Influência do espasmo hemifacial no limiar de sensibilidade mecânica e dolorosa de mulher com disfunção temporomandibular: relato de caso

Abstract

Hemifacial spasm (HFS) is a movement disorder characterized by spasms of muscles innervated by the facial nerve. The quantitative sensory testing (QST) is a method for sensitivity analysis, which investigates the functional state of the somatosensory system of an individual through calibrated stimuli and subjective thresholds of perception. The aim of this study was to evaluate the influence of HFS on the pain sensitivity of female patient with mixed temporomandibular dysfunction (TMD). Patient was initially evaluated through an anamnesis and a physical examination (Research Diagnostic Criteria for Temporomandibular Disorders), as well as QSTs for pain sensitivity analysis. Based on the results of these tests, a conservative treatment was proposed and the tests were repeated. The gathered data suggest that the analyzed patient had very low pain thresholds when compared to the healthy population, before and even after the treatment for TMD and HFS began. Although the results indicated reduced Pressure Pain Threshold (PPT) values on the left side of the face, affected by HFS, the difference when compared to the contralateral side is very subtle, suggesting that the presence of HFS did not influence the PPT. Based on the Conditioned Pain Modulation (CPM) tests, it was found that the mean values of PPT increased significantly in the left masseter and in the anterior temporal muscle and right temporomandibular joint (TMJ), indicating that the patient presented a more prominent alteration in peripheral nervous system. In conclusion, it would appear that HFS does not influence the pain sensitivity and therefore does not correspond to an aggravating factor for TMD.