The aim of this case report is to give comprehensive information on the clinical use of surface electromyography in clinical practice during diagnostics and treatment. A 23-year-old female patient is presented with complaints of fatigue and pain in chewing muscles with deterioration of the symptoms after mastication. In addition, discomfort while clenching, sleeping disorders and headaches are reported by the patient.Surface electromyography is performed, using the following parameters: bilateral symmetry coefficient for temporalis muscles; bilateral symmetry coefficient for masseter muscles; lateral mandible displacement index; bilateral symmetry coefficient for sternocleidomastoideus muscles; sternocleidomastoideus muscles functional activity coefficient; impact potential of examined muscles. The parameters are used not only in diagnostics, but also in evaluating the treatment progress.It can be concluded application of EMG in clinical practice is useful in the situations such as screening for functional activity of chewing muscles disorders, development of evidence-based treatment protocols and diagnosis of combined dental and neurological pathology.
Botulinum Toxin Type A has been introduced as new therapeutic regime in neurological, cosmetic, urinary, gastrointestinal and pain-related conditions. The use of Botulinum Toxin A in craniomandibular disorders is discussed controversially.Local muscle dystonia is defined as movement disorder in combination with sustained muscle contractions. Contortion, repetitive movements and atypical posture are frequently seen symptoms in such cases. The movements are involuntary and often painful. A single muscle or a group of muscles, even the whole body may be involved. Oral dyskinesias are involuntary repetitive movements of the mouth and face. Severe bruxism can be included in this form of movement disorder.Within this study, patients diagnosed with severe bruxism or local muscle dystonia including oral dyskinesia were examined with electromyography before and after treatment. Subjects were randomly allocated to either myo-relaxation medication and relaxation splint therapy or to Botulinum Toxin A injection therapy. Surface EMG parameters of chewing and neck muscles were used to judge the treatment effects. A positive impact of BTA on EMG-characteristics, reflecting the functional condition of facial muscles, had been detected. BTA injections seem to have a positive effect in patients with bruxism and local muscle dystonia. An increased quantity of mandibular movements and a better coordination can be observed after BTA injection. In comparison with a standard myo relaxation therapy, the effects of BTA treatment are more distinct and long standing.BTA appears to be a promising therapeutic regime in patients with focal muscle dystonia and oral dyskinesia. A confirmed diagnosis and lege artis application by experienced clinicians constitute as sine qua non. Further studies are required to improve our knowledge in Botulinum Toxin A treatment of muscle dystonia and dyskinesia.
A 26-year-old female patient presented with a high-grade limitation of her mouth opening. After initial clinical examination and evaluation of medical and dental history, a detailed sequential treatment plan was developed. Primarily, the patient was referred to the physiotherapist. The goal of this treatment phase was to enhance the mouth opening, to enable further examinations including alginate impressions of the upper and lower jaw. Based on the results of the clinical and instrumental analysis, a myo-relaxation splint was fabricated. Equilibration was performed consequently. The mandibular mobility and the subjective symptoms could be positively influenced within this treatment phase. The treatment outcomes were evaluated and recorded by occlusal index and palpation of muscle and joints. The results of an interims analysis, including a second condylography, were used to refine the initial therapy. Special manipulation techniques have been applied during the condylographic recording, to achieve more information on particular situation of the jaw joints. The splint was readjusted to a particular therapeutically position, which has been determined after the second condylography. A lateral mandibular shift was introduced by the new splint. The mouth opening could be increased further with this joint position to a sufficient amount. The patient is pain free, the movement of the jaw is adequate and without severe limitations. The condyle-disk relation is reestablished. The therapeutically achieved jaw positions are now the basis for set up and wax up procedure, to establish the orthodontic treatment plan.Based on this individual case report, the authors want to emphasize, that even in severe cases with involvement of jaw joint structures, a consequent and systematic interdisciplinary treatment sequence is essential to obtain the treatment goals. Consequently, a physiologic relation of condyle and disk should be established, if possible. The jaw mobility should not be the result of stretched ligaments or burden to joint structures such as disk and bilaminar zone. The reported effect of such kinds of treatments is the consequence of interdisciplinary treatment, based on clinical and instrumental findings and the willingness of the team to readjust the treatment if indicated.
From previous research, diseases of the temporomandibular joint are a functional pathology and take a special place among diseases that affect both the joint and the structures surrounding it [1]. Disorders of the anatomical relationship between the components of the joint are the most common reason of temporomandibular joint dysfunction [2]. Patients with this disease need a thorough clinical and functional analysis, in order to identify the relationship between pathology and structural features of the facial skeleton.
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