Ultrasonographic characteristics of myogenous temporomandibular disorders: A scoping review

OBJECTIVE

To identify the available evidence on the ultrasonographic characteristics of masticatory muscles in subjects with myogenous TMD, as well as the potential use of ultrasonography as a diagnostic and treatment assessment outcomes tool.

METHOD

An electronic search of the PubMed, Web of Science and Scopus databases was performed using the following terms: 'ultrasonography', 'ultrasound', 'masseter', 'temporal', 'masticatory muscles', 'temporomandibular disorders', 'temporomandibular joint disorders'. Full-text articles were obtained from the records after applying the inclusion/exclusion criteria.

RESULTS

Thirteen articles were included for analysis: one comparative cross-sectional study, five case-control studies, six clinical trials and one randomised clinical trial. Main ultrasonographic characteristic assessed were local cross-sectional dimension and intramuscular ultrasonographic appearance. Retrieved studies reported the use ultrasonography for diagnosis or treatment assessment purposes showing heterogeneous results. For diagnosis purposes, the results of local cross-sectional dimension are not consistent; therefore, its diagnostic value for myogenous TMD diagnosis is weak. However, more homogeneous results were observed for intramuscular ultrasonographic appearance showing a higher prevalence of type-II pattern in myogenous TMD subjects than non-TMD subjects. On the other hand, for treatment assessment purposes, muscles were observed thinner after treatment compared to pre-treatment. Also, results of intramuscular ultrasonographic appearance show disappearance or reduction of anechoic areas, higher prevalence of type-II pattern and significant distinction of echogenic bands were observed after treating TMD subjects.

CONCLUSION

Ultrasonography cannot be considered as a diagnostic instrument, but maybe as a complementary tool for treatment assessment of myogenous TMD subjects, even though future research is required to confirm its utility.

Evaluation of the efficacy of pharmacological treatment in patients with temporomandibular joint dysfunctions using ultrasonography

STATEMENT OF PROBLEM

Temporomandibular joint dysfunctions (TMDs) are complex problems affecting the temporomandibular joints (TMJs), masticatory muscles, or both. TMDs are considered muscle pain caused by contraction and ischemia in the masticatory muscles, but evaluation of the efficacy of pharmacological treatment is lacking.

PURPOSE

The purpose of this clinical study was to evaluate the changes in masticatory muscles, joint space, and main arteries supplying the TMJs after pharmacological therapy in patients with TMDs using ultrasonography (USG).

MATERIAL AND METHODS

The TMJ space, masseter and temporal muscles, temporal superficial artery (TSA), and facial artery (FA) were examined using USG in 30 participants with acute TMD pain before and after 10 days of symptomatic treatment with analgesic and myorelaxant. The bilateral masseter and temporal muscle thicknesses, joint space, and end-diastolic minimum velocity (Ved), minimum end-diastolic minimum velocity (Vmin), peak systolic maximum velocity (Vmax), pulsatility index (PI), and resistance index (RI) values of the TSA and FA were measured and compared before and after pharmacological treatment. The relationship between the masseter muscle thickness and the Ved and Vmin values of the TSA and FA before and after pharmacological treatment was analyzed using the paired sample t test; the relationship between the temporal muscle thickness, TMJ spaces, and Vmax, PI, and RI values of the TSA and FA was analyzed using the Wilcoxon signed-rank test (α=.05).

RESULTS

A significant difference was found between the right temporal muscle thickness before and after medication (P=.01), whereas no statistically significant difference was found in the left temporal muscle thickness (P>.05). A significant difference was found between pretreatment and posttreatment bilateral masseter thicknesses at rest (right P=.014; left P=.004). No statistically significant difference was found in the bilateral joint space or Vmax, Vmin, Ved, PI, and RI values of the TSA and FA before and after treatment (P>.05).

CONCLUSIONS

Pharmacological treatment in participants with acute TMD led to a reduction in masseter and temporal muscle thickness but did not significantly affect joint space and local blood flow. USG is a useful diagnostic tool in the diagnosis and follow-up of TMDs.

