VNChS dysfunction – the functional pathology of a temporal and mandibular joint caused by muscular, okklyuzionny and spatial violations. Dysfunction of VNChS is followed by a pain syndrome (head, temples, neck pain), clicks in a joint, restriction of amplitude of opening of a mouth, noise and a ring in ears, a dysphagy, a bruksizm, snore etc. The technique of inspection of patients with dysfunction of VNChS includes studying of complaints, the analysis of plaster models of jaws, an orthopan-tomography, a X-ray analysis and a tomography of VNChS, an electromyography, a reoartrografiya, a fonoartrografiya, etc. Treatment of dysfunction of VNChS is carried out taking into account the reasons and can consist in a soshlifovyvaniye of supercontacts of teeth, the correct prosthetics, correction of a bite, carrying caps or the articulate tire, performing surgical treatment.
VNChS dysfunction – violation of coordinate activity of a temporal and mandibular joint owing to change of occlusion, interposition of the VNChS elements and function of muscles. Statistically, from 25 to 75% of patients of stomatologists have symptoms of dysfunction of VNChS. In structure of pathology of maxillary pathology of dysfunction of VNChS the leading place - more than 80% belongs. For the first time communication between dysfunction of a temporal and mandibular joint and ear-aches was noticed by the American otolaryngologist James Kosten in the 30th of last century why VNChS dysfunction is often called Kosten's syndrome. Also in medical literature dysfunction of VNChS meets under names musculoarticulate dysfunction, painful dysfunction, VNChS mioartropatiya, dysfunction of the lower jaw, the "clicking" jaw, etc.
VNChS dysfunction reasons
Treat the main theories of developing of dysfunction of VNChS okklyuzionno-articulation, miogenny and psychogenic. According to the okklyuzionno-articulation theory, the reason of dysfunction of VNChS are covered in zubo-maxillary violations which can be caused by defects of tooth alignments, pathological erasability of teeth, the jaw injuries, the wrong bite, incorrect prosthetics, various anomalies of teeth and jaws which are followed by reduction of height of an alveolar shoot.
According to the miogenny theory, development of dysfunction of VNChS is promoted by violations from maxillary muscles: a tonic spasm, a mechanical overload of chewing muscles, etc., caused by the unilateral type of chewing, a bruksizm, a bruksomaniya, professions connected with big speech loading that finally leads to a chronic microtrauma of the VNChS elements.
The psychogenic theory considers VNChS dysfunctions, that as the factors initiating VNChS dysfunction changes from aspect of activity of TsNS (psychological and physical tension), defiant dysfunction of muscles and violation of kinematics of a joint act.
According to most of researchers, the triad of factors is the cornerstone of dysfunction of VNChS: violation of occlusion, spatial relationship of the VNChS elements, change of a tone of chewing muscles. As the factors contributing to developing of dysfunction of VNChS serve anatomic prerequisites of a structure of a joint, mainly, discrepancy of a form and the sizes of an articulate head and articulate pole.
VNChS dysfunction symptoms
The classical simptomokompleks of dysfunction of VNChS described by J. Kosten is characterized by dull aches in a temporal and mandibular joint; clicking in a joint during meal; dizziness and headache; pain in cervical department of a backbone, a nape and ears; noise in ears and decrease in hearing; burning in a nose and a throat. Now diagnostic criteria of dysfunction of VNChS it is considered to be the following groups of symptoms:
1. Sound phenomena in a temporal and mandibular joint. The most frequent complaint of patients with the VNChS difunction are the clicks in a joint arising when opening a mouth, chewing, a zevaniye. Clicking can sometimes be so loud that it is heard by surrounding people. At the same time joint pain is present not always. Among other noise phenomena the crunch, a krepitation clapping sounds and so forth can take place.
2. Blocking ("locking", "jamming") of a temporal and mandibular joint. It is characterized by unevenness of the movement in a joint when opening a mouth. That is widely to open a mouth, the patient has to catch at first optimum position of the lower jaw, move it here and there, having found a point where the joint "opens".
