Evaluation of the effectiveness of therapeutic and diagnostic blockades in dental patients with myofascial pain syndrome and local sensory disorders

Background. Many outpatient dental patients (up to 67% of cases) experience temporomandibular joint (TMJ) dysfunction. Patients with TMJ dysfunction often have myofascial pain syndrome, as well as sensory maxillofacial disorders. To identify the focus of myofascial pain syndrome, establish the degree of trigeminal neuralgia and the causes of sensory disorders, diagnostic and therapeutic blockades (selective anesthesia) are recommended. The purpose – is to evaluate the effectiveness of selective anesthesia in topical diagnosis of sensory facial and oral disorders in dental patients with myofascial pain syndrome. Materials and methods. In the outpatient dental clinic, 12 patients aged 35 to 70 years (5 women and 7 men) were examined and treated, who complained of sensory disorders and periodic pain in the lower third of the face or in the anterior third of the tongue, and TMJ dysfunction. For topical diagnosis of local sensory disorders in patients, selective blockades of the peripheral branches of the trigeminal nerve were used as torusal and Berscheʼs anesthesia. If necessary, an additional blockade of the mylohyoid nerve, which innervates the mandibular muscles, was conducted. Results and discussion. After a therapeutic and diagnostic blockade of the sensitive branches of the mandibular nerve using torusal anesthesia, the myofascial pain syndrome was relieved in 5 patients, paresthesia disappeared, and the glossalgia stopped in 2 patients. However, 2 patients with sensory buccal disorders and 3 patients with the numb chin syndrome did not show the expected therapeutic effect – total pain relief. During the local Berscheʼs anesthesia, the masticatory muscle tension significantly decreased – the muscles became more elastic. The intensity of the evoked pain decreased to 3.2 ± 0.7 (p ˂ 0.05) according to the NRS scale. In 9 patients who had sensory buccal and lingual disorders, touch sensibility improved. When comparing the clinical results of both methods of selective anesthesia, no statistically significant differences in their effectiveness were found – χ2 – 1.8, p ˃ 0.05. However, pain and dysesthesia on the chin persisted in 3 patients. Only after a blockade of the mylohyoid nerve in these patients, in case of relaxation of the muscles of the oral diaphragm, the pain in the anterior belly of the digastric muscle and the chin discomfort disappeared. Conclusions. To identify the causes of sensory facial and lingual disorders in patients with myofascial pain syndrome associated with TMJ dysfunction, step-by-step selective anesthesia is recommended, which allows for topical diagnosis of injured branches of the trigeminal nerve, establishing myogenic factors of these diseases, as well as the focus of pain syndrome.