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1.
Clin Ter ; 171(5): e414-e420, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32901785

RESUMEN

OBJECTIVE: Surface Electromyography of masticatory muscles (sEMG) is used as a tool to support diagnosis and treatment of Temporomandibular disorders (TMDs). The study aimed at examining jaw muscles pattern in individuals with temporomandibular joint disc displacement with reduction (TMJ/DDR). This sort of subjects was supposed to have a different muscular pattern compared to the control group. MATERIALS AND METHODS: Sixty-four women with unilateral TMJ/DDR and forty TMD-free women underwent a sEMG assessment of masticatory muscles. Descriptive statistics were performed. Student T-Test assessed differences between the two groups. Statistical significance was set at ρ < 0.05. RESULT: The t-test showed statistically significant results only in BAR and SMI scores (ρ value < 0,0001). The other measurements did not differ between the two groups. BAR index values of all healthy subjects were within the reference range. Almost the entire TMJ/DDR group had BAR index out of reference range and anteriorly placed. CONCLUSION: Women with TMJ/DDR showed an altered recruitment of the jaw muscles, with significant difference between the activity of the couple of temporalis and the one of masseters, compared to the control group. A lower chewing efficiency was found in the DDR group compared to the control one.


Asunto(s)
Electromiografía , Disco de la Articulación Temporomandibular/fisiopatología , Trastornos de la Articulación Temporomandibular/fisiopatología , Adulto , Electromiografía/métodos , Femenino , Humanos , Músculo Masetero/fisiopatología , Masticación , Músculos Masticadores/fisiopatología , Persona de Mediana Edad , Músculo Temporal/fisiopatología , Trastornos de la Articulación Temporomandibular/diagnóstico
2.
Folia Med Cracov ; 60(1): 75-83, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32658214

RESUMEN

Temporomandibular disorders (TMD) is one of the most common problem in contemporary dentistry. It is a term covering dysfunction of the masticatory muscles and the temporomandibular joints. Patients are suffering from severe pain, followed by limited mandibular opening and sounds in the temporomandibular joints during jaw movement. TMD influences the quality of life because the symptoms can become chronic and difficult to manage. Radiofrequency waves (RF) are electromagnetic waves with low energy and high frequency. They provide pain relief without causing significant damage to the nervous tissue. The RF therapy is commonly used for physiotherapeutic treatment of skeletal muscle relaxation, as a supportive therapy. The rehabilitation effect of these waves is based on diathermy by means of high-voltage quick alternating current. RF has also found application in physical therapy, as a therapeutic tool for various types of chronic pain syndromes. The aim of this literature review is to show the beneficial effect of radiofrequency waves on the pain of the masticatory muscles in the course of TMD.


Asunto(s)
Músculos Masticadores/fisiopatología , Terapia por Radiofrecuencia/métodos , Trastornos de la Articulación Temporomandibular/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad
3.
Artículo en Inglés | MEDLINE | ID: mdl-32646041

RESUMEN

This study is aimed at investigating the effects of synchronized neuromuscular electrical stimulation (NMES) and chewing exercises on bite force and the masseter muscle thickness in community-dwelling older adults. Material and methods: Forty older adults were enrolled in South Korea and randomly assigned to either an experimental or control group. The experimental group performed chewing exercises using the No-Sick Exerciser equipment synchronized with NMES applied to the bilateral masseter muscles, while the control group performed only chewing exercises. Both groups received interventions for 20 min/day, 5 days/week, for 6 weeks. Bite force was measured using the OCCLUZER device, and masseter muscle thickness was measured using a portable ultrasound. Results: Both groups showed a significant increase in bite force and masseter muscle thickness compared to baseline measurements (p < 0.05). The experimental group showed a significantly higher increase in bite force and masseter muscle thickness than the control group after combined intervention (p < 0.05). Conclusion: This study demonstrates that NMES synchronized with chewing exercises is more efficient in increasing bite force and masseter muscle thickness than chewing exercises alone in community-dwelling older adults.


Asunto(s)
Fuerza de la Mordida , Estimulación Eléctrica , Músculo Masetero , Masticación/fisiología , Músculos Masticadores/fisiopatología , Anciano , Electromiografía , Femenino , Humanos , Vida Independiente , Masculino , Músculo Masetero/anatomía & histología , Músculo Masetero/diagnóstico por imagen , República de Corea , Ultrasonografía
4.
J Neuromuscul Dis ; 7(2): 193-201, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32083589

RESUMEN

BACKGROUND: Paramyotonia congenita (PC; OMIM 168300) is a non-dystrophic myotonia caused by mutations in the SCN4A gene. Transient muscle stiffness, usually induced by exposure to cold and aggravated by exercise, is the predominant clinical symptom, and interictal persistent weakness is uncommon. CASE REPORT: We report a family with a history of PC accompanied by persistent hand muscle weakness with masticatory muscle involvement. Persistent weakness was exacerbated with age, and MR analysis showed marked atrophy of temporal, masseter, and finger flexor muscles with fatty replacement. The PC causative mutation T1313M in the SCN4A gene was prevalent in the family. Administration of acetazolamide chloride improved clinical symptoms and the results of cold and short exercise tests. Phenotypic variation within the family was remarkable, as the two younger affected patients did not present with persistent weakness or muscle atrophy. CONCLUSIONS: PC associated with the T1313M mutation is a possible cause of persistent distal hand weakness.


