After complex orthopaedic-surgical treatment of car crash polytrauma, we face multilevel patient problems, from algodisfunctional to psychological consequences, which are very difficult to manage. Aim of the study: identifying the optimal ways to approach cases of polytrauma with major functional and psychological implications. Material and Methods: We present the cases of two female patients, 19 and 18-year-old, victims of major road accidents that required car extrication. The accidents resulted in minor craniocerebral trauma, weight bearing bones and pelvis fractures, musculoskeletal and skin avulsion, and neurogenic bladder with catheterization. They underwent repeated orthopedic-surgical interventions and plastic surgery after which they were referred to functional rehabilitation. In the rehabilitation department we were confronted with anxious, uncooperative patients, with a very high level of somatic pain, incapable of actively mobilizing in the bed plan, one of them, within the limits of physical resources, presenting agitation and night aggressiveness. Results: After the complex clinical evaluation we initiated the rehabilitation treatment. The initial rehabilitation results were minimal because of the pain threshold, high levels of anxiety and fatigue due to insomnia. We asked for psychological evaluation and counseling and we organized 6 short daily exercise sessions, then four longer ones, so as not to exceed the patients' momentary resources. The level of difficulty of the kinetic training was progressively increased, being constantly adapted to the daily training gains of the patients. The aggressive outbursts in one of the patients were related to the dread of darkness and loneliness at night, as a consequence of incarceration from the night road accident. In 4 weeks we gained independence for eating, spontaneous urination, bedside independent mobilization, verticalisation and walking with a frame for short distances. Conclusions: Pain, somatic dysfunction and posttraumatic stress management is a complex process that requires a multidisciplinary approach, including the psychological one. The rehabilitation particularity consisted of multiple daytime rehabilitation sessions adapted to the daily resources of the patients.

Background: Temporomandibular joint (TMJ) is responsible for vital functions like mas-tication, swallowing, and suction reflex and other relational functions, like talking and phonation. The etiology of temporomandibular joint disorders is multifactorial and in-volves subjective and objective clinical symptomatology. (2) Methods: The therapy is complex and encompasses a series of methods that interconnects various medical spe-cialties. Bad habits and parafunction are risk factors that may initiate and exacerbate a temporomandibular joint pathology. This prospective study aimed to show the positive impact of correct multidisciplinary therapy on the complex of TMJ disorders - pain and bad oral behaviors. The therapy methods used in this study were: medical, prosthetic, or-thodontic, surgical, and physiotherapy (PKT). (3) Results: The data obtained showed good results if the oral habits and TMJ disorders are treated correctly and simultaneous-ly. (4) Conclusions: All therapeutical approaches addressed in this study had beneficial effects on the recovery of the temporomandibular joint.

After complex orthopaedic-surgical treatment of car crash polytrauma, we face multilevel patient problems, from algodisfunctional to psychological consequences, which are very difficult to manage. Aim of the study: identifying the optimal ways to approach cases of polytrauma with major functional and psychological implications. Material and Methods: We present the cases of two female patients, 19 and 18-year-old, victims of major road accidents that required car extrication. The accidents resulted in minor craniocerebral trauma, weight bearing bones and pelvis fractures, musculoskeletal and skin avulsion, and neurogenic bladder with catheterization. They underwent repeated orthopedic-surgical interventions and plastic surgery after which they were referred to functional rehabilitation. In the rehabilitation department we were confronted with anxious, uncooperative patients, with a very high level of somatic pain, incapable of actively mobilizing in the bed plan, one of them, within the limits of physical resources, presenting agitation and night aggressiveness. Results: After the complex clinical evaluation we initiated the rehabilitation treatment. The initial rehabilitation results were minimal because of the pain threshold, high levels of anxiety and fatigue due to insomnia. We asked for psychological evaluation and counseling and we organized 6 short daily exercise sessions, then four longer ones, so as not to exceed the patients' momentary resources. The level of difficulty of the kinetic training was progressively increased, being constantly adapted to the daily training gains of the patients. The aggressive outbursts in one of the patients were related to the dread of darkness and loneliness at night, as a consequence of incarceration from the night road accident. In 4 weeks we gained independence for eating, spontaneous urination, bedside independent mobilization, verticalisation and walking with a frame for short distances. Conclusions: Pain, somatic dysfunction and posttraumatic stress management is a complex process that requires a multidisciplinary approach, including the psychological one. The rehabilitation particularity consisted of multiple daytime rehabilitation sessions adapted to the daily resources of the patients.

1) Background: Temporomandibular joint (TMJ) is responsible for vital functions like mastication, swallowing, and suction reflex and other relational functions, like talking and phonation. The etiology of temporomandibular joint disorders is multifactorial and involves subjective and objective clinical symptomatology. (2) Methods: The therapy is complex and encompasses a series of methods that interconnects various medical spe-cialties. Bad habits and parafunction are risk factors that may initiate and exacerbate a temporomandibular joint pathology. This prospective study aimed to show the positive impact of correct multidisciplinary therapy on the complex of TMJ disorders - pain and bad oral behaviors. The therapy methods used in this study were: medical, prosthetic, or-thodontic, surgical, and physiotherapy (PKT). (3) Results: The data obtained showed good results if the oral habits and TMJ disorders are treated correctly and simultaneous-ly. (4) Conclusions: All therapeutical approaches addressed in this study had beneficial effects on the recovery of the temporomandibular joint. Keywords: therapeutic approach; temporomandibular joint; TMJ disorders; pain; multidisci-plinary therapy