CORRECTION OF FUNCTIONAL SIGNS OF TEMPOROMANDIBULAR JOINT DISORDERS IN MILITARY PERSONNEL WITH POST-TRAUMATIC STRESS DISORDER USING PHYSICAL THERAPY

Abstract

In the current conditions of armed aggression against Ukraine, the prevalence of temporomandibular joint (TMJ) dysfunctions among military personnel has significantly increased, which is due to the high level of post-traumatic stress disorder (PTSD) and associated psychophysiological changes. TMJ dysfunctions in military personnel often remain undiagnosed, worsening the quality of life and functional capacity. Purpose of the work. To determine the effectiveness of physical therapy in the correction of dental functional disorders in military personnel with PTSD and TMJ dysfunction. Methodology. The study involved 37 military personnel: 14 with diagnosed PTSD and TMJ dysfunction (comparison group), 23 without the specified disorders (control group). A 4-week physical therapy program was implemented, which included manual techniques, special exercises for the neck and TMJ, breathing and relaxation techniques (which were performed in an outpatient format and in the form of independent classes). The effectiveness was assessed using the Jaw Functional Limitation Scale (JFLS), the results of palpation of the muscles and structures of the TMJ. Scientific novelty. After the implementation of the 4-week physical therapy program, a significant reduction in complaints was found: the frequency of TMJ pain decreased from 100% to 21.4%, headache from 100% to 0%, neck pain from 85.7% to 0%, and difficulty chewing from 92.9% to 14.3%. The frequency of detection of painful trigger zones in key muscles of the maxillofacial and cervical regions decreased by 3–7 times: in the masseter muscle – from 100% to 14.3%, in the temporalis – from 85.7% to 7.1%, in the scalene muscles – from 100% to 14.3%. In 6 out of 8 TMJ zones according to the Rocabado map, the number of positive reactions to palpation decreased by more than 50%; in particular, in the posterior superior synovium zone – by 71.4%, retrodiscitis – by 58.3%, anterior superior synovium and lateral ligament – by 57.1% each. Functional limitations of the mandible on the JFLS scale significantly decreased: the total score decreased by 40.8%, in the chewing domain – by 51.1%, jaw mobility – by 28.6%, communication – by 36.7%. Conclusions. The developed physical therapy provides a significant reduction in pain and functional load in patients with TMJ dysfunction on the background of PTSD. The preservation of some psychoemotional symptoms indicates the need to supplement physical intervention with a psychotherapeutic component to achieve the full effect.