Differential diagnosis between post-polio syndrome symptoms and temporomandibular disorder: clinical case

Barbosa, Gustavo Augusto Seabra; Morais, Maria Helena de Siqueira Torres

Abstract

Post-poliomyelitis syndrome (PPS) is characterized by the delayed appearance of new neuromuscular symptoms in patients several years after their acute poliomyelitis paralysis. Clinical features of PPS include fatigue, joint and muscle pain, new muscular weakness and bulbar symptoms. The diagnosis is essentially clinical after excluding other neurological, orthopedic or rheumatologic problems. Temporomandibular disorders (TMD) are usually diagnosed by means of comprehensive review of patient history and clinical examination and the symptoms are pain/ discomfort in the jaw, mainly in the region of the temporomandibular joints (TMJs) and/or masticatory muscles, limitation of mandibular function and/or TMJ sounds. In the same way as PPS, the diagnosis of TMD is challenging. This study reports the case of a patient that presented the symptoms of both conditions in the stomatognathic system, and discusses how to achieve the differential diagnosis for proper management of the cases.

diagnosis differential; post-poliomyelitis syndrome; temporomandibular disorders

References

¹ Howard RB. Poliomyelitis and the postpolio syndrome. BMJ. 2005; 330: 1314-8.
² Vranjac, A. Poliomyelitis and the postpolio syndrome. Sao Paulo: State Department of Health; 2006.
³ Nollet F, Beelen A, Prins MH, de Visser M, Sargeant AJ, Lankhorst GJ et al. Disability and functional assessment in former polio patients with and without postpolio syndrome. Arch Phys Med Rehabil. 1999; 80: 136-43.
⁴ Lin KH, Lim YW. Post-poliomyelitis Syndrome: case report and review of the literature. Ann Acad Med Singapure. 2005; 34: 447-9.
⁵ Werhagen L, Borg K. Impact of pain on quality of life in patients with postpolio syndrome. J Rehabil Med. 2013: 45: 161-3.
⁶ Ramaraj R. Post Poliomyelitis syndrome: clinical features and management. Br J Hosp Med. 2007; 68: 648-50.
⁷ Gonzalez H, Khademi M, Borg K. Intravenous immunoglobulin treatment of the post-polio syndrome: sustained effects on quality of life variables and cytokine expression after one year follow up. J Neuroinflammation 2012; 9: 1-12.
⁸ Matyja E. Post-polio syndrome. Part I. The "legacy" of forgotten disease, challenges for professionals and polio survivors. Neurol Neurochir Pol. 2012; 46: 357-71.
⁹ Bertolasi L, Acler M, dall'Ora E, Gajofatto A, Frasson E, Tocco P et.al. Risk factors for post-polio syndrome among an Italian population: a case-control study. Neurol Sci. 2012; 33: 1271-5.
¹⁰ Lim JY, Kim KE, Choe G. Myotonic Dystrophy Mimicking Postpolio Syndrome in a Polio Survivor. Am J Phys Med Rehabil. 2009; 88: 161-5.
¹¹ Suvinen T, Reade PC, Kemppainen P, Könönen M, Dworkin SF. Review of aetiological concepts of temporomandibular pain disorders: towards a biopsychosocial model for integration of physical disorder factors with psychological and psychosocial illness impact factors. Eur J Pain. 2005; 9: 613-33.
¹² Al-Ani Z,Gray R. TMD Current Concepts: 1. An Update. Dent Update. 2007; 34: 278-88.
¹³ Auvenshine RC. Temporomandibular Disorders: Associated Features. Dent Clin N Am. 2007; 51: 105-27.
¹⁴ Niemela K, Korpela M, Raustia A, Ylöstalo P, Sipilä K. Efficacy of stabilisation splint treatment on temporomandibular disorders. J Oral Rehabil. 2012; 39: 799-804.
¹⁵ Jerjes W. Muscle disorders and dentition-related aspects in temporomandibular disorders: controversies in the most commonly used treatment modalities Int Arch Med. 2008; 23: 1-13.
¹⁶ Lucia VO. A technique for recording centric relation. J Dent. 1964; 14: 492505.
¹⁷ Pimentel MJ, Gui MS, Martins de Aquino LM, Rizzatti-Barbosa CM. Features of temporomandibular disorders in fibromyalgia syndrome. Cranio. 2013; 31: 40-5.
¹⁸ Michelotti A, Wijer ,Steenks M, Farella M. Home-exercise regimes for the management of non-specific temporomandibular disorders. J Oral Rehabil. 2005; 32: 779-85.
¹⁹ Dworkin S. Behavioral and educational modalities. Oral Surg Oral Med Oral Pathol. 1997; 8: 128-33.
²⁰ De Felicio CM, Melchior MO, Silva MAM. Effects of orofacial myofunctional therapy on temporomandibular disorders. Cranio. 2010; 28: 250-61.
²¹ Pertes RA, Gross SG. Clinical management of temporomandibular disorders and orofacial pain. Chicago: Quintessence; 2005. p. 197-209.
²² Major PW, Nebbe B. Use and effective of splint appliance therapy: review or literature. Cranio. 1997; 15: 159-66.
²³ Nelson SJ. Principles of stabilization bite splint therapy. Dent Clin North Am. 1995; 39: 403-21.
²⁴ Lindfors E, Magnusson T, Teglberg A. Interocclusal appliances- Indications and clinical routines in general dental practice in Sweden. Swed Dent J. 2006; 30: 123-34.
²⁵ Dylina TJ. A common-sense approach to splint therapy. JProsthet Dent. 2001; 86: 539-45.
²⁶ Okeson JP. Management of temporomandibular disorders and occlusion. 6th ed. Saint Louis: Mosby; 2008. p. 377-99.