Asunto(s)
Debilidad Muscular , Músculo Esquelético , Trastornos Miotónicos , Canal de Sodio Activado por Voltaje NAV1.4/genética , Músculos Faciales/diagnóstico por imagen , Músculos Faciales/patología , Músculos Faciales/fisiopatología , Mano/fisiopatología , Humanos , Imagen por Resonancia Magnética , Músculos Masticadores/diagnóstico por imagen , Músculos Masticadores/patología , Músculos Masticadores/fisiopatología , Debilidad Muscular/etiología , Debilidad Muscular/genética , Debilidad Muscular/patología , Debilidad Muscular/fisiopatología , Músculo Esquelético/diagnóstico por imagen , Músculo Esquelético/patología , Músculo Esquelético/fisiopatología , Trastornos Miotónicos/complicaciones , Trastornos Miotónicos/genética , Trastornos Miotónicos/patología , Trastornos Miotónicos/fisiopatología , Linaje
5.
Int J Med Sci ; 17(2): 153-160, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32038098

RESUMEN

Aims: Systemic Lupus Erythematosus (SLE) is a connective tissue disease characterized by a wide range of pleomorphic pictures, including mucocutaneous, renal, musculoskeletal and neurological symptoms. It involves oral tissues, with hyposalivation, tooth decay, gingivitis, angular cheilitis, ulcers and glossitis. Temporomandibular disorders represent a heterogeneous group of inflammatory or degenerative diseases of the stomatognatic system, with algic and/or dysfunctional clinical features involving temporomandibular joint (TMJ) and related masticatory muscles. The aim of this study was to investigate the prevalence of oral manifestations and temporomandibular disorders (TMD) in SLE patients (Lp) compared with a control group. Methods: Fifty-five patients (9 men and 46 women) with diagnosed Lupus were recruited in the study group. A randomly selected group of 55 patients, matched by sex and age, served as control group. The examination for TMD symptoms and signs was based on the standardized Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) through a questionnaire and clinical examination. Results: Lupus patients complained more frequently (95.8%) of oral and TMJ symptoms (dysgeusia, stomatodynia, masticatory muscle pain during function, neck and shoulder muscles pain and presence of tinnitus) but only xerostomia (χ2=4,1548 p=0,0415), temple headache (χ2=4,4542 p=0,035) and the sensation of a stuck jaw (Mid-p-test p=0,043) were significant. About signs, cheilitis (p=0,0284) oral ulcers (χ2=4,0104 p=0,045) and fissured tongue are significantly more frequent in study group. The salivary flow was significantly decreased in the study group respect to the control one (p<0.0001). As regard to the oral kinematics, restricted movements (RM) in protrusion and left lateral movement were significantly different between study group and controls. In particular, 85,2% of Lp showed limited protrusion versus 56,4% of controls (χ2= 10,91 p<0,001); 59,3% of Lp had also a limitation during left lateral movement versus 47,3% of controls (T=2,225 p=0,0282). About bruxism, only the indentations on the lateral edges of the tongue were found in Lp group (72,7%), with a significant difference respect to controls (χ2=7,37 p=0,007). Conclusions: While masticatory muscles have an overlapping behavior in both groups, the findings collected show a more severe TMJ kinematic impairment in Lp than in controls, with protrusion and left lateral movements significantly different. In addition, a remarkable reduction of salivary flow has been detected in Lp compared to controls. In conclusion, this autoimmune disease seems to play a role in oral manifestations and TMJ disorders, causing an increase in orofacial pain and an altered chewing function.


Asunto(s)
Bruxismo/fisiopatología , Dolor Facial/fisiopatología , Lupus Eritematoso Sistémico/fisiopatología , Trastornos de la Articulación Temporomandibular/fisiopatología , Adulto , Bruxismo/complicaciones , Bruxismo/diagnóstico , Dolor Facial/complicaciones , Dolor Facial/diagnóstico , Femenino , Cefalea/complicaciones , Cefalea/fisiopatología , Humanos , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/diagnóstico , Masculino , Masticación , Músculos Masticadores/fisiopatología , Persona de Mediana Edad , Rango del Movimiento Articular/fisiología , Encuestas y Cuestionarios , Articulación Temporomandibular/fisiopatología , Trastornos de la Articulación Temporomandibular/complicaciones , Trastornos de la Articulación Temporomandibular/diagnóstico , Enfermedades Dentales/complicaciones , Enfermedades Dentales/diagnóstico , Enfermedades Dentales/fisiopatología , Xerostomía/complicaciones , Xerostomía/diagnóstico , Xerostomía/fisiopatología
6.
Muscle Nerve ; 61(2): 213-217, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31778229

RESUMEN

BACKGROUND: Dysphagia is reported in patients with Duchenne or Becker muscular dystrophy. Our clinical experience suggests that, compared with Duchenne patients, impaired mastication and swallowing occur early in Becker patients relative to their skeletal muscle involvement. The aim of this study was to assess dysphagia in Duchenne and Becker patients in relation to ambulatory capacity. METHODS: In patients in the early ambulatory stage, clinical symptoms, quantitative muscle ultrasound of the orofacial muscles, and maximum bite force were assessed. The 6-Minute Walk Test (6MWT) was used to measure ambulatory capacity. RESULTS: Eleven Duchenne and 11 Becker patients were included. Although Becker patients had a greater 6MWT distance than Duchenne patients, the occurrence of mastication and swallowing difficulties was similar. The temporalis muscle was significantly thicker in Becker patients. CONCLUSIONS: Clinicians should be aware of dysphagia in both groups, even when ambulation is still well preserved.


