Conservative care of temporomandibular joint disorder in a 35-year-old patient with spinal muscular atrophy type III: a case study

Abstract

Objective: This article describes the chiropractic clinical management and therapeutic benefits accruing to a patient with temporomandibular joint (TMJ) disorder and spinal muscular atrophy type III.

Clinical features: A 35-year-old white man presented at the university chiropractic outpatient clinic with a complaint of masseter muscle pain and mouth-opening restriction. Temporomandibular joint range of motion evaluation revealed restricted opening (11 mm interincisival), and pain was rated by the patient at an intensity of 5 on a pain scale of 0 to 10.

Intervention and outcome: Chiropractic care was provided and included TMJ mobilization, myofascial therapy, trigger point therapy, and light spinal mobilizations of the upper cervical vertebrae. Final evaluation of TMJ range of motion showed active opening of 12 mm with absence of pain and muscle tenderness of the jaw.

Conclusion: This case suggests that a patient with musculoskeletal disorders related to underlying neurodegenerative pathologies may benefit from chiropractic management adapted to their condition. In the present case, chiropractic treatment of the TMJ represented a viable, low-cost approach with limited adverse effects compared with surgery.

Fig 1

Joint mobilization of the TMJ in distraction. This mobilization is done by pulling down the mandible with contact on the lower teeth and without muscular contraction by the patient.

Fig 2

Joint mobilization in lateral deviation. This mobilization is performed by applying a lateral-medial and downward force vector to the mandibulae with contact on the ramus mandibulae.

Fig 3

Joint mobilization of the TMJ in protrusion and retrusion. This mobilization is performed by applying anterior-posterior and posterior-anterior force vectors to the mandibulae with contact on the mental protuberance.

Fig 4

Proprioceptive neuromuscular facilitation technique of the TMJ muscles. The patient performs isometric contractions of the TMJ muscles (movement in distraction, lateral deviation, protrusion, and also retrusion) followed by passive stretching of the same muscle group.