Improvement of Dysphagia in a Chronic Brain Injury Patient with Temporomandibular Joint Dysfunction: A Case Report
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Acquired brain injury patients who present dysphagia associated with temporomandibular joint dysfunction (TMJD) are more common than expected. TMJD is associated with restriction of mouth opening and jaw movements, thereby interfering with the oral phase of the swallowing process. An 18-year-old female with traumatic brain injury mainly complained of dysphagia when first admitted. After nearly one year of conventional dysphagia therapy, the patient could barely eat a minced diet. The videofluoroscopic swallowing study showed that a soft and bite-sized diet was tolerable to the patient, but the restricted mouth opening and mandibular movement imposed a major limitation of the dietary build-up. After examining the imaging studies, the patient was diagnosed with TMJD attributed to muscle lesion and misaligned stomatognathic system. The patient subsequently underwent a stomatognathic alignment and TMJ strengthening exercise program over a span of two weeks, after which the therapeutic effects were evaluated with the craniomandibular index (CMI) and Mann Assessment of Swallowing Ability (MASA) parameters, before and after the exercise program. The results showed improvements in the neck mobility and orofacial movements, and the patient was able to consume soft and bite-sized diet in the clinical setting. Thus, we propose that active exercise to achieve postural correction and TMJ muscle strengthening are effective treatment options for dysphagia associated with TMJD.
Abstract
Acquired brain injury patients who present dysphagia associated with temporomandibular joint dysfunction (TMJD) are more common than expected. TMJD is associated with restriction of mouth opening and jaw movements, thereby interfering with the oral phase of the swallowing process. An 18-year-old female with traumatic brain injury mainly complained of dysphagia when first admitted. After nearly one year of conventional dysphagia therapy, the patient could barely eat a minced diet. The videofluoroscopic swallowing study showed that a soft and bite-sized diet was tolerable to the patient, but the restricted mouth opening and mandibular movement imposed a major limitation of the dietary build-up. After examining the imaging studies, the patient was diagnosed with TMJD attributed to muscle lesion and misaligned stomatognathic system. The patient subsequently underwent a stomatognathic alignment and TMJ strengthening exercise program over a span of two weeks, after which the therapeutic effects were evaluated with the craniomandibular index (CMI) and Mann Assessment of Swallowing Ability (MASA) parameters, before and after the exercise program. The results showed improvements in the neck mobility and orofacial movements, and the patient was able to consume soft and bite-sized diet in the clinical setting. Thus, we propose that active exercise to achieve postural correction and TMJ muscle strengthening are effective treatment options for dysphagia associated with TMJD.
참고문헌 (18)
- Shiffman MA, "Cosmetic Surgery", pp.3~28 (2013), Springer
- Anderson GC, "The Research Diagnostic Criteria for Temporomandibular Disorders. VI: future directions", J Orofac Pain, 24, pp.79~88 (2010)
- Moore K, "Clinically Oriented Anatomy" (2017), Lippincott Williams & Wilkins
- Horan F., "Gray’s Anatomy: the anatomical basis of clinical practice", pp.1551~ (2009), The British Editorial Society of Bone and Joint Surgery
- Wright EF, "Manual of temporomandibular disorders" (2019), John Wiley & Sons
- Lam P, "The international dysphagia diet standardisation initiative(IDDSI)framework : The kempen pilot", British Journal of Neuroscience Nursing, 13, pp.S18~S26 (2017)
- Schimmel M, "Oro-facial impairment in stroke patients", J Oral Rehabil, 44, pp.313~326 (2017)
- Newlands C, "Oral and maxillofacial surgery" (2020), Oxford University Press
- Oh DW, "Effect of stomatognathic alignment exercise on temporomandibular joint function and swallowing function of stroke patients with limited mouth opening", J Phys Ther Sci, 25, pp.1325~1329 (2013)
- Yılmaz V, "Temporomandibular Joint Dysfunction and Impaired Stomatognathic Alignment : A Problem Beyond Swallowing in Patients With Stroke", Indian J Otolaryngol Head Neck Surg, 72, pp.329~334 (2020)
- Fricton JR, "The craniomandibular index : validity", The Journal of prosthetic dentistry, 58, pp.222~228 (1987)
- Karaca Umay E, "The psychometric evaluation of the Turkish version of the Mann Assessment of Swallowing Ability in patients in the early period after stroke", Turk J Med Sci, 48, pp.1153~1161 (2018)
- Cuccia A, "The relationship between the stomatognathic system and body posture", Clinics(Sao Paulo), 64, pp.61~66 (2009)
- Hackney J, "Relationship between forward head posture and diagnosed internal derangement of the temporomandibular joint", J Orofac Pain, 7, pp.386~390 (1993)
- Olmos SR, "The effect of condyle fossa relationships on head posture", Cranio, 23, pp.48~52 (2005)
- Borello-France DF, "Modification of sitting posture of patients with hemiplegia using seat boards and backboards", Phys Ther, 68, pp.67~71 (1988)
- Geurts AC, "Identification of static and dynamic postural instability following traumatic brain injury", Arch Phys Med Rehabil, 77, pp.639~644 (1996)
- Moraes Ada R, "Therapeutic exercises for the control of temporomandibular disorders", Dental Press J Orthod, 18, pp.134~139 (2013)