RU2848877C1 - Method of ultrasonic diagnosis of the leading type of swallowing in children during the period of tooth change - Google Patents

Abstract

FIELD: medicine; dentistry.

SUBSTANCE: invention can be used to diagnose the leading type of swallowing in children during the period of tooth replacement. An ultrasound examination of the tongue is performed at rest and during swallowing. A sensor is placed in the sagittal plane along the midline of the floor of the mouth. Sonograms are recorded in B and M modes, on which the position of the tongue relative to the palate is assessed in real time and the upward or downward movement of the tip of the tongue and the genioglossus muscle is determined. With upward movement of the tip of the tongue and the geniohyoid muscle and complete adherence of the tongue to the palate dome, a normal somatic type of swallowing is determined. When the tip of the tongue and the genioglossus muscle move downward and the tongue does not fully adhere to the palate, a pathological infantile type of swallowing is determined.

EFFECT: accurate, informative and safe assessment of swallowing dysfunction in children during the period of tooth replacement by means of ultrasonic assessment of the position of the tongue relative to the palate and determination of the movement of the tip of the tongue and the geniohyoid muscle.

2 cl, 6 dwg, 2 pr

Description

The invention relates to the field of medicine, in particular to dentistry, and can be used for the purpose of diagnosing the leading type of swallowing in children (normal, pathological), which affects the change in myodynamic balance in the maxillofacial region (MFR).

The proposed method can be used for children regardless of the stage of formation and morphological features of the dentoalveolar system, for example, during the period of primary or mixed dentition, with premature removal of primary teeth (secondary adentia) or their congenital absence (primary adentia).

The invention can be widely used both in specialized clinics for patient examinations and in general healthcare facilities. The results of this examination are essential for developing interdisciplinary programs for the diagnosis, monitoring, and treatment of established functional disorders that have resulted in changes in the growth and development of the maxillofacial region in growing patients.

It should be clarified that infantile swallowing is considered a myofunctional disorder, which leads to altered myodynamic balance in the oral cavity. This disrupts the growth of orofacial bones, directly affecting the growing body and disrupting vital functions such as swallowing, breathing, chewing, and speech. These disruptions lead to deterioration of the musculoskeletal postural system and, consequently, dysfunction of the visceral organs and systems of the entire growing body.

According to the bioprogressive philosophy of R.M. Ricketts, the swallowing process plays a leading role in the development of dental malocclusion in growing patients, which is why it is so important to evaluate and characterize it at the diagnostic stage [Ricketts RM. Bioprogressive therapy as an answer to orthodontic needs. Part I. Am J Orthod. 1976;70:241–268]. During infantile swallowing, the position of the tongue changes, lowering it to the floor of the oral cavity, which leads to a change in myodynamic balance and disruption of the growth of the maxilla. This leads to deformations of the maxilla, which subsequently affects the position of the mandible with the formation of distal or cross occlusion in combination with vertical incisor or deep disocclusion and directly depends on the trajectory of tongue movements in the sagittal and transverse planes.

The simplest and most widely available method for determining the dominant swallowing type in children is clinical. It includes a visual examination and functional tests. According to Graber T.M. et al., tongue position should be assessed during a clinical visual examination in the physiological resting position of the lower jaw, with the examiner slightly opening the subject's lips to record the tongue's position in the oral cavity at rest and during swallowing. However, even the slightest touch to the lips can cause the mouth to open involuntarily and the tongue to move down to the floor of the oral cavity and toward the lips [Graber T.M, Rakosi T, Petrovic A.G. Dentofacial orthopedics with functional appliances. St. Louis: Mosby, 1985]. The functional swallowing test is based on studying the subject's ability to swallow a bolus of food or liquid in a certain amount of time or on command. The normal swallowing time for liquid food is 0.2 sec, for solid food - 0.5 sec. Infantile swallowing is characterized by the absence of closure of the dental arches, with the tongue inserted between them. This causes compensatory tension in the facial muscles, which is manifested by point depressions on the skin in the area of the corners of the mouth and chin (the "thimble symptom"); the neck is extended and the head is tilted, the chest is sunken. There is also a clinical functional test according to Frankel. It is used to determine the position of the back of the tongue and its changes during orthodontic treatment. The test is performed with specially curved individual loops, which are made from a wire with a diameter of 0.8 mm calcined over a burner flame. After inserting the wire loop into the oral cavity, the position of its handle is recorded before and after the act of swallowing. A change in the position of the loop indicates contact of the back of the tongue with the hard palate or the lack of skill in raising it [Khoroshilkina F.Ya. Orthodontics: textbook 2nd ed., corrected and supplemented. [M: Medical Information Agency, 2010:544]. These functional swallowing tests have an insufficient diagnostic effect due to the lack of proper interaction with growing patients, and also require additional time and skills to fabricate a specially curved, individual loop. During the Frankel test, diagnostic stimulation is applied to only one zone of the tongue, which is ineffective in recording swallowing patterns.

