Successful temporomandibular viscosupplementation protocol in a 47 year-old woman with a 10- year history of temporomandibular pain and impaired function- case report

Abstract

Introduction: Temporomandibular disorders (TMD) are a group of conditions that cause pain and dysfunction in the joint and muscles that control jaw movement. The etiology of TMD is multifactorial and multidisciplinary approaches are important for differential diagnosis and treatment planning [1–3]. This case report describes a viscosupplementation protocol with 4 cycles of sodium hyaluronate with different molecular weights to control osteoarthritis, disk displacement with reduction and intermittent closed lock of a 47-year-old woman with a 10-year history of temporomandibular pain and impaired function.

Materials and methods: Careful anamnesis and detailed clinical examination showed several signs and symptoms, such as facial pain, joint click and discomfort in chewing. Diagnosis consisted of disk displacement with reduction and synovitis. Osteoarthritis of temporomandibular joint (TMJ) and bone structures was confirmed by computed tomography (CT).Treatment was performed in a multidisciplinary group involving experts in orofacial pain, physiotherapist and psychologist. Four monthly intra-articular injections of sodium hyaluronate (Polireumin®: molecular weight 500–730 kDa and Osteonil®: molecular weight 1.000–2.000 kDa) were applied in both temporomandibular joints followed by physical therapy during 4 consecutive months. Protocol consisted of Polireumin® injection in first and third applications and Osteonil® in second and forth months.

Results: At end of treatment, patient showed great improvement in internal articular derangement and full restoration of function by clinical examination , control of all joint and bone changes by CT, and complete abolition of pain. After a 3- years follow-up, patient remained without pain or dysfunction in TMJ biomechanics and the osteoarthritis was under control.

Discussion and conclusions: This case report demonstrates a successful protocol of viscosupplementation with an excellent control of TMD signs and symptoms. Further studies are necessary to assess the results of this protocol under a controlled clinical trial model.

Acknowledgements

PPG-FOUFU, FAPEMIG, CAPES, CNPq