Asunto(s)
Músculos Faciales/fisiopatología , Músculos Masticadores/fisiopatología , Distrofia Muscular de Duchenne/fisiopatología , Algoritmos , Fuerza de la Mordida , Niño , Trastornos de Deglución/etiología , Músculos Faciales/diagnóstico por imagen , Humanos , Masculino , Masticación , Músculos Masticadores/diagnóstico por imagen , Distrofia Muscular de Duchenne/complicaciones , Ultrasonografía , Prueba de Paso , Caminata
7.
Acta Odontol Scand ; 78(1): 57-63, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31401930

RESUMEN

Background: Pain in the temporomandibular region is a main complaint causing disability and distress among temporomandibular disorders sufferers.Objectives: The aim of the study was, over an 11-year follow-up on Finnish adult population, to investigate the prevalence of clinically assessed pain-related temporomandibular disorder (TMD) signs, i.e. temporomandibular joint (TMJ) and masticatory muscles (MM) pain on palpation, and their association with sociodemographic background and denture status.Methods: The data were based on the nationally representative Finnish Health 2000 and Health 2011 Surveys (BRIF8901). The sample comprised 1210 adults who underwent clinical oral examinations including TMD signs assessment. Statistical evaluations included chi-square tests and logistic regressions.Results: The prevalence of palpatory MM pain decreased from 9.5% at baseline to 4.6% in the follow-up. Cross-sectionally, presence of palpatory MM pain significantly associated with gender (p < .001, p = .002) and educational level (p < .001, p = .001) in both years, and with age (p = .006) and denture status (p = .022) at baseline. The prevalence of palpatory TMJ pain increased from 2.1% at baseline to 3.5% in the follow-up. Presence of palpatory TMJ pain significantly associated with gender in both years (p = .012, p = .032). Female gender, lower education and palpatory MM pain at baseline predicted palpatory MM pain in the follow-up.Conclusion: Palpatory MM pain is relatively prevalent in adults, yet with a favourable prognosis. Women and people with low education are more susceptible groups. Previous experience of palpatory MM pain increases the risk of exhibiting it later in life.


Asunto(s)
Dolor Facial/etiología , Estrés Psicológico/epidemiología , Trastornos de la Articulación Temporomandibular/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Dolor Facial/epidemiología , Femenino , Finlandia/epidemiología , Estudios de Seguimiento , Humanos , Masculino , Músculos Masticadores/fisiopatología , Persona de Mediana Edad , Palpación , Prevalencia , Estrés Fisiológico , Trastornos de la Articulación Temporomandibular/psicología , Adulto Joven
8.
Arthritis Care Res (Hoboken) ; 72(8): 1057-1065, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-31207153

RESUMEN

OBJECTIVE: Sjögren's syndrome (SS) induces difficulty in chewing and swallowing due to low salivary flow. However, these symptoms may be associated with other factors, such as orofacial myofunctional disorders and temporomandibular disorder (TMD), which have not been comprehensively assessed in this population. The aims of this study were to investigate orofacial muscles and functions as well as the presence of TMD in patients with SS compared with a group without SS and to analyze whether the patients' experience of limitations in orofacial functioning is associated with the orofacial functional status and muscle pain related to TMD. METHODS: Women with SS based on the 2002 American-European Consensus Group criteria and volunteers paired by age and sex were compared. The examinations included the orofacial myofunctional evaluation with scores (OMES) protocol, tongue and lip strength measures, and electromyography of the masticatory muscles. TMD investigations included clinical examination, self-report of symptoms, and assessment according to the Jaw Functional Limitation Scale. RESULTS: Patients with SS present with impaired muscle and orofacial functions based on lower scores of all categories of OMES (P < 0.0001), tongue strength (P = 0.0003-0.0004), and masticatory muscle activity (P = 0.0002-0.007), as well as worse TMD signs and symptoms (P < 0.05) and jaw functional limitation (P < 0.0001-0.0003). CONCLUSION: Patients' experiences with limitation in mastication and swallowing were associated with orofacial myofunctional status and muscle pain related to TMD. Those disorders should be monitored along with disease control and must be addressed in the clinical evaluation to prevent nutritional and metabolic comorbidities in patients with SS.


Asunto(s)
Discinesias/etiología , Enfermedades Musculares/etiología , Síndrome de Sjögren/complicaciones , Síndrome de Sjögren/fisiopatología , Trastornos de la Articulación Temporomandibular/etiología , Adolescente , Adulto , Estudios de Casos y Controles , Estudios Transversales , Deglución/fisiología , Músculos Faciales/fisiopatología , Femenino , Humanos , Masticación/fisiología , Músculos Masticadores/fisiopatología , Persona de Mediana Edad , Adulto Joven
9.
Pain Res Manag ; 2019: 6256179, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31885756

