Patients with a wide range of cerebrovascular disease may have difficulty in opening their mouths, resulting in failing to swallow foods and maintain their oral hygiene. K-point was introduced as an effective trigger point to stimulate the jaw opening reflex for those patients. K-point stimulation may be useful as one of methods of helping open the jaw for dental examinations, or for placing foods onto the dorsum of the tongue and swallowing them effectively. Although this method cannot always guarantee the success of the jaw opening for every patient, it may still be considered to be an effective one to apply to patients having difficulty in jaw opening and swallowing disorder.
A 42-year old male patient was referred to the Department of Oral Medicine, Kyungpook National University Hospital due to the chief complaint of limite mouth opening. Three years ago, the patient was diagnosed as an infarction of both cerefellar hemispheres, acute obstructive hydrocephalus and acute epidural hematoma of frontal lobe at the department of neurosurgery.Both of the infarcted cerevellar hemispheres and the epidural hematoma of frontal lobe were removed with suboccipital and frontal craniectomu. After the brain surgery jaw opening range was decreased progressively and ultimately mouth opening became almost impossible. Spasmodic and rhythmic contractions of the masseter muscles occurred intermittently during daytime as well as sleeping. Food intake was available only through Levin -tube. Actibe jaw opening exercise was prescribed with the aids of tongue blades. A moist hot pack and indomethacin phonophesis were also applied 20 minutes three times a day to decrease discomfort muscle activities. After a month of treatments, the opening range was increased to 5mm at the premolar area and oral food intake was possibel. The L-tube was removed and the patient was discharged.
Journal of The Korean Society of Integrative Medicine
/
v.8
no.3
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pp.93-101
/
2020
Purpose : Temporomandibular joint disorder (TMJD) is often accompanied by pain and limited range of motion of the jaw joint, which affect patients' quality of life and result in hypertrophy or hyperactivity of the muscles around the jaw joint. In this study, we compared the muscle thickness and tone of the masseter and sternocleidomastoid (SCM) muscles and the jaw range of motion in individuals with and without TMJD. Correlation comparison was performed on the results of the TMJD group. Methods : This study included 40 patients; 20 patients were assigned to an experimental group (TMJD group) and 20 to a control group (non-TMJD group). Ultrasonography, myotonometry, and measurements performed with digital Vernier calipers were used to determine the changes in muscle thickness, muscle tone, and maximum jaw opening, respectively. The independent t-test was used for intergroup comparison of data, and Pearson correlation coefficients were used to compare correlations in the TMJD group results. Results : We observed a significant intergroup difference in the masseter and SCM thickness during the relaxed and clenched phases (p<.05). A significant intergroup difference was also observed in maximum jaw opening (p<.05). With regard to muscle tone, we observed a significant intergroup difference in frequency (p=.011) and stiffness (p=.011) of the masseter, as well as in the frequency (p=.009) and stiffness (p=.026) of the SCM. We observed a moderate negative correlation (r=-.524) between maximum jaw opening and the frequency of the masseter. Additionally, we observed a moderately negative correlation between jaw opening and muscle stiffness (r=-.321). Conclusion : Planning exercise programs to treat patients with TMJD who present with pain should focus on efforts to reduce muscle thickness and achieve muscle relaxation (to reduce muscle tension) for improved jaw range of motion.
The current clinical technique for occlusal vertical dimension recording is based on marking the skin reference points on the patient's face and measuring between these points using caliper-like device. And it is difficult to achieve reliable measurements by this technique because of movable soft tissue. The purpose of this study is to reveal the stability of skin reference points by comparing the relative movement between extra-oral skin reference points and intra-oral reference points using X-ray fluoroscope. 10 test subjects were divided into 2 groups : Group I (natural dentition) and Group II (denture-wearer whose vertical dimension was lost) and Group III consists of identical test subjects to Group II with their upper denture removed and record base inserted. Attaching the 3 mm diameter steel ball to nose tip, lower lip, chin and to existing denture (or record base), fluoroscopic examination and recording were taken during 2 jaw opening and closing movements. After subsequent digitization using personal computer, 1219 still pictures with 0.1 second interval were made. Using the 2 dimensional graphic software, measurements between reference points were executed. Dividing the entire jaw movement into 3 ranges (total, 1st half opening, 2nd half opening), rate of movement and relative movement between extra-oral and intra-oral reference points were calculated and statistically analyzed. The results of this study are as follows. 1 Within the same experimental group, no statistical difference was found in the stability of skin reference between lower lip point and chin point during total range of jaw opening and closing movement (p>.05) 2. In the first half range of jaw opening, statistical difference was found between Group I (natural dentition) and Group II (denture wearer) (p<.05) Group I has greater skin reference stability than Group II. 3. In the first half range of jaw opening, statistical difference was found between Group I and Group III (record base wearer) (p<.05). Group I has greater skin reference stability than Group III. 4. In the first half range of jaw opening, no statistical difference was found in the stability of skin reference between Group II and Group III (p>.05). 5. In the second half range of jaw opening, no statistical difference was found in the stability of skin reference between any experimental groups (p>.05). 6. In patients with their occlusal vertical dimension lost, employing other measuring references rather than skin is recommended because of low stability.
