RU2842403C2 - Method of chewing muscles relaxation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to orthopaedic dentistry, and can be used at all stages of complex treatment of functional disorders of temporomandibular joint (TMJ) and masseter muscles (muscular-articular dysfunction, parafunctions, bruxism). What is offered is a complex involving massage and myogymnastic exercises, wearing a muscle relaxation tray. There are also applied kinesio tapes affecting the shoulder girdle, neck and masticatory muscles for 21 days. Also, the exercise complexity is gradually increased with an interval of one week. Corrective measures are taken to relax the masseter muscles. Method can be recommended for inclusion in the complex rehabilitation of the patients with TMJ disorders. It is also possible to use in patients with other pathologies requiring dental orthopaedic treatment.

EFFECT: method provides higher effectiveness of orthopaedic treatment due to non-invasive correction of the functional state of the dentoalveolar system and masticatory muscles.

1 cl, 3 dwg, 2 tbl, 1 ex

Description

The invention relates to medicine, namely to orthopedic dentistry, and can be used at all stages of complex treatment of functional disorders of the temporomandibular joint (TMJ) and masticatory muscles (muscle-joint dysfunction, parafunctions, bruxism). This pathology occupies a special place among dental diseases due to the difficulties of diagnosis, the complexity of the clinical picture, including symptoms that at first glance are not related to dentistry. As a result, patients for a long time turn to specialists of other profiles (otolaryngologists, neurologists, psychiatrists) and do not receive proper treatment. Many authors believe that the key link in the development of TMJ dysfunction is the discoordinated work of the masticatory muscles, leading to a change in the relationship of the elements of the joint. Etiological factors of dysfunctional conditions of the TMJ can be: functional overload of teeth caused by dentoalveolar anomalies, deformations, absence of a large number of teeth, as well as parafunction of the masticatory muscles (PM).

Parafunctions of the masticatory muscles are spontaneous, chaotic movements of the lower jaw that are not associated with natural physiological acts - chewing, speech, swallowing, and are also accompanied by clenching or grinding of teeth (bruxism). Parafunctions develop as a result of disruption of neuromuscular connections. Changes (increase or decrease) in the tone of the masticatory muscles underlie the pathogenesis and clinical manifestations of parafunctions of the masticatory muscles. An important role is played by the characteristics of temperament and personality, the individual's reaction to stress.

There is a known method for treating TMJ muscle dysfunctions based on the use of medications in the form of tablets or injections, which can reduce psychoemotional reactions, as they cause suppression of the functioning of a number of organs and systems [3].

The disadvantage of this method is the lack of data on the use of kinesiotaping. Only the use of kinesiotherapy is taken into account, in which a doctor is required to participate.

There are known methods of muscle relaxation, which are based on the impact of massage techniques on the facial and chewing muscles [1, 2].

The disadvantage of the listed methods is the lack of impact on the coordinated work of muscles. Also, the influence of the set of exercises on the closure of the jaws, dental arches, and, as a consequence, on occlusal contacts, as well as the functional state of the muscles of the floor of the mouth and tongue is not taken into account.

There is a known method of rejuvenating the face and neck based on the use of massage techniques in combination with kinesiological taping [5].

The disadvantage of this method is its use in cosmetology, it does not take into account the bioelectrical activity of muscles, does not reflect the relationship between the facial and chewing muscles, as well as the muscles of the cervical-shoulder girdle and back.

The closest technical solution is a method for reducing hypertonicity of the masticatory muscles, based on the use of massage techniques that affect the masticatory muscles, as well as the muscles of the associated areas (prototype) [4].

The disadvantage of the prototype is its predominant use in cosmetology. The method does not assume taking into account changes in the closure of the dental arches and the topography of occlusal contacts as a result of its implementation. Taping of the masticatory muscle area is not performed. Of no small importance in the rehabilitation of patients with dysfunctional conditions of the TMJ and masticatory muscles is the relationship of all links of the dentofacial system, as well as the muscular framework of the human body.

The objective of the method of relaxation of the masticatory muscles that we propose is to increase the effectiveness of orthopedic treatment through non-invasive correction of the functional state of the dentoalveolar system (DMS) and masticatory muscles (MM).

The set task is achieved by combining a set of massage techniques together with myogymnastic exercises performed with subsequent use of kinesio tapes. It is proposed to conduct "Complex 21", including an assessment of the functional state of the GM, electromyography of the GM (EMG), an assessment of occlusal contacts (using a special myorelaxation dental splint), as well as the psycho-emotional sphere before and after its implementation.

The method is implemented as follows. "Complex 21" includes massage and myogymnastic exercises, wearing a myorelaxation mouth guard, and applying kinesio tapes that affect the muscles of the shoulder girdle, neck and chewing muscles. One of the key points is the close interaction of the dentist and the patient at the stages of its implementation. In addition, "Complex 21" is designed for a gradual increase in the complexity of the exercises. The following scheme for examination, observation of the patient and his implementation of "Complex 21" is proposed:

At the first stage, a comprehensive dental examination of the patient is carried out, including a thorough collection of anamnesis, examination according to R. Slaviczek, dental examination, palpation of the masticatory and cervical muscles (with pain assessment according to the visual analogue scale (VAS)), EMG of the GM, production of a mouth guard (Patent for Utility Model 207536 U1) and determination of occlusal contacts (according to the mouth guard), as well as assessment of the patient's psychoemotional state (Beck questionnaire). A myorelaxation mouth guard with a platform for tongue positioning is manufactured. A myorelaxation mouth guard, like the Michigan one, is manufactured according to the generally accepted technique from rigid base plastic, and in the area of the palatine folds, a platform for tongue positioning is created from materials for soft linings in removable dentures with modeling of the individual relief of the palatine anatomical formations [6]. This myorelaxation dental splint allows for non-invasive correction of parafunctional activity of the masticatory muscles and bruxism, providing myorelaxation, protective effects, and also normalizes the position of the tongue and lower jaw, in addition, it facilitates the transition to nasal breathing.

