MD1093Z - Method for detection of masticatory muscle activity disorders - Google Patents
Method for detection of masticatory muscle activity disorders Download PDFInfo
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- MD1093Z MD1093Z MDS20160085A MDS20160085A MD1093Z MD 1093 Z MD1093 Z MD 1093Z MD S20160085 A MDS20160085 A MD S20160085A MD S20160085 A MDS20160085 A MD S20160085A MD 1093 Z MD1093 Z MD 1093Z
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- 230000000694 effects Effects 0.000 title claims abstract description 24
- 210000003784 masticatory muscle Anatomy 0.000 title claims abstract description 19
- 238000001514 detection method Methods 0.000 title abstract 2
- 238000000034 method Methods 0.000 title description 9
- 210000000966 temporal muscle Anatomy 0.000 claims abstract description 22
- 210000001352 masseter muscle Anatomy 0.000 claims abstract description 18
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 claims abstract description 15
- 238000001931 thermography Methods 0.000 claims abstract description 7
- 208000029578 Muscle disease Diseases 0.000 claims abstract description 6
- 208000021642 Muscular disease Diseases 0.000 claims abstract description 6
- 238000002405 diagnostic procedure Methods 0.000 claims 1
- 210000003205 muscle Anatomy 0.000 abstract description 14
- 239000003814 drug Substances 0.000 abstract description 2
- 230000001460 masseteric effect Effects 0.000 abstract 2
- 230000002123 temporal effect Effects 0.000 abstract 1
- 208000035475 disorder Diseases 0.000 description 9
- 238000002567 electromyography Methods 0.000 description 9
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- 230000007310 pathophysiology Effects 0.000 description 2
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- 108091008702 infrared receptors Proteins 0.000 description 1
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- 238000010077 mastication Methods 0.000 description 1
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- 208000004296 neuralgia Diseases 0.000 description 1
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Abstract
Description
Invenţia se referă la medicină, în special la diagnosticul funcţional şi stomatologie, şi poate fi utilizată pentru diagnosticul precoce al dereglărilor activităţii muşchilor masticatori. The invention relates to medicine, in particular to functional diagnosis and dentistry, and can be used for the early diagnosis of masticatory muscle activity disorders.
Este cunoscută metoda de diagnostic al dereglărilor activităţii muşchilor masticatori cu utilizarea electromiografiei (EMG) (analiza amplitudinii EMG interferenţiale, analiza amplitudine-frecvenţă a EMG interferenţiale, analiza spectrală a EMG interferenţiale) ce reprezintă o metodă de investigaţie paraclinică care constă în înregistrarea activităţii electrice a muşchilor masticatori. După obţinerea datelor, biopotenţialele sunt amplificate şi vizualizate pe ecranul unui osciloscop. Pentru efectuarea unui examen electromiografic sunt necesare anumite condiţii: temperatura camerei în care se efectuează proba trebuie să fie de 23…24°C. La temperaturi mai scăzute traseul EMG suferă modificări determinate de contracţiile musculare involuntare (frisonare). Investigarea EMG se efectuează în diferite poziţii ale mandibulei (poziţia de postură, poziţia de intercuspidare maximă (PIM), în timpul diferitelor activităţi funcţionale). Ea permite aprecierea forţei de contracţie musculară, simetriei contracţiei muşchilor masticatori de partea stângă şi dreaptă, precum şi a modului de activare a acestor muşchi în timpul mişcărilor mandibulare. Contracţia izometrică, în mod normal, apare sub forma activităţii de menţinere a posturii sau a unei sarcini exterioare. Efortul muscular static prin contracţie izometrică se întâlneşte în poziţia de postură a mandibulei sau în timpul masticaţiei şi deglutiţiei. Contracţia izometrică este întâlnită şi în bruxism, unde epuizarea musculară este datorată efortului prelungit şi comprimării totale a vaselor sanguine în interiorul muşchiului. Dacă la EMG în mod normal există o corelaţie între amplitudinea potenţialelor şi forţa dezvoltată, în contracţia izometrică susţinută apare disocierea electromecanică, caracterizată prin scăderea nivelului forţei de contracţie, odată cu creşterea frecvenţei potenţialelor electrice. The method of diagnosing disorders of masticatory muscle activity using electromyography (EMG) (interferential EMG amplitude analysis, amplitude-frequency analysis of interferential EMG, spectral analysis of interferential EMG) is known, which is a paraclinical investigation method that consists of recording the electrical activity of the masticatory muscles. After obtaining the data, the biopotentials are amplified and visualized on the screen of an oscilloscope. Certain conditions are required for performing an electromyographic examination: the temperature of the room in which the test is performed must be 23…24°C. At lower temperatures, the EMG path undergoes changes determined by involuntary muscle contractions (shivering). EMG investigation is performed in different positions of the mandible (postural position, maximum intercuspation position (PIM), during various functional activities). It allows the assessment of the force of muscle contraction, the symmetry of the contraction of the masticatory muscles on the left and right sides, as well as the way of activating these muscles during mandibular movements. Isometric contraction, normally, occurs in the form of the activity of maintaining posture or an external load. Static muscle effort through isometric contraction is found in the posture position of the mandible or during mastication and swallowing. Isometric contraction is also found in bruxism, where muscle exhaustion is due to prolonged effort and total compression of the blood vessels inside the muscle. If in EMG there is normally a correlation between the amplitude of the potentials and the force developed, in sustained isometric contraction electromechanical dissociation occurs, characterized by a decrease in the level of contraction force, along with an increase in the frequency of the electrical potentials.
