RU2750014C1 - Method for treating hypertension of the masticatory muscles in patients with a reduced lower part of the face using elastic bands - Google Patents

Abstract

FIELD: dentistry.SUBSTANCE: invention relates to dentistry and can be used in patients with reduced height of the lower part of the face with the presence of hypertension of the actual masticatory muscles. To do this, first, when palpating the actual masticatory muscles, the location of the trigger point is determined at the moment of maximum tension when the dentition is closed in the position of central occlusion. The point is in the form of a dense formation and its projection is marked with a marker on the skin. The distance from the head of the lower jaw towards the wing of the patient's nose is measured, not reaching about 0.5-1 cm, depending on the size of the patient's face, to ensure that the actual chewing muscle is covered with a Y-shaped elastic tape, which provides the therapeutic effect of the application. A section of the tape of the corresponding length is cut off with the application on the reverse side of the line corresponding to the initial section of the tape with a length of 1.5 cm, as well as a line dividing it into two equal parts. The tape is cut along the center line so that it becomes Y-shaped. The patient is asked to open his mouth as much as possible and turn his head in the direction opposite to the application. The initial section of the tape is fixed without tension on the temporomandibular joint area, not reaching 2-3 mm, depending on the size of the patient's face, to the head of the lower jaw. The upper strip of tape is glued in the direction from the head of the lower jaw to the wing of the nose, not reaching 0.5-1 cm, with a tension equal to 35-45%, depending on the age of the patient and the size of his face. The lower strip is fixed in the direction from the head of the lower jaw, parallel to the body of the lower jaw, to the chin with a tension equal to 35-45%. The tape is fixed perpendicular to the masseter muscle itself. At the end of the application, iron the tape with your hand, warming it up. The same is done on the opposite side of the patient's face. Impressions are taken from the upper and lower jaws to create a tray in an individually adjustable articulator. The mouthguard is applied 7 days after fixation of the tapes. The patient uses the mouthguard 24 hours a day, removing it during meals and personal oral hygiene. The course of treatment with elastic bands is 42 days, mouthguards - 35 days. At the end of the elastic tape, the patient removes it on his own. Each application lasts for three days over a period of 6 weeks, with a one-day break after every two applications.EFFECT: provides effective treatment of hypertension of the masticatory muscles proper due to the combination of the use of elastic bands and mouth guards, which is due to the selective functioning of certain muscles or their groups, normalization of the distance between the places of attachment of the masticatory muscles, normalization of the height of the lower part of the face, and also provides rapid relief of pain before use mouthguard.2 cl, 2 ex, 15 dwg

Description

The invention relates to dentistry and can be used for disorders of the actual chewing muscles and temporomandibular joint (TMJ), mainly in patients with reduced height of the lower part of the face.

The problem of providing medical dental care to patients with hypertension of the masticatory muscles proper has been studied for a long time, but there is still no single treatment regimen for this pathology of the masticatory apparatus.

There is a known method of treating pain dysfunction and arthrosis of the TMJ using elastic tapes (Iordanishvili A.K., Serikov A.A.Kinesio taping in periodontology and dental arthrology. Periodontology. 2018; 24 (3): 80-83). Elastic bands eliminate the use of the chin-parietal bandage during sleep, which is necessary to immobilize the lower jaw. Keskinruzgar A., Kucuk A.O., Yavuz GY, Koparal M., Caliskan ZG, Utcun M. (Comparison of kinesio taping and occlusal splint in the management of myofascial pain in patients with sleep bruxism.Journal of back and musculoskeletal rehabilitation. 2018; 1: 1-6) suggested the use of elastic bands for hypertension of the actual masticatory muscles, bruxism as monotherapy.

The disadvantage of the known methods is that they did not take into account the degree of abrasion of the hard tissues of the teeth. However, as you know, patients suffering from hypertension of the masseter muscles themselves often have an increased abrasion of the dentition, and, consequently, a decrease in the height of the lower part of the face. It is impossible to achieve a harmonious relationship between the three parts of the face only with the use of elastic bands.

