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BMC Musculoskeletal Disorders

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Open Access 01-12-2022 | Conservative Therapy | Research

Assessment of the masseter stiffness in patients during conservative therapy for masticatory muscle disorders with shear wave elastography

Authors: Anna Olchowy, Piotr Seweryn, Cyprian Olchowy, Mieszko Wieckiewicz

Published in: BMC Musculoskeletal Disorders | Issue 1/2022

Abstract

Background

The complex structure of the stomatognathic system plays a vital role in chewing, digestion, speaking, breathing, facial expression and swallowing. Its complexity is the primary reason for creating multidisciplinary teams to manage temporomandibular disorders (TMD). We aimed to assess the masseter stiffness in patients undergoing conservative therapy for masticatory muscle disorders and evaluate the efficacy of manual therapy and stabilization occlusal splint in the treatment of masticatory muscle disorders.

Methods

This uncontrolled prospective cohort study included 35 patients with masticatory muscle disorders. The study lasted for eight weeks. The patients were treated with manual therapy and stabilization occlusal splint and evaluated using shear wave elastography of the masseter muscles and patient-reported outcome measures (PROMs) to assess pain, anxiety, quality of sleep, satisfaction with life and perceived stress.

Results

After the treatment, the stiffness of both masseter muscles decreased significantly (by 4.21 kPa). The patients reported a significant reduction in pain. At baseline, the median scores ranged from 5 to 8; after treatment, they ranged from 0 to 1 (p < 0.0001). The patients also reported significant improvement in terms of all patient-reported outcome measures. The reduction in stiffness corresponded to the improvement in pain and PROMs, as shown by correlations which were insignificant for all measures.

Conclusions

Conservative therapy of masticatory muscle disorders involving manual therapy and stabilization occlusal splint is effective. It reduces the masseter stiffness as objectively shown in shear wave elastography and improves subjective PROMs scores, including numerical pain assessment and selected questionnaires. Shear wave elastography has the potential for broad application in clinical practice to monitor masticatory muscle disorders treatment effects due to its objectivity and non-invasive character. Further research is recommended on larger patient populations and longer follow-up.

Trial registration

The study was registered at clinicaltrials.gov (NCT03844854). First posted date: 19/02/2019.

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Cuccia A, Caradonna C. The relationship between the stomatognathic system and body posture. Clinics (Sao Paulo). 2009;64:61–6. https://doi.org/10.1590/s1807-59322009000100011.CrossRef

Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for clinical and research applications: recommendations of the international RDC/TMD consortium network* and orofacial pain special interest group†. J Oral Facial Pain Headache. 2014;28:6–27. https://doi.org/10.11607/jop.1151.CrossRefPubMedPubMedCentral

Gauer RL, Semidey MJ. Diagnosis and treatment of temporomandibular disorders. Am Fam Physician. 2015;91:378–86.PubMed

Santosh V, Hinduja S, Manoj R, et al. Overlaid temporomandibular joint disorders and otology symptoms – a diagnostic approach and management considerations for otolaryngologists and dentists. East J Med Sci. 2020;5:25–9. https://doi.org/10.32677/EJMS.2020.v05.i02.001.CrossRef

Wieckiewicz M, Grychowska N, Nahajowski M, et al. Prevalence and overlaps of headaches and pain-related temporomandibular disorders among the polish urban population. J Oral Facial Pain Headache. 2020;34:31–9. https://doi.org/10.11607/ofph.2386.CrossRefPubMed

Madani M, Berardi T, Stoopler ET. Anatomic and examination considerations of the oral cavity. Med Clin North Am. 2014;98:1225–38. https://doi.org/10.1016/j.mcna.2014.08.001.CrossRefPubMed

Butts R, Dunning J, Pavkovich R, et al. Conservative management of temporomandibular dysfunction: a literature review with implications for clinical practice guidelines (Narrative review part 2). J Bodyw Mov Ther. 2017;21:541–8. https://doi.org/10.1016/j.jbmt.2017.05.021.CrossRefPubMed

Ahmed N, Poate T, Nacher-Garcia C, et al. Temporomandibular joint multidisciplinary team clinic. Br J Oral Maxillofac Surg. 2014;52:827–30. https://doi.org/10.1016/j.bjoms.2014.07.254.CrossRefPubMed

Baharvand M, Sedaghat Monfared M, Hamian M, et al. Temporomandibular disorders: knowledge, attitude and practice among dentists in Tehran, Iran. J Dent Res Dent Clin Dent Prospects. 2010;4:90–4. https://doi.org/10.5681/joddd.2010.023.CrossRefPubMedPubMedCentral

10.

