Objective: Cervical dystonia lacks disease-modifying treatment, with therapies mainly providing symptom relief. Temporomandibular Joint Balancing Therapy (TBT) addresses TMJ-related postural issues and may improve symptoms. This study retrospectively analyzes TBT-treated patients at a Korean Medicine clinic to assess its therapeutic potential.

Background: Cervical dystonia involves involuntary muscle contractions causing abnormal postures. Traditional models suggest “function follows form,” but recent research supports “dysfunction follows form.” Dystonic movements deviate from normal biomechanics. TBT restores TMJ balance, improving C2 alignment and postural stability, offering a potential treatment.

Method: A retrospective chart review was conducted for cervical dystonia patients treated at a Korean Medicine clinic (2014-2015). Data included TWSTRS and CDIP-58 scores, demographics, diagnostics, treatments, and outcomes. The study was exempt from IRB review (IRB Number: 1040647-202412-HR-001-01). Sixteen patients met inclusion criteria. The mean disease duration was 22.2 months (SD = 34.3), with a mean age of 49.1 years (SD = 10.0); 7 were men and 9 women. All patients underwent TBT, involving continuous TMJ corrections to restore postural alignment. The average number of deviation corrections was 166 (SD = 96).

Results: TWSTRS scores before treatment: total 51.1 (SD = 15.4), severity 20.2 (SD = 8.3), disability 18.0 (SD = 7.2), and pain 12.8 (SD = 4.5). Post-treatment: total 33.8 (SD = 13.9), severity 10.7 (SD = 7.5), disability 14.1 (SD = 6.2), pain 9.1 (SD = 4.2). CDIP-58 scores improved from 210.0 (SD = 46.8) to 160.1 (SD = 51.3). The average treatment duration was 7.1 months (SD = 4.7). The MCIC threshold for TWSTRS (≥8 points reduction) was exceeded, confirming TBT’s effectiveness. TBT achieved a 17.3-point TWSTRS reduction, surpassing the typical 12-point reduction seen with botulinum toxin (BoNT) therapy. No serious adverse effects were reported.

Conclusion: This study supports the “dysfunction follows form” model in cervical dystonia. C2’s biomechanical interaction with TMJ underscores the need for TMJ correction in treatment. By restoring TMJ equilibrium and C2 alignment, TBT offers a promising approach for sustained symptom relief. Patients with frequent deviation corrections responded faster, suggesting treatment intensity may be key to better outcomes. Future studies should explore this further.

References: 1. In C, Lee Y, Lee Y. Temporomandibular joint yinyang balance treatment improves cervical spine alignment in pain patients, a medical imaging study. J Acupunct Res 2007;24(4):37–45.
2. Tatu L, Jost WH. Anatomy and cervical dystonia: “Dysfunction follows form”. J. Neural Transm. 2017;124:237–243.
3. Espay AJ, Trosch R, Suarez G, Johnson J, Marchese D, Comella C. Minimal clinically important change in the Toronto Western spasmodic torticollis rating scale. Park. Relat. Disord. 2018;52:94–97.
4. Dashtipour K, Mari Z, Jankovic J, Adler CH, Schwartz M, Brin MF. Minimal clinically important change in patients with cervical dystonia: Results from the CD PROBE study. J. Neurol. Sci. 2019 Oct 15;405:116413.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/temporomandibular-joint-balancing-therapy-for-cervical-dystonia-a-retrospective-study/