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New Purpose in Orthognathic Surgery: The postural re-equilibrium cranio-cervico-brachialis
No full textPostural cranio-cervico-brachialis re-equilibrium as effect of the orthognathic surgery
No full textBackground and Objectives: From many years we observed that in subjects with facial asymmetries, especially when vertical and/or transversal dimensions are involved, a high incidence of cranio-cervical-brachialis disorders associated with painful syndromes and functional limitations are present.
Methods: We have planned a research based on anatomical study, clinical observations, diagnostic analysis by imaging (computed tomography [CT], CT-3D and magnetic resonance) and electrophysiological plans. These studies, revealed in these subjects a constant cranio-cervical musculoskeletal alteration that involve skull-base, cranio-axial junction and cervical spine, causing postural modifications and, in a documentable temporal succession, inflammatory-degenerative disorders of the small inter-somatic joints. The patients underwent to orthognathic surgery operations (maxillary, mandibular or bi-maxillary osteotomies) with some surgical expedient as correction with limited displacement of the bones, wide para-osteotomic periosteal detachments, semi-rigid mandibular fixation.
Results: We observed an immediate or gradual disappearance of the painful symptomatology in over the 70% of the symptomatic cases after the orthognathic surgery correction of the facial asymmetry. Consequently not only the restoration of the correct occlusion and of the aesthetic should be the objectives of the orthognathic surgery, but also the postural re-equilibrium for the treatment of the painful syndromes associated to the dysmorphism. The realisation, by the corrective operation, of a new muscular-skeletal equilibrium of the facial structures makes possible an analogous re-equilibrium on the connected cranio-vertebral structures.
Conclusions: The realisation, by the corrective operation, of a new muscular-skeletal equilibrium of the facial structures makes possible an analogous re-equilibrium on the connected cranio-vertebral structures
Tens,electroacupuncture and EMG in TMJ disorders. Preliminary report
No full textIn a correct management of facial pain and TMJ disorders, we have to consider at least 3 pathologies: myofacial pain syndromes, temporomandibular joint disorders, internal derangement. Many times these 3 pathologies are tightly joined each other. According to the disease the chosen treatment is different: myophysiotherapy, orthopedic surgery, meniscectomy, etc. but many times pain is the main problem for the patient. Besides pharmacological treatment (non-narcotic analgesics, sedatives, carbamazepine, etc.), electical currents and acupuncture are used to relieve the pain. We are elevating the effects of TENS and electroacupuncture on the pain and on 2 muscles of mastication (masseter and temporalis). To assess the intensity of the pain before and after treatment the VAS (visual analogue scale) is used; to cheeck the changes in the muscular activity we are using an EMG. Our preliminary results show the effectiveness of these methods in the antalgic response and muscular balance but with different characteristics
Pain relief and Electromyographic evaluation in patients suffering from pain dysfunction syndrome of the temporomandibular joint
No full textAims: To evaluate the effectiveness of the analgesic response to two electric physiotherapy techniques: electroacupuncture (E.A.) and transcutaneus electrical nerve stimulation (T.E.N.S.), in patients suffering from the pain dysfunction syndrome. Moreover, we checked the effects of E.A. and T.E.N.S. on the masseter and temporalis anterior muscles of the same patients.
Method: Fourteen patients, (8 females and 6 males, aged 18-51), suffering from TMJ pain dysfunction syndrome were divided into two groups and treated 7 with E.A. and 7 with T.E.N.S.; we used continous waves at 10-50 Hz for each 20 minutes treatment; the Scott-Huskisson Visual Analogue Scale (V.A.S.) was used to assess the intensity of pain both before and after the treatments. We have investigated the changes in activity of two masticatory muscles, the masseter and temporalis anterior, using superficial electromyography.
Results: Our results show that, in relation to the changes in the masseter and temporalis muscle activity, both E.A. and T.E.N.S. have a good affect on the balance of the muscle; meanwhile, using the Signed Ranked Test, the E.A. is more effective than T.E.N.S. in relieving the pain, with a significant statistical difference (p=0.03).