Publication Dates

Publication in this collection
04 June 2013
Date of issue
Mar 2013

History

Received
19 Mar 2012
Accepted
11 Aug 2012

This work is licensed under a Creative Commons Attribution 4.0 International License.

[1] ¹ Howard RB. Poliomyelitis and the postpolio syndrome. BMJ. 2005; 330: 1314-8.

[2] ² Vranjac, A. Poliomyelitis and the postpolio syndrome. Sao Paulo: State Department of Health; 2006.

[3] ³ Nollet F, Beelen A, Prins MH, de Visser M, Sargeant AJ, Lankhorst GJ et al. Disability and functional assessment in former polio patients with and without postpolio syndrome. Arch Phys Med Rehabil. 1999; 80: 136-43.

[4] ⁴ Lin KH, Lim YW. Post-poliomyelitis Syndrome: case report and review of the literature. Ann Acad Med Singapure. 2005; 34: 447-9.

[5] ⁵ Werhagen L, Borg K. Impact of pain on quality of life in patients with postpolio syndrome. J Rehabil Med. 2013: 45: 161-3.

[6] ⁶ Ramaraj R. Post Poliomyelitis syndrome: clinical features and management. Br J Hosp Med. 2007; 68: 648-50.

[7] ⁷ Gonzalez H, Khademi M, Borg K. Intravenous immunoglobulin treatment of the post-polio syndrome: sustained effects on quality of life variables and cytokine expression after one year follow up. J Neuroinflammation 2012; 9: 1-12.

[8] ⁸ Matyja E. Post-polio syndrome. Part I. The "legacy" of forgotten disease, challenges for professionals and polio survivors. Neurol Neurochir Pol. 2012; 46: 357-71.

[9] ⁹ Bertolasi L, Acler M, dall'Ora E, Gajofatto A, Frasson E, Tocco P et.al. Risk factors for post-polio syndrome among an Italian population: a case-control study. Neurol Sci. 2012; 33: 1271-5.

[10] ¹⁰ Lim JY, Kim KE, Choe G. Myotonic Dystrophy Mimicking Postpolio Syndrome in a Polio Survivor. Am J Phys Med Rehabil. 2009; 88: 161-5.

[11] ¹¹ Suvinen T, Reade PC, Kemppainen P, Könönen M, Dworkin SF. Review of aetiological concepts of temporomandibular pain disorders: towards a biopsychosocial model for integration of physical disorder factors with psychological and psychosocial illness impact factors. Eur J Pain. 2005; 9: 613-33.

[12] ¹² Al-Ani Z,Gray R. TMD Current Concepts: 1. An Update. Dent Update. 2007; 34: 278-88.

[13] ¹³ Auvenshine RC. Temporomandibular Disorders: Associated Features. Dent Clin N Am. 2007; 51: 105-27.

[14] ¹⁴ Niemela K, Korpela M, Raustia A, Ylöstalo P, Sipilä K. Efficacy of stabilisation splint treatment on temporomandibular disorders. J Oral Rehabil. 2012; 39: 799-804.

[15] ¹⁵ Jerjes W. Muscle disorders and dentition-related aspects in temporomandibular disorders: controversies in the most commonly used treatment modalities Int Arch Med. 2008; 23: 1-13.

[16] ¹⁶ Lucia VO. A technique for recording centric relation. J Dent. 1964; 14: 492505.

[17] ¹⁷ Pimentel MJ, Gui MS, Martins de Aquino LM, Rizzatti-Barbosa CM. Features of temporomandibular disorders in fibromyalgia syndrome. Cranio. 2013; 31: 40-5.

[18] ¹⁸ Michelotti A, Wijer ,Steenks M, Farella M. Home-exercise regimes for the management of non-specific temporomandibular disorders. J Oral Rehabil. 2005; 32: 779-85.

[19] ¹⁹ Dworkin S. Behavioral and educational modalities. Oral Surg Oral Med Oral Pathol. 1997; 8: 128-33.

[20] ²⁰ De Felicio CM, Melchior MO, Silva MAM. Effects of orofacial myofunctional therapy on temporomandibular disorders. Cranio. 2010; 28: 250-61.

[21] ²¹ Pertes RA, Gross SG. Clinical management of temporomandibular disorders and orofacial pain. Chicago: Quintessence; 2005. p. 197-209.

[22] ²² Major PW, Nebbe B. Use and effective of splint appliance therapy: review or literature. Cranio. 1997; 15: 159-66.

[23] ²³ Nelson SJ. Principles of stabilization bite splint therapy. Dent Clin North Am. 1995; 39: 403-21.

[24] ²⁴ Lindfors E, Magnusson T, Teglberg A. Interocclusal appliances- Indications and clinical routines in general dental practice in Sweden. Swed Dent J. 2006; 30: 123-34.

[25] ²⁵ Dylina TJ. A common-sense approach to splint therapy. JProsthet Dent. 2001; 86: 539-45.

[26] ²⁶ Okeson JP. Management of temporomandibular disorders and occlusion. 6th ed. Saint Louis: Mosby; 2008. p. 377-99.