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Case Study: Temporomandibular Joint Pain

Patient profile

72 yr old female developed post-dental temporomandibular joint (TMJ) pain after 3 lengthy amalgam removal procedures. Unable to protrude tongue, open mouth, chew solids or form a proper occlusion (bite). After some initial TMJ locking her right TMJ become exquisitely painful and restricted. At the time of the initial consult she was barely able to open her mouth enough to speak.

Assessment

Marked tenderness and tension in chewing muscles and sensitivity of the TMJ. The TMJ can be assessed from either outside or inside the ear. The condyle of the mandible was displaced and unable to undergo either translation or rotation which are key movements enabling the opening of the jaw. The entire neck and upper shoulder girdle were also tense and painful.

 

Muscular balance of head and neck. M, masseter muscle; E, neck extensors muscle; SCM, sternocleidomastoideus muscle; T, temporal muscle; IH, infrahyoid muscles. (From Friedman and Weisberg)

 

Treatment

Treatment consisted of osteopathic manual medicine (including intra-oral mobilisation) and photobiomodulation. The analgesic and anti-inflammatory effect of photobiomodulation appeared to amplify osteopathic treatment effects and self-mobilisation practices.

Outcome

Weekly treatment over 5 weeks has seen a complete recovery of function. This could simply be attributed to the passage of time except that improvement was noted after the initial treatment and at each subsequent treatment.

2/50 Princes Highway Cobargo NSW 2550. Opposite Cobargo Doctors.