Diagnosis and Management of Facial Pain
John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie in Basic Sciences Endocrine Surgery Rhinology, 2018
This is not an uncommon presentation in otolaryngology clinics, where muscular hyper- or parafunction may produce acute or chronic pain in the pre- or periauricular areas, deep otalgia, and tenderness in the temporoparietal and cervical regions of the scalp. Clinical findings may include scalloping of the buccal mucosa in cases of bruxism, tenderness in the muscles of mastication or in the temporomandibular joint itself, and smoothed contours of the pre-molar and molar dentition. Other causes include malocclusion, mal-alignment following dental restorative procedures, stress and anger, excessive chewing (e.g. gum), and degenerative joint disease. Treatment includes joint rest, non-steroidal anti-inflammatory analgesia, correction of aetiological factors, and an occlusal splint (e.g. biteguard) worn at night or, sometimes, longer duration can relieve inflammation in a tender joint. Use of a ‘one-size-fits-all’ splint can worsen symptoms in some people and so these should be custom made. Physiotherapy, temporomandibular joint injection with corticosteroid and local anaesthetic or botulinum toxin, and low-dose amitriptyline may be useful in some resistant cases.
Middle third fractures
John Dudley Langdon, Mohan Francis Patel, Robert Andrew Ord, Peter Brennan in Operative Oral and Maxillofacial Surgery, 2017
The use of arch bars and temporary intermaxillary fixation (IMF) may be very helpful in maintaining the correct reduction during application of the plates. The correct positioning of the fractured maxilla is guided by the anatomic position of the fractured bones, as well as the intercuspation of the dentition. The dental occlusion may not be easily attained if there is a pre-existing abnormal bite and/or missing teeth. Impressions and study models taken pre-operatively with fabrication of an occlusal splint help attain the correct dental bite at operation and may be very helpful.
Intermaxillary Fixation Techniques
Jeffrey R. Marcus, Detlev Erdmann, Eduardo D. Rodriguez in Essentials of CRANIOMAXILLOFACIAL TRAUMA, 2014
To fabricate an occlusal splint, dental impressions are taken. In some cases, this is performed with the patient under anesthesia for comfort. Dental casts are made from impressions; the models are cut at the fracture site to mimic the injury and allow optimal alignment of the segments. The model surgery is completed, and an acrylic splint is created. In the operating room, the fractures are reduced. The splint is placed, and the segments are fitted into it. The splint is then held in place with circummandibular wires.
A skeletal Class III facial asymmetry case with a canted occlusal plane treated by LeFort I with unilateral horseshoe osteotomy
Published in Orthodontic Waves, 2021
Tomoyo Tanaka, Mitsuhiro Hoshijima, Norie Yoshioka, Hiroshi Kamioka
After 13 months of presurgical orthodontic treatment, the maxillary LeFort I osteotomy with unilateral horseshoe osteotomy and mandibular IVRO was performed. After accomplishing a LeFort I osteotomy and down fracture, unilateral horseshoe osteotomy was performed. The right side of split line separated molar region of alveolar bone from the palatine bone and the left side of split line passed through nearest midline of the palatal bone (Figure 6(b), dotted line). The maxilla was advanced 2.0 mm at the ANS with transverse rotation and slight yaw rotation via LeFort I osteotomy, and the right side of the maxilla was trimmed for the upward movement and impacted 5.0 mm with unilateral horseshoe osteotomy (Figure 6(a), shaded area, C). The mandible was set back with IVRO for obtaining Angle Class I occlusion. Occlusal rehabilitation was performed for three months using intermaxillary elastics and an occlusal splint. Postsurgical orthodontic treatment was performed to obtain better teeth interdigitation. The total active treatment period was two years and seven months. After removing the appliance, the mandibular anterior teeth were stabilized with a six-unit lingual bonded retainer, and the upper and lower arches were stabilized with Begg-type retainers. The patient was followed for two years.
Effectiveness of conservative therapeutic modalities for temporomandibular disorders-related pain: a systematic review
Published in Acta Odontologica Scandinavica, 2023
Alexandros Tournavitis, Evangelos Sandris, Anna Theocharidou, Theodora Slini, Maria Kokoti, Petros Koidis, Dimitrios Tortopidis
The main findings of this study regarding the TMD pain reduction showed that occlusal splint and occlusal splint combined with other therapeutic intervention have a superior short-term treatment effect, followed by photobiomodulation and low-level laser therapy. The results revealed a superiority of occlusal splint alone or combined with other therapeutic intervention when compared to control (untreated or patients whose treatment was non-invasive such as counselling and relaxation). Furthermore, the use of occlusal splint was more effective when compared to the other TMD treatment modalities. Significant differences were also detected between low-level laser and photomodulation group and the control group, in short-term post-treatment TMD pain.
Efficacy of occlusal splints in the treatment of temporomandibular disorders: a systematic review of randomized controlled trials
Published in Acta Odontologica Scandinavica, 2020
Si-Hui Zhang, Kai-Xun He, Chen-Jing Lin, Xiang-Dong Liu, Ling Wu, Jiang Chen, Xiaohui Rausch-Fan
An occlusal splint is a removable device affecting the relationship of the mandible to the maxillae. It is one of the most widely used therapeutic methods among the above-mentioned approaches [10], in part due to its low cost [7]. It can be used to reconstruct neuromuscular balance through stabilisation of the occlusion, release of stress from the TMJ, and repositioning of the TMJ in a reversible way [11].
Related Knowledge Centers
- Bruxism
- Mouth
- Occlusion
- Sleep Apnea
- Tooth
- Lip
- Gums
- Temporomandibular Joint Dysfunction
- Tooth Whitening
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