A novel treatment modality for myogenous temporomandibular disorders using aromatherapy massage with lavender oil: A randomized controlled clinical trial

OBJECTIVE

To investigate the effect of aromatherapy massage on pain intensity and maximal mouth opening (MMO) in patients with myogenous TMD.

METHODS

Ninety-one patients were randomly assigned to three groups: Group L (aromatherapy massage with lavender oil, test), group P (massage with sweet almond oil, placebo), and group C (control). Participants were evaluated at T0 (before the intervention), T1 (immediately after the intervention), and T2 (2-month follow-up). Data were analyzed using one-way ANOVA, Tukey's HSD, and Kruskal-Wallis tests.

RESULTS

For T1 and T2, group L showed the greatest MMO values (48.01 ± 0.85 mm; 45.67 ± 0.84 mm), while group C exhibited the lowest values (39.13 ± 0.49 mm; 39.66 ± 0.82 mm) (p < 0.001). For VAS, group L revealed the lowest pain values at T1 (2) and T2 (2) (p < 0.001).

DISCUSSION

Aromatherapy massage with lavender oil was effective in the management of painful TMD conditions and limited mouth opening.

The effects of treatment timing on the management of patients with multiple facial fractures and on the self-perception of TMD recovery

OBJECTIVE

To investigate the effects of time on the orofacial functions and on the self-perception of temporomandibular disorders (TMD) recovery in a population of patients with multiple facial fractures.

METHODS

Orofacial functions and self-perception of TMD recovery was verified in patients with midface and/or lower face fractures. Patients were divided according to the time between fracture reduction and the clinical assessments: 0-1 month (Group 1), 1-3 months (Group 2), and 15 >3 months (Group 3).

RESULTS

Patients in Group 1 presented a greater compromise of swallowing and mastication when compared to patients with older fractures (p = 0.015), whereas patients in Group 3 presented a poorer TMD recovery (TMJ pain: p = 0.010 and tinnitus: p = 0.004).

CONCLUSION

Delays in functional treatments involving the myofunctional orofacial system have a negative impact on the recovery of essential orofacial functions and on TMD symptoms..

Robotic Applications in Orthodontics: Changing the Face of Contemporary Clinical Care

The last decade (2010-2021) has witnessed the evolution of robotic applications in orthodontics. This review scopes and analyzes published orthodontic literature in eight different domains: (1) robotic dental assistants; (2) robotics in diagnosis and simulation of orthodontic problems; (3) robotics in orthodontic patient education, teaching, and training; (4) wire bending and customized appliance robotics; (5) nanorobots/microrobots for acceleration of tooth movement and for remote monitoring; (6) robotics in maxillofacial surgeries and implant placement; (7) automated aligner production robotics; and (8) TMD rehabilitative robotics. A total of 1,150 records were searched, of which 124 potentially relevant articles were retrieved in full. 87 studies met the selection criteria following screening and were included in the scoping review. The review found that studies pertaining to arch wire bending and customized appliance robots, simulative robots for diagnosis, and surgical robots have been important areas of research in the last decade (32%, 22%, and 16%). Rehabilitative robots and nanorobots are quite promising and have been considerably reported in the orthodontic literature (13%, 9%). On the other hand, assistive robots, automated aligner production robots, and patient robots need more scientific data to be gathered in the future (1%, 1%, and 6%). Technological readiness of different robotic applications in orthodontics was further assessed. The presented eight domains of robotic technologies were assigned to an estimated technological readiness level according to the information given in the publications. Wire bending robots, TMD robots, nanorobots, and aligner production robots have reached the highest levels of technological readiness: 9; diagnostic robots and patient robots reached level 7, whereas surgical robots and assistive robots reached lower levels of readiness: 4 and 3, respectively.