In the outpatient clinic, we have many patients who suffer from temporomandibular joint disorders. These vary from MPD syndrome to osteoarthrosis, and many cases have tender spots or areas on the temporomandibular joint region and/or masticatory muscles. Further, they frequently have masticatory muscle pain when opening the jaw. This paper presents the results of our research on the differential diagnosis for tendernesses and pain on opening the jaw in the temporomandibular joint region and the masticatory muscles by joint cavity pumping with local anesthestic. The areas of tenderness and jae-opening paw in 65 patient suffering from temporomandibular joint disorder were examined and recorded before and after anesthetizing the upper joint cavity with 2% lidocaine. Maximum interincisal distance was similarly recorded. The results were as follows : In the area surrounding the upper joint cavity including the lateral pterygoid muscle, the tenderness and jaw-opening pain vanished almost entirely after anesthesia. This was considered a direct infiltrative effect of the local anesthesia. After the anesthesia, 86% of the tendernesses on the sternocleidomastoid muscles, and 66% of those on the posterior belly of the diagstric muscles vanished, while the disappearance rates on the masseter, temporal, and medial pterygoid muscles were 50~60%. Apart from the temporomandibular region, pain on opening the jaw was found on the masseter, temporal, posterior belly of the digastric muscles, and medial pterygoid muscles before anesthesia. The disappearance rates after anesthesia were 90~100% except for the pain of the posterior belly of the digastric muscles, for which the rate was 66%. These results suggest that more than 88% of the tendernesses on the sternocleidomastoid muscle, more than 60% of the tendernesses and jaw-opening pains on the digastric muscle, and more than half of the tendernesses and almost all of the jaw-opening pains in the jaw-closing muscles are referred pains from the temporomandibular joint. The tendernesses that had no change after anesthesia were considered to be derived from spasms of the muscles proper. Generally, maximum interincisal distance increased after anesthesia. The average distance was 34mm before anesthesia, but increased to 41mm after anesthesia. In a few cases, however little or no change was found in those distances. In these cases, pathological changes were found in the joint cavities arthrographically or arthroscopically.
The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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v.17
no.2
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pp.99-105
/
2004
Temporomandibular joint disorder is quite common dental problem. Research has shown that 5 to 15$\%$ of the population have a TMJ disorder requiring some type of treatment. TMJ disorder's symptoms are pains in the jaw and muscles of your face, limitation of opening or closing jaw and noises in jaw joint such as clicking or popping sounds. Two patients with TMJ symptoms visited our clinic. They complained pain, limitation of jaw opening and clicking sound. We treated them by stimulating trigger points on the TMJ muscle with acupuncture and had a good effects. The symptoms is reduced or disappeared.
Purpose: The aim of this study was to elucidate the coordination patterns of the sternocleidomastoid and posterior cervical muscles in response to symmetrical and asymmetrical jaw functions in normal adults. Methods: Twenty-seven healthy volunteers (8 females, 19 males; mean age, $30.4{\pm}2.5$ years) participated in this study. Surface electromyography (EMG) was used to record activities in the masseter, suprahyoid, sternocleidomastoid, and posterior cervical muscles at rest and during maximum tooth clenching, biting of a cotton roll with the anterior teeth, unilateral biting of a cotton roll with the posterior teeth, bilateral biting of cotton rolls with the posterior teeth, and jaw opening while seated. Normalized amplitude, activity indices, and asymmetry indices were compared between the muscles and the jaw tasks. Results: During symmetrical jaw functions (e.g., tooth clenching, biting with the anterior teeth, bilateral biting with the posterior teeth, jaw opening), the sternocleidomastoid and posterior cervical muscles showed elevated EMG amplitudes compared with the resting condition. The co-activation pattern of the sternocleidomastoid muscle was more pronounced than those of the posterior cervical muscles during these tasks. During asymmetrical jaw functions (e.g., unilateral biting with the posterior teeth), the ipsilateral sternocleidomastoid and masseter muscles showed higher contraction activity than did the contralateral muscles, but the contralateral posterior cervical muscles were more active than the ipsilateral muscles. Conclusions: The sternocleidomastoid and posterior cervical muscles were shown to be co-activated and coordinated anteroposteriorly or bilaterally according to symmetrical or asymmetrical jaw function. These results suggest an integrated neural control mechanism for the jaw and neck muscles, and provide further evidence supporting the intimate functional coupling between the trigeminal and cervical neuromuscular systems.