A fost aplicat complexul diagnostic Neuro-MVP Micro(Neurosoft) cu electrozi de suprafaţă în proiecţia muşchilor investigaţi: m. temporalis anterior şi m. masseter. The Neuro-MVP Micro (Neurosoft) diagnostic complex was applied with surface electrodes in the projection of the investigated muscles: m. temporalis anterior and m. masseter.
Indicii tonusului muscular se apreciază prin determinarea în stare de confort relativ a amplitudinii medii (µV) a EMG: Muscle tone indices are assessed by determining the average amplitude (µV) of the EMG in a state of relative comfort:
- 30…50 µV - norma; - 30…50 µV - norm;
- 51… 80 µV - activitate musculară patologică; - 51… 80 µV - pathological muscle activity;
- > 80 µV - activitate musculară adaptivă; - > 80 µV - adaptive muscle activity;
- < 30 µV - activitate de decompensare (afectare organică). - < 30 µV - decompensation activity (organic damage).
Se determină asimetria totală a activităţii muşchilor masticatori (conform Naeije) şi indicele activităţii musculare (AcI) (Scopel; Mazzetto, 2014). The total asymmetry of masticatory muscle activity (according to Naeije) and the muscle activity index (AcI) are determined (Scopel; Mazzetto, 2014).
Valoarea AcI tot variază între minus 100% şi plus 100% - în cazurile de indici cu semn negativ se constată predominarea activităţii pe stânga, iar în cazurile cu semn pozitiv - pe dreapta.Valorile negative indică predominarea activităţii muşchilor temporali (la persoane sănătoase TA>MM), iar valorile pozitive indică predominarea activităţii muşchilor maseteri [1]. The AcI value still varies between minus 100% and plus 100% - in cases of indices with a negative sign, the predominance of activity on the left is observed, and in cases with a positive sign - on the right. Negative values indicate the predominance of activity of the temporal muscles (in healthy people TA>MM), and positive values indicate the predominance of activity of the masseter muscles [1].
Dezavantajele metodei cunoscute constau în aceea că este o investigaţie de contact, care duce la schimbări ale tonusului muscular cu modificarea inclusiv a temperaturii, ceea ce duce la obţinerea unor date ce nu corespund stării muşchilor masticatori, totodată se obţin rezultate numai în anumite puncte, unde se aplică electrozii de suprafaţă, şi nu ale muşchiului integral. The disadvantages of the known method are that it is a contact investigation, which leads to changes in muscle tone including temperature changes, which leads to obtaining data that does not correspond to the state of the masticatory muscles, at the same time, results are obtained only at certain points, where surface electrodes are applied, and not of the entire muscle.
Problema pe care o rezolvă invenţia constă în elaborarea unei metode de determinare a prezenţei dereglărilor muşchilor masticatori prin investigarea muşchiului integral, care ar permite diagnosticul precoce şi rapid prin intermediul unor manipulări neinvazive, care pot fi utilizate şi la copii. The problem that the invention solves consists in developing a method for determining the presence of masticatory muscle disorders by investigating the entire muscle, which would allow early and rapid diagnosis through non-invasive manipulations, which can also be used in children.
