Os efeitos da terapia manual aplicada na região cervical e torácica sobre a temperatura de músculos mastigatórios e sobre os sinais e sintomas de disfunção temporomandibular: estudo clínico, randomizado, placebo-controlado

Abstract

Introduction: Temporomandibular dysfunction (TMD) is a complex multifactorial dysfunction commonly associated with other conditions such as cervical spine disorders. Although there is evidence of the correlation between a TMD and neck dysfunctions, treatment approaches address local and direct. Since TMD etiology is multidimensional, the present study hypothetize that a cervical and thoracic approach could reduce the signs and symptoms of TMD. Purpose: To evaluate the effects of a manual therapy protocol applied to the cervical and thoracic region on the signs and symptoms of TMD, as well as the temperature of the temporomandibular joint (TMJ), masticatory and cervical muscles. Methods: 30 subjects with a diagnosis of TMD according to RDC/TMD classified as severe or moderate, according to the Fonseca’s Anamnestic Index (FAI) were randomized into two groups: experimental (miofacial release and joint mobilization) and placebo ultrassound. The interventions were performed twice a week, 8 sessions total. Volunteers were assessed for TMD severity by FAI; Pain in TMJ and masticatory muscles, using a Numerical Pain Scale (END); Mandibular range of motion (ROM), through pachymetry; Level of pain and craniofacial dysfunction, according to the Craniofacial Pain and Dysfunction Index (CF-IDD); Cervical dysfunction level, according to Neck Disorders Index (NDI); Regarding the surface temperature of the TMJ and the anterior temporal muscles, masseter and upper trapezius, under pre and post intervention conditions, and under a 30 days follow-up. The study was approved by the Ethics and Research Committee of Universidade Nove de Julho and is registered in Clinical Trials under the number NCT02822469.Statistical analysis: Data distribution was normal. ANOVA was performed followed by Tukey's multiple comparison for group versus time interaction. The category changes between the moments and the groups were analyzed following a contingency table using the proportional comparison test for each category. The level of significance of 5% was considered. Results: Of the 186 volunteers screened, only 28 complete the study. No statistically significant difference was found between groups for any of the variables studied. Conclusion: The proposed treatment protocol applied to the thoracic and cervical region did not alter pain, ROM, TMD severity, cervical dysfunction level and superficial temperature of the TMJ and the masseter, anterior temporal and upper trapezius muscles in patients with severe and/or moderate TMD.