The effectiveness of orthodontic and osteopathic correction in patients with dental anomalies and musculoskeletal dysfunction of the temporomandibular joint in the presence of concomitant somatic dysfunctions and without it

Introduction. The influence of the dental apparatus on the balance of the body in an upright position has been widely discussed in the literature for several decades. Examination of the patient taking into account his postural balance makes it possible to clarify the reasons for the low effectiveness of pain syndromes treatment of the craniocervical region caused by malocclusion, as well as ineffective correction of musculoskeletal dysfunction of the temporomandibular joint (MSD TMJ) associated with posture disorders.The aim of the study is to evaluate the effectiveness of treatment of patients with dental anomalies and musculoskeletal dysfunctions of the temporomandibular joint and concomitant somatic dysfunctions (if any) by methods of orthodontic and osteopathic correction.Materials and methods. The study involved 102 patients aged from 18 to 45 years with TMJ. All patients underwent orthodontic and osteopathic examination. 3 groups of patients were formed: № 1 — exclusively with dental anomalies TMJ (occlusive dysfunction), who received only orthodontic treatment, № 2 with concomitant somatic (extra-occlusive) dysfunctions, who received only orthodontic treatment, and №3 with concomitant somatic (extra-occlusive) dysfunctions, who received both orthodontic and osteopathic treatment. Orthodontic treatment of musculoskeletal dysfunction of the TMJ consisted of the occlusive kappa manufacturing. Osteopathic correction was carried out individually, taking into account the identified somatic dysfunctions, on average 3 sessions. Patients also received drug therapy, and they performed myohymnastics for the masticatory muscles. The clinical dysfunction index (Helkimo M.) was used to control the elimination dynamics of the TMJ's musculoskeletal dysfunction symptoms. The assessment of the pain dynamics in the TMJ was carried out by a visual-analog scale (VAS). The evaluation of the osteopathic treatment effectiveness was carried out on the basis of computer stabilometry data and osteopathic examination data. A stabilometric study was performed on the «ST-150» («Biomera») stabiloplatform in the Romberg sample (European foot installation) with open and closed eyes in two positions of the lower jaw: 1) in a state of physiological rest (tooth rows are separated); 2) in the kappa with closed tooth rows.Results. The MSD TMJ symptoms were eliminated 10 weeks after the start of treatment in all (100 %) patients of group № 1 and group № 3. Among the patients in group № 2, only 12,1 % of patients had complete absence of MSD TMJ symptoms, while all patients in this group had a statistically significant decrease in the clinical index of Helkimo dysfunction. In one third of the group № 2 patients on the 12th week of orthodontic treatment, headaches and/or pains in other parts of the musculoskeletal system (neck, back, shoulders, arms) prevailed among complaints and which were previously indicated in the anamnesis. This occurred after the elimination of the MSD TMJ symptoms. The absolute majority of patients in group № 3 (97,1 %) noted the complete disappearance of headaches and/or pains in other parts of the musculoskeletal system (neck, back, shoulders, arms). Also, in patients of this group, stabilometric indicators were normalized in a state of physiological rest and in the kappa.Conclusion. Patients with somatic dysfunctions need complex treatment with the participation of an osteopath and a dentist. When assessing the osteopathic status of a patient, it is important to determine whether the patient has only occlusive dysfunctions or there are also extra-occlusive ones. Additional osteopathic correction is recommended for patients with extraocclusive dysfunctions in order to achieve treatment results comparable in effectiveness and timing.

Histological examination of cranial synchondroses as functionally significant elements in the cranial osteopathic concept