The therapeutic effect of elastic bands is based on the creation of favorable conditions for improving sanogenetic processes, which are realized through mechanisms of pain reduction, normalization of microcirculation, restoration of functional muscle activity, enhancement of proprioception through stimulation of cutaneous mechanoreceptors, normalization of joint function and elastic properties of the fascia. The use of elastic bands reduces muscle spasticity, relieves pain [Ponomarenko GN, Physical and rehabilitation medicine [Electronic resource]: national leadership / Ed. G.N. Ponomarenko - M .: GEOTAR-Media, 2020. - 688 p.].

For many years, in the rehabilitation of patients with hypertension of the masticatory muscles, a mouthguard, a plastic apparatus that serves to separate the dentition, has been used. The mechanism of action of mouthguards in disorders of the masticatory muscles is based on the normalization of the reflex connection between the central nervous system and the masticatory muscles.

A number of domestic [Arsenina O. I., Komarova A. V., Popova N. V., Egorova D. O. The use of an elastocorrector to eliminate discoordination of the work of the masticatory muscles in patients with dysfunction of the temporomandibular joint. Dentistry. 2020; 99 (2): 61-65] and foreign [Zhang F., Wang X., Dong J, Zhang J., Lu Y. Effect of occlusal splints for the management of patients with myofascial pain: a randomized, controlled, double- blind study. Chin Med J. 2013; 126: 2270-2275] scientists in the complex therapy of patients with hypertension of the masticatory muscles prefer mouthguards to achieve their relaxation.

Indications for the use of mouth guards are:

• hypertension of the masticatory muscles;

• pain in the chewing muscles and TMJ;

• clicking in the temporomandibular joint;

• optimization of the ratios of the temporomandibular joint elements;

• normalization of the position of the lower jaw in three mutually perpendicular planes (sagittal, transversal and vertical).

There are three main stages in the treatment with mouthguards.

The first stage - search and diagnostic, consists in finding the optimal position of the lower jaw and the height of the lower part of the face.

The second stage - active treatment - implies the restructuring of the dynamic stereotype of the masticatory muscles, including the extinction of the myostatic reflex and the complete adaptation of the patient to the new position of the lower jaw. This is achieved by normalizing the distance between the insertion sites of the masticatory muscles. The aligners provide a stable establishment of the height of the functional rest of the masticatory muscles with the appearance of an interocclusal distance, the restoration of the optimal position of the lower jaw in the skull.

The third stage is retention. Prosthetics is performed according to a given position of the lower jaw.

The disadvantage of using mouth guards is the impossibility of quickly eliminating pain and hypertension of the masticatory muscles.

The objective of the invention is to create a method for treating hypertension of the masseter muscles proper in patients with reduced height of the lower part of the face by using combined therapy - using mouth guards and elastic bands.

The problem is solved by the proposed method for treating hypertension of the masseter muscles proper in patients with reduced height of the lower part of the face.

The invention is illustrated by photographs, where in FIG. 1 - Elastic tapes Kinexib Ultraviolet, fig. 2 - Finding the trigger point of the masseter muscle proper, in Fig. 3 - Determination of the size of the application area, FIG. 4 - Selecting the size of the elastic band. The marking of the elastic band, in Fig. 5 - Creation of a Y-shaped elastic band, FIG. 6 - Rupture of the base paper of the initial section of the elastic band, FIG. 7 - Fixation of the initial section of the tape in the area of the temporomandibular joint, in Fig. 8 - Fixing the top strip of the Y-shaped tape. Shows the degree of tension of the upper strip of the Y-shaped tape, in Fig. 9 - Fixation of the lower strip of the Y-shaped elastic band, FIG. 10 - Fixed elastic band in the area of the right own masseter muscle. The resulting folds of the elastic band are shown, showing the application of the elastic band with tension, FIG. 11 - The dentition of the patient P. in the position of functional rest, in Fig. 12 - (a, b). The occlusal surface of the upper (a) and lower (b) dentition, in Fig. 13 - Y-shaped elastic bands applied to the area of the right and left masseter muscles and the mouthguard in the oral cavity, FIG. 14 - Patient P. before treatment with a mouthguard. The functional height of the lower face was 44 mm, in FIG. 15 - Patient P. after treatment with a mouthguard. The functional height of the lower face has increased to 50 mm.

