Disfunção craniocervicomandibular ascendente com alteração vestibulococlear: Relato de caso

Abstract

Craniocervicomandibular dysfunction (CCMD) represents a complex alteration of the stomatognathic system, which encompasses interdependent structures such as the mandible, skull, hyoid bone, supra- and infrahyoid muscles, and the cervical spine. These components form a functional biomechanical unit — the craniocervicomandibular system — in which any structural or functional alteration can compromise the balance of the entire system. The close relationship between the cervical spine, the temporomandibular joint (TMJ), and dental occlusion causes postural imbalances of the head to influence mandibular positioning and muscle function, leading to the development of painful and dysfunctional symptoms.CCMD is a multifactorial condition involving musculoskeletal, neurological, and psychological aspects. In addition to orofacial manifestations, it can trigger otoneurological symptoms such as tinnitus, vertigo, hearing loss, and aural fullness due to anatomical and neurophysiological connections between the stomatognathic system and the vestibulocochlear nuclei. These interactions, mainly mediated by the trigeminal nerve and other cranial pathways, explain the symptomatic overlap between temporomandibular disorders and auditory or balance disturbances. Such complexity often hinders differential diagnosis, resulting in isolated and less effective treatments. The management of CCMD should be conservative and interdisciplinary. The use of stabilizing occlusal splints reduces masticatory muscle hyperactivity and provides symptomatic relief. Manual therapy, postural rehabilitation, and acupuncture have shown positive results when integrated into dental treatment. Moreover, psychological support — especially through cognitive-behavioral therapy — assists in controlling emotional and behavioral factors that exacerbate pain and bruxism. Reporting clinical cases of CCMD with vestibulocochlear symptoms is essential to broaden the understanding of the condition and to reinforce the importance of interdisciplinary collaboration. This approach enables dentists to recognize the early signs of dysfunction, understand its relationship with the craniocervical system, and contribute decisively to comprehensive diagnosis and functional rehabilitation of the patient.