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SHORT COMMUNICATION Table of Contents   
Year : 2008  |  Volume : 19  |  Issue : 3  |  Page : 278-279
Strapping for temporomandibular joint dysfunction


1 Department of Rehabilitation, CSI Mission Hospital, Codacal PO, Tirur - 676 108, Kerala, India
2 Department of Oral and Dental Surgery, CSI Mission Hospital, Codacal PO, Tirur - 676 108, Kerala, India

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Date of Submission10-Oct-2007
Date of Decision20-Apr-2008
Date of Acceptance25-Apr-2008
 

   Abstract 

Temporomandibular joint dysfunction (TMJD) is a common problem seen in many of the dental clinics. Management of this depends on an accurate diagnosis of the cause for the TMJD. Physical therapy and rehabilitation play a vital role in the management of these dysfunctions. Physical therapy is useful in treating post-traumatic stiffness of the TMJ while strapping of the TMJ for a dysfunction along with conventional physical therapy is of benefit in terms of reduction in click, decrease in pain, and an improvement in function.

Keywords: Strapping, TMJ dysfunctions, physical therapy, rehabilitation

How to cite this article:
Babu AS, John SM, Unni A. Strapping for temporomandibular joint dysfunction. Indian J Dent Res 2008;19:278-9

How to cite this URL:
Babu AS, John SM, Unni A. Strapping for temporomandibular joint dysfunction. Indian J Dent Res [serial online] 2008 [cited 2019 Aug 22];19:278-9. Available from: http://www.ijdr.in/text.asp?2008/19/3/278/42966
Temporomandibular joint dysfunction (TMJD) is a term used to describe a common disorder characterized by pain and derangement of the TMJ. [1] This is a common sight in most dental clinics and is the most common cause of pain in the jaw.


   Case report Top


A 38-year-old male presented with pain in the left TMJ after he sustained a traumatic injury which resulted in a subcondylar fracture of the left mandible. The fracture was manually reduced and immobilized with intermaxillary fixation using Erich's arch bar for 6 weeks. After 6 weeks, he presented with pain in the left TMJ, limited mouth opening and difficulty in eating and speaking. He had no significant medical history. He was referred to physical therapy with a diagnosis of post-traumatic stiffness of the TMJ for further evaluation and management.

Examination

The initial physical therapy assessment was done on the day of referral from the dental surgeon. He is a healthy male with normal vital signs. On examination, he had decreased mouth opening (1.5 cm) with grade 2 tenderness over the left TMJ. Mouth opening was measured by measuring the distance between the incisal edges of the upper and lower central incisors. Functional mouth opening was assessed by having the patient try and insert two or three flexed proximal interphalangeal joints within the mouth. At this time, he was able to put in only one finger. An audible click from the left TMJ was appreciated during mouth opening. This was accompanied by a lateral deviation of the mandible to the right. Pain was recorded using the Visual Analog Scale (VAS). The patient reported a VAS of eight.

Treatment

He was started on intensive physical therapy for improving joint mobility that comprised of ultrasound in the continuous mode at 1 W/cm 2 using a 3 MHz head for 5 min to each joint. Grade two mobilization of the joint for antero-posterior and lateral glides were done. Active exercises consisting of mouth opening, mandibular protraction and lateral deviations, neck flexion-extension, protraction-retraction, and shoulder shrugging were taught. Hold-relax techniques for the TMJ were also incorporated into the treatment to help bring about relaxation. Therapy was done on a daily basis with each session lasting 45-60 min. The patient was instructed to carry out active exercises and relaxation at home three times a day, consisting of three sets of 10 repetitions each. However, he continued to have a persisting click despite the physical therapy. An excessive lateral movement of the mandible was observed during mouth opening and hence strapping was considered in the management to help prevent the lateral deviation of the jaw and thereby reduce the dysfunction.

Strapping of the left TMJ to prevent lateral movement of the joint to the right was done with the mouth in the relaxed position. The strap was applied directly onto the skin midway on the body of the mandible on the right side. The strap was then pulled across the symphysis menti with a force directed to the left in the transverse plane [Figure 1]. The strap was then secured directly onto the skin just below the opposite mastoid process [Figure 2]. Appropriate precautions were taken to check for any skin reactions to the tape used for strapping. No adverse reactions to the tape used for strapping was observed. Repeated mouth opening revealed no click following the strapping. The strap was applied by the physical therapist everyday for 2 weeks and was kept for at least 6 h everyday. Gentle isometric strengthening exercises for the masseter and pterygoids were also started with the strap on. He continued his regular routine of exercises and relaxation for another 2 weeks.

Follow-up

At the end of 2 weeks, a marked improvement in mouth opening to 3.5 cm was seen. Functional mouth opening also had improved and he was able to insert three flexed proximal interphalangeal joints into his mouth. Resolution of the dysfunction was noted by a decrease in pain to a VAS of 0 and also the absence of lateral deviation of the mandible on mouth opening. A home program consisting of regular range of movement exercises, relaxation and strengthening was taught to the patient. He was advised not to bite hard food and to gradually progress to hard and tough foods. At 3 months follow-up, the patient revealed no symptoms other than the occasional click on extreme mouth opening. The patient continued the exercises, and at 6 months follow up was found to have no dysfunction with a normal mouth opening both functionally and as by insical distance measurement (4 cm). He was also able to tolerate a normal diet and had no difficulty in eating hard and tough food.


   Discussion Top


TMJ dysfunction is a common problem present in 20% of the population. [2],[3] Physical therapy involving combinations of active exercises, manual therapy, postural correction, and relaxation techniques has been described as the main stay of management for TMJ dysfunction according to the American Academy of Craniomandibular Disorders and the Minnesota Dental Association. [4],[5]

In this case report, it is seen that conventional physical therapy alone did not bring about much change in the TMJD. However, the addition of strapping did bring about both short- and long-term benefits in regard to pain, tenderness, click, mouth opening and function for this patient. Strapping for the TMJ lacks scientific evidence for advocating it as part of a treatment option and hence, randomized control trials on a larger population would be needed to verify this result.


   Acknowledgments Top


The authors would like to thank Ms. Manjula Sukumari Noone, Dr. Ann Johns and Dr. Sunderlal Babu for their help and guidance.

 
   References Top

1.Corrigan, Maitland: Practical orthopaedic medicine. Butterworth and Co; 1983. p. 216-23.  Back to cited text no. 1    
2.Pedroni CR, De Oliveira AS, Guaratini MI. Prevalence study of signs and symptoms of temporomandibular disorders in university students. J Oral Rehabil 2003;30:283-9.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Nassif NJ, Al-Salleeh F, Al-Admawi M. The prevalence and treatment needs of symptoms and signs of temporomandibular disorders among young adult males. J Oral Rehabil 2003;30:944-50.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Medlicott MS, Harris SR. A systematic review of the effectiveness of exercise, manual therapy, electrotherapy, relaxation training and biofeedback in the management of temporomandibular disorder. Phys Ther 2006;86:710-25.  Back to cited text no. 4    
5.Sturdivant J, Fricton JR. Physical therapy for temporomandibular disorders and orofacial pain. Curr Opin Dent 1991;1:485-96.  Back to cited text no. 5  [PUBMED]  

Top
Correspondence Address:
Abraham Samuel Babu
Department of Rehabilitation, CSI Mission Hospital, Codacal PO, Tirur - 676 108, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.42966

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    Figures

  [Figure 1], [Figure 2]



 

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