Imagenological resources for the diagnosis and monitoring of alterations in the patient with dysfunction of the mandibular cranio-cervical system

Abstract

The skull, mandible and cervical spine present neurological and biomechanical connections, generating a functional complex called craniocervicomandibular system (SCCM). The study of the dysfunctions of this system focuses on the pathophysiology of these related structures. Its diagnosis should be based on the clinical and functional examination and the corresponding imaging analyses. A clinical case of a 20-year-old male patient is reported, who attended the Postgraduate Dentofacial Orthopedics and Orthodontics area of the University of Carabobo, referring to mild joint pain, for which a clinical evaluation, lateral cephalic x-ray, and open mouth anteroposterior (AP) x-ray and cone beam computed tomography (CBCT) were performed. The clinical findings, the indicated therapy, as well as the changes observed in the control are described. Clinically, he presented postural asymmetry, straight profile, skeletal class II. In the closed mouth CBCT of the temporomandibular joint, both condyles of the mandible are observed in a posterior position, with increased anterior joint space, in the open mouth AP radiograph, asymmetry of the joint spaces and in the Rocabado analysis in the lateral cephalic radiograph, anterior rotation of the skull, reduced subocipital space between atlas and axis, low hyoid. The treatment plan consisted of orthopedic physiotherapy and the use of the anterior orthostatic guide type splint (MAGO), a marked improvement in symptoms and craniocervical posture was observed. An interdisciplinary approach is essential, considering the craniocervical relationship in the field of orthodontics, to achieve accurate diagnoses and stable treatments over time.