During the first visit, the patient is taught how to perform exercises independently and how to apply tapes to the masticatory muscles. Exercises are performed once a day before bed, after which the muscles of the maxillofacial area are taped (for a period of 6-7 hours). Taping of the shoulder girdle and neck is performed by the doctor on days 1, 4, 7, 11, 14, 17.

Control days for intermediate express diagnostics are days 7 and 14. An examination according to R. Slavichek, muscle palpation (VAS assessment), and an assessment of the patient's psycho-emotional state are performed. The patient is taught to perform new exercises.

On the 21st day, a repeat comprehensive examination of the patient is carried out.

Method of applying tapes.

Taping the upper edge of the trapezius muscle (Figure 1). Kinesiology taping technique: inspection and palpation testing of the proposed area for kinesiotape application are performed. Kinesiotape is used in the form of an “I” application, 21-25 cm long and 3 to 5 cm wide (depending on body type), the edges are rounded. We ask the patient to tilt their head to the side at 45°, attach one end of the kinesiotape (anchor) to the acromial process, and apply the other end of the kinesiotape slightly below the scalp, turning the patient's head in the other direction. We ask the patient to relax the trapezius muscle, and apply the tape along the belly of the trapezius muscle with a slight tension at the end.

Taping the back of the neck (Figure 1). Kinesio tape is used in the form of a “Y” application, 22-25 cm long and 5 cm wide. The tape is cut in half at 2/3 of its length, all edges are rounded. We apply the kinesio tape to the area of the back of the neck along the spine with an anchor in the middle of the thoracic spine. We ask the patient to tilt their head forward slightly, after which we fix the kinesio tape first along the spine, and then along the oblique muscles of the neck with a tension of up to 5%.

Application of tapes to the area of the masticatory muscles (Figure 2).

Relaxation scheme for relieving tension from the masseter muscle itself: measure a 5 cm wide kinesiotape from the lower part of the zygomatic bone to the submandibular line. Divide the tape strip of the obtained length into three equal parts. An “I”-shaped application is used, the edges are rounded. The anchor of the first strip is installed in the submandibular line at the angle of the lower jaw with the mouth closed, the rest are installed at intervals of 0.5 cm in the forward direction. The tapes are applied in the direction of the zygomatic bone with the mouth maximally open without tension.

Relaxation scheme for relieving tension in the temporomandibular region: divide a strip of tape 5 cm wide and 7-8 cm long into three equal parts. Use an "I"-shaped application, round the edges. The anchor of the first tape is installed in front of the tragus of the ear by 0.5 cm, the tape is applied without tension diagonally downwards, overlapping the tapes of the first relaxing scheme, while asking the patient to puff out his cheek. The other two tapes are applied using a similar technique with the anchor below the first along the branch of the lower jaw at an interval of 0.5 cm.

Taping of the temporal region: measure a 5 cm wide kinesiotape from the highest point of the eyebrow to the cheekbone. Divide the tape strip of the obtained length into two equal parts. Use an “I”-shaped application, round the edges. Tape anchors are placed on the forehead above the highest point of the eyebrow on the right and left. Tapes are applied in the direction of the cheekbone without tension (Figure 2).

Taping of the hyoid bone: a triangle-shaped application is used (Figure 3). A triangle is cut out from a 5x5 cm strip of tape with a base along the width of the tape and a vertex located along the length of its stretch. The anchor (base of the triangle) is placed on the projection of the hyoid bone (to find it, it is necessary to make a swallowing movement). The tape is applied without tension, while the chin is pulled forward.

Performing a set of exercises:

Week 1:

Exercise 1 (development of shoulder joints).

Starting position: standing or sitting on a chair, feet on the floor. Place the palms of both hands on the waist, elbows to the sides, shoulders down. Then make small circular movements with the shoulders from front to back so that one circle is completed in 10-15 seconds. If stiffness or painful areas occur, slow down the rotation of the shoulders and continue to perform more slowly. Perform the exercise for at least 1 minute.

Exercise 2 (relaxation of the trapezius muscles).

Starting position: standing or sitting, head level, gaze directed at the horizon. Straighten your arms to the sides to a comfortable height, fingers should be straight and tense. Then slowly move your hands forward and join them together, keeping your fingers tense. Hold the position for 30 seconds. Inhale through the nose, exhale through the mouth. After this, slowly move your arms to the sides until you feel the interscapular muscles contract. Hold the position for 30 seconds. Perform the exercise 2-3 times.

Exercise 3 (relaxation of the trapezius muscles).

Starting position: sitting on a chair. The exercise on the left is performed with the right hand and vice versa. The II-V fingers of the hands are pressed tightly to the working surface and rolling-pressing movements are performed from the neck to the shoulder, repeating 3-4 times. Then, grasping the muscle with the I-V fingers of the hand, circular kneading movements of a small diameter are performed to soften the tissues of the working area and relax the muscle. The manipulation is repeated on the opposite side. The exercise is performed for 1-2 minutes.

Exercise 4 (for the back of the neck).