In order to test the application of elastic bands in a clinical setting, 103 patients (37 men and 66 women) aged 21 to 65 years (mean age 33.2 ± 5.7) were examined. The average duration of functional disorders of the masticatory muscles proper in the entire group was 3.1 ± 2.1 g.

Evaluation of the effectiveness of treatment was carried out by analyzing the changes in patients' complaints, the dynamics of the intensity of the manifestation of pain symptoms in the actual masticatory muscles using the VAS, as well as the bioelectric picture of the actual masticatory muscles. Statistical data processing was carried out using the IBM SPSS Statistics 24 software (IBM, USA).

The proposed method for the treatment of hypertension of the actual masticatory muscles in patients with reduced height of the lower part of the face using elastic bands is disclosed in clinical examples.

Example 1. Patient U., 74 years old, complained of pain and fatigue in the actual chewing muscles. Symptoms, according to the patient, appeared about 5 years ago. The main diagnostic methods were clinical (questionnaires using a visual analogue scale of pain) and paraclinical (electromyography).

Objectively. An external examination of the face showed a decrease in the height of the lower part of the face, deepening of the nasolabial and chin folds. The mouth opening was 38 mm.

There was a deformation of the occlusal surfaces of the teeth of the lower jaw.

The intensity of pain in the actual masticatory muscles according to the VAS scale was 8.2 points. The nature of the pain was aching, arising both at rest and during movements of the lower jaw. There were hypertension of the actual chewing muscles, rapid fatigue of the actual chewing muscles, blocking of movements of the lower jaw, and limited opening of the mouth (38 mm). On palpation, trigger points were identified in the actual masticatory muscles. The patient indicated the frequent occurrence of headache, irritability, and emotional excitability.

An electromyographic study showed that before treatment, in a state of functional rest, the voluntary activity of the masticatory muscles proper was determined with volleys equal to 1.8 μV.

Diagnosis. Hypertension of the actual chewing muscles (bruxism (F45.82).

Treatment with elastic bands is suggested. Each application lasted for three days for 6 weeks, with a one-day break after every two applications.

The primary task in the treatment of a patient complaining of pain in the actual masticatory muscles and TMJ is to relieve the pain symptom. For this, it was decided to use elastic tapes on the area of the actual chewing muscles and temporomandibular joint.

We used elastic tapes Kinexib Ultraviolet (Suzhou Sunmed Co, Ltd, China) approved by Roszdravnadzor (registration certificate for a medical device dated April 26, 2019 No. RZN 2019/8334). The Kinexib Ultraviolet roll consists of 5 cm wide tapes having a tear line every 25 cm (Fig. 1). According to the manufacturer, the elastic bands are 97% viscose and 3% cotton; hypoallergenic acrylic glue is applied to one side of the tape.

Formally, elastic tape can be applied with tension from 0 to 100%, however, the maximum degree of tension (76-100%) is rarely used. When tapes are applied to the TMJ area and the actual masticatory muscles, the degree of tension may vary depending on the tone of the actual masticatory muscles, general physical fitness, face size, age, sex, weight and volume of the patient.

Y-shaped ribbons were used. In this case, the upper strip of the tape should cover the point of origin of the masseter muscle itself (the zygomatic process of the upper jaw and the zygomatic arch), and the lower one - the point of its end (the angle of the lower jaw). The use of other types of tapes (for example, I-shaped) does not allow covering both points of attachment of the masseter muscle itself.

