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A multidisciplinary approach to treating musculoarticular dysfunction of the temporomandibular joint with obvious pain syndrome

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Objective: to investigate the efficiency of an integrated approach to treating craniomandibular dysfunction, by changing the biomechanical tempomandibular joint (TMJ) movement pattern via botulinum toxin type A injection into the masticatory muscles.

Patients and methods. The investigation enrolled 20 patients aged 18-45 years with clinical signs of muscular-articular dysfunction of the TMJ. Before and after treatment, all the patients underwent magnetic resonance imaging of the TMJ and masticatory muscles, as well as ultrasonography and surface electromyography (EMG) of the masticatory muscles.

Results. There was a significant reduction in pain syndrome, an improvement in the relationship of intra-articular TMJ elements, and a change in the structure of the masticatory muscles. The EMG indices were near-normal. Four-six months after treatment, the majority of patients showed an increase in the amplitude of mouth opening (95%), reductions in resting pain (85%) and in the frequency of TMJ clicking (90%).

Conclusion. The management of patients with severe chronic pain syndrome in the presence of muscular-articular dysfunction of the TMJ requires the participation of an orthodontist to correct malocclusion and a neurologist to treat local myofascial pain syndrome. 

About the Authors

O. A. Shakhmetova
«SOGAZ» International Medical Center, Saint Petersburg
Russian Federation
8A, Malaya Konyushennaya St., Saint Petersburg 191186

T. M. Sinitsina
I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia, Saint Petersburg
Russian Federation
41, Kirochnaya St., Saint Petersburg 193015


1. De Kanter RJ, Truin GJ, Burgersdijk RC, et al. Prevalence in the Dutch adult population and a meta-analysis of signs and symptoms of temporomandibular disorder. J Dent Res. 1993 Nov;72(11):1509-18.

2. Goulet JP, Lavigne GJ, Lund JP. Jaw pain prevalence among French-speaking Canadians in Quebec and related symptoms of temporomandibular disorders. J Dent Res. 1995 Nov; 74(11):1738-44.

3. Силин АВ. Проблемы диагностики, профилактики и лечения морфофункциональных нарушений в височно-нижнечелюстных суставах при зубочелюстных аномалиях. Дисс. ... докт. мед. наук. Санкт-Петербург; 2007. 215 с. [Silin AV. Problems of diagnosis, prevention and treatment of morphological and functional disturbances in the temporomandi bular joints of dentoalveolar anomalies. Diss. ... doct. med. sci. Saint-Petersburg; 2007. 215 p.]

4. Фадеев РА, Кудрявцева ОА, Польщикова ИВ. Выявление окклюзионных нарушений и подготовка к их устранению у пациентов с дисфункциями височно-нижнечелюстных суставов. Дентал Юг. 2008;(7):44-6. [Fadeev RA, Kudryavtseva OA, Pol'shchikova IV. Detection of occlusal disorders and preparation for their elimination in patients with dysfunction of the temporomandibular joints. Dental Yug. 2008;(7):44-6. (In Russ.)].

5. Орлова ОР, Мингазова ЛР, Вейн АМ. Лицевые боли мышечной природы: клинико- физиологические особенности и лечение ботулотоксином типа А (диспортом). В кн.: Тезисы докладов Российской научно-практической конференции «Клинические и теоретические аспекты острой и хронической боли». Нижний Новгород; 2003. С. 113-5. [Orlova OR, Mingazova LR, Vein AM. Facial pain muscle nature: clinical and physiological features and treatment with botulinum toxin type A (Dysport). In: Tezisy dokladov Rossiiskoi nauchno-prakticheskoi konferentsii «Klinicheskie i teoreticheskie aspekty ostroi i khronicheskoi boli» [Abstracts of the Russian scientific-practical conference «Clinical and theoretical aspects of acute and chronic pain»]. Nizhnii Novgorod; 2003. P. 113-5.]

6. Ураков АЛ, Сойхер МИ, Сойхер МГ, Ре- шетников АП. Хроническая лицевая боль, связанная с гипертонусом жевательных мышц. Российский журнал боли. 2014;(2):22-5. [Urakov AL, Soikher MI, Soikher MG, Reshetnikov AP. Chronic facial pain associated with hypertonicity of the masticatory muscles. Rossiiskii zhurnal boli. 2014;(2):22-5. (In Russ.)].

7. Al-Ahmad HT, Al-Qudah MA. The treatment of masseter hypertrophy with botulinum toxin type A. Saudi Med J. 2006 Mar;27(3):397-400. 8. Jost W, Valerius KP. Pictorial Atlas of Botulinum Toxin Injection: Dosage, Localization, Application. 1st edition. Quintessence Pub Co; 2008. 264 p.


For citations:

Shakhmetova O.A., Sinitsina T.M. A multidisciplinary approach to treating musculoarticular dysfunction of the temporomandibular joint with obvious pain syndrome. Neurology, Neuropsychiatry, Psychosomatics. 2017;9(2):46-49. (In Russ.)

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ISSN 2074-2711 (Print)
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