Uloga fizioterapije u bolesnika s poremećajem temporomandibularnog zgloba

Abstract Temporomandibular disorders are musculoskeletal disorders of the stomatognathic system related to other parts of the locomotor system: pain in the temporomandibular joint (TMJ), craniocervical muscular fatigue, especially of the masticatory muscles, limitation of mandibular movements, and presence of joint clicking. Since there is no gold standard in the treatment of temporomandibular disorders, noninvasive and reversible methods are preferred. Physical therapy, particularly exercise and mobilization of temporomandibular joints with masticatory muscles, have a very important role in the treatment. Moreover, once the physical therapist instructs the patient, he/she can continue doing the exercises at home according to an individual exercise program and depending on the subjective evaluation of its effects on pain reduction and improvement of mandibular mobility. Although causal co-dependence with cervicocranial disorders has not been completely confirmed, it has been recommended to include disturbances related to the cervical spine into joint physical therapy within a framework of physiatric-rheumatologic treatment. Along with a review of the literature, particular attention has been given to integrated diagnosis and physical therapy of functional disorders of the temporomandibular and border cervical regions.Sažetak Temporomandibularni poremećaji su muskuloskeletni poremećaji stomatognatskog sustava srodni drugim dijelovima lokomotornog sustava: pritužbe na bol u temporomandibularnom zglobu, umor kraniocervikalnih mišića, posebice žvačnih mišića, ograničene kretnje mandibule i prisutnost škljocanja u zglobu. Kako ne postoji zlatni standard u liječenju temporomandibularnih poremećaja, prednost se daje neinvanzivnim i reverzibilnim metodama. Fizikalna terapija, posebice vježbanje i mobilizacija temporomandibularnih zglobova sa žvačnim mišićima ima istaknutu ulogu u liječenju. Štoviše, kad ga fizioterapeut poduči, bolesnik može nastaviti vježbati kod kuće prema individualnom programu ovisno o subjektivnoj procjeni učinka na smanjivanje bolova i povećanju pokretljivosti mandibule. Iako nije potpuno utvrđena uzročna međuovisnost s cervikokranijalnim poremećajima, preporuča se u sklopu fizijatrijsko-reumatološke obrade u jedinstvenu fizikalnu terapiju uključiti i poremećaje vezane za cervikalnu kralježnicu. Uz pregled literature dan je naglasak na integriranu dijagnostiku i fizikalnu terapiju funkcijskih poremećaja temporomandibularnog i graničnog cervikalnog područja