RESUMEN

Background: Tenderness of masseters and temporalis can be considered a relevant tool for diagnosis of myo-type craniofacial pain disorders, but a limit of pain score systems is that they are based on subjective pain perception. Surface electromyography (sEMG) is a noninvasive and reliable tool for recording muscle activity. Therefore, we investigated whether a correlation exists between tenderness on masseters and temporalis, assessed by subjective pain scale, and muscles activity, evaluated by sEMG, in patients with painful temporomandibular disorder (TMD) and concurrent tension-type headache (TTH). Methods: A cross-sectional study on fifty adult volunteer patients with TMD and TTH, who underwent tenderness protocol according to Diagnostic Criteria for TMD (DC/TMD) guidelines, was conducted followed by sEMG recording of temporalis and masseters. Pearson's correlation was performed to investigate the correlation between muscular activity and subjective pain scores. Results: An overall moderate correlation between muscle tenderness and sEMG values (y = 1 + 1.2 · x; r 2 = 0.62; p < 0.0001), particularly in the temporalis, was observed. Segregation of data occurred according to tenderness and sEMG values. At the highest pain score, the mean sEMG absolute value was higher at the temporalis than the masseters. Conclusions: Our study provides evidence that subjective pain perception can be objectively quantified at a magnitude proportional to pain severity. At greater tenderness scores, higher sEMG activity at the level of temporalis could help discriminate clinically prevalent TTH versus prevalent TMD. sEMG confirms to be an accurate tool to reliably objectify the subjective perception of pain. When combined with clinical evaluation and patients' symptoms, sEMG increases diagnostic sensitivity in the field of myo-type craniofacial pain disorders. This trial is registered with NCT02789085.


Asunto(s)
Electromiografía/métodos , Dimensión del Dolor/métodos , Trastornos de la Articulación Temporomandibular/diagnóstico , Cefalea de Tipo Tensional/diagnóstico , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Músculos Masticadores/fisiopatología , Mialgia/diagnóstico , Mialgia/fisiopatología , Percepción del Dolor/fisiología , Trastornos de la Articulación Temporomandibular/fisiopatología , Cefalea de Tipo Tensional/fisiopatología
10.
Medicine (Baltimore) ; 98(46): e17934, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31725647

RESUMEN

BACKGROUND: Numerous treatment modalities have been attempted for masticatory muscle pain in patients with temporomandibular disorders (TMD). To compare the treatment efficacy of more than 2 competing treatments, a network meta-analysis (NMA) was conducted. METHODS: This study was reported with reference to the extended Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for reporting of systematic reviews incorporating network meta-analyses. Medline via Pubmed, Embase via OVID, and Cochrane Library Central were searched (up to February 11, 2019). Axis I protocol of Diagnostic Criteria or Research Diagnostic Criteria for Temporomandibular Disorders (DC/TMD, RDC/TMD) were chosen as diagnostic standards. The PICOS (Problem/patient, Intervention, Comparison, Outcome, Study design) method was used to screen trials under eligibility criteria. And the NMA was performed with mvmeta commands in Stata (StataCorp, Tex). RESULTS: Of 766 studies searched, 12 randomized clinical trials (RCTs) were finally included. Nineteen different therapies were found and further categorized into 9 treatment modalities. The general heterogeneity was not found among included trials. But predictive intervals (PrIs) were conspicuously wider than confidential intervals (CIs) of all pairwise comparisons, indicating that heterogeneity may exist between studies. Complementary therapy showed the greatest probability (42.7%) to be the best intervention. It also had the highest mean rank (2.3) in the rankogram and the biggest value of surface under the cumulative ranking (SUCRA, 84.1%). CONCLUSIONS: Based on the limited evidence of available trials, complementary therapy seemed to be slightly more effective than remaining treatment modalities for pain reduction in TMD patients with masticatory muscle pain. High-quality randomized controlled trials are expected to validate the findings.


Asunto(s)
Terapias Complementarias/métodos , Músculos Masticadores/fisiopatología , Trastornos de la Articulación Temporomandibular/terapia , Analgésicos/uso terapéutico , Toxinas Botulínicas/uso terapéutico , Terapias Complementarias/efectos adversos , Humanos , Metaanálisis en Red , Ensayos Clínicos Controlados Aleatorios como Asunto
11.
Medicine (Baltimore) ; 98(38): e17193, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31567965

RESUMEN

BACKGROUND: Sleep bruxism is a masticatory muscle activity characterized as rhythmic (phasic) or nonrhythmic (tonic). In children and adolescents, etiological factors, such as breathing pattern and sleep quality, have recently been addressed in studies investigating sleep bruxism. New therapies for adults, such as botulinum toxin, have been investigated, but such techniques are not applicable for individuals in the growth and development phase. METHODS: The participants will be 76 children, which will be randomly allocated to a control group, that is group 1, absence of bruxism; group 2, children with bruxism treated with infrared light-emitting diode (LED); and group 3, bruxism treated with occlusal splint. All participants will be submitted to a clinical evaluation to evaluate muscle activity and salivary biomarkers, before and after treatments. Muscle activity will be verified by electromyography of muscles mastication, masseter and temporal, and salivary biomarkers observed will be cortisol and dopamine levels. DISCUSSION: Photobiomodulation therapy has piqued the interest of researchers, as this noninvasive method has demonstrated positive results in problems related to muscle tissues. This document describes the protocol for a proposed study to evaluate morphological and psychosocial aspects in children and adolescents with awake bruxism and their responses to photobiomodulation therapy with infrared LED. CLINICAL TRIALS:.


