APPLICATION OF SELECTIVE ANESTHESIA FOR TOPIC DIAGNOSIS OF SENSORY DISORDERS OF THE FACE AND PROSOPALGIA IN PATIENTS WITH DYSFUNCTION OF THE TEMPOROMANDIBULAR JOINTS

Mokryk O. Ya., Havryltsiv S. T., Ushtan S. V., Dmytryshyn Yu. B.

DENTISTRY

Scentific article

A significant number of dental outpatients (up to 76% of cases) are diagnosed with temporomandibular joint dysfunction. Patients with musculoskeletal dysfunction of the TMJ may also experience sensory disturbances of the face, myogenic chronic pain (prosopalgia). In clinical practice, the use of diagnostic and therapeutic blockades (selective anesthesia) is effective to detect the focus of pain on the face or to establish the level of damage to the branches of the trigeminal nerve. The aim of the study – to study the effectiveness of selective anesthesia for the topical diagnosis of sensory disorders of the face and prosopalgia in patients with temporomandibular joint dysfunction.Materials and methods of research. For topical diagnosis of local sensory disorders in the lateral part of the face and prosopalgia in 11 patients with dysfunction of the temporomandibular joints, intraoral selective anesthesia of the buccal nerve was used at its location near the lateral pterygoid and temporal muscles according to the methods of S.M. Shuvalov and Iwanaga J. and co-authors. Results. After selective anesthesia in the area of the lateral pterygoid muscle on the affected side, all patients indicated relief of pain in the TMJ and in 8 cases also in the lateral area of the face. At the same time, the paresthesia of the skin of the buccal or chin areas in the corner of the mouth disappeared. However, in 3 clinical cases, sensory disorders persisted in the buccal area, intraoral palpation of the temporalis muscle caused pain in such patients. After applying local anesthesia according to the method of Iwanaga J. and co-authors, the local clinical manifestations of buccal nerve neuropathy were reduced. Blockade of motor and sensory branches of the mandibular nerve in the area of the lateral pterygoid muscle according to the method of S.M. Shuvalov proved to be more effective and statistically significant (Pearson’s criterion – χ2 – 4,545, p=0,034) for topical diagnosis of sensory disorders of the face and prosopalgia. Conclusions. The use of selective anesthesia for the topical diagnosis of sensory disorders on the face and prosopalgia in patients with painful dysfunction of the temporomandibular joints allows to establish the myogenic causes of local clinical symptoms of buccal nerve neuropathy.

temporomandibular joint dysfunction, facial sensory disorders, prosopalgia, buccal nerve, topical diagnosis, selective anesthesia.

