Investigation of the efficacy of myofunctional treatment in oral stage swallowing disorder accompanying temporomandibular joint dysfunction

This study was aimed to examine the effect of tongue strengthening exercises in addition to Manuel treatment applied in individuals with oral stage swallowing disorder (Oral dysphagia=OD) due to temporomandibular joint dysfunction (TMD). Our study included 44 individuals who applied to the dental clinic of Şanlıurfa Viranşehir State Hospital and were diagnosed with OD due to TMD, aged 18-65, meeting the inclusion criteria and completing the treatment. Individuals were divided into three groups by simple closed-envelope randomization method: control group (n=12), manual therapy (MT) group (n=15), and orofacial myofunctional treatment (OMT) group (n=17). The control group was given home exercise and patient training organized by a physiotherapist. Subjects were asked to do the exercise 3 days a week for ten weeks. Subjects in the MT group received a comprehensive program, including temporomandibular joint and cervical mobilizations, in addition to home exercise and patient training. In the OMT group, a treatment program including home exercise, patient education, and tongue strengthening protocols in addition to MT was applied. MT and OMT groups were applied for ten weeks, two sessions with 30-45 minutes each per week, for 20 sessions. After three months, assessments were repeated with 28 subjects who could be contacted. All the subjects were evaluated for problems and recovery after the treatment with the following tests. Temporomandibular Disorders Research Diagnostic Criteria (TMD/RDC), head posture, Jaw Function Limitation Scale (JFLS-20), 100 ml Water Swallow Test (WST), Eating Evaluation Tool-10 (EAT-10), tongue strength and endurance evaluation, Swallow Quality of Life questionnaire (Swal-QoL), and the Neck Disability Index (NDI) was used. When the pre-treatment, post-treatment, and 3rd-month data of all three groups were compared, an improvement was observed in pain intensity, head posture, range of motion of the mandible, jaw functionality, and neck disability in all three groups (p<0.05). There was no improvement in swallowing function evaluations in the exercise group (p>0.05). In the MT group, only WST and EAT-10 data for swallowing function improved (p<0.05). In the OMT group, improvement was observed in WST, EAT-10, Swal-Qol, and tongue strength and endurance data (p<0.05). After the treatment, comparing the three groups to each other, it was determined that the OMT group had the most improvement in jaw functionality and swallowing-related quality of life and with a reduction in pain and dysphagia symptoms (p<0.05). As a result, it was found that OMT, including tongue strengthening exercises combined with home exercises and MT, was superior to MT and exercises alone in reducing dysphagia and improving swallowing-related quality of life. Therefore, it may be recommended to add the OMT approach in individuals with OD due to TMD.