Initial position: head is positioned straight. II-IV fingers of both hands are placed on the back of the neck on one side of the spine, so that the fingers of one hand are above the fingers of the other and are in one line. The fingers are pressed tightly to the working surface for 5-10 seconds. Then the fingers are slowly used in a rolling-pressing motion in opposite directions, while the fingers of the upper hand are moved up, the lower hand - down. It is necessary to work only the soft tissues of the neck, without putting pressure on the spine. The exercise is repeated on the other side. The exercise is performed for 1 minute.

Exercise 5 (for the scalene muscles of the neck).

Starting position: sitting on a chair or standing. Slowly turn your head to the side until the first discomfort appears and hold the position for 15 seconds. From the achieved position, very slowly move your chin down until the first discomfort appears and hold this position for 15 seconds. Then slowly move your chin up also until the first discomfort appears and stay in this position for 15 seconds. Repeat the exercise on the opposite side. Perform the exercise once.

Exercise 6 (for the sternocleidomastoid muscles).

Starting position: sitting on a chair. Turn your head to the side, and on the opposite side, with the first and second fingers of both hands, grasp the upper portion of the sternocleidomastoid muscle and compress it for 20-30 seconds. Then, with the indicated fingers of both hands, perform kneading, rubbing, stretching massage movements to soften the sternocleidomastoid muscle for 1 minute. After this, stretch the muscle, directing the arms in different directions. Repeat the exercise on the opposite side.

Exercise 7 (relaxation of the muscles of the floor of the mouth)

Starting position: sitting on a chair. The working fingers of both hands are placed under the lower jaw on the right and left so that the fingertips are immersed in the underlying muscles to a depth of 5-10 mm, and the distal phalanges are pressed against the lower jaw from the inside. The remaining fingers are placed on the cheeks. Then the working fingers slowly slide along the muscles of the floor of the mouth, exerting mechanical pressure. If tense or painful areas appear, the working fingers are fixed on them for 10-20 seconds without releasing the pressure. Then continue sliding the fingers. In this way, the entire muscle canvas of the floor of the mouth is worked out. The exercise is repeated 2-3 times.

Exercise 8 (relaxation of the masticatory muscles).

Initial position: sitting on a chair. The working II-IV fingers of both hands are placed on the parotid-chewing area on both sides under the zygomatic arch. Then slowly open the mouth and simultaneously perform a rolling-pressing movement with the working fingers from the zygomatic arch to the angle of the lower jaw along the chewing muscles proper. The exercise is performed for 1 minute.

Exercise 9 (relaxation of the chewing muscles).

Starting position: sitting on a chair. Using the working fingers of both hands, create a pincer-like grip on a horizontal fold 2-3 cm long at the outer corner of the eye. Then pull the captured fold upwards as much as possible vertically and make 5-7 intercepting movements with the fingers, pulling fibrous areas, skin adhesions with integumentary tissues, underlying muscles or their individual bundles into the fold. In places where the fold is difficult to hold, perform squeezing, pressing, kneading, stretching massage movements to soften the underlying tissues. Then stretch the fold from the center to the sides and slowly roll it down by 1-2 cm and repeat the described manipulations. In this way, work on the entire lateral area of the face from the outer corner of the eye to the angle of the lower jaw. Then perform the exercise on the other side. Perform the exercise once.

Exercise 10 (relaxation of the tongue muscles).

Starting position: sitting on a chair. Using the working fingers of both hands, grasp the tip of the tongue like a pincer, creating compression of this area. If the pain is 5-6 points out of 10, hold this position for 15-20 seconds. Then move the fingers to another area of the tongue and repeat the manipulations. Treat the entire surface of the tongue from the tip to the root. Perform the exercise once.

Week 2:

Exercise 1 (relaxation of the muscles of the front of the neck).

Starting position: sitting on the edge of a chair, legs bent at the knees at an angle of 90°, feet fully resting on the floor. Both arms, straightened at the elbows, are turned with the fingers towards each other at an angle of 180° and placed above the knees. Then the body weight is transferred to the arms, and the back is rounded. In this case, the head should be directed downwards, the back of the neck is relaxed. Pressing movements are performed with the chin to relax tense tissues. Remain in this position for 20-30 seconds, then take the starting position. The exercise is performed 1-2 times.

Exercise 2 (stretching the neck muscles).

Starting position: sitting or standing. The head is positioned straight. The II-IV fingers of both hands are crossed in a lock and placed on the back of the head, and the I fingers of the hands should be on the border of the hairline. First, the hands slowly make a stretching movement upward to lengthen the muscles of the back of the neck. Then, the occipital region presses on the hands, while the chin is directed downwards and backwards to stretch the muscles that extend the neck. The achieved position is fixed for 1 minute. The exercise is performed 1 time.

Exercise (relaxation of the suboccipital muscles).

Starting position: sitting, back and head straight. Work is performed on one side with the hand of the same name. The second finger of one hand is bent in the form of a "hook" and placed on the area of the cranio-vertebral junction until the finger is in close contact with the working surface. Then a slow pressing-rolling movement is made with the finger down along the entire surface of the neck, while the chin is also directed downwards. Work on the entire back surface of the neck first on one side, then change hands and work on the other side. The exercise is performed 2-3 times.

Exercise 4 (for relaxation of the neck and collar zone).

Starting position: sitting. Place the II-IV fingers of both hands on the neck-shoulder angles and press firmly against the working surface. Maintaining the depth of pressure, slowly make a rolling-pressing movement backwards on both sides along the spine with the fingers. Then return to the starting position and make the same movement to the sides towards the shoulders. Perform the exercise for 1 minute.