Esenţa invenţiei constă în aceea că se efectuează o angrenare maximală a maxilarelor, după care ipsilateral se trasează linii oblice pe traiectul muşchilor maseter şi temporal anterior până la marginile lor, cu ajutorul termografiei se determină profilul de temperatură pe liniile trasate, apoi se stabilesc valorile medii ale profilurilor de temperatură, şi în cazul când diferenţa dintre valoarea medie a profilului de temperatură a muşchiului temporal anterior şi a muşchiului maseter este mai mare de 0,4…0,7°C, se stabileşte lipsa dereglărilor musculare, în cazul când este de 0,4…0,2°C, se stabileşte prezenţa dereglărilor limitrofe, iar în cazul când este mai mică de 0,2°C sau când temperatura muşchiului maseter este mai mare decât temperatura muşchiului temporal anterior, se stabileşte prezenţa dereglărilor severe ale activităţii muşchilor masticatori. The essence of the invention consists in performing a maximum engagement of the jaws, after which oblique lines are drawn ipsilaterally along the path of the masseter and anterior temporal muscles to their edges, using thermography, the temperature profile is determined on the drawn lines, then the average values of the temperature profiles are established, and in the case when the difference between the average value of the temperature profile of the anterior temporal muscle and the masseter muscle is greater than 0.4…0.7°C, the absence of muscle disorders is established, in the case when it is 0.4…0.2°C, the presence of borderline disorders is established, and in the case when it is less than 0.2°C or when the masseter muscle temperature is higher than the anterior temporal muscle temperature, the presence of severe disorders of the activity of the masticatory muscles is established.
Rezultatul invenţiei constă în determinarea rapidă şi precoce a prezenţei dereglărilor muşchilor masticatori, prin intermediul unei metode neinvazive, care poate fi utilizată şi la copii. The result of the invention consists in the rapid and early determination of the presence of masticatory muscle disorders, through a non-invasive method, which can also be used in children.
Termografia infraroşie contemporană permite determinarea la distanţă a temperaturii, aprecierea integrală a microcirculaţiei şi metabolismului ţesuturilor, prezenţei semnelor inflamatorii. Pentru investigaţii a fost utilizat termograful IRTIS2000 (Rusia) cu următoarele caracteristici tehnice: receptorul infraroşu - InSb (HgCdTe), diapazonul spectral - 3…5 (8…12) µm, sensibilitatea la 30°C (±0,02°C). Asigurarea tehnică şi programele IRTIS permit obţinerea termoprofilurilor în orice zonă interesată. Termogramele au fost analizate prin intermediul programului specializat IRPrewiew. Analiza modificărilor în timp s-a bazat pe indicii temperaturilor maximale, minimale şi medii. S-au analizat termoprofilul în zona muşchilor masticatori şi izotermele regiunilor respective. Termografia reflectă integral activitatea muşchilor, care include starea patului microcirculator (arteriole, vasele medii şi mici şi anastomozele arterio-venoase). Contemporary infrared thermography allows for remote temperature determination, comprehensive assessment of tissue microcirculation and metabolism, and the presence of inflammatory signs. For the investigations, the IRTIS2000 thermograph (Russia) with the following technical characteristics was used: infrared receptor - InSb (HgCdTe), spectral range - 3…5 (8…12) µm, sensitivity at 30°C (±0.02°C). Technical support and IRTIS programs allow obtaining thermoprofiles in any area of interest. Thermograms were analyzed using the specialized IRPrewiew program. Analysis of changes over time was based on the maximum, minimum, and average temperature indices. The thermoprofile in the area of the masticatory muscles and the isotherms of the respective regions were analyzed. Thermography fully reflects the activity of the muscles, which includes the state of the microcirculatory bed (arterioles, medium and small vessels, and arteriovenous anastomoses).
Pentru patologiile musculare algice oro-faciale a fost propus un criteriu de apreciere a temperaturii bazat pe analiza diferenţelor de temperatură (zonei simetrice faciale/zone sănătoase şi afectate/zone dureroase şi nedureroase etc.). În normă diferenţele de temperatură sunt în intervalul 0,0±0,25°C; regiuni fierbinţi sunt considerate acele regiuni, care au temperaturi > +0,35°C, iar regiuni reci - care au temperaturi < -0,35°C; regiunile cu temperatura cuprinsă între 0,26…0,35°C sunt considerate equivocale (Gratt). Conform autorilor (Gratt), aplicarea acestui principiu a dat posibilitatea de a evidenţia unele particularităţi importante ale activităţii vasomotor-metabolice în regiunea muşchilor faciali. De exemplu, zonele fierbinţi au fost depistate în neuralgie traumatică, zonele cu temperatură normală deseori se atestă în neuralgia trigeminală etc. For orofacial painful muscular pathologies, a temperature assessment criterion based on the analysis of temperature differences (symmetrical facial area/healthy and affected areas/painful and painless areas, etc.) was proposed. Normally, temperature differences are in the range of 0.0±0.25°C; hot regions are considered those regions with temperatures > +0.35°C, and cold regions - those with temperatures < -0.35°C; regions with temperatures between 0.26…0.35°C are considered equivocal (Gratt). According to the authors (Gratt), the application of this principle made it possible to highlight some important peculiarities of vasomotor-metabolic activity in the facial muscle region. For example, hot areas were detected in traumatic neuralgia, areas with normal temperature are often observed in trigeminal neuralgia, etc.