Videofluoroscopy is a modern radiographic method for assessing swallowing from the initial to the final phase of the food bolus in real time [Farooque U, Hassan S.A, Sm I, Shah et al. The videofluorographic swallowing study: a review of the literature. Preprints, 2020. DOI:10.20944/preprints202012.0504.v1]. A disadvantage of this method is the use of barium and X-ray radiation, which prevents frequent repetition of such a study in children and is unsafe in patients with concomitant somatic diseases.

Another modern method for assessing the condition of the oral cavity organs and tongue movement during swallowing is dynamic magnetic resonance imaging (DMRI) [Honda Y. Kinetic MRI using high-speed sequence to evaluate swallowing. Oral radiology. 2006;19:14-21]. However, this method may not ensure accuracy due to changes in head position during the examination, which in turn will lead to changes in the size of the pharyngeal cleft and the direction of the food bolus flow.

The closest to the proposed invention are: a method for functional diagnostics of the dentoalveolar system using the analysis of muscle biopotentials and the assessment of their coordinated activity (RU 2729446 C2, published on August 6, 2020) and a method for comprehensive diagnostics of occlusion (RU 2694175 C1, published on July 9, 2019), which include the analysis of biopotentials of the orofacial muscles and the assessment of their coordinated activity, as well as a graphic recording of the movements of the mandible during functional tests, which include a swallowing test. These methods are aimed at identifying functional disorders of the dentoalveolar system at the planning stage of a comprehensive treatment plan. Electromyography records the amplitude of the biopotential waves of the temporal, masseter, suprahyoid, and sternocleidomastoid muscles. Kinesiography records the trajectory of mandibular movements, their amplitude, speed, and deviations during opening and closing the mouth, swallowing, and forward and lateral movements of the mandible. The disadvantages of the above-mentioned methods are that the proposed functional studies assess the work of the masticatory muscles of the maxillofacial region and the position of the mandible in static and dynamic states during functional tests. However, they do not take into account the primary anatomical component involved in swallowing—the tongue. They do not allow for an assessment of the tongue's position relative to the palate or the nature of its movement during swallowing in the sagittal and transverse planes.

The proposed method for diagnosing swallowing disorders involves performing an ultrasound examination of the tongue at rest and during swallowing in B- and M-modes to visualize in real time the position of the tongue relative to the palate and determine the movement of the genioglossus muscle during swallowing. Using an eL18-4 PureWave ultra-wide-field linear array transducer, positioned in the sagittal plane along the midline of the floor of the mouth in M-mode, the upward or downward movement of the tip of the tongue and genioglossus muscle is determined, which allows for the assessment of normal (somatic) or pathological (infantile) swallowing in the sagittal and transverse planes. This method provides an accurate, informative, and safe ultrasound assessment of swallowing disorders in growing patients and enables the development of a comprehensive treatment plan to reduce treatment time and the recurrence rate of the pathology under study.

A method for ultrasound diagnostics of the leading type of swallowing in children during the period of tooth change, including conducting an ultrasound examination of the tongue at rest and during the act of swallowing, characterized in that it is carried out on a stationary ultrasound device of the expert class "Philips EPIQ 7", with Pure Wave visualization technology and the use of Tissue Specific Imaging - TSI software using an ultra-wide-plane sensor with a linear matrix eL18-4 PureWave, removing (recording) sonograms in B- and M-modes, in which the position of the tongue relative to the palate is assessed in real time and the ascending or descending movement of the tip of the tongue and the genioglossus muscle is determined, by which the presence of a normal (somatic) or pathological (infantile) type of swallowing in the sagittal and transverse planes is judged. The method can be implemented in a dental chair using a portable LOGIQe ultrasound device with a 12L linear, broadband, multi-frequency sensor.