Exercise 5 (relaxation of the structures of the parotid-masticatory region).

Starting position: sitting, chin down. Work alternately on each side with both hands in the parotid-masticatory area, starting under the zygomatic arch and up to the angle of the lower jaw. The II-IV fingers of the opposite hand are placed on the anterior border of the masseter muscle itself (to detect it, tightly close the teeth), and the II finger of the same hand is bent in the form of a “hook” and placed under the zygomatic arch next to the fingers of the other hand, pressing it tightly to the working surface throughout the entire manipulation. With a half-open mouth, maintaining the depth of pressure, perform a slow rolling-pushing movement directed back to the ear. In painful areas, stop the movement, while applying pressure until the pain subsides. Repeat the movement in this area 3-5 times. Then, using the same technique, work out the entire surface in turn up to the angle of the lower jaw. Then move to the other side of the face and repeat the technique.

Exercise 6 (relaxation of the chewing muscles).

Starting position: sitting. The exercise is performed in the parotid-chewing area simultaneously on both sides. The second fingers of both hands are placed under the zygomatic arch on the same sides, and the first fingers of both hands are placed in the area of the angle of the lower jaw. Then, using a pincer-like grip, create a horizontal fold, after which open the mouth, while the folds should slip out of the created grip. The exercise is performed for 1 minute.

Exercise 7 (relaxation of the muscles of the floor of the mouth).

Starting position: sitting. The working fingers of both hands are raised vertically upwards and placed in the submandibular region to a depth of 5-10 mm. Then, with the working fingers, small circular rotational movements are made, accompanying them with pressure on the underlying tissues of the floor of the oral cavity. If dense and painful areas are detected, they are worked on for 10-20 seconds, after which they move on to other areas of the submandibular region. The described technique is used to work on the entire submandibular region on both sides. The exercise is performed for 2 minutes.

Exercise 8 (to inactivate trigger points (TP) in the area of the medial and lateral pterygoid muscles).

Initial position: sitting. Consists of gradually increasing the pressure on the TT until the patient feels slight pain. The pressure force is maintained until the pain disappears, and then increased until the pain reoccurs. It is performed several times until the patient stops feeling pain when the pressure force is increased. With intraoral access, the patient inserts the second finger of the same hand into the oral cavity and applies pressure in the area of the medial pterygoid muscles successively on the right and left, and then on the area of the lateral pterygoid muscles.

Exercise 9 (to restore coordinated contraction of the masticatory muscles and normalize the range of motion of the lower jaw).

Initial position: sitting in front of a mirror. The patient places the 2nd finger of the same hand in the area of the condyle projection, and the 1st finger in the area of the angle of the lower jaw (thus, it is possible to tactilely control the movement of the head of the lower jaw). The 2nd finger of the other hand is placed on the vestibular surface of the incisors of the lower jaw. The patient slowly performs movements of the lower jaw down, up, forward, backward, right and left, relying on vision and tactile sensations to exclude deviations and deflections. Normally, the ratio of the size of mouth opening to lateral movement is 4/1.

Exercise 10 (for language).

Initial position: sitting in front of a mirror. The patient moves the tongue along the palate sequentially forward-backward and left-right (20 times). The tip of the tongue is pressed against the palatine folds, the patient takes a deep breath, and then swallows (6 times). The tip of the tongue is pressed against the palatine folds, while the patient slowly opens the mouth so that there are no clicks in the joint (6 times).

Week 3:

1) Exercise 1 (for developing the shoulders, shoulder blades, collarbones).

Starting position: sitting or standing, head straight, gaze directed at the horizon. It is necessary to straighten the lumbar deflection, pull in the stomach, lower the shoulders down. Straighten both arms at the elbows and lower them down, turning the palms towards the body. Then slowly make circular movements with the shoulders back, so that the palms of the hands turn towards the body with the back side. The movement should be performed only by the shoulder joints. After this, make the opposite movement, returning to the starting position. The exercise is performed for 1 minute.

2) Exercise 2 (working on the neck).

Starting position: stand with your back to the wall, head and back pressed against the wall, and feet 15-20 cm away. From this position, slowly lower your chin and hold it for 1 minute. The base of your head and the back of your neck should be in closer contact with the wall. Then bend your body forward in an arc so as to further strengthen the contact of your neck with the wall. Hold this position for 1 minute. Perform the exercise once.

3) Exercise 3 (to reduce muscle hypertension in the upper back area).

Starting position: sitting with your back or half sideways to the table. The exercise is performed alternately on each side. To work the right side: place your right arm bent at the elbow on the table with the palm down, move the right shoulder blade toward the spine, and tilt your head toward the right shoulder. Then slowly straighten the elbow of your right arm and simultaneously resist with your head until you feel tension in the upper part of the trapezius muscle on the right. Hold this position for 30 seconds. Then stretch the trapezius muscle: to do this, place the II-IV fingers of both hands on it and, with pressure, direct your hands in different directions, stretching the specified muscle. First, stretch a large area, moving from the center of the muscle to the shoulder and back of the head. Then stretch small areas, placing the working fingers of both hands on the muscle at a distance of 3-5 cm from each other and directing them in opposite directions. At the end, kneading and stretching massage movements are performed with the fingers to soften the trapezius muscle. Stretching manipulations are performed for 1-2 minutes. Then the muscle on the left is worked out. The exercise is performed 1 time.

4) Exercise 4 (working on the back of the neck).

Starting position: standing or sitting. Place the working fingers of both hands on the back of the neck on either side of the spine and create a fold of soft tissue with the grip. Then use the fingers to perform rubbing movements without putting pressure on the spine. Work the entire back of the neck. Perform the exercise once.

