Wechsler Stephen
Memorial Sloan Kettering Cancer Center, Sillerman Center for Rehabilitation, 515 Madison Avenue, New York, NY 10022, p: 646-888-1900 f: 646-888-1906.
Rehabil Oncol. 2020 Jul;38(3):127-133. doi: 10.1097/01.reo.0000000000000190.
Acromegaly is a disorder typically caused by a benign pituitary adenoma resulting in hypersecretion of growth hormone. Common sequelae, including musculoskeletal changes and arthropathies can result in facial pain and temporomandibular disorder (TMD) that persist beyond primary treatment. Due to the unique etiology of facial pain and TMD in cases of acromegaly, the generalizability of established physical therapy (PT) literature for treatment of TMD cannot be assumed. The purpose of this case report was to illustrate an example of multimodal PT as a treatment strategy for facial pain and TMD secondary to acromegaly following treatment for benign pituitary macroadenoma.
48-year-old male patient with history significant for benign pituitary macroadenoma, presented with facial pain and TMD secondary to acromegaly. Patient-reported outcomes of pain, function, and quality of life were assessed utilizing the Gothenburg Trismus Questionnaire (GTQ) at baseline, eighth PT visit, and eight weeks following course of PT. Quantity and quality of jaw mobility were assessed at baseline and post-intervention using standard goniometric measurements and observation. A total of nine PT sessions were delivered over three months consisting of manual therapy, relaxation techniques, neuromuscular re-education, and therapeutic exercise.
After eight PT visits, patient's GTQ score improved from 81% to 67.6%, with a corresponding decrease in pain and improved symmetry of jaw mobility. Eight weeks following last PT visit, patient's GTQ score further decreased from 67.6% to 61.3%.
Conservative management through multimodal PT may be effective in managing facial pain and TMD secondary to acromegaly following treatment for benign pituitary macroadenoma.
肢端肥大症是一种通常由良性垂体腺瘤引起的疾病，导致生长激素分泌过多。常见的后遗症，包括肌肉骨骼变化和关节病，可导致面部疼痛和颞下颌关节紊乱（TMD），这些症状在初始治疗后仍会持续。由于肢端肥大症患者面部疼痛和TMD的病因独特，不能假定已有的物理治疗（PT）文献中治疗TMD的方法具有普遍适用性。本病例报告的目的是举例说明多模式PT作为治疗良性垂体大腺瘤后肢端肥大症继发面部疼痛和TMD的一种治疗策略。
一名48岁男性患者，有良性垂体大腺瘤病史，因肢端肥大症继发面部疼痛和TMD前来就诊。在基线、第8次PT就诊时以及PT疗程结束后8周，使用哥德堡牙关紧闭问卷（GTQ）评估患者报告的疼痛、功能和生活质量结果。在基线和干预后，使用标准测角测量和观察评估下颌活动度的数量和质量。在三个月内共进行了9次PT治疗，包括手法治疗、放松技术、神经肌肉再教育和治疗性锻炼。
经过8次PT治疗后，患者的GTQ评分从81%提高到67.6%，疼痛相应减轻，下颌活动度对称性改善。在最后一次PT就诊后8周，患者的GTQ评分进一步从67.6%降至61.3%。
通过多模式PT进行保守治疗可能有效管理良性垂体大腺瘤治疗后肢端肥大症继发的面部疼痛和TMD。