Selective Effects of Manual Massage and Foam Rolling on Perceived Recovery and Performance: Current Knowledge and Future Directions Toward Robotic Massages

Manual massage and foam rolling are commonly used by athletes for warm-up and recovery, as well as by healthy individuals for well-being. Manual massage is an ancient practice requiring the intervention of an experienced physiotherapist, while foam rolling is a more recent self-administered technique. These two topics have been largely studied in isolation from each other. In the present review, we first provide a deep quantitative literature analysis to gather the beneficial effects of each technique through an integrative account, as well as their psychometric and neurophysiological evaluations. We then conceptually consider the motor control strategies induced by each type of massage. During manual massage, the person remains passive, lying on the massage table, and receives unanticipated manual pressure by the physiotherapist, hence resulting in a retroactive mode of action control with an ongoing central integration of proprioceptive feedback. In contrast, while performing foam rolling, the person directly exerts pressures through voluntary actions to manipulate the massaging tool, therefore through a predominant proactive mode of action control, where operations of forward and inverse modeling do not require sensory feedback. While these opposite modes of action do not seem to offer any compromise, we then discuss whether technological advances and collaborative robots might reconcile proactive and retroactive modes of action control during a massage, and offer new massage perspectives through a stochastic sensorimotor user experience. This transition faculty, from one mode of control to the other, might definitely represent an innovative conceptual approach in terms of human-machine interactions.

Acupuncture for lumbar myofascial pain Protocol for a systematic review of randomized controlled trials

BACKGROUND

Lumbar myofascial pain is a major contributor to chronic low back pain. Acupuncture has been applied as an effective treatment for chronic low back pain worldwide. However, few critical systematic reviews focus on the effect of acupuncture on chronic low back pain caused by lumbar myofascial pain have been published. The study aims to evaluate the current evidence on the efficacy of acupuncture for chronic low back pain caused by lumbar myofascial pain.

METHODS

A total of 7 databases will be searched from their inception to March 2019, including PubMed, Medline, Embase, the Cochrane Central Register of Controlled Trials, the Chinese National Knowledge Infrastructure database, the Chinese Biomedical database, and the Wanfang database. Randomized controlled trials (RCTs) that compared the effect of acupuncture for lumbar myofascial pain will be included. The primary outcomes will be reduction of lumbar myofascial pain assessed by Visual Analog Scale (VAS). Secondary outcomes are questionnaires to evaluate the effects of treatment on patients' daily life activities and psychological status; and adverse events. The primary and secondary outcomes will be assessed before (0 day) treatment and at 0, 7, 30, and 90 days after treatment. Data synthesis will be computed by RevManV.5.3.5 software when a data-analysis is allowed. Methodological quality will be evaluated with the risk of bias according to Cochrane Handbook.

RESULTS

The results of this study will be published in a peer-reviewed journal.

CONCLUSION

The study will provide evidence to illustrate acupuncture is an effective therapeutic intervention for chronic low back pain caused by lumbar myofascial pain.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42019129735.

Association of facial massage, dry needling, and laser therapy in Temporomandibular Disorder: case report

This case report aims to evaluate the treatment of Temporomandibular Disorder (TMD) of muscular origin by associating facial massage (FM), dry needling (DN), and low-level laser therapy (LLLT). The pre- and post-treatment evaluations consisted of clinical examinations based on the Research Diagnostic Criteria (RDC) for TMD, pain intensity quantification by means of the Visual Analog Scale (VAS), mandibular movement measurement, and electromyographic (EMG) analysis of the masseter and temporal muscles. Post-therapy assessment indicated a decrease in pain sites of 58%, in pain intensity mean (1.3), and an increase in the maximum aperture of 10 mm, in addition to normalization of EMG signals. We conclude that, after application of the treatment protocol, there was a decrease in painful sites, gain in amplitude of mandibular movements, and normalization of EMG activity.

