RU2440063C1 - Mechanotherapeutic apparatus in temporomandibular joint dysfunction syndromes, pain syndromes and ankyloses - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: prospective invention refers to medicine, particularly dentistry, and can be used for treating the diseases associated with limited opening of mouth and jaw stiffness. An apparatus comprises a cylindrical body provided with a spring, a handle coupled with the spring by a wire, and rods perpendicular to a body and spring axis. The rods are movable along a slot coaxial to the body in a reciprocating and perpendicular direction, enclosed in a case with their ends rigidly coupled with a mandibular impression tray. On a screw-and-nut of the body, there is a pair of the rods perpendicular to a maxillary tray; these rods are provided with hinges to incline the tray 10-15°. The trays are filled with impression silicone mass.

EFFECT: provided gradual uniform opening of mouth during treatment in the patients with dislocated intra-articular meniscus, TBJ pain syndromes and ankylosis to a physiological position, creation of a cosmetic, hygienic, painless apparatus causing no therapeutic inconveniences.

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Description

The invention relates to medicine, in particular to dentistry, and can be used to treat diseases associated with limited opening of the mouth and stiffness in the temporomandibular joints (TMJ).

According to M.N. Puzin et al. (2002); T.A. Gaidarova (2003); N.A. Rabukhina et al. (2006); Yu.A. Petrosova (2007), from 40% to 70% of the population of Russia have various violations of TMJ functions.

The treatment of patients with TMJ ankylosing diseases, in its complexity and relevance, occupies a special place among the problems of modern dentistry.

Persistent changes in the maxillofacial region caused by ankylosis, deforming arthrosis, lead to complete or almost complete immobility of the lower jaw, impaired growth, and also deformation of the adjacent parts of the facial skeleton that grows with age (N.N. Kasparova et al, 1981; Yu .M. Bernadsky, 1991; Yu.A. Petrosov et al., 1996; M.M. Berlova, 2001).

To date, the problem of rehabilitation of patients with this pathology remains unresolved, in particular, due to the presence of postoperative relapses and deformations resulting from incompleteness, as well as the ambiguity of rehabilitation measures. A very important point in consolidating the results of surgical or orthopedic treatment methods is the mandatory use of a complex of myogymnastics and mechanotherapy. To carry out mechanotherapy, several types of simulators were proposed.

To ensure constant breeding of the jaws, the adaptation of N.N. Ezhkin was used. It consists in the following: a double-folded rubber plate with a length of 5 cm and a width of 2 cm is placed between the molars. To prevent the plate from slipping off its teeth, it is wrapped with gauze, then it is inserted between the molars and the back side with a curved side. Patients wear such a plate around the clock. To increase the force of dilution of the jaws, the plates are introduced from two sides. As the opening of the mouth increases, the plates are replaced with thicker ones (“Traumatology and reconstructive surgery of the maxillofacial region.” Kiev, 1973, p. 245, see Appendix 1).

The disadvantages of the device:

1. Constant breeding of the jaws is required.

2. Need to wear around the clock.

3. Poor fixation and stabilization.

4. Unhygienic, uncomfortable.

To conduct mechanotherapy for TMJ ankylosis, the MMSI apparatus is used with two spoons fixed to two steel rods pivotally interconnected (“Traumatology and reconstructive surgery of the maxillofacial region.” Kiev, 1973, p. 245, see Appendix 1).

The disadvantages of the apparatus:

1. Bulky, uncomfortable.

2. Constant breeding of the jaws is required.

3. Does not provide a degree of controlled opening of the mouth.

An analogue of the invention is also the apparatus of A. V. Smirnov ("Surgical Dentistry". M., 1959, p. 378, see Appendix 2), consisting of two tires or orthopedic (impression) spoons that are filled with impression mass. Two arcuate springs made of steel wire with a diameter of 2-3 mm are strengthened to the side surfaces of tires or spoons, thanks to which the device evenly presses on the upper and lower dentition, while expanding the jaw.