Alhussini DA, Mominkhan DM, Alhamed FJ, et al. Prevalence and awareness of temporomandibular joint disorders among patients in king abdulaziz university, dental hospital. J Dent Health Oral Disord Ther. 2017;8:603–8. https://doi.org/10.15406/jdhodt.2017.08.00300.CrossRef

11.

Nenadic I, Urban MW, Greenleaf JF, et al. Ultrasound elastography for biomedical applications and medicine. Wiley; 2016. https://www.wiley.com/enus/Ultrasound+Elastography+for+Biomedical+Applications+and+Medicine-p-9781119021513.

12.

Creze M, Nordez A, Soubeyrand M, et al. Shear wave sonoelastography of skeletal muscle: basic principles, biomechanical concepts, clinical applications, and future perspectives. Skeletal Radiol. 2018;47:457–71.CrossRef

13.

Olchowy A, Wieckiewicz M, Winocur E, et al. Great potential of ultrasound elastography for the assessment of the masseter muscle in patients with temporomandibular disorders. Syst Rev, Dentomaxillofac Radiol. 2020;49:20200024. https://doi.org/10.1259/dmfr.20200024.CrossRef

14.

Kishimoto R, Suga M, Koyama A, et al. Measuring shear-wave speed with point shear-wave elastography and MR elastography: a phantom study. BMJ Open. 2017;7:e013925–e013925. https://doi.org/10.1136/bmjopen-2016-013925.CrossRefPubMedPubMedCentral

15.

Lee SM, Chang W, Kang HJ, et al. Comparison of four different shear wave elastography platforms according to abdominal wall thickness in liver fibrosis evaluation: a phantom study. Med Ultrason. 2019;21:22–9. https://doi.org/10.11152/mu-1737.CrossRefPubMed

16.

Zaki M, Hazem M, Elsamman M. Shear wave elastography in assessment of liver stiffness and prediction of gastro-esophageal varices in patients with liver cirrhosis. Egypt J Radiol Nuclear Med. 2019;50:16. https://doi.org/10.1186/s43055-019-0015-x.CrossRef

17.

Calvete AC, Rodríguez JM, de Dios Berná-Mestre J, et al. Interobserver agreement for thyroid elastography. J Ultrasound Med. 2013;32:495–504. https://doi.org/10.7863/jum.2013.32.3.495.CrossRefPubMed

18.

Olchowy C, Olchowy A, Hadzik J, et al. Dentists can provide reliable shear wave elastography measurements of the stiffness of masseter muscles: a possible scenario for a faster diagnostic process. Adv Clin Exp Med. 2021;30:575–80. https://doi.org/10.17219/acem/134875.CrossRefPubMed

19.

Olchowy C, Więckiewicz M, Sconfienza LM, et al. Potential of using shear wave elastography in the clinical evaluation and monitoring of changes in masseter muscle stiffness. Pain Res Manage. 2020;2020:4184268. https://doi.org/10.1155/2020/4184268.CrossRef

20.

Ariji Y, Nakayama M, Nishiyama W, et al. Can sonographic features be efficacy predictors of robotic massage treatment for masseter and temporal muscle in patients with temporomandibular disorder with myofascial pain? Cranio. 2016;34:13–9. https://doi.org/10.1179/2151090314y.0000000037.CrossRefPubMed

21.