The distance between the upper and lower strips of the Y-shaped tape, fixed on the face of patients, is individual for each of them and depends on the type of structure of the face, its size, shape.

Before the application of elastic tapes, the skin of the face was wiped with an alcohol-containing cleanser, if necessary, the hair was shaved off at the site of application.

Fixation of elastic bands was carried out as follows:

• palpation of the actual masticatory muscles determined the location of the trigger point at the moment of maximum tension when closing the dentition in the position of central occlusion. This point was defined as a dense formation and its projection was marked with a marker on the skin (Fig. 2);

• using a ruler to measure the distance from the head of the lower jaw towards the wing of the patient's nose, not reaching it 0.5 cm (Fig. 3);

• cut a section of the tape to the appropriate length (see the previous point above). On the reverse side of the tape, a line was applied corresponding to the initial section of the tape (1.5 cm long, which was measured with a ruler), as well as a line dividing the tape into two equal parts, which was also measured with a ruler (Fig. 4);

• cut the tape along the center line so that it acquired a Y-shape (Fig. 5);

• proceeded to the direct fixation of the tape. Torn the paper base of the tape in the region of the initial (about 1.5 cm long, as measured with a ruler) section of the tape (Fig. 6);

• to create tension on the skin, the patient was asked to open his mouth as much as possible and turn his head in the direction opposite to the application. Without touching the adhesive base of the tape, its initial section was fixed without tension on the temporomandibular joint area, not reaching 2 mm to the head of the lower jaw, which was measured using a ruler (Fig. 7);

• the upper strip of tape was glued in the direction from the head of the lower jaw to the wing of the nose, not reaching 0.5 cm (as measured with a ruler). With an original belt length of 83 mm, an actual length after tension of 112 mm was obtained. After mathematical calculations, it was revealed that this is 35% higher than the original value of the tape length. Equation made: 83 mm - 100%; 112 mm - x%, x = 112 mm * 100% / 83 mm = 135%, that is, the degree of tape tension increased by 35%.

If trigger points were found on palpation in this area, then they must be covered with tape. The upper strip of tape should cover the starting point of the masseter muscle itself (the zygomatic process of the upper jaw and the zygomatic arch). According to observations, the tension of the elastic tape 35-45% for this category of patients was optimal, since they had hypertonicity of the actual masticatory muscles, a decrease in the functional height of the lower part of the face with the absence of free interocclusal space. In this regard, a correlation was observed between the tone of the actual chewing muscles and the degree of tension of the elastic tape (Fig. 8);

• the lower strip was fixed in the direction from the head of the lower jaw, parallel to the body of the lower jaw, to the chin with a tension equal to 35-45%. If trigger points were found on palpation in this area, then they must be covered with tape. The length of the upper and lower strips of the Y-shaped tape should be the same to prevent deformations (separation) of one of the parts of the tape already fixed (Fig. 9);

• at the end of the application, the tape was ironed by hand, thus warming it up. The criterion for the correct application of the elastic tape with tension is the appearance of folds (Fig. 10);

• the same manipulations were performed on the opposite side of the patient's face.

Upon completion of the action of the elastic tape, the patient independently removed it. Each application lasted for three days for 6 weeks, with a one-day break after every two applications. Already after two weeks, the intensity of pain in the actual masticatory muscles on the VAS scale was 5.1 points.

Positive effects of monotherapy of hypertension of the actual masticatory muscles using elastic bands:

• the proposed method of treating hypertension of the masseter muscles proper using elastic bands implies an increase in the degree of tension up to 35-45% (while Kase K, Wallis J, Kase T, editors. Clinical Therapeutic Applications of the Kinesio Taping Method. 2nd ed. Toyko: Ken Ikai Co Ltd; 2003 recommend applying elastic bands with a tension of 0-15%);

