Evaluation of Efficacy of Ultrasonography in the Assessment of Transcutaneous Electrical Nerve Stimulation in Subjects with Myositis and Myofascial Pain

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.

Effect of transcutaneous electrical nerve stimulation on pain, edema, and trismus after surgical removal of impacted third molars: a split-mouth randomized clinical trial

BACKGROUND

The transcutaneous electrical nerve stimulation (TENS) stimulus inhibits the activity of nociceptive neurons of the central nervous system. Pain relief is achieved by increasing the pulse amplitude of TENS to induce a non-painful paranesthesia beneath the electrodes. This study aimed to assess the effect of TENS on acute pain, edema, and trismus after surgical removal of impacted third molars.

MATERIAL AND METHODS

This randomized, double blind, split-mouth clinical trial was conducted on 37 patients with bilaterally impacted mandibular third molars. The angle and body of mandible at the site of surgery in one randomly selected quadrant underwent TENS immediately after surgery (50 Hz, 100-µs short pulse, 15 minutes for 6 days). The TENS stimulator device was used in off mode for the placebo quadrant. The pain score (primary outcome) was measured for 7 days postoperatively, and edema and trismus (secondary outcomes) were assessed at 2, 4 and 7 days, postoperatively. The results were analyzed by repeated measures ANOVA using R software (alpha=0.05).

RESULTS

The overall mean pain score was significantly lower in the TENS than the placebo group (P<0.05). The number of taken analgesics in the first 3 days was significantly lower in the TENS group (P<0.001). Postoperative edema in the TENS group was lower than the placebo group but only the difference was not statistically significant (P>.05). The inter-incisal distance, as an index to assess trismus, was not significantly different between the two group at day 2, but it was significantly higher in the TENS group after the second day (P<0.001).

CONCLUSIONS

TENS effectively decreased pain and trismus following impacted third molar surgery, and may be recommended as a non-pharmaceutical method to relieve postoperative symptoms.

Comparison of the Efficiency of High-Intensity Laser Therapy and Transcutaneous Electrical Nerve Stimulation Therapy in Patients With Symptomatic Temporomandibular Joint Disc Displacement With Reduction

PURPOSE

Many different treatment modalities have been tried in the treatment of temporomandibular joint (TMJ) disorders and different results have been reported. The aim of the study was to investigate and compare the effects of high-intensity laser therapy (HILT) and transcutaneous electrical nerve stimulation (TENS) therapy on the treatment of patients with TMJ disc displacement with reduction(DDWR).

METHODS

Researchers conducted a prospective, single-blind, controlled clinical trial on patients with TMJ disc disease at a university's oral and maxillofacial surgery clinic. One hundred two patients were randomized into 3 groups (HILT, TENS and control group). The patients were evaluated in terms of maximum mouth opening (MMO), assisted MMO, Visual Analog Scale (VAS) (pain), and VAS (function). In addition, the disability status of the patients with the Jaw Functional Limitation Scale-20 (JFLS-20) and the quality-of-life with the Oral Health Impact Profile (OHIP-14) was evaluated.

RESULTS

At the start of the trial, in terms of socio-demographic characteristics, no significant differences existed between the groups. Significant improvements were seen in pain (VAS), MMO, total JFLS-20 and total OHIP-14 scores in the HILT and TENS groups compared to the control group. At week 4, the VAS pain score decreased significantly in the HILT group compared to the TENS group (48 and 25%, respectively), while the MMO was significantly increased (24 and 10%, respectively). In addition, there was a significant improvement in both the total JFLS-20 score and the total OHIP-14 score at weeks 4 and 12 in the HILT group compared to the TENS group (P < .05).

CONCLUSION

It was observed that the healing effect of pulsed Nd: YAG laser therapy was significantly higher than TENS in patients with DDWR. Therefore, HILT should be a priority option over TENS therapy in patients with disc displacement.

