Facial Pain and Temporomandibular Joint Dysfunction Secondary to Acromegaly: Treatment with Manual Therapy, Neuromuscular Re-education - A Case Report.

BACKGROUND AND
PURPOSE: 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. CASE DESCRIPTION: 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. OUTCOMES: 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%. DISCUSSION: Conservative management through multimodal PT may be effective in managing facial pain and TMD secondary to acromegaly following treatment for benign pituitary macroadenoma.