Olchowy C, Grzech-Leśniak K, Hadzik J, et al. Monitoring of changes in masticatory muscle stiffness after gum chewing using shear wave elastography. J Clin Med. 2021;10:2480. https://doi.org/10.3390/jcm10112480.CrossRefPubMedPubMedCentral

22.

Peck CC, Goulet JP, Lobbezoo F, et al. Expanding the taxonomy of the diagnostic criteria for temporomandibular disorders. J Oral Rehabil. 2014;41:2–23. https://doi.org/10.1111/joor.12132.CrossRefPubMedPubMedCentral

23.

Sreekumar S, Janakiram C, Mathew A. Effects of prosthetic rehabilitation on temporomandibular disorders: protocol for a randomized controlled trial. JMIR Res Protoc. 2021;10:e33104. https://doi.org/10.2196/33104.CrossRefPubMedPubMedCentral

24.

Azangoo Khiavi H, Ebrahimi H, Najafi S, et al. Efficacy of low-level laser, hard occlusal appliance and conventional pharmacotherapy in the management of myofascial pain dysfunction syndrome; a preliminary study. J Lasers Med Sci. 2020;11:37–44. https://doi.org/10.15171/jlms.2020.07.CrossRefPubMedPubMedCentral

25.

Shousha T, Alayat M, Moustafa I. Effects of low-level laser therapy versus soft occlusive splints on mouth opening and surface electromyography in females with temporomandibular dysfunction: a randomized-controlled study. PLoS One. 2021;16:e0258063. https://doi.org/10.1371/journal.pone.0258063.CrossRefPubMedPubMedCentral

26.

Marfurt CF, Rajchert DM. Trigeminal primary afferent projections to “non-trigeminal” areas of the rat central nervous system. J Comp Neurol. 1991;303:489–511. https://doi.org/10.1002/cne.903030313.CrossRefPubMed

27.

Goats GC. Massage–the scientific basis of an ancient art: Part 1 The techniques. Br J Sports Med. 1994;28:149–52. https://doi.org/10.1136/bjsm.28.3.149.CrossRefPubMedPubMedCentral

28.

da Costa BR, Vieira ER. Stretching to reduce work-related musculoskeletal disorders: a systematic review. J Rehabil Med. 2008;40:321–8. https://doi.org/10.2340/16501977-0204.CrossRefPubMed

29.

Carlson CR, Collins FL Jr, Nitz AJ, et al. Muscle stretching as an alternative relaxation training procedure. J Behav Ther Exp Psychiatry. 1990;21:29–38. https://doi.org/10.1016/0005-7916(90)90046-n.CrossRefPubMed

30.

Conti PC, de Azevedo LR, de Souza NV, et al. Pain measurement in TMD patients: evaluation of precision and sensitivity of different scales. J Oral Rehabil. 2001;28:534–9. https://doi.org/10.1046/j.1365-2842.2001.00727.x.CrossRefPubMed

31.

Cohen S. "Perceived stress in a probability sample of the United States," in The social psychology of health, S. Spacapan and S. Oskamp Eds.: Sage Publications, Inc.; 1988. p. 31–67. https://psycnet.apa.org/record/1988-98838-002. https://www.cmu.edu/dietrich/psychology/stress-immunity-disease-lab/scales/pdf/cohen,-s.--williamson,-g.-1988.pdf.

32.

Juczyński Z, Ogińska-Bulik N. Narzędzia pomiaru stresu i radzenia sobie. Warszawa: Pracownia Testów Psychologicznych; 2009.

33.

Spitzer RL, Kroenke K, Williams JBW, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166:1092–7. https://doi.org/10.1001/archinte.166.10.1092.CrossRefPubMed

34.

Buysse DJ, Reynolds CF 3rd, Monk TH, et al. The Pittsburgh sleep quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193–213. https://doi.org/10.1016/0165-1781(89)90047-4.CrossRefPubMed

35.

Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14:540–5. https://doi.org/10.1093/sleep/14.6.540.CrossRefPubMed

36.

Diener E, Emmons RA, Larsen RJ, et al. The satisfaction with life scale. J Pers Assess. 1985;49:71–5. https://doi.org/10.1207/s15327752jpa4901_13.CrossRefPubMed

37.