• before direct fixation of the tapes, it is necessary to ask the patient to open his mouth and turn his head in the direction opposite to the application, which creates additional tension on the skin (the criterion of tension is the creation of folds on the tape). This technique contributes to an enhanced lifting effect, and, consequently, an increase in microcirculation in the skin, the underlying connective tissue and the intercellular substance, the elimination of metabolic products, the improvement of lymphatic drainage (in known methods, for example, Benlidayi IK, Salimov F., Kurkcu M., Guzel R . Kinesio Taping for temporomandibular disorders: Single-blind, randomized, controlled trial of effectiveness. Journal of Back and Musculoskeletal Rehabilitation 2016; 29: 373-380 suggest applying elastic bands in the natural position of the head);

• before applying the tapes, it is imperative to palpate the actual chewing muscles in order to find trigger points, which must be covered with an elastic tape (Keskinruzgar A., Kucuk A.O., Yavuz GY, Koparal M., Caliskan ZG, Utkun M. Comparison of kinesio taping and occlusal splint in the management of myofascial pain in patients with sleep bruxism.Journal of Back and Musculoskeletal Rehabilitation 2019; 32 (1): 1-6) paid attention to trigger points only when making a diagnosis);

• the proposed method of applications involves the use of Y-shaped tapes fixed perpendicular to the masseter muscle itself (Keskinruzgar A., Kucuk A.O., Yavuz GY, Koparal M., Caliskan ZG, Utkun M. Comparison of kinesio taping and occlusal splint in the management of myofascial pain in patients with sleep bruxism.Journal of Back and Musculoskeletal Rehabilitation 2019; 32 (1): 1-6 recommend fixing elastic bands parallel to the course of the masseter muscle itself);

• the use of elastic bands contributes to the selective functioning of the actual chewing muscles.

Negative effects of monotherapy of hypertension of the actual masticatory muscles using elastic bands:

• lack of normalization of the height of the lower part of the face;

• no decrease in the severity of nasolabial folds;

• impossibility of creating the height of functional rest of the actual chewing muscles with the appearance of interocclusal distance.

Conclusion: the presence of the negative effects indicated above did not allow to achieve harmonization of the three parts of the face and the possibility of moving to a further stage of orthopedic treatment.

Example 2. Patient P., 63 years old, came to the clinic with complaints of pain, stiffness and tension, the actual chewing muscles, especially after awakening. According to patient P., 3 months after prosthetics with implantation prostheses on the upper and lower jaws, she began to notice a change in the shape of all artificial teeth associated with their wear. The patient also noted a decrease in the height of the lower part of the face, the severity of the nasolabial folds.

The main diagnostic methods were clinical (questionnaires using a visual analogue scale of pain) and paraclinical (electromyography).

Objectively. On external examination of the face, there was a pronounced decrease in the height of the lower part of the face, drooping of the corners of the mouth, the severity of the nasolabial and chin folds. The mouth opening was 28 mm.

The patient was prosthetic with preliminary implantation prostheses for the upper and lower jaws (Fig. 11).

There were marked facets of abrasion on the occlusal surfaces and cutting edges of artificial teeth of implantable prostheses (Fig. 12 a, b).

The intensity of pain in the actual masticatory muscles according to the VAS scale was 9.3 points. The pain was aching, prolonged, occurred both at rest and during movements of the lower jaw. Hypertension of the actual chewing muscles, their stiffness, tension, fatigue, blocking of movements of the lower jaw, and limited opening of the mouth (28 mm) were revealed. On palpation, trigger points were noted in the actual masticatory muscles. During the initial examination, the height of the functional rest of the masticatory muscles proper could not be determined. The patient noted the frequent occurrence of headaches, picky to others, capriciousness.

An electromyographic study showed that before treatment, in a state of functional rest, the voluntary activity of the masticatory muscles proper was determined with volleys equal to 1.4 μV.

Diagnosis. Hypertension of the actual chewing muscles (bruxism (F45.82).

Treatment was prescribed - combined therapy with elastic bands and mouth guards.