Valoarea temperaturii este determinată de cel puţin trei factori: circulaţia sanguină, metabolismul ţesuturilor investigate, termoconductibilitatea de la ţesuturile subiacente. Investigaţiile au fost realizate la temperatura aerului de 20…22°C, umiditatea relativă a aerului de 40…70%, viteza curentului de aer nu mai mare de 0,25 m/s. Respectarea acestor condiţii este strict necesară, pentru a evita angiospasmul şi alte efecte nedorite. S-au exclus sursele de căldură directe, s-au anulat toate procedurile fizioterapeutice şi preparatele vasoactive, pacientul nu fuma, nu consuma cafea şi alcool. Pacientul se adapta la temperatura mediului ambiant timp de 20 min. În investigaţii s-a determinat temperatura în zonele de proiecţie ale structurilor sistemului stomatognat. Standardizarea condiţiilor şi zonelor de cercetare a dat posibilitatea de a obţine date veridice la pacienţii investigaţi. Cu 24 de ore înainte de examinarea termografiei nu se folosesc creme, pudră şi alte remedii aplicate pe regiunea cefalică, pentru a evita modificările temperaturii. The temperature value is determined by at least three factors: blood circulation, metabolism of the investigated tissues, thermal conductivity of the underlying tissues. The investigations were carried out at an air temperature of 20…22°C, relative air humidity of 40…70%, air flow speed not exceeding 0.25 m/s. Compliance with these conditions is strictly necessary to avoid angiospasm and other undesirable effects. Direct heat sources were excluded, all physiotherapeutic procedures and vasoactive preparations were canceled, the patient did not smoke, did not consume coffee and alcohol. The patient adapted to the ambient temperature for 20 min. In the investigations, the temperature was determined in the projection areas of the structures of the stomatognathic system. Standardization of the conditions and research areas made it possible to obtain reliable data in the investigated patients. 24 hours before the thermography examination, creams, powders and other remedies applied to the head region should not be used, to avoid temperature changes.
Metoda se efectuează în modul următor. The method is performed in the following way.
Persoanei i se propune să efectueze o angrenare maximală a maxilarelor, după care ipsilateral se trasează linii oblice pe traiectul muşchilor maseter şi temporal anterior până la marginile lor, cu ajutorul termografiei se determină profilul de temperatură pe liniile trasate, apoi se stabilesc valorile medii ale profilurilor de temperatură, şi în cazul când diferenţa dintre valoarea medie a profilului de temperatură a muşchiului temporal anterior şi a muşchiului maseter este mai mare de 0,4…0,7°C, se stabileşte lipsa dereglărilor musculare, în cazul când este de 0,4…0,2°C, se stabileşte prezenţa dereglărilor limitrofe, iar în cazul când este mai mică de 0,2°C sau când temperatura muşchiului maseter este mai mare decât temperatura muşchiului temporal anterior, se stabileşte prezenţa dereglărilor severe ale activităţii muşchilor masticatori. The person is asked to perform a maximum engagement of the jaws, after which oblique lines are drawn ipsilaterally along the path of the masseter and anterior temporal muscles to their edges, using thermography, the temperature profile is determined on the drawn lines, then the average values of the temperature profiles are established, and if the difference between the average value of the temperature profile of the anterior temporal muscle and the masseter muscle is greater than 0.4…0.7°C, the absence of muscle disorders is established, if it is 0.4…0.2°C, the presence of borderline disorders is established, and if it is less than 0.2°C or when the masseter muscle temperature is higher than the anterior temporal muscle temperature, the presence of severe disorders of the activity of the masticatory muscles is established.