5) Exercise 5 (massage of the chewing muscles).

Starting position: sitting. Determine the location of the masseter muscle proper (to do this, close your teeth and palpate the muscle in the parotid-masticatory area). The chin should be lowered, the mouth half-open. The II finger of the same hand, bent like a "hook", is placed under the zygomatic arch on the proper, and the I finger of the same hand is placed under the lower jaw. From the starting position, the II finger slides down along the surface of the muscle to the I, creating pressure until pain sensations of 5-6 points out of 10 appear. In the areas with the greatest pain, stop and continue pressing until the intensity of the pain decreases. In this way, the entire muscle surface is worked out. Then the exercise is performed on the other side of the face. The exercise is performed 1 time.

6) Exercise 6 (relaxation of the muscles of the floor of the mouth).

Starting position: sitting. The working fingers of both hands are raised vertically upwards and placed in the submandibular region to a depth of 5-10 mm. Then, with the working fingers, small circular rotational movements are made, accompanying them with pressure on the underlying tissues of the floor of the oral cavity. If dense and painful areas are detected, they are worked on for 10-20 seconds, after which they move on to other areas of the submandibular region. The described technique is used to work on the entire submandibular region on both sides. The exercise is performed for 2 minutes.

7) Exercise 7 (resistance to movements of the lower jaw from the neutral position (teeth closed) to the extreme possible for each direction).

Starting position: sitting. Use your fingers to resist the movements of the lower jaw down, up, forward, right and left, changing the position of your fingers. The speed of the movements is minimal, and the amplitude is maximal. It is necessary to hold the resistance in the extreme positions for 6 seconds. Repeat the movement in each direction 2-3 times.

8) Exercise 8 (to restore the coordinated rhythmic function of the masticatory muscles).

Starting position: sitting in front of a mirror. It is necessary to determine the midline between the upper and lower incisors. The patient places the II fingers of both hands on the heads of the lower jaw, and touches the back of the palate with the tip of the tongue (which prevents the anterior displacement of the lower jaw) and slowly opens the mouth. Visually and tactilely monitors the absence of lateral or anterior displacement of the lower jaw. The patient opens and closes the mouth 20 times within 1 minute (until a slight contact is felt between the teeth). At a slower pace of the exercise, unwanted muscle tension may occur.

9) Exercise 9 (to eliminate lateral displacement of the lower jaw).

Initial position: sitting in front of a mirror (in order to control the midline of the face), the tip of the tongue is pressed tightly against the left or right upper lateral teeth. The patient slowly opens the mouth along the midline (without deviating the lower jaw to the sides). Each day, gradually increase the amplitude of mouth opening. The exercise is performed for 1-2 minutes.

10) Exercise 10 (to relax the muscles of the tongue).

Initial position: sitting. The patient attempts to move the chin up, down, left, right with the hand. The chin remains in place. For muscle relaxation of the tongue muscles, exercises are performed with the tongue sticking out to the tip of the nose, circular licking of the upper and lower lips clockwise and counterclockwise, resting the tongue on the front lower teeth with subsequent relaxation. The frequency of each exercise is 6 times).

Example 1. Clinical example of implementation of the method.

Patient N. came to the orthopedic dentistry clinic with complaints of discomfort in the area of the chewing muscles, their tension and fatigue after eating hard food, and concerns about his health.

Patient examination:

External examination: the skin is clean, the facial configuration is changed: visible hypertrophy of the masticatory muscles is noted. Regional lymph nodes are not palpated. Palpation of the temporomandibular joint is painless, the movement of the mandibular heads is asynchronous, without pathological noises. Opening of the mouth, lateral movements of the lower jaw are carried out in full, painless, S-shaped opening of the mouth is noted.

Visual examination of the oral cavity: the relationship of the dental arches according to the type of orthognathic bite. The dental arches are complete.

Dental formula:

ABOUT P P ABOUT 18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 P P P P

Teeth 1.3, 1.1, 2.1, 2.3, 3.3, 3.2, 3.2, 4.1, 4.2, 4.3 have enamel cracks, abrasion facets within the enamel. Teeth 1.7, 1.6, 3.5, 3.6, 3.7, 4.6 are under fillings, marginal adhesion is not violated, IROPZ = 0.4 - 0.5. Teeth 1.4, 2.4 have abfraction defects. Imprints of teeth are visualized on the mucous membrane of the cheeks along the line of closure of the teeth.

The data of palpation and EMG of the GM before treatment are presented in Tables 1, 2. The assessment of the psychoemotional sphere before and after treatment was carried out using the Beck Depression Scale: before treatment, this indicator was 10 points.

After the examination, the patient was diagnosed with: K07.6 TMJ pain dysfunction syndrome. K02.8 Pathology of hard tissues of teeth 1.7, 1.6, 3.5, 3.6, 3.7, 4.6. Chewing dysfunction.

Therapy was prescribed in the form of “Complex 21”.