Vassar M. A note on the score reliability for the satisfaction with life scale: an RG study. Soc Indic Res. 2008;86:47–57. https://doi.org/10.1007/s11205-007-9113-7.CrossRef

38.

Gierk B, Kohlmann S, Kroenke K, et al. The somatic symptom scale-8 (SSS-8): a brief measure of somatic symptom burden. JAMA Intern Med. 2014;174:399–407. https://doi.org/10.1001/jamainternmed.2013.12179.CrossRefPubMed

39.

Olchowy A, Więckiewicz M, Malysa A. et al. Determination of Reference Values of the Masseter Muscle Stiffness in Healthy Adults Using Shear Wave Elastography, Int J Environ Res Public Health. 2021;18. https://doi.org/10.3390/ijerph18179371.

40.

Botticchio A, Mourad F, Fernández-Carnero S et al. Short-Term Morphological Changes in Asymptomatic Perimandibular Muscles after Dry Needling Assessed with Rehabilitative Ultrasound Imaging: A Proof-of-Concept Study. J Clin Med. 2021;10. https://doi.org/10.3390/jcm10020209.

41.

Raadsheer MC, Van Eijden TM, Van Spronsen PH, et al. A comparison of human masseter muscle thickness measured by ultrasonography and magnetic resonance imaging. Arch Oral Biol. 1994;39:1079–84. https://doi.org/10.1016/0003-9969(94)90061-2.CrossRefPubMed

42.

Gil-Martínez A, Paris-Alemany A, López-de-Uralde-Villanueva I, et al. Management of pain in patients with temporomandibular disorder (TMD): challenges and solutions. J Pain Res. 2018;11:571–87. https://doi.org/10.2147/JPR.S127950.CrossRefPubMedPubMedCentral

43.

Medlicott MS, Harris SR. A systematic review of the effectiveness of exercise, manual therapy, electrotherapy, relaxation training, and biofeedback in the management of temporomandibular disorder. Phys Ther. 2006;86:955–73.CrossRef

44.

Takashima M, Arai Y, Kawamura A, et al. Quantitative evaluation of masseter muscle stiffness in patients with temporomandibular disorders using shear wave elastography. J Prosthodont Res. 2017;61:432–8. https://doi.org/10.1016/j.jpor.2017.01.003.CrossRefPubMed

45.

Best TM, Gharaibeh B, Huard J. Stem cells, angiogenesis and muscle healing: a potential role in massage therapies? Br J Sports Med. 2013;47:556–60. https://doi.org/10.1136/bjsports-2012-091685.CrossRefPubMed

46.

Deregibus A, Ferrillo M, Grazia Piancino M, et al. Are occlusal splints effective in reducing myofascial pain in patients with muscle-related temporomandibular disorders? A randomized-controlled trial. Turk J Phys Med Rehabil. 2021;67:32–40. https://doi.org/10.5606/tftrd.2021.6615.CrossRefPubMedPubMedCentral

47.

Gryglas A, Dudkowiak R, Smigiel R. Tetany as a frequent cause of an emergency consultations–etiology, symptoms and cure. Przegl Lek. 2015;72:20–4.PubMed

48.

Williams A, Liddle D, Abraham V. Tetany: a diagnostic dilemma. J Anaesthesiol Clin Pharmacol. 2011;27:393–4. https://doi.org/10.4103/0970-9185.83691.CrossRefPubMedPubMedCentral

Title: Assessment of the masseter stiffness in patients during conservative therapy for masticatory muscle disorders with shear wave elastography
Authors: Anna Olchowy
Piotr Seweryn
Cyprian Olchowy
Mieszko Wieckiewicz
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Conservative Therapy
Craniomandibular Dysfunction and Stress
Massage
Published in: BMC Musculoskeletal Disorders / Issue 1/2022
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-022-05392-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Assessment of the masseter stiffness in patients during conservative therapy for masticatory muscle disorders with shear wave elastography

Abstract

Background

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

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