The elastic bands were applied the day after the initial examination as described in the previous clinical example. A distinctive feature was that the degree of tension of the elastic band was 45%, which was associated with a high intensity of pain on the VAS scale in the masticatory muscles proper, tension in the muscles, rapidly progressing generalized abrasion of artificial teeth of implantable prostheses.

With an initial belt length of 80 mm, an actual length after tension of 116 mm was obtained. After mathematical calculations, it was found that this is 45% higher than the original value of the tape length. Equation made: 80 mm - 100%;

116 mm - x%, x = 116 mm * 100% / 80 mm = 145%, then

there is a 45% increase in the degree of belt tension.

Each application lasted for three days for 6 weeks, with a one-day break after every two applications. On the day of the initial examination, impressions were taken from the upper and lower jaws to create a splint, which was applied 7 days after fixation of the tapes. The mouthguard was created in an individually adjustable articulator. The patient used the tray 24 hours a day, removing it during meals and personal hygiene of the oral cavity (Fig. 13). The course of treatment with elastic bands was 42 days, mouthguards - 35 days.

Already after two weeks, the intensity of pain in the masticatory muscles on the VAS scale was 3.1 points.

The proposed technique has qualities that distinguish it favorably from other known methods.

Positive effects of treating hypertension of the chewing muscles proper with elastic bands and mouth guards:

• the proposed method of applying elastic bands for the treatment of hypertension of the actual masticatory muscles involves an increase in the degree of tension to 35-45%),

• before direct fixation of the tapes, it is necessary to ask the patient to open his mouth and turn his head in the direction opposite to the application, which creates additional tension on the skin (the criterion is the creation of folds on the tape). This technique contributes to an enhanced lifting effect, and therefore an increase in microcirculation in the skin, the underlying connective tissue and the intercellular substance, the elimination of metabolic products, the improvement of lymphatic drainage, which allows you to quickly normalize the state of the masticatory muscles.

• before applying the tapes, it is imperative to palpate the actual chewing muscles in order to find trigger points, which must be covered with an elastic tape,

• the proposed application technique involves the use of Y-shaped tapes fixed perpendicular to the masseter muscle itself,

• the use of elastic bands in combination with a mouthguard contributes to the selective functioning of the actual masticatory muscles, normalization of the distance between the attachment points of the actual masticatory muscles,

• normalization of the height of the lower part of the face,

• reducing the severity of nasolabial folds,

• creation of the height of the functional rest of the actual masticatory muscles with the appearance of the interocclusal distance,

• elimination of blockage of movements of the lower jaw,

• quick relief of pain symptom (in 1-2 weeks).

The therapeutic effect of elastic bands, according to the literature, is based on the following mechanisms:

• activation of microcirculation in the skin, the underlying connective tissue and intercellular substance, excretion of metabolic products, improvement of lymphatic drainage due to the elastic properties of the tapes due to the provided lifting effect [Kase K, Wallis J, Kase T, editors. Clinical Therapeutic Applications of the Kinesio Taping Method. 2nd ed. Toyko: Ken Ikai Co Ltd; 2003];

• reduction of pain syndrome (in accordance with the theory of portal pain control R. Melzack and P. Wall, 1965) [Williams S, Whatman C, Hume PA, et al .: Kinesio taping in treatment and prevention of sports injuries: a metaanalysis of the evidence for its effectiveness. Sports Med 2012, 42: 153-164. doi: 10.2165 / 11594960-000000000-00000];

• restoration of functional activity of muscles and normalization of joint function by regulating the afferent flow emanating from the proprioceptors of the skin, masticatory muscles and TMJ [Wang Y.-H, Chen S.-M, Chen J.-T., Yen W.-C, Kuan T.-S., Hong C.-Z., The effect of taping therapy on patients with Myofascial pain syndrome: a pilot study. Taiwan Journal of Physical Medicine and Rehabilitation, 2008, 36 (3): 145-150].

