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

Objective: To present a rare presentation of paroxysmal hemicrania (PH) in the orofacial region.

Methods: A retrospective record review was performed using the International Classification of Headache Disorders criteria for PH. Inclusion criteria were initial diagnosis of PH and at least one confirmatory diagnosis at follow-up.

Results: Four patients were diagnosed with orofacial PH 2015-2021. Average age was 56.5 years. Patients were most seen by dentists (n=7) and neurologists (n=5) and had a median of 19.5 months of diagnostic delay. Pain intensity was severe, episodes occurring daily and lasting 4-90 minutes. Lacrimation was the most common autonomic feature. All patients presented with intraoral pain and temporomandibular disorders. Maximum indomethacin dosage ranged from 75-225 mg/day. Verapamil was the most effective adjuvant therapy.

Conclusions: Orofacial PH presents a diagnostic challenge with significant delays, multiple referrals and unconventional pain locations. Intolerance to indomethacin resulted in the need for adjuvant treatment modalities.

Objective: This double-blinded randomized controlled trial investigated the immediate effects of myofascial release (MFR) and post-isometric relaxation (PIR) on muscle stiffness, tone, pain, and maximum mouth opening (MMO) in individuals with bruxism, compared with a control group.

Methods: Sixty participants were randomized into MFR (n = 20), PIR (n = 20), or control groups (n = 20). Each intervention was a single standardized session. The primary outcomes were muscle stiffness and tone, while secondary outcomes included pain severity (VAS), and MMO.

Results: Both MFR and PIR significantly reduced masseter and sternocleidomastoid stiffness and tone (p < .05), except left sternocleidomastoid stiffness in MFR, with no changes in controls. MFR was superior to control for pain (p = .010) and masseter stiffness (p = .030), while PIR showed superiority only for left tone (p = .034). Both interventions reduced VAS scores (p < .001) and improved MMO (p < .05).

Conclusion: A single MFR or PIR session reduced stiffness, tone, and pain and improved MMO in bruxism. MFR showed stronger effects, whereas PIR yielded limited benefits.

Objective: To evaluate changes in the oropharyngeal airway (OP) with Herbst appliances using either dental or skeletal anchorage (HDA vs. HSA) in growing patients with Class II division 1 malocclusion.

Design, setting, and participants: Forty patients (12.6 ± 1.4 years) at the peak of pubertal growth were randomized (HDA= 20; HSA= 20), for 12 months. Outcomes: change in OP volume, airway length and cross-sectional areas (minimum, maximum, average), by CBCT.

Results: Thirty-four patients completed the study (HDA= 19; HSA= 15); and intention-to-treat (ITT) analysis was applied. Within-group analysis revealed a significant improvement for minimum axial area (HDA, p = .0061). Between-group comparisons showed significantly higher mean values in the HSA group for volume (p = .0044), airway length (p = .004), maximum cross-sectional area (p = .0188), and average area (p = .0122).

Conclusions: HSA and HDA increased OP dimensions in growing Class II patients. Although HSA did not demonstrate a statistically superior effect, the dimensional changes represent morphological adaptations. Long-term studies are required to determine respiratory benefits.

Objective: This scoping review is intended to identify and synthesize global evidence on barriers and facilitators influencing referral pathways for TMD management, highlighting implications for oral and maxillofacial surgeons (OMS) and interprofessional care models.

Methods: Following Joanna Briggs Institute and PRISMA-ScR guidelines, comprehensive searches were performed. Eligible studies discussed factors affecting the diagnosis, management, or referral of TMD patients. Data were extracted and synthesized using inductive thematic analysis.

Results: Six thematic domains emerged: educational, structural/institutional, communicational, systemic, cultural/professional, and technological. The most recurrent barriers were insufficient undergraduate training, fragmentation between dental and medical services, and lack of standardized referral criteria. Facilitators included interprofessional education, use of evidence-based clinical pathways, and digital referral systems.

Conclusion: Referral systems for TMD remain fragmented worldwide. Strengthening interprofessional education, implementing structured referral criteria, and integrating digital decision-support within OMS services are crucial steps to align clinical practice with evidence and reduce surgical overtreatment.

Background: Referred facial pain is a rare but important presentation of systemic disease. This paper describes orofacial pain associated with lung cancer, discusses key diagnostic considerations, and illustrates phenotype-based management. i.

Clinical presentation: Two patients with known pulmonary malignancy developed unexplained orofacial pain. Case 1 involved a 37-year-old male with dull, intermittent pain in the left ear and face. Case 2 involved a 63-year-old female with episodic, burning pain radiating from the right pharynx, right face and ear. Both were misdiagnosed, one as persistent idiopathic facial pain (atypical facial pain), the other as glossopharyngeal neuralgia. Clinical examination and imaging revealed no local pathology. Their pain was attributed to referred pain from lung cancer. Both responded to phenotype-guided management, including tricyclic antidepressants, gabapentinoids, and carbamazepine.