Immediate Effect of Masticatory Muscle Activity with Transcutaneous Electrical Nerve Stimulation in Muscle Pain of Temporomandibular Disorders Patients

Transcutaneous electrical nerve stimulation (TENS) is a non-invasive treatment modality for acute and chronic pain. However, little information for muscle activity is available on the immediate effects of TENS in masticatory muscle pain related to temporomandibular disorders (TMDs). The present study aimed to evaluate the immediate effects of TENS treatment on TMD-related muscle pain. Thirty-six patients with TMD-related muscle pain and 39 healthy subjects served as TMD and control groups, respectively. For objective evaluations, maximum mouth opening, and maximum bite force were measured before and after TENS. The pain intensity was assessed according to a 100-mm visual analog scale (VAS). TENS was applied to painful muscles for 20 min with frequencies of 100–200 Hz. The treatment outcome was evaluated using Global Rating of Change (GRC) scales. In the TMD group, VAS values significantly decreased after TENS. Although there was significant increase in the maximum mouth opening after TENS for only TMD group, the maximum bite force of both groups was significantly greater after TENS. According to GRC scales, one patient with TMD-related muscle pain expressed negative feelings after TENS. Conclusively, TENS treatment might quickly relieve pain in masticatory muscles and improve masticatory functions in patients with TMD-related muscle pain.

The predictive role of the posterior tibial tendon cross-sectional area in early diagnosing posterior tibial tendon dysfunction

A hypertrophied posterior tibial tendon (PTT) has been considered to be an important morphologic parameter of PTT dysfunction (PTTD). Previous research has demonstrated that the PTT thickness (PTTT) is correlated with early signs of PTTD. However, the thickness is different from hypertrophy. Thus, we devised the PTT cross-sectional area (PTTCSA) as a new predictive parameter for diagnosing the PTTD.The PTT data were acquired from 14 patients with PTTD and from 20 normal individuals who underwent ankle magnetic resonance imaging. We measured the PTTT and PTTCSA at the PTT on the ankle magnetic resonance imaging.The mean PTTT was 2.43 ± 0.39 mm in the normal group and 3.40 ± 0.42 mm in the PTTD group. The average PTTCSA was 16.10 ± 4.27 mm in the normal group and 26.93 ± 4.38 mm in the PTTD group. The receiver operator characteristic analysis curve demonstrated that the highest predictive value of the PTTT was 3.07 mm, with 85.7% sensitivity, 85.0% specificity. The highest predictive value of the PTTCSA was 22.54 mm, with 92.9% sensitivity, 90.0% specificity.Our findings suggest that the PTTCSA was a more valid predictor of PTTD, even though the PTTT and PTTCSA were both significantly associated with PTTD.

Masseter muscle thickness and elasticity in periodontitis

This study aimed to compare the thickness and elasticity of the masseter muscle between patients with gingivitis and patients with periodontitis. A total of 124 patients (63 gingivitis, 61 chronic periodontitis) were recruited at the start of the study, but only 84 patients were declared as final participants. Patients were divided into two groups: (1) patients suffering from gingivitis and (2) those with generalized chronic periodontitis. Clinical (PI, plaque index; GI, gingival index; PD, probing depth; CAL, clinical attachment loss; and BOP, bleeding on probing scores) and ultrasonographic (thickness and elasticity of the masseter muscle) measurements of periodontitis were performed. There were no significant differences in gender, age, body mass index, education status, income level, or marital status between the two groups (P > 0.05). The mean age ± SD for the gingivitis and periodontitis groups was 39.5 ± 10.8 years and 44.8 ± 8.8 years, respectively. There were significant differences between the two groups in the number of PI, GI, PD, CAL, and BOP scores. There were significant differences between the two groups when thickness of masseter during contraction and at rest was taken into account. The gingivitis group had significantly thicker masseter during both contraction and rest. On the other hand, when the elasticity of the masseter was evaluated, there were no significant differences found between the two groups and two sides for each group. Masseter muscle thickness in the periodontitis group was found to be decreased compared with that in the gingivitis group. Furthermore, loss of periodontal tissues due to periodontitis reduces the masticatory ability.