Design, path planning improvement and test of a portable massage robot on human back

A massage robot that helps to improve the quality of human life has attracted more interests of researchers and consumers. A portable back massage robot that is compact and space-saving was designed to be used on human back instead of a traditional large-scale structure robot. To design the massage robot, the models of electric circuit, magnetic circuit and mechanics were analyzed to achieve optimal massage force. Parameters of the massage actuator are determined based on the influence analysis of the coil current, the coil turns and the distance between the moving core and the yoke on the electromagnetic force. The massage coverage of human back, which is used to calculate the massage effect, could be improved by an excellent path planning algorithm. This article proposed an efficient full covered path planning algorithm for the designed massage robot, and the relevant algorithm models were established. Simulation results show that the coil current is much more sensitive to electromagnetic force of the moving core compared to the other two factors, and the presented path planning algorithm completes full coverage of the massage robot on the back area. The experimental platform of the massage robot was built, and the influence of the input signal duty cycle, the input signal voltage and the hardness of the massage object on the massage effect was discussed by testing the values of acceleration. The tested results show that the massage effect is best when the duty cycle is in the range of 1/8–1/2. Meanwhile, the hardness of massage parts affects the massage intensity. The consistency between the tested results of path planning and simulation verifies the feasibility of the simulation procedure and indicates that the massage robot can attain the desired massage performance and realize the planned paths.

Tratamento para disfunções temporomandibulares: uma revisão sistemática

RESUMO Introdução: A disfunção temporomandibular (DTM) é complexa e multifatorial. São encontrados, na literatura, estudos que comparam diferentes métodos de tratamento. Objetivo: Investigar estudos sobre o tratamento das disfunções temporomandibulares (DTMs) nas diversas áreas da saúde, avaliando a eficácia das técnicas empregadas, principalmente no que se refere ao uso da terapia miofuncional orofacial. Estratégia de pesquisa: Os artigos compilados neste estudo foram selecionados por meio da base de dados PubMed, utilizando os descritores “temporomandibular disorders and oral motor therapy”, “orofacial myofunctional therapy and temporomandibular disorders” e “temporomandibular disorders and myofunctional rehabilitation”. O levantamento realizado limitou-se aos artigos publicado nos idiomas Inglês e Português, entre janeiro de 2006 e dezembro de 2016. Critérios de seleção: Foram incluídos artigos sobre os tratamentos das DTMs associados aos exercícios musculares e/ou terapias manuais. Publicações sem acesso completo, repetidas por sobreposição das palavras-chave, revisões de literatura, cartas ao editor e não relacionadas diretamente ao tema foram excluídas. Resultados: Dos 102 estudos selecionados, 22 atenderam aos critérios estabelecidos. Em geral, a maioria dos tratamentos descritos apresentou efeitos benéficos para pacientes com DTMs. Foi observada grande variabilidade da metodologia adotada para a aplicação e verificação dos efeitos dos tratamentos e somente poucos estudos fizeram uso de grupo controle. Conclusão: Apesar do crescimento no número de pesquisas sobre DTMs, ainda não é possível estabelecer qual a melhor técnica de tratamento. Após análise dos artigos selecionados, observou-se que as técnicas combinadas de terapia (ex.: exercício associado ao uso de equipamento para redução da dor) produzem melhores resultados, com maior redução da dor e melhora da mobilidade mandibular.

Magnetic resonance and sonographic imagings of masticatory muscle myalgia in temporomandibular disorder patients

This article reviews recently published studies investigating the MRI and sonographic diagnosis of masticatory muscle myalgia in temporomandibular disorder patients. The MRI and sonographic features of muscle after treatment are also discussed. Literature published within the last 15 years was obtained from the PubMed database using the following Mesh terms: magnetic resonance imaging (MRI) or sonography, masticatory muscle pain, and treatment. MRI and sonography enable accurate visualization and evaluation of the masticatory muscles, thereby increasing our understanding of pathology and cause of pain associated with these muscles. Although therapeutic efficacy is often evaluated based on clinical findings, MR and sonographic imaging studies may also be valuable.