Avaliação clínica e funcional do sistema estomatognático de pacientes submetidos à craniotomia pterional

• Main Author: Santos, Carlos Michell Tôrres
• Publication Date: 2013
• Format: Doctoral thesis
• Language: por
• Source: Repositório Institucional da UFS
• Download full: https://ri.ufs.br/handle/riufs/3587
• topic: Craniotomia; Articulação temporomandibular; Cefaleia; Craniotomy; Temporomandibular joint; Headache; CNPQ::CIENCIAS DA SAUDE

Introduction: the pterional craniotomies are usually employed in the treatment of aneurysms of the anterior circulation and tumor resection. This technique requires dissection of the temporalis muscle and its reintegration, potentially affecting the temporomandibular joint. Objective: to evaluate the clinical and functional evolution of stomatognathic system in patients undergoing elective pterional craniotomy and interfascial dieresis. Methods: this prospective cohort study evaluated 15 patients at Benefit Foundation Cirurgia Hospital who underwent pterional craniotomy, of both genders aged between 21 and 60 years. To conduct the study of temporomandibular dysfunction, were applied self-reported symptoms of temporomandibular disorders questionnaire and the Research Diagnostic Criteria for Temporomandibular Disorders.Clinical examination of the pain applied the visual analogue scale of pain and Brazilian version of the McGill pain questionnaire, directed to the head and temporomandibular joint of the operated side, as well as the pressure pain threshold of the masseter and anterior temporalis muscles. The examination of the masticatory function was carried out through research of surface electromyography during mandibular rest and mastication for the masseter and anterior temporalis muscles, and estimation of masticatory performance. Finally, the impact that the headache had on the lives of individuals studied was investigated by applying the version 6 of headache impact test. All assessments were performed before surgery, as well as 60, 120 and 180 days postoperatively. For the entire study was considered the statistical significance level of 5%. Results: the subjects reported a significant difficulty in opening the mouth (p < 0,005) and pain on palpation of the temporomandibular joint (p < 0,005) at 60 days after surgery, while the majority of such patients had limitation of mouth opening round the postoperative period (p < 0,005). Furthermore, there was also a significant reduction in the average values of the functional (p < 0,001) and muscle (p < 0,005) indices at 60 and 120 days postoperatively and a significant increase of temporomandibular index at 60 days after surgery (p < 0,005). The pressure pain threshold of the masticatory muscles showed a significant reduction of their values at 120 days postoperatively (p < 0,005), while a significant reduction in masticatory performance was observed at 180 days after surgery (p < 0,005). The impact of headache was significantly lower at 180 days post-surgery (p < 0,005). Conclusion: in the sample studied, the patients had worsening of the signs and symptoms of temporomandibular disorder, worsening of algic perception to palpation in the anterior temporalis muscle, presentation of pain on palpation of the temporomandibular joint, limitation of mouth opening, gradual reduction of masticatory performance and impact that the headache had on the lives of individuals evaluated. In contrast, there was no change in the electrical activity of the masticatory muscles