Conclusion: These cases highlight the diagnostic challenges of facial pain attributed to lung cancer (FPLC), its frequent misdiagnosis, the need for dedicated diagnostic criteria and phenotype-based management.

Objective: To explore the influence of bullying, self-esteem and sleep-disordered breathing on awake bruxism in a case-control study.

Methods: This case-control study associated awake bruxism with bullying, self-esteem, and sleep-disordered breathing in 436 children. The cases (n = 218) had awake bruxism, while the controls (n = 218) were matched for age and sex. Data were collected through validated questionnaires and clinical examinations.

Results: Logistic regression showed no significant associations between awake bruxism and race, family income, self-esteem, sleep-disordered breathing, or bullying (p > .05). Bullying was highly prevalent in both groups (81.2% vs. 78.4%), with similar odds ratios (OR = 1.19; 95% CI: 0.74-1.90).

Conclusion: These psychosocial and socioeconomic variables do not influence awake bruxism.

Objective: To evaluate the relationship between self-reported sleep bruxism and temporomandibular joint (TMJ) alterations on MRI, focusing on disc morphology, disc position, and condylar changes.

Methods: A total of 162 patients (135 females, 27 males; mean age 37.6 ± 13.9 years) were categorized into bruxism (n=100) and non-bruxism (n=62) groups. MRI examinations were assessed for disc morphology, disc displacement, and condylar bone changes. Logistic regression analyses were performed, adjusting for age and gender.

Results: Sleep bruxism was independently associated with anterior disc displacement without reduction (ADDwoR). No significant associations were found between bruxism and disc morphology or condylar degenerative changes, including erosion, sclerosis, flattening, or osteophytes.

Conclusion: .Sleep bruxism appears specifically associated with ADDwoR, rather than with morphological or degenerative TMJ alterations. These findings indicate that bruxism may primarily influence joint dysfunction through functional loading of the disc, whereas osseous remodeling likely reflects multifactorial processes. Further longitudinal studies are needed.

Objective: This study aimed to describe the frequency of oral behaviors and generalized anxiety among university students and assess their association using the Oral Behavior Checklist-21 (OBC-21) and Generalized Anxiety Disorder-7 (GAD-7).

Methods: An online questionnaire was sent to students at the University of Trieste, Italy. Mann-Whitney U compared OBC-21 scores by sex; Spearman Correlation and linear regression (adjusted for age and sex) assessed the association between OBC-21 and GAD-7 scores. Fisher's exact test examined categorical relationships.

Results: A total of 1,687 students completed the questionnaire (response rate 9.5%; 73% females). Mean OBC-21 and GAD-7 scores were 23.9 ± 8.3 and 9.5 ± 5.2, respectively. Higher OBC-21 scores were associated with younger age (p = 0.004) and females sex (p < 0.001). Oral behaviors and anxiety were moderately correlated (r = 0.42, p < 0.001), confirmed by regression. Categorized scores also showed a significant association (p < 0.001, Cramér's V = 0.308).

Conclusion: Oral behaviors are significantly associated with generalized anxiety in university students, underscoring the importance of integrating mental health assessment into oral health care.

Background: Undiagnosed obstructive sleep apnoea (OSA) presents risks in oral and maxillofacial surgery (OMFS), yet tools such as STOP-Bang often underperform in non-obese patients with craniofacial anomalies. This study aimed to develop and preliminarily assess the Jain's Obstructive Sleep Apnoea Questionnaire (JOSAQ), a craniofacial-focused screening tool tailored for OMFS practice.

Methods: JOSAQ, a two-stage, 20-item instrument combining patient-reported symptoms and clinician-assessed craniofacial features, underwent Delphi consensus and vignette-based comparison with STOP-Bang. Fifteen experts participated in the Delphi process, and 20 clinicians rated 25 standardized clinical vignettes.

Results: Content validity was high (S-CVI = 0.89). JOSAQ identified more high-risk cases than STOP-Bang (62% vs 44%, p < .01) with higher Inter-rater reliability (κ = 0.72 vs 0.64), and better clarity scores. Completion times were similar.

Conclusion: JOSAQ enhances screening sensitivity and inter-rater reliability without increasing assessment time, particulary benefiting non-obese patients with craniofacial anomalies. Multicentre validation against polysomnography is recommended.

Objective: This study investigated the correlation between oral behaviors measured by the Oral Behaviors Checklist (OBC) and the frequency of awake bruxism (AB), assessed by Ecological Momentary Assessment (EMA).

Methods: Seventy-five individuals with AB completed the OBC and responded to ten daily mobile prompts that assessed real-time jaw muscle behavior for a week.

Results: Non-functional OBC scores correlated positively with overall AB (r = 0.384, p < .001) and individual AB-behavior frequencies measured by EMA, except for a negative correlation with teeth contact (r = -0.289, p = .012).

Conclusion: Functional OBC scores were not associated with AB frequencies. The OBC may serve as a preliminary screening instrument in identifying AB-related behaviors.