Asunto(s)
Terapia por Luz de Baja Intensidad/métodos , Bruxismo del Sueño/radioterapia , Niño , Protocolos Clínicos , Humanos , Rayos Infrarrojos/uso terapéutico , Músculos Masticadores/fisiopatología , Músculos Masticadores/efectos de la radiación , Ferulas Oclusales , Bruxismo del Sueño/fisiopatología , Bruxismo del Sueño/terapia
12.
Wiad Lek ; 72(9 cz 2): 1732-1735, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31622256

RESUMEN

OBJECTIVE: Introduction: Pathological abrasion of hard dental tissues is accompanied by both morphological and functional disorders of the dentofacial system. Among the functional changes, changes in the bioelectrical activity of the masticatory muscles are primarily considered. The aim was to study the functional state of the masticatory muscles in patients with pathological abrasion of hard dental tissues of varying degrees of severity compared with the norm. PATIENTS AND METHODS: Materials and methods: Electromyographic studies were conducted in 89 patients aged 18 to 59. 70 patients had pathological abrasion of hard dental tissues of various degrees and 17 patients had intact dentitions and physiological forms of occlusion. RESULTS: Results: The results of electromyographic studies showed an extension of the chewing period, a reduced chewing rhythm, a deterioration of chewing efficacy in case of the pathological abrasion of teeth, compared with the norm, which increased in dynamics. The correlation between excitatory and inhibitory processes, however, sharply deteriorated with an increase in the duration of activity due to the reduction of the relative bioelectric rest period. The magnitude of the biopotential amplitude decreased relative to the norm with a serious violation of the coordination of masticatory muscles in general. CONCLUSION: Conclusions: The results of electromyographic studies of the masticatory muscles make it possible to determine the degree of functional changes in the neuromuscular system of the dentofacial system of patients with pathological abrasion of hard tissues of varying severity, compared with the norm. This indicates a decrease in chewing efficacy and the progression of morphological disorders that increase in dynamics.


Asunto(s)
Masticación , Músculos Masticadores/fisiopatología , Traumatismos de los Dientes/complicaciones , Diente , Adolescente , Adulto , Oclusión Dental , Electromiografía , Humanos , Persona de Mediana Edad , Adulto Joven
13.
Neuromuscul Disord ; 29(9): 664-670, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31488385

RESUMEN

The distribution of muscle weakness in myasthenia gravis (MG) patients with acetylcholine receptor (AChR) antibodies is highly variable. As muscle groups respond differently to therapeutic interventions, it is important to acknowledge this variability. We analysed the distribution of muscle weakness in 225 AChR MG patients over time. On the basis of combinations of muscle weakness, seven phenotypes were defined: 'ocular' (O), 'bulbar' (B), 'neck/limbs/respiratory' (NLR), or a combination (O+B, O+NLR, B+NLR and O+B+NLR). MG remained restricted to ocular weakness in 5%, whereas 7% never had ocular weakness. At last follow-up, ocular or bulbar weakness had resolved more frequently than NLR weakness (40%, 38% and 25%; p = 0.003, respectively). Patients with O, B or OB phenotype at baseline had a higher age at onset and were more frequently male than patients with NLR, ONLR, BNLR or OBNLR phenotype (52.7 ±â€¯17.5 vs. 44.0 ±â€¯18.9; p = 0.007 and 64% vs. 37%; p = 0.002, respectively). MG patients have heterogeneous distributions of muscle weakness and frequently shift between phenotypes. The phenotypic variations found in AChR MG suggest that also other factors aside from the AChR antibody mediated immune response are of importance in determining the disease expression in MG.


Asunto(s)
Músculos Masticadores/fisiopatología , Debilidad Muscular/fisiopatología , Miastenia Gravis/fisiopatología , Músculos del Cuello/fisiopatología , Músculos Oculomotores/fisiopatología , Músculos Faríngeos/fisiopatología , Músculos Respiratorios/fisiopatología , Adulto , Edad de Inicio , Anciano , Blefaroptosis/etiología , Blefaroptosis/fisiopatología , Inhibidores de la Colinesterasa/uso terapéutico , Estudios de Cohortes , Trastornos de Deglución/etiología , Trastornos de Deglución/fisiopatología , Diplopía/etiología , Diplopía/fisiopatología , Progresión de la Enfermedad , Disartria/etiología , Disartria/fisiopatología , Extremidades , Músculos Faciales/fisiopatología , Femenino , Glucocorticoides/uso terapéutico , Humanos , Inmunosupresores/uso terapéutico , Masculino , Masticación , Persona de Mediana Edad , Debilidad Muscular/etiología , Músculo Esquelético/fisiopatología , Miastenia Gravis/complicaciones , Miastenia Gravis/tratamiento farmacológico , Fenotipo , Prednisona/uso terapéutico , Estudios Prospectivos , Bromuro de Piridostigmina/uso terapéutico
14.
J Appl Oral Sci ; 27: e20180510, 2019 May 30.
Artículo en Inglés | MEDLINE | ID: mdl-31166550

RESUMEN

INTRODUCTION: Intermaxillary fixation (IMF) is a classic method for immobilization of the mandible after mandibular fractures and corrective surgery. However, it has been suggested that IMF may be a risk for developing temporomandibular joint (TMJ)-related symptoms, especially when applied for longer periods. OBJECTIVE: To evaluate the clinical function of TMJs and masticatory muscles 10-15 years after mandibular setback surgery and subsequent six weeks of IMF. The patients' self-reported TMJ and masticatory muscle symptoms were also addressed. METHODOLOGY: Thirty-six patients (24 women and 12 men) treated with intraoral vertical ramus osteotomies and subsequent six weeks of IMF, underwent a clinical examination of TMJs and masticatory muscles 10-15 years after surgery and completed a five-item structured questionnaire reporting subjective TMJ-related symptoms. Mean age by the time of clinical examination was 34.1 years (range 27.2-59.8 years). The clinical outcome was registered according to the Helkimo clinical dysfunction index. Descriptive and bivariate statistics were performed and level of significance was set to 5%. RESULTS: Mean maximum unassisted mouth opening 10-15 years after surgery was 50.1 mm, (range 38-70 mm, SE 1.2), statistically significantly greater in men compared to women (p=0.004). Mean Helkimo dysfunction group was 1.5 (range 1-3, SE 0.10). Eighty-one percent experienced pain on palpation in either the masseter muscle, temporal muscle or both, and 31% experienced pain when moving the mandible in one or more directions. Thirty-one percent reported pain from palpating the TMJs. In the questionnaire, none reported to have pain during chewing or mouth opening on a weekly or daily basis, but 22% reported difficulties with maximum opening of the mouth. CONCLUSION: Ten to fifteen years after mandibular setback surgery the patient's mandibular range of movement is good. Despite clinically recognizable symptoms, few patients reported having TMJ- or masticatory muscle-related symptoms in their daily life.


