Inter relation of Craniomandibular disorders and vertebral spine. Case report

Understanding the complex inter relation of Craniomandibular disorders require a wide comprehension not only on anatomy and physiology of head and neck, but also of the vertebral spine.

The cervical spine is the flexible link between the head and the trunk.

1 FOTO

The patient consults in the clinic with strong complaints of: Ache in the top of the head, frontal ache, pain in the back of the head, scalp ache, pain in the eyebrow zone, ache behind the eyes, shoulder ache.

2 FOTO

Cervical pain, numbness and tingling in the hands and fingers. Pain in both TMJ (temporomandibular joints)

Dizziness, blocked ears sensation.

Ringing ears

3 FOTO

Constant difficult to open the mouth

Difficult for mastication

Bruxism.

When she was 4 years old she had a car accident and was thrown out of the vehicle.

SHE RELATES INTENSE HEADACHE SINCE INFANCY.

4 A DENTES

The patient relates that when she was fourteen years old she had “maxillary cists” and many teeth where extracted

She began to break frontal teeth when she was twenty years old. Prostheses where constructed but the sensation was that anything fixed.

5 DENTES

She continued with headache.

4 B ELECTRO HABITUAL 1 CORTADA

Surface electromyography, dynamic record in habitual occlusion. In this protocol we ask to the patient to open the mouth, to close, bite strong and swallow. In this electromyographic record we measure 8 muscles: Right and left anterior temporalis, right and left masseters, right and left superior trapezius and right and left digastrics. We observe very low activity of the superficial temporalis right and left and an almost absence of activity in both masseters. Both digastrics show activity when the patient is biting, what is not physiologic because the digastrics are muscles that work in mouth opening and NOT in mouth closing.

6 PANORAMICA

In the radiographic exam we observe the absence of dental elements 16, 15,22,26,27,38,36,46 and 47. Other dental permanent elements are present

The panoramic radiograph shows the asymmetry of the corps and the ramus of the mandible

7 LAMINOGRAFIA

TMJ laminography of the patient before treatment in habitual occlusion and opening. Asymmetry of the articular cavities. Important asymmetry of the mandibular heads.

7 LAMINOGRAFIA COR

Significant flattening of the anterior surface of the articular process in the left side. Anterior angulation of the articular process of the right side and flattening of the posterior and anterior surfaces.

Structural modifications of the mandibular condylar process as one of the sequels of traumatism in infancy http://www.craniomaxillary.com

8 CERVICAL INICIAL CRISTIANE KELLY

The cervical spine is the flexible link between the head and the trunk.

The cervical spine gives sustainability to the cranium and guarantees the movement. Any dysfunction of this balance can provoke pain.

REMEMBER WHEN PATIENT WAS FOUR YEARS OLD SHE HAD A CAR ACCIDENT AND WAS THROWN OUT OF THE VEHICLE.

An often overlooked result of sudden hyperextension or hyperflexion of the cervical muscles is the trauma to the intra-articular structures of the temporomandibular joint. The damage is caused by force acting on connecting structures of different mass and weight. The difference in velocity between cranium and mandible which is in a muscle ligamentous sling during hyperflexion or hyperextension can cause stretching, tearing or overt detachment of the posterior and lateral ligaments of the temporomandibular joint. This factor, in itself, can cause anterior and medial displacement of the articular disc.

8 CERVICAL INICIAL CRISTIANE KELLY

Loss of the physiologic cervical lordoses of the patient, inter-vertebral spaces diminishing, increase of the space between the posterior arc of the atlas and the occipital

9 FRONTAL-1

Frontal radiograph of the patient in habitual occlusion. ROCABADO (1984) refers that the ideal position for the head in space depends on three planes: bipupilar plane, otic plane and occlusal transverse plane. These three planes keep a horizontal and parallel relation that assures postural stability for the cranium. Is evident that this premises are not present in this patient.

10 RESSONANCIA DIR E ESQU

One of the slices of the MRI in closed mouth shows a small disc with and anterior displacement on the right side. In the open slice of the RNM (not included in this post) the disc is not recaptured on the right side.

Significant flattening of the anterior surface of the articular process in the left side.