Results obtained

Table 1. Results of muscle palpation (scores). Palpation area Muscle condition (right/left) Before treatment On the 7th day On the 14th day After treatment (21 days) 1. Shoulders and neck 6/5 5/5 3/3 1/1 2. Atlanto-occipital region 4/3 3/3 2/1 1/1 3. Temporal muscle 2/2 2/2 2/1 1/1 4. Masseter muscle 2/2 2/2 2/1 1/1 5. Tubercle of the maxilla (lateral pterygoid muscle) 9/10 6/5 4/4 3/3 6. Medial pterygoid muscle 5/5 5/4 3/3 2/2 7. Floor of the oral cavity (mylohyoid muscle, digastric muscle, supra-, infrahyoid muscles) 5/5 4/4 3/2 1/1 8. Sternocleidomastoid muscle 2/2 2/2 1/1 1/1 9. Omohyoid muscle 1/1 1/1 1/1 1/1 10. Language 1/1 1/1 1/1 1/1

Table 2. EMG activity of the LM before and after “Complex 21”. Muscle name Test "Peace" Test "Central occlusion" Opening/Closing Test to after to after to after Temporalis, D (µV) 52 38 44 48 556 165 Masseter, D (µV) 67 44 74 50 463 181 Temporalis, S (µV) 63 46 80 53 597 157 Masseter, S (µV) 235 44 201 64 443 198

The assessment of the psycho-emotional sphere after treatment according to the Beck Depression Inventory was 4 points.

During the therapy, the movements of the lower jaw became synchronous, no displacement of the lower jaw along the midline was noted when opening the mouth. According to EMG and palpation examination, the functional state of the masticatory muscles was normalized. The patient was recommended further dental treatment by an orthopedic dentist to replace the existing fillings with all-ceramic inlays with a pronounced occlusal relief.

Thus, the corrective measures carried out using the proposed method of relaxation of the masticatory muscles can be recommended for inclusion in the complex rehabilitation of patients with TMJ disorders, and can also be used in patients with other pathologies requiring dental orthopedic treatment.

Sources of information

1. Patent No. 2691254 C1, Russian Federation, IPC A61H 7/00. Method for correcting psychoemotional state using facial massage: No. 2018126522: declared 18.07.2018: published 11.06.2019 / A. D. Dubinskaya. - EDN INVTWM.

2. Patent No. 2705237 C1, Russian Federation, IPC A61H 7/00, A61H 1/00, A61H 23/00. Method for neuromuscular relaxation of facial muscles: No. 2019111984: declared 19.04.2019: published 06.11.2019 / A. D. Dubinskaya. - EDN CNKMEE.

3. Patent No. 2705240 C1, Russian Federation, IPC A61B 5/0488, A61H 39/00, A61H 7/00. Method for predicting the course and selecting a method for treating muscle dysfunctions of the temporomandibular joint: No. 2018125595: declared 11.07.2018: published 06.11.2019 / A. V. Yatsuk, K. A. Sivolapov; applicant Federal State Budgetary Educational Institution of Additional Professional Education "Russian Medical Academy of Continuous Professional Education" of the Ministry of Health of the Russian Federation (FGBOU DPO RMANPO of the Ministry of Health of the Russian Federation). - EDN VFSCLS.

4. Patent No. 2723220 C1, Russian Federation, IPC A61H 7/00, A61H 23/06. Method for reducing hypertonicity of the masticatory muscles: No. 2019121561: declared 10.07.2019: published 09.06.2020 / A. D. Dubinskaya. - EDN TQJYMQ.

5. Patent No. 2735641 C1, Russian Federation, IPC A61H 1/00. Method for rejuvenation of the face and neck: No. 2020114851: declared 04/14/2020: published 11/05/2020 / Yu. V. Chikurov. - EDN ZBSMUU.

6. Patent for Utility Model No. 207536 U1, Russian Federation, IPC A61C 7/00. Mouthguard with a tongue positioning platform: No. 2021116046: declared 03.06.2021: published 01.11.2021 / Yu. V. Ageeva, V. I. Shemonaev, S. V. Klauchek, A. N. Parkhomenko; applicant Federal State Budgetary Educational Institution of Higher Education "Volgograd State Medical University" of the Ministry of Health of the Russian Federation. - EDN RSXYFF.

Claims (41)