Asunto(s)
Técnicas de Fijación de Maxilares/efectos adversos , Maloclusión de Angle Clase III/cirugía , Músculos Masticadores/fisiopatología , Maxilar/cirugía , Trastornos de la Articulación Temporomandibular/fisiopatología , Articulación Temporomandibular/fisiopatología , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Maloclusión de Angle Clase III/fisiopatología , Maxilar/fisiopatología , Persona de Mediana Edad , Mialgia/fisiopatología , Valores de Referencia , Autoinforme , Estadísticas no Paramétricas , Trastornos de la Articulación Temporomandibular/etiología , Factores de Tiempo , Resultado del Tratamiento
15.
Trials ; 20(1): 215, 2019 Apr 11.
Artículo en Inglés | MEDLINE | ID: mdl-30975204

RESUMEN

BACKGROUND: There are many comorbidities associated with Down syndrome (DS), including obstructive sleep apnea (OSA) and masticatory muscle alteration. Muscular hypotonia, in particular, of the masticatory and oropharyngeal muscles is one of the main characteristics of individuals with DS, resulting in impairments of speech, swallowing, and mastication in these individuals. In addition, total or partial obstruction of the airways during sleep can occur due to pharyngeal hypotonia, leading to snoring and to OSA. This progressive respiratory disorder is associated with a high risk of morbidity and mortality in individuals with DS. The aim of this research is to assess the therapeutic effects of surface neuromuscular electrical stimulation (NMES), the mastication apparatus (MA), and a mandibular advancement oral appliance (OAm) with an embedded thermosensitive microchip on the functions of masticatory muscles (bilateral masseter and temporal muscles), physiological sleep variables, and salivary parameters in adult patients with DS. METHODS: The patients with DS will be randomly selected and divided into three groups (DS-NMES, DS-MA, and DS-OAm) with a minimum of 10 patients in each group. A thermosensitive microchip will be embedded in the OAm to record its compliance. The therapeutic effects on masticatory muscle function will be investigated through electromyography, a caliper, and a force-transducer device; the sleep variables, in turn, will be evaluated by means of polysomnography. The physicochemical and microbiological properties of the saliva will also be analyzed, including the salivary flow, viscosity, buffer capacity, cortisol levels (susceptibility to psychological and/or physical stress), and Pseudomonas aeruginosa levels (risk of aspiration pneumonia) in these patients. The methods determined for this study will be carried out prior to and after 2 months of the recommended therapies. DISCUSSION: The primary outcomes would be the improvement and/or reestablishment of the function of masticatory muscles and the physiological sleep variables in this target public since individuals with DS commonly present generalized muscular hypotonia and dysfunction of the oropharyngeal musculature. As a secondary outcome indicator, the impact of the applied therapies (NMES, MA, and OAm) on the salivary microbiological and physicochemical properties in DS individuals will also be assessed. Furthermore, the compliance of OAm usage will be measured through a thermosensitive microchip. TRIAL REGISTRATION: Registro Brasileiro de Ensaios Clínicos, RBR-3qp5np . Registered on 20 February 2018.


Asunto(s)
Síndrome de Down/terapia , Terapia por Estimulación Eléctrica , Músculos Masticadores/fisiopatología , Saliva/microbiología , Sueño/fisiología , Adolescente , Adulto , Síndrome de Down/fisiopatología , Electromiografía , Humanos , Hidrocortisona/análisis , Pseudomonas aeruginosa/aislamiento & purificación , Saliva/química , Tamaño de la Muestra , Adulto Joven
16.
Med Oral Patol Oral Cir Bucal ; 24(2): e165-e171, 2019 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-30818308

RESUMEN

BACKGROUND: Neurodegenerative diseases that affect the cerebellum, especially in elderly individuals, cause impairment of motor coordination and quality of life. The presente study evaluated the electromyographic activity and thickness of the right and left masseter and temporal muscles, and the maximum molar bite force of individuals with spinocerebellar ataxia. MATERIAL AND METHODS: Twenty-eight individuals were divided into two groups: those with (n=14) and without (n=14) spinocerebellar ataxia. Data on the masticatory muscles obtained from the electromyographic activity (resting, right and left laterality and protrusion), muscle thickness (maximal voluntary contraction and tensile strength) and maximum bite force (right and left) were tabulated and descriptive analysis using Student's t-test (P ≤ 0.05). RESULTS: In the comparison between groups, greater electromyographic activity was demonstrated for individuals with spinocerebellar ataxia, with a statistically significant difference in protrusion and laterality for the temporal muscles (P = 0.05). There was no statistically significant difference between the groups for masticatory muscles thickness in the conditions evaluated. For maximum molar bite force, the group with spinocerebellar ataxia showed lower bite force (P ≤ 0.05). CONCLUSIONS: The data obtained suggest that spinocerebellar ataxia promotes functional reduction in the stomatognathic system, mainly affecting the electromyographic activity and bite force, hindering chewing, with a resultant alteration of nutritional intake and a decrease of quality of life.