Introduction. In recent decades, medical science has accumulated convincing evidence of the fact that the normal activity of a human brain depends on the functional integration of its vascular system, a circulation system of cerebrospinal fluid and biomechanical features of a skull, forming a single structural and functional system.The aim of the study is to research the histological structure of functionally significant cranial synchondroses in the middle and elderly age group, to find possible points of osteopathic influence application in their structure. Materials and methods. The study was performed on cadaver material of 27 persons (7 men — 26 %, 20 women — 74 %) who died at the age from 49 to 66 years (57,5±5,3 years) from various somatic pathologies, but had no history of craniocerebral injuries with fractures of osseous structures. Small bone fragments with sutures of interest/synchondroses (spheno-occipital synchondrosis, petro-jugular synchondrosis, sphenopetrosal synchondrosis) were subjected to standard histological processing followed by microscopy.Results. Evaluating histological specimens of spheno-occipital synchondrosis, we observed the similar pattern: highly mineralized tissues at the edges of the bodies of the sphenoid and occipital bones were connected without elements of cartilagi-nous or connective tissue. In all cases, no fibrous or nerve tissue elements were found during the in situ immunohistochemical reactions. Reactions with the CD34 antibody mark multiple vessels of the Volkmann's or Haversian canals. Evaluating histological specimens of petro-jugular and sphenopetrosal synchondroses, we found the presence of cartilage tissue in the suture in the form of small islands of various sizes (from 20 to 120 microns) with signs of degeneration and a small number of remained chondrocytes. When evaluating specimens with immunohistochemical reactions with antibodies against the S100 protein, no elements of the nervous tissue were detected.Conclusion. Spheno-occipital synchondrosis has a temporary nature. With age, its cartilaginous tissue is replaced by osseous one. According to the histological structure, sphenobasilar synchondrosis demonstrates the complete absence of a cartilaginous component in the middle and elderly age groups. Petro-jugular and sphenopetrosal synchondroses retain the cartilaginous component in their suture throughout lifetime. During histological examination of the petro-jugular and sphenopetrosal synchondroses, the cartilaginous component is represented by variety of small islands. In all synchondroses, there is an absence of vascular and nervous components. At the same time, we revealed the presence of a prominent vascular bed in the bone tissue. The fact requires emphasizing the importance of liquid potency and elastic component in cartilaginous and osseous tissues as an application point for osteopathic techniques.

The role of elastic bands (kinesiotapes) in complex therapy of patients with temporomandibular joint osteoarthrosis

Introduction. Temporomandibular joint (TMJ) arthrosis is a chronic disease, characterized by dystrophic and degenerative changes in TMJ with aseptic inflammatory process. The prevelence of TMJ arthrosis in patients with a history of other TMJ disorders varies between 32-39 % of cases. Complex treatment of TMJ arthrosis includes pharmacotherapy, physiotherapy, exercise therapy for TMJ and massage of the masticatory muscles, manual therapy, prosthodontics, but these treatment methods are not always lead to a desired result.The aim of the study is to improve the traditional treament method of patients suffering from TMJ arthrosis by using elastic tapes (kinesiotapes).Materials and methods. 68 patients were examined at the «Galaxy» Beauty Institute Clinic (St. Petersburg) and FSBEI HE SamSMU MOH Russia (Samara). Comparison group of patients was prescribed pharmacotherapy, exercise therapy for TMJ and massage of masticatory muscles, while for the main group of patients the same therapy was enhanced by elastic bands. The effectiveness of therapy was evaluated using a visual-analog pain scale (VAS), mouth opening width and electromyography of the masticatory muscles.Results. Noticeable positive effect in the main group of patients was observed on the 21th day of treatment. By this time patients noticed significant decrease in pain intensity from 8,77±0,8 to 5,19±0,5 (Z1-4=-5,88; p1-4=0,0015) points as well as increase in mouth opening width from 21-23 to 33-35 mm. Similar changes in the comparison group of patients were achieved only by the beginning of fifth week of treatment (Z1-6=-5,58; p1-6=0,0015). The range of mouth opening width increased from 21-23 to 27-29 mm. Amplitude of masticatory muscles biopotentials in maximum intercuspation in patients of the main group almost approached to the normal results by the beginning of the fourth week. In patients of the comparison group the amplitude of masticatory muscles biopotentials remained reduced even by the end of observations (42 day of the study).Conclusion. Thus, the combination of elastic bands applications with conventional treatment methods of TMJ arthrosis greatly increases the effectiveness of therapy and allows to relief pain and normalize bioelectric activity of masticatory muscles in a relatively short time. Due to the simplicity of elastic bands application it is possible to teach patients the technique of self-applying bands and recommend to use them as a prevention of relapse of TMJ arthrosis.

Investigation of the possible effectiveness of osteopathic correction in the complex treatment of children in the first year of life with hip dysplasia

Introduction. Congenital dysplasia of the hip joints is one of the main among congenital diseases of the musculoskeletal system in children and requires a long period of treatment, including in a hospital settings. Standard methods of treatment contain the orthopedic and rehabilitation measures: the use of abduction splints, a complex of physiotherapy exercises, general massage, the use of various physiotherapeutic procedures. Osteopathic correction is not included in the standards of care for this category of patients. At the same time, these standard treatment methods do not always give a desired result, and sometimes even lead to the development of complications. All this facts determines the need to search for additional therapeutic techniques.The aim of the study is to research the possible effectiveness of osteopathic correction as part of the complex treatment of children in the first year of life with hip dysplasia.Materials and methods. The study included 34 children with a diagnosis of hip dysplasia (ICD code-10 — Q65.8). The patients were randomly divided into 2 equivalent groups: study and control. Participants in both groups received standard treatment; the participants of the main group additionally underwent osteopathic correction of the revealed somatic dysfunctions. Before and after the course of treatment, the patients' osteopathic status, the disease clinical manifestations, and the X-ray data of the hip joints were assessed.Results. The inclusion of osteopathic correction in the complex with standard treatment procedures for children of the first year of life with hip dysplasia is accompanied by a statistically significant decrease in the detection frequency of the somatic dysfunctions at the regional and local levels. The median duration of standard orthopedic treatment also decreases (p<0,05).Conclusion. The obtained results demonstrate that the inclusion of osteopathic correction in the complex treatment of children in the first year of life with hip dysplasia shortens the treatment time for patients. It is recommended to continue research in this direction with a larger sample size.

