INNOVATIVE APPROACHES TO THE COMPREHENSIVE REHABILITATION OF PATIENTS WITH TMJ DYSFUNCTION AGAINST THE BACKGROUND OF GENERALIZED JOINT HYPERMOBILITY

Roshchin Evgeny Mikhailovich

Goal. To develop innovative approaches to the comprehensive rehabilitation of patients with temporomandibular joint (TMJ) dysfunction against the background of generalized joint hypermobility (HGS). Materials and methods. The study included 120 patients (average age 32.5±7.2 years; 78% of women) with clinical signs of TMJ and HHS dysfunction verified according to the Bayton criteria (≥4 points). All patients underwent a comprehensive clinical and instrumental examination, including dynamic 3D CT and functional MRI of the TMJ, electromyography (EMG) of the masticatory muscles, as well as an assessment of pain intensity on a visual analog scale (VAS), the volume of movements of the lower jaw and quality of life according to the OHIP-14 questionnaire. The personalized rehabilitation program included an individual selection of occlusive splints based on the results of 3D CT, local injections of botulinum toxin type A (BTA) under EMG control and EMG-triggered electrical stimulation of the masticatory muscles. The effectiveness of treatment was evaluated 2 weeks, 1, 3 and 6 months after the start of therapy. Results. According to the data obtained, already 2 weeks after the start of treatment, there was a statistically significant decrease in the intensity of pain according to VAS by 56.8% (p<0.001), an increase in the volume of mouth opening by 29.3% (p<0.01) and an improvement in the quality of life according to OHIP-14 by 41.5% (p<0.001) compared with baseline indicators. The maximum therapeutic effect was observed after 6 months: pain reduction by 85.4%, an increase in the volume of movements of the lower jaw by 69.7% and an increase in the quality of life by 89.6% (all p<0.001). At the same time, 78.3% of patients managed to achieve complete elimination of functional disorders of the TMJ. Conclusion. The developed personalized rehabilitation program, based on the principles of multidisciplinary and individual approach, can significantly improve the effectiveness of treatment of TMJ dysfunction in patients with HHS.

Keywords:temporomandibular joint, dysfunction, generalized hypermobility of joints, comprehensive rehabilitation, personalized medicine