Metoda revendicată a fost utilizată pe un lot de 30 de persoane sănătoase, la care s-a determinat temperatura medie în muşchiul maseter (MM) de 31,19 ± 0,30 şi muşchiul temporal anterior (TA) de 31,71±0,24 şi apoi pe un lot de pacienţi cu diverse patologii, cum este de exemplu bruxismul nocturm, şi s-a determinat temperatura medie în muşchiul maseter de 32,15±0,28 şi în muşchiul temporal anterior de 31,83±0,25, unde s-a determinat prezenţa de dereglări pronunţate în musculatura masticatorie. The claimed method was used on a group of 30 healthy people, in which the average temperature in the masseter muscle (MM) was determined to be 31.19 ± 0.30 and the anterior temporal muscle (TA) to be 31.71 ± 0.24, and then on a group of patients with various pathologies, such as nocturnal bruxism, and the average temperature in the masseter muscle was determined to be 32.15 ± 0.28 and in the anterior temporal muscle to be 31.83 ± 0.25, where the presence of pronounced disorders in the masticatory muscles was determined.
Exemplul 1 Example 1
Persoana T.A., 28 ani. T°C medie MM = 31,10°C, TA = 31,71°C (TA>MM). În urma investigaţiilor suplimentare nu s-au depistat patologii ale sistemului stomatognat sau alte patologii ale sistemului nervos central şi periferic. Person T.A., 28 years old. Average T°C MM = 31.10°C, TA = 31.71°C (TA>MM). Following additional investigations, no pathologies of the stomatognathic system or other pathologies of the central and peripheral nervous system were detected.
Exemplul 2 Example 2
Pacientul P.A., 46 ani. T°C medie MM = 31,57°C, TA = 31,83°C (TA≥MM). În urma investigaţiilor suplimentare s-a depistat prezenţa de bruxism nocturn cu dereglări limitrofe ale activităţii muşchilor masticatori. Patient P.A., 46 years old. Average T°C MM = 31.57°C, TA = 31.83°C (TA≥MM). Following additional investigations, the presence of nocturnal bruxism with borderline disorders of masticatory muscle activity was detected.
Exemplul 3 Example 3
Pacientul S.N., 48 ani. T°C medie MM = 32,49°C, TA = 31,77°C (TA<MM). În urma investigaţiilor suplimentare s-a depistat prezenţa de bruxism nocturn cu dereglări severe ale activităţii muşchilor masticatori. Patient S.N., 48 years old. Average T°C MM = 32.49°C, TA = 31.77°C (TA<MM). Following additional investigations, the presence of nocturnal bruxism with severe disorders of the activity of the masticatory muscles was detected.
1. Fiziopatologia sistemului orofacial. Explorarea funcţională: electromiografia (EMG). 2012, p. 309-316. <http://pathophysiology.umft.ro/data/media/ro/program/dentara/11_fiziopatologia-sistemului-orofacial_md-2012-2013.pdf> 1. Pathophysiology of the orofacial system. Functional exploration: electromyography (EMG). 2012, p. 309-316. <http://pathophysiology.umft.ro/data/media/ro/program/dentara/11_fiziopatologia-sistemului-orofacial_md-2012-2013.pdf>
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| Title |
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| Fiziopatologia sistemului orofacial. Explorarea funcţională: electromiografia (EMG). 2012, p. 309-316. <http://pathophysiology.umft.ro/data/media/ro/program/dentara/11_fiziopatologia-sistemului-orofacial_md-2012-2013.pdf> * |
| Дурново Е.А., Марочкина М.С., Хомутинникова Н.Е., Потехина Ю.П., Янова Н.А. ВОЗМОЖНОСТИ ИНФРАКРАСНОЙ ТЕРМОГРАФИИ В КОМПЛЕКСНОЙ ДИАГНОСТИКЕ ЗАБОЛЕВАНИЙ ЧЕЛЮСТНО-ЛИЦЕВОЙ ОБЛАСТИ. Современные проблемы науки и образования, 11.07.2012, №4, http://www.science-education.ru/ru/article/view?id=6657 * |
| Решетников А. П., Сойхер М. Г., Копылов М. В. ИНФРАКРАСНАЯ ТЕРМОГРАФИЯ ЩЕК ПРИ ПРИЕМЕ ВОДЫ И ПИЩИ. Журнал Фундаментальные исследования, 2013, № 9, с.904-906 * |
| Ураков А.Л , Сойхер М.И., Сойхер М.Г., Решетников А.П., Мингазова Л.Р. Инфракрасная термография и электромиография в диагностике и лечении миогенного болевого феномена области лица. 2014, <http://www.rusvrach.ru/derm/archive/derm-01-2014/5394-magazine-dermatology-2014-01-002.html> * |
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