RU2523692C1 - Method for rehabilitation treatment of tongue dysfunction following frenuloplasty in patients using removable appliances - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: removable individual replaceable myogymnastic element (RIRME) representing an individually curved orthodontic wire having a many-sided bead is fixed for 2 hours a day and for a period of logopaedic treatment into closed canals of the palatal plate of the removable appliance. A patient moves his/her tongue: touches the bead and displaces it in different directions along the wire trajectory. As the range of motions increases, the RIRME is changed by a new one with the complex trajectory and a smaller bead. The lessons are continued until the tongue functions are recovered completely.

EFFECT: method enables shortening the rehabilitation period that is ensured by orthodontic treatment in a combination with functional correction and use of the myogymnastic element that is complicated in the process of treatment.

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Description

The invention relates to medicine and can be used in practical dentistry.

Recently, more and more doctors orthodontists are faced with pathology of the dentition, the reason for which is a short frenum of the tongue. Tongue frenulum (frenulum linguae) is a vertical fold of the mucous membrane that goes from the lower surface of the tongue to the bottom of the oral cavity. In front, the fold reaches the oral surface of the gum [1]. A short frenum of the tongue is an anomaly in which the tip of the tongue is fixed to the bottom of the oral cavity and does not go beyond it. The bridle is shortened in front, where in most cases it is a thin transparent film devoid of blood vessels. With age, this film becomes more dense and sometimes abundantly vascularized. The restriction of the mobility of the tongue associated with a short bridle can cause some disorders of the functions in which this organ takes part. A shortened frenum of the tongue is the cause of the development of dentoalveolar anomalies; the processes of chewing, swallowing, sound formation and sound pronunciation are disrupted [2]. Such children need comprehensive treatment, including surgical preparation, work with an orthodontist and speech therapist.

Indication for surgery is a violation of the articulation of sounds in children 2-3 years of age. The operation is performed in children 3-4 years of age during the formation of the correct speech. A shortened bridle of the tongue restricts its movement, so a functional breakdown is a check for mobility. The patient is asked with an open mouth to get the tip of the tongue to the mucous membrane of the cheeks and the red border of the upper and lower lips.

If the language is not fully executed, a decision is made to conduct the operation. Two standard operations are used to lengthen the frenum of the tongue: plastic with counter triangular flaps (Z-plastic) according to the method of A. A. Limberg and plastic with a cross section [3].

To restore the full volume of the tongue movement and position it in the correct position after surgical correction, it is necessary to carry out myogymnastics, which includes a number of exercises for the tongue and a hardware method.

Among the known hardware methods, the closest to the claimed one is the method proposed by Professor Rolf Hinz. This method (prototype) involves the use of the vestibular Mirra plate with a bead, which is designed to stimulate the muscles of the tongue. Having placed the plate in the oral cavity, the child immediately begins to instinctively roll the bead with his tongue in the hard palate, thus stimulating the tone of the lingual muscle. This plate is used for the period of classes with a speech therapist and for several hours at home [4].

The disadvantage of this method, in our opinion, are: standard sizes (2 sizes: for milk and removable bites), the same type of arrangement and the inability to replace the myogymnastic element (wire with a bead), the standard path of movement and the diameter of the bead, unidirectional action (the inability to simultaneously use a removable orthodontic apparatus and vestibular plate with a bead).

Objective: to improve the quality of rehabilitation treatment of tongue dysfunction after frenuloplasty in patients using removable orthodontic appliances.

The goal is achieved by combining a removable orthodontic apparatus, which includes a palatal plate made of hypoallergenic plastic, and a removable individual replaceable myogymnastic element (SIZME), which is an orthodontic wire of various sections, curved according to individual characteristics, and worn on it with a multifaceted bead diameter. SIZME is installed by means of the voltage of the wire element in the blind channels of the palatine plate behind the upper incisors. It is recommended that patients daily for 2-3 hours a day and for a period with a speech therapist, independently or with the help of their parents, fix the SIZME into the palatine plate of the orthodontic apparatus and perform the following actions: try to touch the bead and move it in any direction along the path indicated by the wire, thereby stimulating the activity of the muscles of the tongue. As the volume of tongue movements increases and the functions normalize, the SIZME is replaced with a new one with a bead of a smaller diameter and with a more complex trajectory. Recommendations remain the same.

Example. Parents of the patient D. born in 2007 appealed to the basic dental polyclinic GBOU VPO "Ryazan State Medical University of the Ministry of Health of the Russian Federation" to the Department of Orthopedic Dentistry and Orthodontics with complaints about the location of the upper incisors of the child horizontally, impaired speech and chewing. During the examination, the diagnosis was made: protrusion of the upper incisors, a short frenum of the tongue. Recommended: frenuloplasty followed by hardware correction of protrusion of the upper incisors. After consultation with a speech therapist, myogymnastics was prescribed to restore the volume of tongue movements during sound pronunciation with diligence in the anterior third of the hard palate. Patient D. was made a palatal plate with a vestibular arch and a removable individual replaceable myogymnastic element in the anterior third of the hard palate. Parents were given recommendations on the installation and removal of the myogymnastic element in the palatine plate with the vestibular arch. Recommendations were also given about the time and periods of myogymnastics. After a six-month use of this plate with a removable individual replaceable myogymnastic element, the range of tongue movements increased. The speech therapist noted an improvement in sound pronunciation with palatal diligence of the tongue. The result of treatment is positive, the prognosis is positive.

Thus, the claimed method allows you to simultaneously combine orthodontic treatment and functional correction of patients with a short frenulum of the tongue after frenuloplasty; individualize the treatment process, which can significantly accelerate the rehabilitation period in children using removable orthodontic structures after frenuloplasty.

Information sources

1. Human anatomy. Edited by S.S. Mikhailov and L.L. Kolesnikov. - Ed. 3rd, rev. and add. - M .: Medicine, 1999 .-- 736 p.

2. Guide to pediatric outpatient surgery. Monograph. / A.I. Lenyushkin. - L .: Medicine, 1986. - 335 p. - Bibliography: p.331.

3. Zelensky V. A., Mukhoramov F. S. Pediatric surgical dentistry and maxillofacial surgery: Textbook - M .: GEOTAR-Media, 2008. - 208 p.

4. Correction of speech in children: the view of the orthodontist. Ed. Ya.V. Kostina, V.M. Chapala. M.: SC Sphere, 2008 .-- 70 p.

Claims (1)

A method of rehabilitation treatment of tongue dysfunction after frenuloplasty in patients using removable orthodontic appliances, which consists in the fact that for 2 hours a day and for a period of training with a speech therapist in the blind canals of the palatine plate of a removable orthodontic apparatus, a removable individual replaceable myogymnastic element (SIZME) is fixed, representing an orthodontic wire bent according to individual characteristics and a polyhedral bead put on it; while the patient performs actions with his tongue: he touches the bead and moves it in various directions along the path indicated by the wire; as the range of motions increases, the SIZME is changed to a new one with a complicated wire path and a smaller bead; classes continue until the restoration of the function of the language.