A method of relaxing the masticatory muscles, which consists of performing a set of massage and myogymnastic exercises, characterized in that the massage and myogymnastic exercises are performed for 21 days, During the first week, perform the following exercises: from a standing or sitting position on a chair, place your feet on the floor, place the palms of both hands on your waist, point your elbows to the sides, lower your shoulders down, then make circular movements with your shoulders from front to back - complete one circle in 10-15 seconds, perform the exercise for at least a minute, from a standing or sitting position, place your head straight, direct your gaze to the horizon, raise your straightened arms to the sides to a comfortable height, straighten and tense your fingers, then move your hands forward and bring them together, while maintaining the tension in your fingers, hold the position for 30 seconds, inhale through your nose, exhale through your mouth, then spread your arms to the sides, hold the position for 30 seconds, perform the exercise 2-3 times; from a sitting position on a chair, the exercise is performed on the left with the right hand and vice versa, the II-V fingers of the hands are pressed and rolling-pressing movements are performed from the neck to the shoulder, repeated 3-4 times, then the trapezius muscle is grasped with the I-V fingers of the hand and circular kneading movements are performed, the manipulation is repeated on the opposite side, the exercise is performed for 1-2 minutes; the head is positioned straight, the II-IV fingers of both hands are placed on the back of the neck on one side of the spine, so that the fingers of one hand are above the fingers of the other and are on the same line, the fingers are pressed for 5-10 seconds, then the fingers are used to perform rolling and pressing movements in opposite directions, while the fingers of the upper hand are moved up, the lower hand - down, repeated on the other side, the exercise is performed for 1 minute; from a sitting position on a chair or standing, turn your head to the side until the first discomfort appears and hold the position for 15 seconds, from the achieved position, move your chin down until the first discomfort appears and hold this position for 15 seconds, then move your chin up until the first discomfort appears and stay in this position for 15 seconds, repeat on the opposite side, perform the exercise 1 time; from a sitting position on a chair, turn your head to the side and on the opposite side, with the first and second fingers of both hands, grasp the upper portion of the sternocleidomastoid muscle and compress it for 20-30 seconds, then with the indicated fingers of both hands, perform kneading-rubbing stretching massage movements for 1 minute, after which direct your hands in different directions, repeat the exercise on the opposite side; from a sitting position on a chair, place the first fingers of both hands under the lower jaw on the right and left, immerse the fingertips in the underlying muscles to a depth of 5-10 mm, and press the distal phalanges against the lower jaw from the inside, place the remaining fingers on the cheeks, then slide the first fingers along the muscles of the floor of the mouth, if tense or painful areas appear, fix the first fingers on them for 10-20 seconds without releasing the pressure, then continue sliding the fingers, repeat the exercise 2-3 times; from a sitting position on a chair, place the II-IV fingers of both hands on the parotid-chewing area on both sides under the zygomatic arch, then open the mouth and simultaneously perform a rolling-pressing movement with the II-IV fingers from the zygomatic arch to the angle of the lower jaw along the chewing muscles, perform the exercise for 1 minute; from a sitting position on a chair, with the first and second fingers of both hands, using a pincer grip, create a horizontal fold 2-3 cm long at the outer corner of the eye, then pull the captured fold vertically upwards as much as possible and make 5-7 intercepting movements with the fingers, then stretch the fold from the center to the sides and roll it down by 1-2 cm and repeat the described manipulations, thus working on the area of the face from the outer corner of the eye to the corner of the lower jaw, then perform the exercise on the other side, perform the exercise 1 time; from a sitting position on a chair, use fingers I and II of both hands to grasp the tip of the tongue, then move the fingers to another part of the tongue and repeat the manipulations, treat the entire surface of the tongue from the tip to the root, perform the exercise once; in the second week, perform the following exercises: from a sitting position on the edge of a chair, legs bent at the knees at an angle of 90°, feet fully resting on the floor, both arms straightened at the elbow joints, turned with fingers towards each other and placed above the knees, then rounded the back, while the head is directed downwards, the back of the neck is relaxed, pressing movements are performed with the chin, hold the specified position for 20-30 seconds, the exercise is performed 1-2 times; from a sitting or standing position, place your head straight, interlock the II-IV fingers of both hands and place them on the back of your head, and place the I fingers on the hairline, first stretch your arms up, then press on your hands with the occipital region, while directing your chin down and back, hold the achieved position for 1 minute, perform the exercise once; from a sitting position, straighten your back and head, perform the exercise on one side with the hand of the same name, bend the second finger of one hand in the form of a hook and place it on the area of the cranio-vertebral junction, then make a pressing-rolling movement with your finger down along the entire surface of the neck, while directing the chin down, work the entire back surface of the neck first on one side, then change hands and work on the other side, perform the exercise 2-3 times; from a sitting position, place the II-IV fingers of both hands on the cervical-shoulder angles and press, use your fingers to make a rolling-pressing movement backwards on both sides along the spine, then return to the starting position and make the same movement to the sides towards the shoulders, perform the exercise for 1 minute; from a sitting position, chin down, perform the exercise alternately on each side with both hands in the parotid-masticatory region, starting under the zygomatic arch and up to the angle of the lower jaw, place the II-IV fingers of the opposite hand on the anterior border of the masseter muscle, and bend the II finger of the same hand in the form of a hook and place it under the zygomatic arch next to the fingers of the other hand, pressing it tightly to the parotid-masticatory region throughout the entire duration of the exercise, open the mouth halfway and perform a rolling-pressing movement directed backwards towards the ear, stop the movement in painful areas, while applying pressure until the pain subsides, repeat the movement in this area 3-5 times, then use the same technique to work out the entire surface in turn up to the angle of the lower jaw, after which move to the other side of the face and repeat the technique; from a sitting position, the exercise is performed in the parotid-chewing region simultaneously on both sides, the second fingers of both hands are placed under the zygomatic arch on the same sides, and the first fingers of both hands are placed in the area of the angle of the lower jaw, then a horizontal fold is created with a pincer-like grip, after which the mouth is opened, while the folds should slip out of the created grip, the exercise is performed for 1 minute; from a sitting position, the first fingers of both hands are raised vertically upward and placed in the submandibular region to a depth of 5-10 mm, then the working fingers perform circular rotational movements, accompanying them with pressure on the underlying tissues of the floor of the oral cavity, if dense and painful areas are detected, they