Cranio-The Journal of Craniomandibular & Sleep Practice最新文献

Introduction: A bidirectional interaction may exist between temporomandibular disorders (TMD) and otologic symptoms. This study aimed to evaluate changes in patient-reported otologic symptoms following temporomandibular joint (TMJ) arthrocentesis.

Materials and methods: This retrospective cohort study included 40 patients who underwent TMJ arthrocentesis. Demographic data, TMJ-related clinical findings, otologic symptoms, and visual analog scale (VAS) scores were assessed preoperatively and at a 30-day follow-up.

Results: .The majority of patients were female (82.5%), with a mean age of 35.4 ± 11.03 years. Significant reductions were observed in otalgia and tinnitus after arthrocentesis (p < .05). No significant changes were detected in hearing loss or vertigo (p > .05). VAS scores showed significant improvement in TMD symptoms, otalgia, and tinnitus, while hearing loss and vertigo remained unchanged.

Conclusion: TMJ arthrocentesis was associated with subjective improvement in otalgia and tinnitus in patients with TMD, whereas hearing loss and vertigo showed no significant change.

Objective: To evaluate supervised machine learning (ML) models for classifying temporomandibular joint (TMJ) disc displacement on MRI using morphometric and signal intensity features.

Methods: This retrospective study analyzed 324 TMJs from 162 individuals who underwent 3T MRI. Extracted features included condylar anteroposterior and mediolateral diameters, disc and condyle morphology, and lateral pterygoid muscle signal intensity ratios. Six ML algorithms (Random Forest, Gaussian Naïve Bayes, Logistic Regression, AdaBoost, Gradient Boost, and k-Nearest Neighbor) were evaluated using stratified 5-fold cross-validation. Performance was assessed with accuracy, macro-averaged recall, precision, F1-score, and ROC-AUC.

Results: All models demonstrated good classification performance (ROC-AUC >0.80). AdaBoost achieved the highest ROC-AUC (0.88), while Gaussian Naïve Bayes showed the most balanced overall metrics. Mediolateral condylar diameter and disc morphology were key features associated with disc displacement categories.

Conclusions: ML models can identify MRI-based morphometric patterns related to TMJ disc displacement and may support radiologic assessment, while clinical diagnosis should continue to rely on established standards of care.

Objective: This study utilized a meta-analysis of two-sample Mendelian randomization (MR) to investigate the causal link between multiple sclerosis (MS) and trigeminal neuralgia (TN).

Methods: Using genetic summary data from the OpenGWAS database (European descent), researchers identified eight MS GWAS studies as exposures and one TN study as the outcome. Ten MR approaches, including IVW and MR-Egger, were employed. Pooled estimates were calculated using a fixed-effects inverse-variance model, with significance set at P < 0.05.

Results: Seven of the eight MS exposures showed a positive causal association with TN. The meta-analysis confirmed that MS significantly increases TN risk by 11% (IVW: 95% CI = 1.05-1.16; P < 0.001). Sensitivity analyses indicated no evidence of pleiotropy or heterogeneity, ensuring robust findings.

Conclusion: Genetic predisposition to MS is a causal factor for TN. Further research is required to explore underlying biological pathways and validate these results across diverse populations.

Objective: To assess associations between temporomandibular disorder (TMD) subtypes and oral health-related quality of life (OHRQoL) using meta-analysis.

Methods: A systematic search of MEDLINE, PubMed, Web of Science, and the Cochrane Library identified studies up to 6 March 2024 using DC/TMD for TMD diagnosis and OHIP-based OHRQoL outcomes. Two reviewers independently screened records, extracted data, and assessed risk of bias. Standardized mean differences (SMDs) were pooled, and sensitivity analyses were performed.

Results: Five studies comprising 3,267 participants were included. Compared with intra-articular TMD (IT), pain-related TMD (PT) and combined TMD (CT = PT + IT) were associated with poorer overall OHRQoL (SMD = 0.74, P < 0.001 for PT; SMD = 0.84, P < 0.001 for CT). Direct comparison showed CT had a more pronounced negative impact than PT (SMD = 0.13, P < 0.01). PT and CT also showed greater impairments in functional and psychosocial OHRQoL domains. Sensitivity analyses supported the robustness of findings.

Conclusion: Patients with PT and CT symptoms exhibit significantly greater impairments in overall and domain-specific OHRQoL compared with those with IT symptoms, despite the limited number of studies included, highlighting the need for tailored treatment strategies based on TMD subtype.

Registration: PROSPERO (CRD42024544762).

Background: Patient-Reported Outcome Measures (PROMs) serve as critical tools for quantifying patient's subjective experience. The aim of this study was to systematically identify and synthesize the psychometric properties of TMD-specific PROMs.

Methods: A systematic search was conducted until September 15, 2025. Studies reporting on the development, validation, or cross-cultural adaptation of TMD-specific PROMs were included. Data on psychometric properties were narratively synthesized.

Results: The review of 91 studies yielded 43 PROMs. The Fonseca Anamnestic Index was the most extensively validated screening tool. Jaw Functional Limitation Scale, Tampa Scale for Kinesiophobia, and the Oral Health Impact Profile for TMD demonstrated excellent reliability (Cronbach's α often >0.85-0.95) and cross-cultural validity. Test-retest reliability was strong for most tools (ICCs commonly >0.80), and convergent validity showed moderate-to-strong correlations with established measures.