The disadvantages of the apparatus:

1. Constant breeding of the jaws is required.

2. Injury to the mucous membranes of the cheeks and lips.

3. Does not provide a degree of controlled opening of the mouth.

The closest analogue of the invention is an apparatus for mechanotherapy in children. Yu.A. Petrosova, V.F. Zhuravskaya (copyright certificate No. 501756, “Diagnosis and orthopedic treatment of diseases of the temporomandibular joint”, Krasnodar, 2007, pp. 255-256, see Appendix 3).

The device consists of a rigid plastic head cap, which is made according to a print taken from the child’s head. Using clamps, a metal support bracket is attached to the plastic cap, on the middle of the cross-section of which an earring with a fixed rod is fixed. A two-arm lever is pivotally fixed to the earring, one shoulder of which is connected to the fixed rod by a rubber rod. The other arm of the lever is an intraoral part, consisting of a metal arch, on it at the level of molars of the left and right sides there are three vertical metal rods that are inserted into bushings welded to the dentogapital splint made on the lower jaw according to the impression. The focal point of the proposed apparatus is the head cap.

The disadvantages of the apparatus:

1. Bulky, unhygienic.

2. Constant breeding of the jaws is required.

3. Does not provide a degree of controlled opening of the mouth.

4. The plastic head cap causes discomfort when worn.

5. Applies only to children and adolescents.

6. Patients interrupt treatment early, do not use the device due to its inconvenience.

Tasks:

- increasing the effectiveness of complex treatment and rehabilitation of patients with dislocations of the intraarticular meniscus, arthrosis and ankylosis of the temporomandibular joints;

- providing regulation of the degree of opening of the mouth in dynamics to a physiological position;

- creating a comfortable position of the lower jaw and comfortable conditions for the patient during treatment;

- aesthetics, hygiene, reliable fixation in the oral cavity.

- eliminating the possibility of trauma to the teeth and oral mucosa;

The essence of the proposed device is that the device contains a cylindrical body equipped with a spring connected by a cable to the handle and parallel rods located perpendicular to the axis of the housing and the spring, the rods are mounted to move along the grooves and coaxial with the body of the slot in the reciprocating direction and are enclosed the casing and their ends are rigidly connected to the impression spoon on the lower jaw; a pair of also perpendicularly located rods to the spoon on the upper jaw are fixed on the screw-nut of the case, which at the ends have the ability to tilt the spoon by 10-15 °, and the spoons are filled with a silicone mass with an individual impression.

The technical result of the invention is the provision of a gradual uniform opening of the mouth during treatment in patients with dislocations of the intraarticular meniscus, arthrosis and TMJ ankylosis to a physiological position, the creation of a cosmetic, hygienic apparatus that does not cause pain and inconvenience to the patient during treatment. The device allows you to adjust the degree of opening of the mouth during treatment due to the proposed relationship of structural elements.

The advantages of the device over previously known.

Serial production is simple, the device is applicable for all age groups, cosmetic, hygienic, firmly fixed in the oral cavity, does not cause functional overload of the teeth on the upper and lower jaws, is simple to manufacture, does not injure surrounding tissues, provides a smooth, adjustable mouth opening for the patient. The design of the apparatus does not cause difficulties in adapting to treatment.

For a better understanding of the design, the apparatus is schematically depicted in FIGS. 1, 2, 3, where FIG. 1 is a sectional view of the apparatus, in front view, FIG. 2 is a spring-loaded handle, FIG. 3 is a sectional view of the apparatus, in horizontal view; pos. 1 - cable, 2 - impression spoons, 3 - case, 4 - spring, 5 - rods, 6 - screw-nut, 7 - brackets, 8 - casing on the spring, 9 - groove coaxial with the casing, 10 - rods in casing, 11 - screw, 12 - spring-loaded handle.

