Український стоматологічний альманах (Mar 2017)
MYOFASCIAL SYMPTOMS IN CLINIC COMPRESSION OF DISLOCATION OF THE TEMPOROMANDIBULAR JOINT DYSFUNCTION
Abstract
Observed patients complain of mimic muscles paresis (myofascial symptoms) usually with a pain in the area of temporomandibular joint (TMJ), chewing muscles, in the area of auditory meatus on the side of paresis. An ongoing treatment of myofascial pain syndrome was determined by otolaryngologists, neurologists or alternative medicine specialists resulted in a short term improvement of patient´s condition. Medical treatment was conducted without considering that pathogenesis of the disease mainly caused by a dysfunctional TMJ on the side of paresis. The issue here is that the algorithm of diagnostic measures with paresis of mimetic muscles does not include the research of TMJ components´ correlation between each other. The research was based on targeted radiography and bioelectrical activities of chewing muscle. Results of such a research allow us effective planning of etiopathogenetic treatment. Goal of the conducted research is an elaboration of myofascial symptom pathogenesis for patients with musculoarticular compressive and dispositional dysfunction of the TMJ. Research methodology and objects of a study. The results of complete clinical trials of nine patients with symptom of mimic muscles paresis in line with musculoarticular compressive dispositional dysfunction of TMJ were analysed. Researched patients were between 20 and 42 years old. Medical history of people showed previous and current somatic diseases including neurotic disorders. Diagnosis of musculoarticular compressive and dispositional dysfunction of TMJ was based on evaluation of complaints, type of occlusion, palpation of TMJ and chewing muscles, determination of trigger points. General clinical research was complimented by orthopantomography and zonography of both TMJs in a closed and opened mouth positions. The width of joint space of both TMJs was compared in three areas in a closed mouth position with the way head shift in relation to the articular tubercle. In order to get an objective evaluation of bioelectrical activities of chewing muscles of all nine patients were asked to participate in electromyography which allowed us consider the highest value of biopotential during the teeth compression on a side of myofascial syndrome as well as on the other side. Findings of the research and evaluation. All nine previously mentioned patients expressed complaints regarding the face asymmetry, were not able to close the eyelids completely on one of the eye sides, had pain in one of the TMJs (three - on the right side and six - on the left side), had incomplete chewing due to the pain in parotideomasseteric area which was irradiating into the ear, temple and forehead. During the medical examination of patients the asymmetry of their face was clearly visible. One corner of lips was lowered .Bell´s-symptom was noted when they were closing the eyes. “Sail” symptom was slightly recognizable. A visible constriction of joint space was noted on a side of pain and paretic effects after conducting the electromyography of TMJ in a closed mouth position. At the same time an expansion of the joint was examined on the other side of TMJ. Electromyograms of chewing muscles during the contraction of jaws showed lower bioelectrical activity on a side of facial nerve paresis were compared to the other jaw side. Systematic analysis of all anatomic components of both TMJ was retrieved by palpation, X-ray, electromyogram researches of chewing muscles and after a careful consideration of patient´s complaints allows us prove the cause of the mimic muscular paresis symptom which is directly linked to musculoarticular compressive dispositional dysfunction of TMJ while one of the joints being overloaded with the pressure and during the compression of the front upper temporal branch of facial nerve while being positioned abnormally.
