Is the use of manual therapy in the craniomandibular and cervical regions beneficial for reducing orofacial pain and increasing mandibular mobility? Systematic review

ABSTRACT

BACKGROUND AND OBJECTIVES:  The use of manual therapy in the craniomandibular and cervical regions in the treatment of patients with temporomandibular disorders (TMD) has become common practice, and the literature supports the use of these techniques to relieve pain and improve the range of mandibular movement. Therefore, the organization of scientific findings can help clinicians make informed decisions. Thus, the objective of this systematic review was to evaluate the effectiveness of manual therapy in the craniomandibular region in patients with TMD and to compare it with manual therapy in the cervical region in terms of pain intensity and range of mandibular movement.

CONTENTS:  Following PRISMA guidelines, Randomized Clinical Trials were included with a population of adults of both genders with signs and symptoms of TMD. Case reports, pilot studies, case series, editorials, opinion letters, letters to the editor, literature reviews, cohort studies, and case-control studies were excluded. The search strategy was created using MESH and synonyms for TMD, cervical treatment, manual therapy, physiotherapy, exercise, pain, and mandibular range of motion. The databases Medline, Embase, Pubmed, Cochrane Library, Virtual Health Library, PEDro, Scielo, LILACS and Central were used. The Cochrane ROB2 risk of bias and the PEDro scale were used to assess the methodological quality of the included studies. Eight studies were eligible, published between 2013 and 2022, totaling 339 individuals with TMD aged between 18 and 65 years. The results of the present review showed that patients undergoing manual therapy in the craniomandibular and cervical regions, with or without the addition of exercises and/or patient education, present a progressive reduction in the intensity of orofacial pain and gains in mandibular range of motion.

CONCLUSION:  The results expand the data reported by other systematic reviews that investigated different aspects of the application of manual therapy in individuals with TMD. Manual therapy in the craniomandibular and cervical regions, whether associated with exercises and/or patient education, presents a clinically relevant improvement in the intensity of orofacial pain and mandibular range of motion.

Keywords:
Cervical vertebrae; Musculoskeletal manipulations; Pain; Rehabilitation; Temporomandibular joint dysfunction syndrome

HIGHLIGHTS

This review highlighted significant improvements in pain and mandibular range of motion with manual therapy in the craniomandibular region, compared to the cervical region, in TMD patients.

Manual therapy in the upper cervical spine with exercises reduced orofacial pain in women with TMD.

Some studies combined manual therapy with various exercises, offering a comprehensive overview of the therapeutic approaches evaluated.

This review offers valuable insights into the effectiveness of different manual therapy modalities on TMD, helping professionals to choose the most effective treatments.