The mechanism of action of mouthguards in disorders of the masticatory muscles is based on the normalization of the reflex connection between the central nervous system and the masticatory muscles. As a result, a restructuring of the dynamic stereotype of the masticatory muscles occurs, including the extinction of the myostatic reflex and the complete adaptation of the patient to the new position of the lower jaw. This is achieved by normalizing the distance between the insertion sites of the masticatory muscles. The mouthguards provide a stable establishment of the height of the functional rest of the masticatory muscles with the appearance of the interocclusal distance, the restoration of the optimal position of the lower jaw in the skull [Bulycheva EA, Trezubov VN, Chikunov C.O., Shpynova A.M., Alpatieva Yu.V. Analysis of the results of instrumental treatment of patients with hypertension of the masticatory muscles. Forum of Practicing Dentists. 2013, 1: 4-15].

After normalization of the height of the lower part of the face and elimination of hypertension of the actual masticatory muscles using elastic bands and mouth guards, the preparatory stage of the patient's treatment was completed, which made it possible to proceed with the continuation of orthopedic treatment (Fig. 14, 15).

The proposed method for the treatment of hypertension of the actual masticatory muscles in persons with a reduced lower part of the face allows you to simultaneously eliminate hypertension of the actual masticatory muscles, normalize the height of the lower part of the face, accelerate pain relief, bring the state of the masticatory muscles to physiological norm, and eliminate the possibility of relapses.

Claims (3)

1. A method of treating hypertension of the masseter muscles proper in patients with reduced height of the lower part of the face using elastic bands, including the use of a mouthguard, characterized in that first, when palpating the actual masticatory muscles, the location of the trigger point is determined at the moment of maximum tension when closing the dentition in the central position occlusion, and the point is defined as a dense formation and its projection is marked with a marker on the skin, then using a ruler measure the distance from the head of the lower jaw towards the wing of the patient's nose, not reaching it about 0.5-1 cm, depending on the size of the face the patient to cover the actual chewing muscle with a Y-shaped elastic tape, providing the therapeutic effect of the application, then a section of the tape of the appropriate length is cut off, a line corresponding to the initial section of the tape 1.5 cm long is applied to the reverse side of the tape, as well as a line dividing it into two equal parts, after which I cut t the tape along the central line so that it acquires a Y-shape, to create tension on the skin, ask the patient to open his mouth as much as possible and turn his head in the opposite direction from the application, without touching the adhesive base of the tape, fix its initial section to the TMJ area without tension, do not reaching 2-3 mm, depending on the size of the patient's face to the head of the lower jaw, the upper strip of tape is glued in the direction from the head of the lower jaw to the wing of the nose, not reaching it 0.5-1 cm, with a tension equal to 35-45% depending on the patient's age and the size of his face, the lower strip is fixed in the direction from the head of the lower jaw, parallel to the body of the lower jaw, to the chin with a tension equal to 35-45%, and the tape is fixed perpendicular to the chewing muscle itself, at the end of the application, the tape is ironed by hand, thus warming it up, the same manipulations are carried out on the opposite side of the patient's face, at the initial appointment, impressions are taken from the upper and lower jaws to create a mouthguard in an individually adjustable articulator, which is applied 7 days after fixing the bands, the patient uses the mouthguard 24 hours a day, removing it during meals and individual oral hygiene, and the course of treatment with elastic bands is 42 days, mouthguards - 35 days, after the end of the elastic tape, the patient removes it on his own, while each application lasts for three days for 6 weeks with a one-day break after every two application procedures. 2. The method according to claim 1, characterized in that if trigger points were found during palpation in the area of the upper strip of the tape, then they must be covered with a tape, and the upper strip of the tape should cover the point of origin of the masseter muscle itself - the zygomatic process of the upper jaw and zygomatic arch. 3. The method according to claim 1, characterized in that if trigger points were found on palpation in the region of the lower tape, then they must be covered with a tape, and the length of the upper and lower bands of the Y-shaped tape must be the same to prevent deformations, separation already fixed to one of the parts of the tape.

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