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Physiotherapy treatment of craniocervical mandibular disorders

What are cranio-cervico-mandibular disorders?

Temporomandibular disorders indicate a generic state of neuromuscular suffering in the head and neck caused by inflammation of the joint and/or stress of the head and neck muscles, commonly known as myofascial syndrome of the masticatory and cervical muscles. This disorder involves a wide group of structures: the skull, the cervical spine, the auditory and balance apparatus, the postural system, and the neuromuscular system.

In this context, a fundamental role is played by the temporomandibular joint. When the position of the mandible is altered relative to the skull, dysfunction of the masticatory muscles and the temporomandibular joint occurs, which in turn causes an alteration in the posture of the skull, the cervical spine, and dysfunction of the muscles of the neck and trunk. As you can see, it is a complex pathological condition with muscular, articular, neurological symptoms, and involvement of the autonomic nervous system.

What is the TMJ? (Temporomandibular joint)

The TMJ, an acronym for temporomandibular joint, represents the joint that connects the mandible with the temporal bone (which is part of the cranial bones) and allows us to chew, opening and closing the mouth. This joint, by its anatomical nature, and especially because it is moved by the force of various muscles, is often subject to multiple pathologies that compromise its normal functioning. In these cases, they are referred to as cranio-cervico-mandibular disorders.

The causes of cranio-cervico-mandibular disorder

The mandible, incorrect dental occlusion, or so-called oral parafunctions such as bruxism (teeth grinding) and clenching. In the majority of cases, underlying cranio-cervico-mandibular disorders involve an individual predisposition, due to anatomical and functional characteristics, which are then influenced by triggering factors such as traumas, parafunctions, or stress, causing the typical symptoms.

Cranio-cervico-mandibular disorder symptons

The symptoms may include pain in the temporomandibular joint, toothache, headaches, neck pain, back pain, earaches, tinnitus, hearing loss, dizziness, and joint noises of the affected joint. As you can see, these disorders manifest with various and seemingly unrelated symptoms, which can cause confusion for both the patient and often the specialist.

In addition to the aforementioned symptoms, other related disorders can be listed, all somehow linked to the onset of cranio-cervico-mandibular disorders: chewing and swallowing disturbances, bruxism, alteration of mandibular movements, and postural instability.

Cranio-cervico-mandibular disorders’ physiotherapic treatment

In cases of cranio-cervico-mandibular disorders, early diagnosis and prompt and appropriate therapeutic intervention reduce the risk of symptom chronicization. Faced with dysfunctions simultaneously affecting different body areas, a multidisciplinary diagnostic and therapeutic intervention is necessary, involving multiple specialists coordinated in teams that address all clinical issues related to cranio-cervico-mandibular disorders simultaneously, aiming to restore health to the entire area and reduce healing times.

In this context, the role of physiotherapy is to improve physiological movements, seeking to restore proper balance in this area and adjacent areas (head, neck, and back) both through manual therapy and specific exercises.

Regarding incorrect dental occlusion, it is important, especially in children, to complement the dentist’s treatment (which may involve the adoption of orthodontic appliances) with physiotherapy treatment to re-educate tongue and swallowing movements, which often accompany and promote dental malocclusion.

In addition to manual work and patient education, the physiotherapist will prescribe specific exercises to be performed at home, in order to optimize treatment results and consolidate achieved goals.

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