3. Pain syndrome. At dysfunction of VNChS morbidity in trigger points is defined: chewing, temporal, hypoglossal, cervical, wing-shaped, - clavicular and mastoidal, trapezoid muscles. The prozopalgiya (front pain), headaches, ear pains, a toothache, pressure and eye pain are typical. The pain syndrome at dysfunction of VNChS can imitate neuralgia of a trigeminal nerve, cervical osteochondrosis, VNChS arthritis, otitis and other diseases.
4. Other symptoms. At dysfunction of VNChS can take place of dizziness, a sleep disorder, a depression, a bruksizm, a dysphagy, noise or a ring in ears, a kserostomiya, a glossalgiya, paresteziya, photophobia, snore, in a dream, etc.
Diagnosis of dysfunction of VNChS
The variety of clinical displays of dysfunction of VNChS results in difficulties of diagnostics therefore patients can is long to be examined by the neurologist, the otolaryngologist, the therapist, the rheumatologist and other experts. Meanwhile, patients with dysfunction of VNChS need joint cooperation of the dentist and neurologist.
At primary survey of the patient complaints, the anamnesis of life and a disease become clear, the palpation and an auskultation of area of a joint is carried out, extent of opening of a mouth and mobility of the lower jaw is estimated. In all cases removal of molds is made for the subsequent production of diagnostic models of jaws, okklyudogramma are carried out.
For assessment of a condition of a temporal and mandibular joint the orthopan-tomography, ultrasonography, VNChS X-ray analysis, a computer tomography of VNChS is carried out. For the purpose of identification of defeat of circumarticular soft fabrics MRT VNChS is shown. Definition of indicators of arterial haemo dynamics is made by doppler sonography or a reoartrografiya. From functional researches at VNChS dysfunction the electromyography, a fonoartrografiya, a gnatodinamometriya have the greatest value.
Treatment of dysfunction of VNChS
For the main treatment patients with dysfunction of VNChS need reduction of load of a temporal and mandibular joint (meal of a soft consistence, restriction of speech loading). Depending on the reasons and the accompanying violations, various experts can participate in treatment of dysfunction of VNChS: stomatologists (therapists, orthopedists, orthodontists), manual therapists, vertebrolog, osteostalemates, neurologists, psychologists.
For elimination of the pain syndrome accompanying VNChS dysfunction the pharmacotherapy (NPVS, antidepressants, sedatives, a botulinoterapiya, blockade, intra articulate injections of glucocorticosteroids), the dosed miogimnastika, massage, physical therapy is shown (laser therapy, an induktotermiya, an electrophoresis, ultrasound, etc.). Important elements of complex therapy can be psychotherapy and it is BAREFOOT - therapy, allowing to reach functional relaxation of chewing muscles.
Dental treatment of dysfunction of VNChS according to indications can include the measures directed to a reconstruction of the correct smykaniye of teeth (a selective prishlifovyvaniye of teeth, elimination of the overestimating seals, competent prosthetics or reprosthetics and so forth). For correction of the wrong bite treatment by means of breket-systems is carried out. In certain cases orthopedic and orthodontic treatment of dysfunction of VNChS fixed devices is preceded by carrying orthopedic tires or a cap.
In case of lack of effect of conservative therapy of dysfunction of VNChS surgical intervention can be required: miotomiya of a lateral wing-shaped muscle, kondilotomiya of a head of the lower jaw, artroplastik, etc.
Forecast and prevention of dysfunction of VNChS
Treatment of dysfunction of VNChS is obligatory. The neglect this problem can be fraught with development of dystrophic changes (arthrosis) and immobilization of a temporal and mandibular joint (anchylosis). Complex treatment of dysfunction of VNChS taking into account etiologichesky factors guarantees positive result.
The prevention of dysfunction of VNChS demands decrease in level of a stress and excess loads of a joint, timely and high-quality prosthetics of teeth, correction of a bite, correction of violations of a bearing, treatment of a bruksizm.