Rapid Resolution of Masseteric MPDS Using Trigger Point Therapy

From Chronic Jaw Pain to 90% Relief in 10 Days: A Precision-Driven Approach to Myofascial Pain Dysfunction Syndrome (MPDS)

ABSTRACT
Myofascial Pain Dysfunction Syndrome (MPDS) remains one of the most misdiagnosed causes of chronic orofacial pain, often leading to unnecessary imaging and prolonged pharmacological therapy. This case report highlights a 45-year-old female presenting with chronic unilateral masseteric pain with referred temporalis headache and systemic “feverish” sensation. Despite normal MRI and CBCT findings, a targeted clinical examination identified an active trigger point in the left masseter. Immediate trigger point therapy resulted in ~50% reduction in pain, with 90% resolution at 10-day follow-up. This case reinforces the principle of clinical diagnosis over imaging, emphasizing precision, minimal intervention, and rapid functional recovery.

KEYWORDS
MPDS, myofascial pain, jaw pain treatment, TMJ pain without joint issue, masseter trigger point, facial pain diagnosis, orofacial pain specialist India, TMJ Mumbai, non-dental facial pain.

Case Report
Patient Information
A 45-year-old female presented with pain in the left jaw region for 2 months, radiating to the left temporal area, along with a subjective feverish sensation.

Clinical Examination
Pain Assessment (Graded Scale)

Left Masseter: Grade 3 (Severe)
Left Temporalis: Grade 2 (Moderate, referred)
Mandibular Function

Mouth opening: 45 mm
Lateral excursion: 7 mm bilaterally
No deviation or restriction
Pain during mastication present
TMJ Examination

No joint sounds
No tenderness
Normal translation
Muscle Examination

Left masseter (middle belly):Active trigger point present
Taut band palpable
Positive jump sign
Reproducible referred pain to temporalis
Other muscles: Non-tender
Occlusion

Overjet: 1 mm
Overbite: 2 mm
No occlusal interferences

Radiographic Findings
MRI TMJ: No intracapsular pathology
CBCT/OPG: No odontogenic or bony abnormalities

Diagnosis
Myofascial Pain Dysfunction Syndrome (MPDS) involving left masseter with referred temporalis pain

Treatment:- conservative management with self care exercises.

Outcome
Immediate

~50% reduction in pain
Follow-up (10 days)

~90% pain reduction
Complete resolution of temporalis headache and feverish sensation
No pain during chewing

Discussion
This case highlights the limitation of relying solely on imaging in orofacial pain diagnosis. Despite normal MRI and CBCT findings, the patient had significant pain originating from a myofascial trigger point. Referred pain patterns can mimic TMJ disorders, leading to diagnostic errors.

Early identification and treatment of trigger points can prevent unnecessary interventions, reduce treatment duration, and improve patient outcomes.

Clinical Significance
MPDS should be considered in all cases of unilateral facial pain with normal imaging
Trigger point therapy is highly effective and underutilized
Clinical examination remains superior to imaging for muscular pain diagnosis

Conclusion
Accurate diagnosis of myofascial pain using clinical examination enables rapid, effective, and minimally invasive treatment. This case reinforces a results-driven clinical approach focused on precision and efficiency.

Author
Dr. Sorabh Jain, MDS (Prosthodontics)
Special Interest: Orofacial Pain & TMJ Management
Mumbai, India

Website: http://www.DrProstho.com

Practice Philosophy
Right diagnosis. Minimum intervention. Maximum results.