Combined use of osteopathic correction and transcranial micropolarization of the brain in the treatment of children with attention deficit hyperactivity disorder

Introduction. Attention deficit hyperactivity disorder (ADHD) is a neurobehavioral disorder that occurs in 5-8 % of school-age children and persists into adulthood in 60 % of cases. At the present stage of neurology development, a number of significant drawbacks have been noted in the pharmacological correction of ADHD: the need for a long course of medication, the problem of polypragmasia, side effects and allergic reactions. Thus, there is a real need to develop non-drug ways to correct ADHD. Previous studies have demonstrated a sufficiently high clinical efficacy of transcranial micropolarization of the brain in the treatment of this patients group. Some studies have shown the effectiveness of the osteopathic correction use, which can increase the effectiveness of selective and sustained attention in children with ADHD. At the same time, the question of the possibility of combining various non-drug methods of treatment is quite acute.The aim of the study is to research the feasibility of osteopathic correction using in combination with transcranial micropolarization of the brain in the complex treatment of children with ADHD.Materials and methods. A controlled randomized trial was conducted in the period from January 2018 to February 2020 in Ekaterinburg and St. Petersburg. 68 patients with the established diagnosis attention deficit hyperactivity disorder aged 6 to 10 years, including 42 boys and 26 girls, were under observation. All patients, depending on the used treatment method, were divided by simple randomization into two comparable groups: the main group — 34 people, 22 boys and 12 girls, average age 7,4±1,2 years; the control group consisted of 34 people, 20 boys and 14 girls, with an average age 7,8±1,1 years. Patients received drug therapy with hopanthenic acid in age-related dosages (30 mg/kg body weight), course duration of 2 months, and transcerebral micropolarization of the brain. Each patient received one course of micropolarization, consisting of 15 sessions, the duration of each session was 30 minutes. Patients of the main group received osteopathic correction in addition to the therapy described above. In total, 4 sessions of 60 minutes each were held. The interval between the first sessions was 10 days, between subsequent sessions — from 10 to 14 days. There were evaluated the osteopathic status, the severity of ADHD manifestations and the short-term memory indicators, and the type and properties of the nervous system were determined for all patients, regardless of the group, before the start of treatment, as well as after the completion of the course of complex therapy.Results. After the therapy, there was a statistically significant decrease (p<0,05) in scores quantity on the ADHD assessment scale (ICD-10 criteria) both in the main and in the control groups, which reflects a decrease in the severity of clinical manifestations of this syndrome and demonstrates the effectiveness of the used therapy methods. In patients of the main group who received osteopathic correction, compared with the control group, there was also a significant (p<0,05) decrease in the number of regional dominant somatic dysfunctions, an increase in short-term memory indicators and a change in the type and properties of the nervous system (from weak to stable).Conclusion. The therapy carried out both with the use of osteopathic correction and without it, equally leads to a decrease in the degree of manifestations of ADHD. This indicates the clinical effectiveness of both studied integrated approaches to the treatment of children with ADHD. At the same time, osteopathic correction in the treatment of patients with ADHD significantly increases the indicators characterizing short-term memory and changes the type of response of the nervous system. These changes can be regarded as a potential opportunity to increase the learning ability of children and improve their socialization.