are worked on for 10-20 seconds, the exercise is performed for 2 minutes; in a sitting position, the patient inserts the second finger of the hand of the same name into the oral cavity and applies pressure in the area of the medial pterygoid muscles successively on the right and left, and then on the area of the lateral pterygoid muscles; in a sitting position in front of a mirror, the patient places the second finger of the hand of the same name in the area of the projection of the condyle, and the first finger in the area of the angle of the lower jaw, the second finger of the other hand is placed on the vestibular surface of the incisors of the lower jaw, the patient performs movements of the lower jaw down, up, forward, backward, right and left; in a sitting position in front of a mirror, the patient moves the tongue along the palate sequentially forward-backward and left-right 20 times each, pressing the tip of the tongue against the palatine folds, the patient takes a deep breath, and then swallows 6 times, pressing the tip of the tongue against the palatine folds, while the patient opens the mouth in such a way that there are no clicks in the joint, 6 times; in the third week, perform the following exercises: from a sitting or standing position, place your head straight, direct your gaze to the horizon, straighten your lumbar arch, pull in your stomach, lower your shoulders down, straighten both arms at the elbows, lower them down, turn your palms toward your body, then make circular movements with your shoulders back and turn your palms toward your body with the back side, then reverse the movement and return to the starting position, perform the exercise for 1 minute; from a standing position with your back to the wall, press your head and back against the wall, and move your feet 15-20 cm away, from this position lower your chin and hold it for 1 minute, while the base of your head and the back of your neck come into closer contact with the wall, then bend your body forward and tighten the contact of your neck with the wall, hold your body in this position for 1 minute, perform the exercise once; from a sitting position with your back or half-side to the table, perform the exercise alternately on each side, for the right side, bend the right arm at the elbow and place it on the table with the palm down, move the right shoulder blade toward the spine, and tilt the head toward the right shoulder, then straighten the elbow of the right arm and simultaneously resist with the head until you feel tension in the upper part of the trapezius muscle on the right, hold the body in this position for 30 seconds, then place the II-IV fingers of both hands on the trapezius muscle and with pressure direct the hands in different directions, first perform stretching from the center of the muscle, place the II-IV fingers of both hands at a distance of 3-5 cm from each other and perform stretching in opposite directions, at the end, use your fingers to perform kneading and stretching massage movements, perform stretching for 1-2 minutes, then work out the muscle on the left, perform the exercise 1 time; from a standing or sitting position, place the I-IV fingers of both hands on the back of the neck on the sides of the spine and use the grip to create a fold of soft tissue, then use the fingers to perform rubbing movements without putting pressure on the spine, working the entire back of the neck, perform the exercise once; from a sitting position, close the teeth and palpate the chewing muscle in the parotid-masticatory region, lower the chin down, keep the mouth slightly open, place the 2nd finger of the same hand, bent into a hook, under the zygomatic arch, and the 1st finger of the same hand under the lower jaw, then slide the 2nd finger down along the surface of the muscle to the 1st, then perform the exercise on the other side of the face, perform the exercise 1 time; from a sitting position, the fingers of both hands are raised vertically upward and placed in the submandibular region to a depth of 5-10 mm, then the fingers are used to make circular rotational movements, accompanying them with pressure on the underlying tissues of the floor of the oral cavity, if dense and painful areas are detected, they are worked on for 10-20 seconds, after which they move on to other areas of the submandibular region, the entire submandibular region is worked on on both sides, the exercise is performed for 2 minutes; from a sitting position, use your fingers to resist the movements of the lower jaw down, up, forward, right and left, while changing the position of your fingers, hold the resistance for 6 seconds, repeat the movement in each direction 2-3 times; from a sitting position in front of a mirror, determine the midline between the upper and lower incisors, place the second fingers of both hands on the heads of the lower jaw, and touch the palate with the tip of the tongue and open the mouth, open and close the mouth 20 times within 1 minute; from a sitting position in front of a mirror, press the tip of the tongue against the upper teeth, open the mouth without deviating the lower jaw to the sides, gradually increase the amplitude of mouth opening every day, perform the exercise for 1-2 minutes; from a sitting position, move your chin up, down, left, right with your hand, while keeping your chin in place, stick your tongue out to the tip of your nose, lick your upper and lower lips in a circular motion clockwise and counterclockwise, rest your tongue on your front lower teeth and then relax, do each exercise 6 times; and also apply kinesio tapes using the following technique: taping the upper edge of the trapezius muscle: rounding the edges of the kinesiotape 21-25 cm long and 3 to 5 cm wide, tilting the head to the side at 45°, attaching the anchor of the kinesiotape to the acromial process, and placing the other end of the kinesiotape below the scalp, turning the patient's head to the other side, relaxing the trapezius muscle and placing the tape along the belly of the trapezius muscle with tension at the end; taping the back of the neck: kinesiotape 22-25 cm long and 5 cm wide is cut in half by 2/3 of the length and all edges are rounded, kinesiotape is applied to the area of the back of the neck along the spine with an anchor in the middle of the thoracic spine, the patient tilts his head forward, after which the kinesiotape is fixed first along the spine, and then along the oblique muscles of the neck with tension of up to 5%; the area of the masticatory muscles is taped: a 5 cm wide kinesiotape is measured from the lower part of the zygomatic bone to the submandibular line, the kinesiotape of the obtained length is divided into three equal parts, the edges are rounded, the anchor of the first strip is installed at the corner of the lower jaw with the mouth closed, the rest are installed at intervals of 0.5 cm in the forward direction, the kinesiotape is applied in the direction of the zygomatic bone with the mouth fully open; the temporomandibular region is taped: kinesiotape 5 cm wide and 7-8 cm long is divided into three equal strips, the edges are rounded, the anchor of the first tape is installed in front of the tragus of the ear by 0.5 cm, the first tape is applied without tension diagonally downwards, while the patient inflates the cheek, the remaining two tapes are applied using a similar technique with an anchor below the first, along the branch of the lower jaw at intervals of 0.5 cm; taping the temporal region: measuring a 5 cm wide kinesiotape from the highest point of the eyebrow to the cheekbone, dividing the kinesiotape of the resulting length into two equal parts, rounding the edges, placing the kinesiotape anchors on the forehead above the highest point of the eyebrow on the right and left and applying them towards the cheekbone without tension; taping of the hyoid bone: use a triangular application, cut out a triangle with a base the width of the tape from a 5x5 cm strip of tape, place the base of the triangle on the projection of the hyoid bone, apply the tape without tension, while pulling the chin forward.