The device is used as follows:

For dysfunctional syndromes (difficult to fix, chronic dislocation of the meniscus), arthrosis, fibrous ankylosis, silicone imprints are removed from the upper jaw with an impression spoon 2 with brackets 7 and the lower jaw with an impression spoon 2, which can be easily removed from the apparatus. Then the spoon for the lower jaw 2 is fixed with the help of the rods 10 on the casing 8 with a screw 11. The spoon for the upper jaw 2 is fixed with the help of the rods 10 with a screw-nut 6 located on the housing 3. Using the screws 11 and the screw-nut 6, horizontal movement can be adjusted 2 spoons and adjust the device individually, according to the bite of the patient. With the help of a spring-loaded handle 12 connected by a cable 1 to the spring 4, the patient makes compressive and expanding movements with a sick hand. In this case, the lower spoon 2 with the rods 10, fixed to the casing 8 by the screw 11, moves along the groove 9 in the housing 3 up and down, spreading the jaw.

The degree of opening of the mouth depends on the compression force of the handle 12 patients. After a preliminary transcranial electrostimulation session (TES-therapy) and ozokerite therapy, patients undergo mechanotherapy every day for 15-20 minutes until the TMJ is easily fatigued, 4-5 times a day. During the break, myogymnastic exercises are performed. Patients continue mechanotherapy until the mouth is fully opened 40-42 mm. The results of treatment are controlled on the basis of clinical, electromyographic studies, examinations of TMJ by magnetic resonance imaging.

Example.

Patient Zh-ba, 45 years old, fell ill in 2003. She connects the disease with a lower jaw injury during a car accident. At the beginning, the patient felt constant aching pain in the right mandibular joint, difficulty opening the mouth for a week. I did not apply for dental care. After a month the pains disappeared, but there were clicks when opening the mouth and eating. In 2005, the patient felt jammed in the right TMJ. The movements of the lower jaw in different directions set it in place. Then blockages in the joint became more common. In 2007, the patient got jammed in the right TMJ, after which she could not put the meniscus in its place. When opening the mouth, the lower jaw shifted to the right, there was a restriction in movement, pulling pains. Within two years, the opening of the mouth decreased, it became within 1 cm, pain in the right TMJ intensified and the patient was forced in December 2009 to contact the Department of Orthopedic Dentistry of KSMU. After a clinical examination and magnetic resonance imaging, the diagnosis was made: right-sided fibrous ankylosis of TMJ. Under conduction anesthesia according to Bershe-Dubov, fibrous adhesions were manually broken. The opening of the mouth was reached up to 3 cm. A spacer was made of self-hardening plastic and installed in the oral cavity on the chewing teeth on the affected side. The patient used the wedge-shaped strut for 3 days at night - constantly, and wore 1 hour during the day with an hour break. During the break, the patient performed mechanotherapy with the help of our apparatus and a set of myogymnastic exercises. From the first days after the redress, TES therapy was carried out for 10 days. After 20 days from the start of treatment, the patient could open her mouth to a physiological norm of 4.0 cm, pain in the right TMJ disappeared and freedom of movement of the lower jaw appeared in the vertical, sagittal and transverse directions. The lower jaw was established in the midline of the face; opening the mouth free, without bias. The synchronization of the contraction of the masticatory muscles, the range of movements of the lower jaw, which is clinically, electromyographically and examined by magnetic resonance imaging, are fully restored.

The device was tested for 3 years for 65 patients with diseases accompanied by limitation of mouth opening and stiffness in the TMJ. It was found that the use of the device allows you to gradually open your mouth to physiological norms, to ensure the full range of movements of the lower jaw, biomechanics of TMJ, and in combination with TES-therapy halves the duration of treatment and medical and social rehabilitation of patients. It is recommended for widespread use in practical dentistry.

Claims (1)

Apparatus for mechanotherapy for dysfunctional syndromes, arthrosis and ankylosis of the temporomandibular joints, having spoons for impressions from the jaw, a spring, characterized in that the apparatus contains a cylindrical body equipped with a spring connected by a cable to the handle and parallel rods located perpendicular to the axis of the body and springs, rods are mounted to move along grooves and slots coaxial with the housing in the reciprocating and perpendicular directions and are enclosed in a casing and their ends rigidly connected to the impression spoon on the lower jaw; a pair of also perpendicularly located rods to the spoon on the upper jaw are fixed on the screw-nut of the case, which at the ends have the ability to tilt the spoon by 10-15 °, and the spoons are filled with a silicone mass with an individual impression.

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