Spontaneous changes of skull morphology in premature babies: A preliminary study using plagiocephalometric analysis

Aim — to develop a reliable protocol to study the spontaneous changes in te skull morphology, specifically plagiocephaly in premature infants.Materials and methods. Evaluation of the degree of asymmetry using a plagiocephalometric tool and passive motion assessment for axial rotation and clinical examination of the neck muscles in six preterm infants. All measures are taken four times over a two months period.Results. About the placement of thermoplastic bands, a maximal variability of 3 % and 5 % was found for intra-and inter- observations respectively for the indices of interest (ODDI, CPI, CVAI). The variability of measures taken on photocopies was less than 1 %. 67 % of children had a preferential position on the third measure (T3) and 83 % on the fourth measure (T4). The prevalence of plagiocephaly was 17, 67, 33 and 50 % at T1, T2, T3 and T4 respectively considering a threshold of oblique diameters difference (ODDI) of 104 % . No influence of gender, gestational age, primiparity or asymmetry in muscle tension and/or rotation has been highlighted. In comparison with previous data, a very highly significant difference (p=0,001) was found for the index head values.Conclusion. This study has demonstrated the feasibility of the method. More consistent data should be considered, with a broader sample in order to provide a relevant analysis of the morphometric changes of the skull base. According to the criteria of the literature, three premature infants out of six had a plagiocephaly at T4 and we observed a normalization of morphometric values was observed in two infants.

Experience in the use of tissue flossing for the prevention and treatment of muscle cramps

Introduction. Cramps are sudden, involuntary, painful tonic muscle spasms of individual muscles or muscle groups lasting from several seconds to several minutes. It occurs in patients of different age categories with a frequency of up to 37 %. Tissue flossing (flossing, voodoo flossing) is an effect on the musculature, tendons, fascia (myofascial structures) of the extremities with the help of a special elastic band circularly wound on the limb, and subsequent physical exercises in this condition in order to improve blood circulation in the limb segment, increase tissue mobility, elasticity and extensibility of muscle-fascial structures. Tissue flossing can help to increase the volume of movements in the joints, reduce pain and increase flexibility.The aim to study the effects of tissue flossing on the frequency and intensity of manifestations of cramps. Materials and methods. The publication was based on the materials obtained during the observation of 7 patients with cramps. The aggressive nature of the muscle spasms forced them to seek medical help. In order to assess the effect on the frequency and intensity of cramps, patients underwent circular winding of an elastic band on a limb segment (tissue flossing) in which cramps occurred, followed by physical exercises (mainly flexion and extension at a pace of one movement per second) without additional load (with their weight) for 1 minute. Then the elastic band was removed and the patient continued to perform the same movements also for a minute with a frequency of one movement per second. Patients performed exercises 1-2 times a day for 5-14 days.Results. In five out of seven patients, cramps did not resume after the first use of tissue flossing. In two of the seven patients, cramps stopped after 7 days of exercise use. At follow-up in one (out of seven) patients, cramps resumed 2 months after the use of tissue flossing, but with a lower intensity. In the other six (out of seven) patients in the subsequent follow-up period (from 14 days to 6 months), cramps did not resume.Conclusion. According to the preliminary results of observations, it can be assumed that the tissue flossing method is effective for preventing cramps of various genesis as an independent and additional method of treatment.

Physical parameters of neutrality in the work of an osteopathic physician

An osteopathic practitioner often meets the problem of physical fatigue, which is caused by a forced posture, excessive tension of the muscles of the trunk and arms, irrational biomechanical patterns of posture and movements, lack of support points, or switching points of mechanical energy of movement (fulcrum). These factors lead together to fatigue, which is felt as weariness and prevents the development of a pathophysiological state of overwork. Prevention of overwork by an osteopathic doctor can consist of a number of measures of labor organization and ergonomics, one of which is building a state of physical neutrality — a spatial position of the body that allows working with the patient as efficiently as possible and minimizing fatigue.

Prevalence of endocrine pathology in childhood and adolescence

All over the world, the endocrine system diseases in children attract the attention of researchers of various specialties, since this pathology is characterized by the duration of the course and subsequent often developing complications that worsen the quality of life and the prognosis of the health status of children and adolescents. The prevalence and structure of endocrine pathology in childhood and adolescence differ significantly from those in adults. Due to the fact that children make up a significant share in the structure of medical care requests for osteopathy in medical institutions, osteopathic doctors need to know the basics of diagnosis and prevention of endocrine diseases in children and adolescents. The peculiarity of endocrine diseases with onset in childhood is the beginning of their development against the background of physiologically significant for the development of the body processes of growth and sexual development, which determines the need for a multidisciplinary clinical approach to differential diagnosis between the endocrine pathology and the constitutional features of physical and sexual development of a healthy child.

Possibilities of osteopathic methods of diagnosis and correction in gallbladder dyskinesia

Functional disorders of the digestive system (including gallbladder dyskinesia) are widespread among the adult population of the Russian Federation. Their combination in a fairly large percentage of cases with degenerative-dystrophic diseases of the spine, and the probable vertebrogenic causality of a number of the gastrointestinal tract pathological conditions lead to the need using new approaches in diagnosis and treatment, including non-drug methods. This clinical case shows the possibility of osteopathic diagnostics and correction in gallbladder dyskinesia.