Conclusions: The results indicate that E.A. and T.E.N.S. are effective physiotherapy techniques and suggest their use to relieve pain and to balance masticatory muscles in patients suffering from T.M.J. pain dysfunction syndrome
Muscular disorders of temporomandibular joint treated with electroacupuncture
No full textBackground and Objectives: Temporomandibular joint (TMJ) pain and dysfunction syndrome (PDS) is a common disorder of TMJ. Treatment options include: counselling, physiotherapy, pharmacotherapy, splint therapy, intra-articular steroids, arthrocentesis, surgery and further referral (orthodontic, neurology, ENT, etc.). Physiotherapy is beneficial to any patient with PDS of TMJ in which there is muscular involvement; electroacupuncture (EA) is one physiotherapy treatment and many international studies have demonstrated its effectiveness. Our group used EA since 2001 associated with surface electromyography of the masticatory muscles.
Methods: During past 5 years we have examined 503 outpatients suffering from PDS of TMJ, 80 of these patients have been treated with EA, continuous waves, 2–20Hz, 20minutes for each treatment, one course=8–10 treatments. The points used are those according to the theory of traditional Chinese medicine (named by Chinese name and international WHO code): Hegu LI-4, Jiache ST-6, Xiaguan ST-7, Tinggong SI-19, Shangguan GB-3, Ear Eliao TE-22, etc. In 35 patients we have evaluated the muscular imbalance of muscles anterior temporalis and masseter before and after EA by a surface electromyography.
Results: 53 patients needed one course of EA (8–10 treatments) to have a significant reduction of the pain (by V.A.S.), 10 patients needed two courses of EA to have a satisfactory result and 17 patients did not have satisfactory results after two courses of EA. Electromyography showed that by using EA the involved muscles came back to a normal and well-balanced activity.
Conclusions: Acupuncture and electroacupuncture are effective methods to treat PDS of TMJ with muscular involvement
Intraosseous Hemangioma of the mandibular ramus
No full textPURPOSE: Intraosseous vascular lesions are rare conditions, comprising only 0.5% to 1% of all intraosseous tumors. They mainly occur in the second decade of life especially in women. The mandible is a quite rare location (the most common locations are the vertebral column and skull). According to the World Health Organization, hemangiomas are benign vasoformative neoplasms of endothelial origin. However, the origin of central hemangioma is debatable. Some authors believe that it is a true neoplasm, whereas others state it is a hamartomatous lesion. The patient may be completely symptom-free or may present discomfort, pulsatile bleeding and mobile teeth. Derangement of the arch form or accelerated dental exfoliation may be observed in the childhood. Most frequently radiographic finding is an unilocular or a multilocular radiolucent image with honeycombs or soap bubble appearance. Differential diagnosis includes neoplasms such as ameloblastoma, cystic lesions such as residual cyst, keratocyst and fibro-osseous lesions such as fibrous dysplasia. Wide surgical excision remains the gold standard although there are some therapeutic alternatives. We present a very rare case of intraosseous mandibular ramus hemangioma. MATERIALS AND METHODS: A 64-year-old female patient came to the Maxillofacial Surgery Operative Unit of the University of L’Aquila because of a radiolucent image observed randomly on the panoramic radiography and involving all the left mandibular ramus. Anamnestic and clinical data excluded pathologies such odontogenic cystes (the left inferior third molar was absent because extracted but it was not impacted or with follicular lesion). CT performed pre-operatively showed the lesion as a wide osteolytic and homogenous area with regular limits. It was very important to the surgical planning because axial, panorex and dental reconstructions described in detail the large osteolysis of the all internal cortex of the left ramus and therefore also near the delicate neurovascular mandibular structures (lingual nerve, inferior alveolar nerve and vessels). An intraoral transcortical complete excision was performed. The histological examination revealed a mesenchymal tumor with numerous capillaries and dilated vessels immunohistochemically being positive for CD31, but not for D2-40. In addition, there was a remarkable increase of osteoclasts that sometimes exhibited Howship's lacunae. The tumor was diagnosed as “ Intraosseous hemangioma with bone degradation”. The follow-up at two years show no recurrence and the complete reconstruction of bone without using filler. Histological findings suggest further investigated whether there could be an association between angiogenesis and osteoclastogenesis as a central pathway leading to centrifuge bone destruction in the case of intraosseous hemangiomas
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