Objective: To discuss a pediatric patient with acute temporomandibular disorder due to a sports-related trauma requiring chiropractic and oral surgical co-management.
Clinical Features: A 12-year-old girl sought chiropractic care for temporomandibular joint dysfunction (TMD) resulting from a volleyball injury after referral from her oral surgeon. Severe trismus was seen, along with spasm of the masticatory muscles and evidence of joint effusion. Mouth opening was significantly restricted and painful limiting her diet, ability to sing, smile, yawn and brush her teeth. Though not complaining specifically of neck pain, findings consistent with upper-crossed syndrome were present along with indicators of vertebral subluxation. Cervical ROM was limited and in some planes aggravated her TMJ pain.
Intervention and Outcome: Treatment consisted of chiropractic adjustments to the cervical and thoracic spine using Diversified Technique along with instrument-assisted soft-tissue mobilization directed to the musculature of her cervical and thoracic regions and muscles of mastication. Therapeutic exercises were attempted. TENS and low-level laser was also administered to reduce TMJ pain. Improvement in pain, TMJ ROM, CROM along with reduced indicators for vertebral subluxation were initially reported; however, her progress plateaued leading to advanced imaging and subsequent surgical intervention.
Conclusion: This young athlete ultimately required treatment by an oral and maxillofacial surgeon. Her condition resolved only after TMJ arthrocentesis with manipulation of the mandible under anesthesia. Clinicians treating TMJ disorders should be aware of its various origins, treatment options and complications and be willing to consult with or refer to the appropriate specialist when needed. This case provides an argument for interdisciplinary collaboration for some temporomandibular joint disorders.
Author keywords: Chiropractic; Temporomandibular Joint (TMJ); Temporomandibular Disorders (TMD); Adolescent; Closed Lock; Anterior Disc Displacement; Maxillofacial Surgery
Author affiliation: Private Practice of Chiropractic; Assistant Professor, Anatomy & Physiology at Frostburg State University, Frostburg, Maryland, United States
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