Anterior angulation of the articular process of the right side and flattening of the posterior and anterior surfaces. Structural modifications of the mandibular condylar process as one of the sequels of traumatism in infancy www.craniomaxillary.com

11 BITE

Her masticatory muscles were electronically deprogrammed with an electronic mandibular deprogrammer.

A jaw tracker then registered a neurophysiologic position from where an intraoral appliance was constructed and tested with SEMG (Surface Electromyography)

We consider not only the jaw tracker information after the electronic deprogramming but fundamentally the information of the MRI for the decision of the bite record for the tridimensional construction of the intraoral device.  For this we use the neurophysiologic technique of Dr. Learreta.

The patient presents a pathological free way space of 9,2 mm and a mandibular retro position of 5,2 mm.

12  B DENTES-1ORTOSE

With this data we construct an intraoral device tested electromiographically to support the new neurophysiological occlusion

12 B ELECTRO com DIO 1 CORT

Dynamic Surface electromyography record wearing the DIO (Intra Oral Device) constructed in neurophysiologic position. In this protocol we ask to the patient to open the mouth, to close, to bite strong and swallow WITH THE DEVICE IN THE MOUTH

In this electromyographic record we measure 8 muscles: Right and left anterior temporalis, right and left masseters, right and left superior trapezius and right and left digastrics. We observe the activity in both superficial temporalis and in both masseters and the reduction of the digastrics activity when the patient is biting.

Even is not an ideal record when we compare with the initial record in habitual occlusion shows the progress of the treatment, in the first record the patient could not activate her masseters. This shows a strong tool in the control of the treatment.

13 A LAMINOGRAFIA COMPARATIVO CRISTIANE KELLY

Patient´s comparative laminographies: initial in habitual occlusion where we can observe the retro position of the mandibular heads and with the intraoral device in neurophysiological position with a tridimensional decompression of the retrodiscal space.

13 B electros comparativas

Patient’s electromyographic records comparison (A) in habitual occlusion and (B) with the device in neurophysiological position.

14 FOTO COMPARATIVA FRONTAL

Patient’s frontal postural image in habitual occlusion and with the device in neurophysiological position. Tridimensional recovery of the vertical dimension. Improvement of the head and shoulder posture.

15 CERVICAL COMPARATIVO CRISTIANE KELLY

As the occlusal vertical dimension is amended IN BALANCE WITH MASTICATORY MUSCLES AND TEMPOROMANDIBULAR JOINTS, a significant change in the cervical posture happens that need to be evaluated and follow by trained professionals in this area

16 FOTO COMPARATIVA PERFIL

Patient’s postural lateral imagesin habitual occlusion and with the device in neurophysiological position. Tridimensional recovery of the vertical dimension. Improvement of the head and shoulder posture.

17 COLUNA E PERFIL COMP

Postural lateral images and lateral radiographs and cervical spine in habitual occlusion comparison with the device in neurophysiological position. IMPROVEMENT OF THE CERVICAL SPINE.
 As the occlusal vertical dimension is amended in balance with masticatory muscles and temporomandibular joints, a significant change in the cervical posture happens that need to be evaluated and follow by trained professionals in this area.

DEPOIMENTO

I searched for the Clinicamy to calm down my pain. The headache began since childhood. Nothing was ever found, a lot of exams, medications and no results.

Approximately with 14 or 15 years old I had cists in the mouth and loose some teeth. Before that, with 4 years old I had a car accident and I was thrown out of the vehicle.

Probably then everything began. Because I grinded my teeth ( I didn´t perceive that) I began to lose other teeth.

DEPOIMENTO 2

Pain increased, pressure in the neck and head, spine, and knees. Misalignment of the spine with dehydration of the vertebral discs, arthrosis signals in C4-C5, C5-C6, e C6-C7. I was recommended by my dentist Dr João de Souza to search an alternative for my pain, at that time he was wearing a DIO for the treatment of a TMJ dysfunction with Dr. Lidia Yavich.

In that time he didn´t treat TMJ Pathologies, today he studied how to treat cases like mine.

That was the salvation for my pain. The treatment propitiated a better quality of life.

In this moment when muscles, temporomandibular joints and occlusion are in balance, the patient will initiate a neurophysiological rehabilitation treatment with implants and prostheses.

5 thoughts on “Inter relation of Craniomandibular disorders and vertebral spine. Case report

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