1. Makyeyev VF, Telishevsʹka UD, Shybinsʹkyy VYA, Telishevsʹka OD, Kulinchenko RV. Skronevo-nyzhnʹoshchelepni rozlady. Lʹviv: Kvart; 2018. 404 s. [in Ukrainian].
2. Telishevsʹka UD. Stupenevyy zvʺyazok mizh skronevo-nyzhnʹoshchelepnymy rozladamy ta symptomamy, shcho yikh suprovodzhuyutʹ. Ukrayinsʹkyy stomatolohichnyy alʹmanakh. 2014;3:57-61. [in Ukrainian].
3. Maeda S, Miyawaki T, Kuboki T, Shimada M. A trigeminal neuralgia-like paroxysmal pain condition presumably due to buccal nerve compression in the temporalis muscle. The Journal of Craniomandibular & Sleep Practice. 2001;19(1):56-60.
4. Alvira-González J, Gay-Escoda C. Sensory disturbances of buccal and lingual nerve by muscle compression: A case report and review of the literature. J Clin Exp Dent. 2016;8(1):93-6.
5. Welte-Jzyk C, Pfau DB, Hartmann A, Daubländer M. Somatosensory profiles of patients with chronic myogenic temporomandibular disorders in relation to their pain DETECT score. BMC Oral Health. 2018;18:138.
6. Mythili K, Muralidhar T, Sowmya A, Gautam K, Junad К. Myofascial pain with referral from the anterior digastric muscle mimicking a toothache in the mandibular anterior teeth: a case report. Quintessence International. 2020;51(1):56-62.
7. Takezawa K, Ghabriel M, Townsend G. The course and distribution of the buccal nerve: clinical relevance in dentistry. Australian Dental Journal. 2018;63:66-71.
8. Akita K, Shimokawa T, Sato T. An Anatomic study of the positional relationships between the LPM and its surrounding nerves. Euro. J. Anat. 2003;7(1):5-14.
9. Rajeshwari MS, Pushpa MS. Study of lateral pterygoid muscle and its relation with the maxillary artery and buccal nerve and an anatomical classification based on its insertion. Int J Anat Res. 2015;3(4):1680-4.
10. Iwanaga J, Tubbs RS. Buccal Nerve Dissection Via an Intraoral Approach: Correcting an Error Regarding Buccal Nerve Blockade. Journal of Oral and Maxillofacial Surgery. 2019;77(6):1154.
11. Shinichi A, Hiroyoshi N, Tadashi N, Masahito Y, Sung-Yoon W, Hee-Jin K, et al. Analysis of the Intramuscular Innervation of the Lateral Pterygoid Muscle. Journal of Hard Tissue Biology. 2011;20(3):259-264.
12. Trevell DG, Simons DG, Simons LS. Miofastsial’nyye boli i disfunktsii. Rukovodstvo po triggernym tochkam. Tom 2. M.: Med; 2005. 1171 s. [in Russiаn].
13. Moayedi M, Krishnamoorthy G, Tony He PY, Agur A, Weissman-Fogel I, Tenenbaum HC, et al. Structural abnormalities in the temporalis musculo-aponeurotic complex in chronic muscular temporomandibular disorders. Pain. 2020 Aug;161(8):1787-1797.
14. Shabalina VS. Neyrostomatologiya. Disfunktsii zubochelyustnoy sistemy. M.: Geotar-Media; 2013. 360 s. [in Russiаn].
15. Yeong-Gwan I, Byung-Gook K. Management of Lateral Pterygoid Myalgia with Diagnostic Local Anesthetic Injection: A Report of 2 Case. Journal of Oral Medicine and Pain. 2010;35(4):275-281.
16. Vlassakov KV, Narang S, Kissin I. Local Anesthetic Blockade of Peripheral Nerves for Treatment of Neuralgias. Systematic Analysis. Anesthesia & Analgesia. 2011;12(6):1487-1493.
17. Shuvalov SM. Izbrannyye raboty po chelyustno-litsevoy khirurgii: monografiya. Vinnitsa: Kniga-Vega; 2016. 240 s. [in Ukrainian].
18. Anugerah A, Nguyen K, Nader A. Technical considerations for approaches to the ultrasound-guided maxillary nerve block via the pterygopalatine fossa: a literature review. Reg Anesth Pain Med. 2020;45(4):301-5.
19. Fernandes L, Randall M, Idrovo L. Peripheral nerve blocks for headache disorders. Pract Neurol. 2021;21:30-5.
20. Smith MH, Lung KE. Nerve Injuries after Dental Injection: A Review of the Literature. J. Can Dent Assoc. 2006;72(6):559-64.
21. Takezawa K, Ghabriel M, Townsend G. The course and distribution of the buccal nerve: clinical relevance in dentistry. Australian Dental Journal. 2018;63:66-71.
22. Young AL, Khan J, Thomas DC, Quek SYP. Use of Masseteric and Deep Temporal Nerve Blocks for Reduction of Mandibular Dislocation. Anesth. Prog. 2009;56:9-13.
23. Quek SY, Kalladka M, Kanti V, Subramanian G. A new adjunctive tool to aid in the diagnosis of myogenous temporomandibular disorder pain originating from the masseter and temporalis muscles: Twin-block technique. J. Indian Prosthodont Soc. 2018;18:181-5.
24. Grigorenko MP, Pis’menova NN. Miofastsial’nyy bolevoy disfunktsional’nyy sindrom litsa (miofastsial’naya prozopalgiya, kraniomandibulyarnaya disfunktsiya, disfunktsiya visochno-nizhnechelyustnogo sustava). Mezhdunarodnyy studencheskiy nauchnyy vestnik. 2017;5:1. Dostupno: https://eduherald.ru/ru/article/view?id=17793. [in Russiаn].

«Bulletin of problems biology and medicine» Issue 4 (162), 2021 year, 320-324 pages, index UDK 616.724-039-036-079.4

10.29254/2077-4214-2021-4-162-320-324