The purpose of this study is to investigate the effects of Bee Venom Herb-Acupuncture on the jaw opening reflex evoked by tooth pulp stimulation. Rats were anesthetized with thiopental sodium given intraperitoneally in an initial dose of 80mg/kg. Maintenance doses of 5mg/kg thiopental sodium were given through a cannular in the femoral vein as required to maintain light anesthesia. To apply noxious stimuli, a pair of enameled wires were inserted into the tooth pulp of the lower incisor. The effects of conditioning stimuli were estimated as an indicator of the degree of suppression of the digastric muscle electromyogram(dEMG) in the jaw opening reflex. Bee Venom Herb- Acupuncture(0.2% solution 0.1ml/rat) was injected to Hapgok(LI4) loci. In addition, Normal Saline (0.1ml/rat) was injected to Hapgok loci so as to compare the degree of suppression elicited from Bee-Venom. By administration of Bee Venom Herb-Acupuncture, the amplitude of dEMG was maximally suppressed to $67.5{\pm}3.38%$ ipsilaterally, 73.33{\pm}8.00%$ contralaterally. Generally, the dEMG activities caused by electrical stimulation were gradually suppressed during the stimulation and maximal suppressive effect showed at 15min after its onset. However the dEMG activities by Be Venom Herb-Acupuncture were immediately suppressed after its onset and the suppressive effect continued for a long time compared to electrical stimulation. In conclusion, Bee Venom Herb-Acupuncture may have a different mechanism of analgesia from that of electro-acupuncture and contribute to the modulation of pain analgesia.
Skull-base osteomyelitis is a rare disease affecting the medulla of the temporal, sphenoid, and occipital bones. In general, it occurs due to external ear canal infections caused by malignant external otitis. Skull-base osteomyelitis usually affects elderly diabetic patients. The patient, a 58-year-old man, was referred for evaluation and management of the left jaw. Clinical examination of the patient revealed pain in the left jaw and mouth-opening deflection to the left. The maximum active mouth opening was measured to about 27 mm. Panoramic, CT, and CBCT revealed bone resorption patterns in the left condyle. Through control of diabetes, continued pharmacological treatment, arthrocentesis, and occlusal stabilization appliance therapy were carried out. The extent of active mouth opening was increased to 45 mm, and pain in the left jaw joint was alleviated. This was a case wherein complications caused by failure to control diabetes induced skull-base osteomyelitis. There is a need for continued discussion about the advantages and disadvantages of arthrocentesis with lavage for patients with skull-base osteomyelitis and other treatment options.
Moon, Ji Seung;Koo, Soo Kweon;Kim, Young Joong;Lee, Sang Hoon;Lee, Ho Byoung;Park, Geun Hyung;Lee, Sang Jun
Journal of Clinical Otolaryngology Head and Neck Surgery
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v.29
no.2
/
pp.190-197
/
2018
Background and Objectives : Positional OSAS is characterized by an apnea-hypopnea index (AHI) score >5, which, while sleeping in the supine position, is double that in non-supine position. This study was performed to compare the clinical characteristics of positional OSAS and non-positional OSAS patients, and the effects of the modified jaw thrust maneuver during drug-induced sleep endoscopy (DISE) between positional OSAS and non-positional OSAS patients. Materials and Methods : 68 positional OSAS patients and 19 non-positional OSAS patients were included. They all underwent full-night polysomnography and DISE. The modified jaw thrust maneuver was introduced during DISE. Airway structural changes induced by the modified jaw thrust maneuver were evaluated and documented. Results : There were no statistically significant differences in Friedman stage or tonsil grade, body mass index, Epworth sleepiness scale (ESS) score, blood pressure, AHI, or obstructive pattern between the positional and non-positional OSAS patients. However, mean arterial oxygen saturation (SaO2), lowest SaO2, and total arousal index values were more severe in the non-positional OSAS patients. After introduction of the modified jaw thrust maneuver, retrolingual level obstruction showed a tendency toward a higher rate of airway opening in positional OSAS patients than in non-positional OSAS patients. Conclusions : The effects of a mandibular advancement device (MAD) can be estimated by carrying out a modified jaw thrust maneuver during DISE. The tendency toward a higher rate of airway opening in positional OSAS patients than non-positional OSAS patients in retrolingual level obstruction after jaw thrust maneuver introduced during DISE may be clinically important for MAD.
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