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Refractory Temporomandibular Joint Pain Resolved with Intraoral Osteopathic Manipulative Treatment

Journal: The AAO Journal Date: 2023/06, 33(2):Pages: 28-29. doi: Subito , type of study: case report

Full text    (https://meridian.allenpress.com/aaoj/article/33/2/20/493544/LBORC-NUFA-Poster-Abstracts-2023-Students)

Keywords:

case report [514]
female [379]
OMT [2951]
osteopathic manipulative treatment [2973]
temporomandibular dysfunction [32]
women [333]

Abstract:

Introduction/Background: The temporomandibular joints (TMJ) are intricate joints comprised of the temporal bone and mandible. These joints, along with the temporalis, masseter, medial and lateral pterygoid muscles play a vital role in smooth mandibular motion. Disorders of these jaw muscles, TMJ, and facial nerves leads to temporomandibular disorders (TMD). Complications include jaw discomfort, headaches, and jaw locking. Case: A 36-year-old female presented with neck pain and left-sided migraine headaches for 15+ years secondary to two major MVAs. The neck pain was constant, aching, with 7/10 intensity. The headaches were persistent, sharp, with 8/10 intensity. Subsequently, she reported suffering from bilateral TMD with pain and jaw-locking worse on the left side. Prior to receiving OMT in April of 2021, the patient visited chiropractors and dentists with minimal relief noted. OMT was directed towards somatic dysfunctions involving the head, TMJ, and cervical spine. Several modalities were utilized, the most effective being intraoral, direct myofascial release, maxillary decompression, counterstrain, OA decompression and cranial osteopathy. An at-home muscle energy technique was demonstrated to strengthen her TMJ. Results: Through 5 OMT visits, the patient reports significant improvement regarding her TMD. Tenderness is minimal on palpation, and she experiences negligible jaw-locking. Upon observation, there is no longer asymmetrical TMJ motion with left-sided deviation. She notices decreased TMJ stiffness and increased ease during chewing. This patient continues to receive OMT for her other complaints, which have markedly improved overall. Discussion: The findings of this case promote the use of intraoral OMT to benefit patients with refractory TMD. Limitations include that this is an invasive technique unable to be tolerated by all individuals. This report suggests further support for the clinical application of cranial and TMJ OMT.


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