Conclusion: Numerous validated PROMs for TMDs are available, however future work should focus on developing integrated tools with extensive validation.

Objectives: To evaluate the long-term effectiveness of arthrocentesis in patients with TMJ disc displacement without reduction (DDWoR) and to identify prognostic factors that may influence treatment outcomes.

Methods:  This study comprised 78 patients diagnosed with TMJ/DDWoR according to the DC/TMD and treated with arthrocentesis between 2014 and 2022. Patients were evaluated preoperatively, postoperatively, and at long-term follow-up using the Visual Analog Scale (VAS) for pain and maximum mouth opening (MMO) for function. Treatment success was assessed according to clinician-assessed criteria and patient self-evaluation.

Results: Significant improvements in both pain and function were observed postoperatively and sustained through long-term follow-up (both p < .001). The success rate was 53.85% according to clinician-assessed criteria and 56.41% based on patient-reported outcomes. VAS scores were significantly associated with success outcomes across all time points (p < .05). Age showed a statistically significant positive association with self-evaluation success (p = .035).

Conclusion: Results support that arthrocentesis is an effective treatment option for patients with TMJ/DDWoR.

Background: Bruxism, the most common repetitive oral behavior, is reported widely in young adults due to excessive stress and sleep abnormalities. If left undiagnosed, it may cause pathologic alteration in condylar morphology.

Methods: This Institutional Ethics Committee approved cross-sectional comparative study comprised of 100 patients, equally divided into groups. The study group diagnosed based on the self-reported questionnaire while control group patients were recruited retrospectively. The patients were evaluated using CBCT.

Results: Flattening 26 (52%) and sclerosis 31 (62%) were more frequent in bruxers than non-bruxers (p < .05). Surface erosion 4 (8%) and osteophytes 14 (28%) were also noted in bruxers. Interestingly, non-bruxers also showed osteophytes 16 (32%) and surface erosion 9 (18%), which became the point to be focused on.

Conclusion: Condylar alterations were more frequently observed in participants with possible bruxism. Prompt intervention can be inculcated to halt progress of the condition.

Trial registration: The study has been registered under Clinical trial registry - India (CTRI registration number: CTRI/2023/05/052782) on May 17, 2023.

Objective: To review and synthesize published case reports on the use of sphenopalatine ganglion (SPG) block in orofacial and headache disorders, focusing on techniques and clinical outcomes.

Methods: A review of 55 case reports and series extracted data on 29 papers, including diagnoses, SPG block technique, anesthetic or drug, outcomes, and adverse effects.

Results: SPG block was reported in trigeminal neuralgia and neuropathies, burning mouth syndrome, non-specified facial pain, autonomic cephalalgias, migraine, tension type headache, COVID related headache and acute cephalalgias. The most frequently used technique was intranasal with cotton tip applicators, with lidocaine 2-10% as the most common agent. Most reports document relief, but long-term data is not available. Neurogenic pain conditions and migraine showed superior therapeutic responses to the SPG block procedure.

Conclusion: SPG block appears effective and safe, though higher-level evidence is still needed.

Introduction: Oral dysesthesia (OD) is a chronic orofacial pain disorder characterized by abnormal sensations - burning, tingling, altered taste, or phantom foreign body perception without identifiable mucosal pathology. Frequently conflated with Burning Mouth Syndrome, OD exhibits a heterogeneous clinical profile warranting distinct diagnostic consideration.

Methods: This narrative review explored potential mechanisms underlying OD, including peripheral and central sensitization, neurotransmitter imbalances, hormonal and psychosomatic influences, and proprioceptive dysregulation, particularly neurosensory mismatch involving trigeminal proprioceptive and nociceptive convergence.

Results: Proprioceptive dysregulation may contribute to OD through processes analogous to phantom limb phenomena. Current management - pharmacologic, behavioral, and neuromodulatory - remains limited by mechanistic non-specificity. Preliminary concepts of a custom-fabricated oral device suggest it may modulate proprioception, provide sensory gating, mechanical protection, and potential drug delivery as a non-pharmacologic adjunct.

Conclusion: Theoretical application of such a device could influence maladaptive feedback loops, representing a potential multimodal therapeutic approach that warrants further investigation.

Objective: To evaluate the knowledge of Italian physiotherapists regarding temporomandibular disorders (TMD) management and to investigate the use of evidence-based strategies.

Methods: A survey was distributed to 412 Italian physiotherapists collecting data on demographics, education, TMD knowledge, assessment, and treatment strategies.

Results: Most respondents (73.3%) reported no formal TMD training during their bachelor, and more than half (51.0%) treated no TMD patients in an average month. 67.2% provided a TMDs definition according to literature, and 92.0% recognized the primary structural pain generators. 21.8% were familiar with the DC/TMD diagnostic criteria, while misconceptions persisted regarding occlusion (26.7% endorsing a causal role) and posture (28.6%). 81.1% used education , and 88.3% adopted a multimodal strategy consistent with guidelines.

Conclusions: Italian physiotherapists showed good general TMDs knowledge and frequent use of guideline-consistent treatment. However, limited undergraduate exposure, variable postgraduate education, and persisting misconceptions highlight the need for more standardized and evidence-based training in this context.