Yatsenko P. Muscle and Joint Compression-Dislocation Dysfunction of the Temporomandibular Joint, Peculiarities of Clinical Diagnostics and Treatment Qualifying

The object of the study is the clinical-functional and radio-anatomical characteristics of the masticatory musculoskeletal complex in patients with compression-dislocation dysfunction of the TMJ. On the ground of annual reports of the clinic KU POCSKSP of orthopedic dentistry with implantology and the Department of Surgical Dentistry and Maxillofacial Surgery with Plastic and Reconstructive Surgery of the Head and the Neck for the period of four years (2015-2018) for patients with dysfunctional states of the TMJ it has been proven that muscle and joint compression-dislocation dysfunction ranks second after occlusal and articulatory pathologies and makes 33.57% of the total amount of medical care encounters due to TMJ pathology. Total number of the patients with newly diagnosed compression-dislocation dysfunction of the TMJ, who have never had orthopedic pathology and who underwent complex examination and treatment, amounted to 115 persons aged from 19 to 45 years. For differential diagnosis 29 patients with hypermobility of articular heads and12 patients with muscle and joint contracture of the TMJ were included to the scientific research. Intact group was composed of 14 patients of the same build and weight with the difference of ± 2.2 kg aged 24 – 36 years with physiological occlusion. Out of 115 patients with muscle and joint compression-dislocation dysfunction of the TMJ 47 patients were diagnosed with light, 42 with moderately severe and 26 with severe stage of the disease. During examination along with conventional methods of clinical examination functional examination of the salivary glands was applied, which involved general sialometry, sialometry of parotid glands with study of physicochemical characteristics of the saliva; psychometric testing: VAS scale of pain; electromyography of mastication muscles and temporal muscles to determine the degree of functional disturbances of the muscles; orthopantomography, periapical X-ray, CT of the TMJ; MRI of the joints to specify anatomic changes in the components of the TMJ; taking photos of the face and occlusion of the patients. Statistical processing of the results was carried out using the Microsoft Office Excel software package in the Real Statistics 2019 extension. To check the distribution of signs for normality, the Shapiro-Wilkie test was used, followed by pairwise comparison according to Student's criteria. When distributing traits that differed from normal, an analysis using the Khruskal-Wallis method followed by a paired Mann-Whitney comparison was used. To analyze the groups before and after treatment, the Wilcoxon test was used. The author indicates the scientific novelty of the study: it is proved that among the occlusal, post-traumatic, neurogenic dysfunctions of the TMJ, dysfunctional states at anomalies of the bite, hypermobility of the joint heads, musculoskeletal compression-dislocation dysfunction of the TMJ occupies the first place along with the pain symptom. For the first time it is proved that musculoskeletal compression-dislocation dysfunction of the TMJ is caused by the phenomena of compression of one of the articular heads on the bilaminar area with clearly expressed manifestations of myalgia. On the opposite side, this determines the inadequate dislocation of the articular head to the front; it is proved that in patients with musculoskeletal compression-dislocation dysfunction of the TMJ there are disturbances of the bioelectric activity of the motor fibers of the actual masticatory and temporal muscles both on the side of the compression and on the side of the dislocation of the joint head with the phenomena of paradoxical reactions; it is established for the first time that the functional state of salivary glands is related to the level of pain symptom and muscular activity in patients with TMD; it is proved for the first time that in patients with muscular-articular compression-dislocation TMJ dysfunction, computer-assisted X-ray and magnetic resonance imaging shows asymmetry of the location of the articular heads of the varying degree with respect to the articular tubercle and the articular fossa. In some patients, the probable cause of musculoskeletal compression-dislocation dysfunction of the TMJ may be asymmetry of the sizes and forms of articular heads of the lower jaw; it is established that the development of muscular-articular compression-dislocation dysfunction of the TMJ in the absence of absence of defects and deformations of dental arches is greatly influenced by the mechanical disruption of the capsule (according to MRI data) and unilateral masticatory muscle overload; the hypothesis of musculoskeletal compression and dislocation dysfunction of TMJ is proposed; for the first time, on the basis of the revealed pathogenesis of musculoskeletal compression-dislocation dysfunction of TMJ, methods of treatment of the disease have been developed and put into practice.