Asunto(s)
Fuerza de la Mordida , Ataxias Espinocerebelosas/fisiopatología , Sistema Estomatognático/fisiopatología , Adulto , Brasil , Estudios de Casos y Controles , Oclusión Dental , Electromiografía , Femenino , Lateralidad Funcional , Humanos , Masculino , Mandíbula , Músculo Masetero/fisiopatología , Masticación , Músculos Masticadores/fisiopatología , Persona de Mediana Edad , Diente Molar , Estudios Prospectivos , Calidad de Vida , Músculo Temporal/fisiopatología , Trastornos de la Articulación Temporomandibular/fisiopatología
17.
Rev. esp. cir. oral maxilofac ; 41(1): 8-16, ene.-mar. 2019. ilus, tab, graf
Artículo en Español | IBECS | ID: ibc-182841

RESUMEN

Objetivos: El síndrome de dolor miofascial (SDM) de la musculatura masticatoria (MM) constituye la patología más frecuente dentro de los trastornos temporomandibulares (TTM). En cuanto al tratamiento del SDM de la MM, no existen protocolos estandarizados. Hay evidencia de que la acupuntura es eficaz en el tratamiento del dolor miofascial. El objetivo del presente estudio es analizar la eficacia de la acupuntura en el tratamiento del SDM de la MM en términos de reducción de la intensidad del dolor y la duración de la reducción del dolor en el tiempo. Material y métodos: Se realizó un estudio observacional prospectivo en 30 pacientes diagnosticados de SDM de la MM que fueron tratados mediante 15 sesiones de acupuntura. Las variables del estudio fueron: 1) Porcentaje de pacientes que alcanzan una respuesta clínica relevante a lo largo del seguimiento (disminución del dolor de, al menos, un 50 % en la escala visual analógica con respecto al inicial o bien una reducción total del dolor a < 30 mm en la misma escala). 2) Reducción del dolor muscular orofacial después del tratamiento, expresado en milímetros (mm), dentro de la escala visual analógica (EVA). 3) Máxima apertura oral (MAO) expresada en mm. 4) Estabilidad del efecto terapéutico. Las variables fueron evaluadas antes del tratamiento, a los 3, 6, 9 y 12 meses. Resultados: La mediana de edad fue de 42 años (33-53). Con respecto al sexo, 28 de los 30 pacientes (93 %) fueron mujeres. El seguimiento fue completo para los 30 pacientes. Al final del seguimiento, 20 de los 30 pacientes (67 %, IC 95% 49-81) mantuvieron una reducción del dolor a la categoría leve (EVA < 30 %) o bien una reducción > 50 % del basal. A lo largo del estudio, el porcentaje de pacientes que alcanzó el criterio de respuesta clínica relevante preestablecido se mantuvo estable (67-80 %), no variando significativamente a lo largo del tiempo. Conclusiones: Los resultados del estudio demuestran que la acupuntura es eficaz en el control del dolor del SDM de la MM. Los efectos terapéuticos de la acupuntura son de inicio temprano (< 3 meses), estables y se mantienen hasta el final del seguimiento de un año


Objectives: Myofascial Pain Syndrome (MPS) of the Masticatory Muscles (MM) is one of the most prevalent diseases included in the Temporomandibular Joint Dysfunction Syndrome. Regarding its treatment, there are not standarized protocols. There is some evidence that acupuncture is effective in MPS of the MM treatment. The objective of the present study is to analyze the efficacy of acupuncture for the treatment of MPS of the MM, in terms of pain intensity reduction and duration of the pain reduction along time. Patients and methods: This is an observational prospective study. Thirty patients diagnosed of MPS of the MM were treated with 15 sessions of acupuncture. The variables of the study included were: 1) Percentage of patients that achieved a relevant clinical response (pain reduction of at least 50 % from the initial value, in a visual analogue scale, or a visual analogue scale pain value less than 30 milimeters). 2) Pain reduction after treatment, measured in milimeters in a visual analogue scale (VAS). 3) Maximal mouth opening measured in milimeters. 4) Stability of the pain reduction. The variables were evaluated before treatment and 3, 6, 9 and 12 months after. Results: The median of age was 42 years (33-53). Twenty eight patients were female (93 %). The follow up period lasted one year and all the patients completed it. At the end of the follow up period, 20 of the 30 patients (67 %, IC 95 % 49-81) maintained a pain reduction in a mild category (VAS < 30 %) or a total reduction of > 50 % from de initial pain value. Along the follow-up period, the percentage of patients that achieved a relevant clinical response maintained stable (67-80 %). Conclusions: The results of the study show that acupuncture is effective in the treatment of MPS of the MM. Treatment effects appear early (< 3 months) and maintain stable within the first year


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Analgesia por Acupuntura/métodos , Síndromes del Dolor Miofascial/terapia , Músculos Masticadores/fisiopatología , Resultado del Tratamiento , Síndrome de la Disfunción de Articulación Temporomandibular/terapia , Estudios Prospectivos
18.
Med. oral patol. oral cir. bucal (Internet) ; 24(2): e165-e171, mar. 2019. tab
Artículo en Inglés | IBECS | ID: ibc-180639

