Minimally invasive approach to temporomandibular disorders in a patient with congenital muscular torticollis. Case report

Abordagem minimamente invasiva de disfunções temporomandibulares articulares em paciente com torcicolo muscular congênito. Relato de caso

BACKGROUND AND OBJECTIVES  Temporomandibular disorders (TMD) are often associated with biomechanical and postural factors such as congenital muscular torticollis (CMT). This report describes a minimally invasive therapeutic approach in a patient with TMD and CMT, highlighting the efficacy of arthrocentesis combined with viscosupplementation.

CASE REPORT  The 31-year-old female patient with a previous diagnosis of CMT and TMD symptoms (joint pain, crepitation, and limited mouth opening) underwent clinical evaluation according to the Diagnostic Criteria for TMDs (DC/TMD) and imaging tests (computed tomography and magnetic resonance imaging). After unsatisfactory response to conservative treatment (occlusal splint, physical therapy, and dry needling), a minimally invasive approach was adopted, consisting of ultrasound-guided arthrocentesis and viscosupplementation with 1% sodium hyaluronate. Significant improvement was observed after the minimally invasive protocol, with increased mouth opening (from 28 mm to 42 mm), pain reduction, and bone recorticalization in the right temporomandibular joint. The integrated approach demonstrated efficacy in functional restoration and symptom relief.

CONCLUSION  The combined use of arthrocentesis and viscosupplementation was associated with clinical and functional improvement in a patient with refractory temporomandibular disorder and congenital muscular torticollis, suggesting a potential role for minimally invasive approaches in complex TMD cases.

Keywords:
Minimally invasive surgical procedures; Temporomandibular joint disorders; Temporomandibular joint; Torticollis

Systematic evaluation by the DC/TMD, associated with imaging tests when necessary, is essential for the correct diagnosis and therapeutic planning in complex cases involving muscular, joint, and postural components

Arthrocentesis associated with viscosupplementation with sodium hyaluronate can be effective in cases of refractory joint TMD, promoting significant pain relief and relevant functional gain in mouth opening

The clinical case reinforces the importance of an interdisciplinary and staged approach to the management of TMDs, reserving minimally invasive interventions for situations in which well-conducted conservative treatments are not sufficient