Rheumatoid arthritis (RA) is a chronic inflammatory joint disease characterized by immunologic abnormalities. Although the temporomandibular joint (TMJ) can be involved, TMJ changes with RA are unclear, and an optimal treatment for open bite in patients with RA has not been established. We report a new experimental conservative TMJ treatment for RA patients. The patients had RA associated with regression of the mandible and open bite. We used separate-type splints with surgical brackets and intermaxillary rubber traction.
Clinical findings showed a decrease in the range of open bite and the anterior part of the mandible after intermaxillary rubber traction.
We recommend the use of splints with surgical brackets as a conservative treatment for improving open bite and for preventing replacement of the mandible.

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A case of treatment by physiotherapy for severe restriction of mouth opening caused by cicatricial contracture of the temporal muscle and jaw paralysis of the right side after extracting a trigeminal schwannoma, is reported. The patient was a 34-year-old male, who underwent a craniotomy to excise trigeminal schwannoma in the Department of Neurosurgery in our hospital in July 2005. Since restriction of mouth opening and jaw paralysis of the right side occurred immediately after surgery, the patient consulted our department for treatment on November 1, 2005. At the first examination, the maximum mouth opening was 11mm with deflection. Clenching on the right side was impossible, and the occlusion showed a posterior open bite of the right side. Further, the areas innervated by all divisions of the right trigeminal nerve were hypoesthesic. Mouth opening exercises using the patient's own fingers were initiated from the first examination to improve the cicatricial contracture of the temporal muscle. One month later, the maximum mouth opening had increased to 21mm. Thereafter, mouth opening exercises were performed using a Tange-type gag to obtain further improvement. Four months after the start of mouth opening exercise, the maximum mouth opening had increased to 35mm. Simultaneously, the patient also received physiotherapy treatment, regarding a disturbance of clenching due to jaw paralysis, through clenching exercises using a hollow rubber tube. These exercises also began from the first examination. After four months, occlusal force was regained in terms of having no obstacle in daily life.

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