RESUMEN

Background: Neurodegenerative diseases that affect the cerebellum, especially in elderly individuals, cause impairment of motor coordination and quality of life. The presente study evaluated the electromyographic activity and thickness of the right and left masseter and temporal muscles, and the maximum molar bite force of individuals with spinocerebellar ataxia. Material and Methods: Twenty-eight individuals were divided into two groups: those with (n=14) and without (n=14) spinocerebellar ataxia. Data on the masticatory muscles obtained from the electromyographic activity (resting, right and left laterality and protrusion), muscle thickness (maximal voluntary contraction and tensile strength) and maximum bite force (right and left) were tabulated and descriptive analysis using Student’s t-test (P ≤ 0.05). Results: In the comparison between groups, greater electromyographic activity was demonstrated for individuals with spinocerebellar ataxia, with a statistically significant difference in protrusion and laterality for the temporal muscles (P = 0.05). T here was no statistically significant d ifference b etween t he g roups for m asticatory muscles thickness in the conditions evaluated. For maximum molar bite force, the group with spinocerebellar ataxia showed lower bite force (P ≤ 0.05). Conclusions: The data obtained suggest that spinocerebellar ataxia promotes functional reduction in the stomatognathic system, mainly affecting the electromyographic activity and bite force, hindering chewing, with a resultant alteration of nutritional intake and a decrease of quality of life


No disponible


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Ataxias Espinocerebelosas/fisiopatología , Sistema Estomatognático/fisiopatología , Músculos Masticadores/fisiopatología , Perfil de Impacto de Enfermedad , Electromiografía , Fuerza de la Mordida , Músculo Masetero/fisiopatología , Músculo Temporal/fisiopatología , Estudios Prospectivos , Estudios de Casos y Controles
19.
Medicine (Baltimore) ; 98(6): e14391, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30732181

RESUMEN

INTRODUCTION: Temporomandibular disorder (TMD) is considered the main cause of orofacial pain of non-dental origin, and a public health problem. The symptomatology is muscular and/or articular pain, restriction of the mandibular range of motion, and changes in the mandibular movement pattern. Due to its complexity there are already treatments using various forms of therapy. Photobiomodulation using light sources, such as low-level laser or light emitting diodes (LED), with different wavelengths, in a single or combined form, allows one more therapeutic resource to be explored. The objective of this study is to evaluate the effects of photobiomodulation with the simultaneous use of red and infrared LEDs, on pain, range of mandibular movements, and on the electrical activity of masticatory muscles in individuals with TMD. METHODS: A randomized, controlled, double-blind clinical trial is proposed, which will involve 33 individuals (n = 11 per group) of both sexes, ages 18 to 45 years in 3 groups: LED group; placebo group; and control group, submitted to 6 non-consecutive sessions of photobiomodulation totaling 2 weeks of treatment. The Research Diagnostic Criteria for Temporomandibular Disorders-RDC/TMD will be used to assess and determine the participants' TMD. The pain will be assessed using the Visual Analog Scale - VAS, the mandibular range of motion will be determined with the aid of a digital caliper, and the electrical activity of the masticatory muscles will be verified by electromyography. A mixed plate of 18 red LEDs-660 nm and 18 infrared LEDs-850 nm with power of 3.5 mW per LED, 4.45 mW/cm, radiant exposure of 5.35 J/cm, will be used for photobiomodulation. The irradiated area will be 14.13 cm, and energy of 75.6 J, in the TMJ region and in the bilateral masseter and temporal muscles. Participants from all groups will be reassessed after the first therapeutic intervention, and at the end of treatment. DISCUSSION: We expect the use of photobiomodulation with LEDs, infra and red, to reduce pain, improve temporomandibular joint function in patients with TMD, and thus improve the general conditions of the patient.


Asunto(s)
Rayos Infrarrojos/uso terapéutico , Terapia por Luz de Baja Intensidad/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Trastornos de la Articulación Temporomandibular/radioterapia , Adolescente , Adulto , Método Doble Ciego , Electromiografía , Femenino , Humanos , Masculino , Mandíbula/fisiopatología , Músculos Masticadores/fisiopatología , Persona de Mediana Edad , Rango del Movimiento Articular , Articulación Temporomandibular/fisiopatología , Trastornos de la Articulación Temporomandibular/fisiopatología , Resultado del Tratamiento , Escala Visual Analógica , Adulto Joven
20.
Sci Rep ; 9(1): 1408, 2019 02 05.
Artículo en Inglés | MEDLINE | ID: mdl-30723236

RESUMEN

Military pilots are characterized by peculiar job conditions related to intense accelerative stresses. For this, they frequently report work-related neck and back pain and are affected by bruxism. The aim of this case-control study is to analyze the occlusion time (OT) in a sample of military pilots affected by bruxism, compared with healthy non-pilot subjects. 14 military pilots, all males (mean age 35.14 ± 2.32 y), affected by bruxism, were compared with an age matched control group of 14 male subjects (mean age 32.29 ± 4.84 y). The T-Scan computerized occlusal analysis system (Tek-Scan Inc., Boston, MA, USA) was used to record the subjects' occlusion times during 4 mandibular opening-closing movements. Military pilots affected by bruxism showed a statistically significant lower (reduced of 85%) mean OT, compared with control subjects (p < 0.0001). Military pilots are characterized by a highly reduced occlusion time compared to healthy non-pilot subjects. This feature could not be only related with the presence of bruxism but with their particular clinical job-related condition that causes different dental and stomatognathic system problems. Further studies are encouraged to enhance the scientific knowledge in this field.


Asunto(s)
Fuerza de la Mordida , Bruxismo/fisiopatología , Personal Militar , Enfermedades Profesionales/fisiopatología , Pilotos , Adulto , Estudios de Casos y Controles , Humanos , Masculino , Mandíbula/fisiopatología , Músculos Masticadores/fisiopatología
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