USE OF SELECTIVE BLOCKADES OF THE MANDIBULAR NERVE BRANCHES IN THE ALGORITHM FOR THE DIAGNOSTIC LOCAL SENSORY DISORDERS AND PROZOPALGIA IN PATIENTS WITH DYSFUNCTION OF THE TEMPOROMANDIBIAL JOINTS

Abstract

The complex anatomical and functional organization of the maxillofacial region and its nervous system determines the diversity of pathogenetic mechanisms of facial pain (proso palgia) and local sensory disorders. Patients with TMJ dysfunction often develop myofascial pain syndrome, and sensory disorders of the face and oral cavity may also occur. To identify the focus of pain syndrome on the face, topical diagnostics – establishing the level of damage to the branches of the trigeminal nerve and the causes of sensory disorders, the use of diagnostic and therapeutic blockades (selective anesthesia) is effective. In a dental clinic, 12 patients aged 35 to 70 years (5 women and 7 men) were examined and treated, complaining of sensory disorders and the appearance of painful paroxysms in the lower third of the face or in the front of the tongue, and dysfunction of the temporomandibular joints. For topical diagnosis of damage to the branches of the mandibular nerve, which caused local sensory disorders in patients, selective blockades (conduction anesthesia) of the buccal, chin, and lingual nerves were applied using standard techniques. To determine whether myogenic factors are the cause of sensory disorders and prosopalgia, selective blockades of the motor branches of the mandibular nerve were performed using the Bershe method and the mylohyoideus nerve using the method we developed. Results. After diagnostic blockade of the sensitive branches of the mandibular nerve, 7 patients had partial relief of pain and disappearance of paresthesia. However, 5 patients with facial sensory disorders failed to achieve a therapeutic effect. After Berche anesthesia, prosopalgia was reduced, the masticatory muscles relaxed, and trigger points disappeared. In 9 patients who had sensory disorders on the cheek or tongue, sensory disorders in these anatomical areas disappeared. No statistically significant differences in the effectiveness of the applied selective anesthesia techniques were found – χ2 – 1.8, p > 0.05. However, 3 patients still had pain and sensory disorders on the chin after these anesthesias. Only after the blockade of the maxillohyoid nerve did these patients experience relaxation of the muscles of the floor of the mouth, and trigger points and unpleasant sensations on the chin disappeared. Conclusions. In the algorithm for diagnosing local sensory disorders and prosopalgia in patients with temporomandibular joint dysfunction, the two-stage use of selective anesthesia – blockade of the sensitive and motor branches of the mandibular nerve – is effective. This allows, at the first stage, to conduct topical diagnostics of damage to the sensitive branches of this nerve, and at the second stage, to identify myogenic factors of pain syndrome (prosopalgia) and sensory disorders on the face and tongue.