non-reducing disc displacement of the temporomandibular joint [J]. Dentomaxillofacial Radiol, 2006, 35(4): 289-294.
[22] Segami N, Murakami K, Lizuka T. Arthrographic evaluation of disk position following mandibular manipulation technique for internalderangement with closed lock of the temporomandibular joint [J]. J Craniomandib Disord, 1990, 4(2): 99-108.