The invention is illustrated by graphic materials, where:

Fig. 1 – Patient F., 8.5 years old with distal disocclusion, vertical incisor disocclusion of the 1st degree, anomaly of the position of teeth 1.2, 1.1, 2.1, 2.2, 3.2, 3.1, 4.1, 4.2, infantile type of swallowing in the anterior direction (face in front, profile, voluntary swallowing “thimble symptom”).

Fig. 2 – dental arches of patient F., 8.5 years old.

Fig. 3 – the presented sonogram in B- and M-modes of patient F., 8.5 l, shows the distal position of the tongue, the downward movement of the genioglossus muscle (infantile type of swallowing in the forward direction).

Fig. 4 – patient D., 8 years old with right-sided palatine occlusion, deep transverse occlusion, anomaly of the position of teeth 1.2, 1.1, 2.1, 2.2, 3.2, 3.1, 4.1, 4.2, infantile type of swallowing in the lateral direction (face, profile, smile).

Fig. 5 – dental arches of patient D., 8 years old.

Fig. 6 – the presented sonogram in B- and M-modes of patient D., 8 years old, shows an asymmetrical position of the tongue and its incomplete adherence to the posterior third of the palate, alternating movement of the tip of the tongue and the genioglossus muscle of varying amplitude (infantile type of swallowing in the lateral direction).

The effectiveness of the method is demonstrated by the clinical examples below.

Clinical example 1 (see Figs. 1-3). Patient F., 8.5 years old, presented to the clinic complaining of malpositioned teeth and facial profile abnormalities. Objectively: the facial configuration is unchanged from the front, while in profile, the chin is displaced posteriorly, the profile is convex, the "thimble symptom" and tension in the neck muscles are observed during voluntary swallowing, and a double chin is observed due to the distal position of the tongue (Fig. 1). In the oral cavity, there is narrowing of the upper and lower dental arches, occlusion of the canines and first molars according to Angle's class I with a tendency toward the distal type, vertical incisor disocclusion of 3 mm, and a sagittal gap of 5 mm. The tongue is retroverted (Fig. 2).

Based on the obtained clinical examination data, a preliminary diagnosis was made: distal disocclusion, tendency to vertical incisor disocclusion, anomaly of the position of teeth 1.2, 1.1, 2.1, 2.2, 3.2, 3.1, 4.1, 4.2, infantile swallowing type.

Next, to clarify the preliminary diagnosis and develop a comprehensive treatment plan, the patient underwent an ultrasound examination of the tongue at rest and during swallowing.

Analysis of B- and M-mode sonograms revealed incomplete adhesion of the tongue to the dome of the palate in the anterior third and a distal position. During voluntary swallowing and on command, a downward movement of the tongue tip and genioglossus muscle was observed, characteristic of an infantile, anterior swallowing (Fig. 3).

Based on the obtained diagnostic data of the functional component of the occlusal disorder, the final diagnosis was: distal disocclusion, vertical incisor disocclusion of the 1st degree, anomaly of the position of teeth 1.2, 1.1, 2.1, 2.2, 3.2, 3.1, 4.1, 4.2, infantile type of swallowing in the forward direction.

A comprehensive treatment plan is proposed, which is primarily aimed at normalizing the position and function of the tongue, which will subsequently ensure effective active mechanotherapy with correction of occlusion anomalies.

Clinical case 2 (see Figs. 4-6). Patient D., 8 years old, presented to the orthodontic clinic complaining of protruding maxillary anterior teeth and rightward displacement of the mandible. Objectively, the face is asymmetrical, the chin is shifted to the right, there is a tendency toward a dolichocephalic type, and the profile is convex (Fig. ₄ ). In the oral cavity, there is a 4 mm shift of the cosmetic center to the right and a vertical overlap in the frontal region of more than ^1/2 of the crowns of the lower incisors. The sagittal gap is 2 mm, caused by protrusion of the maxillary incisors and retrusion of the mandibular incisors. The diastema is 3 mm, and there is right-sided palatine occlusion. The tongue is located on the floor of the oral cavity (Fig. 5).

Based on the obtained data from the clinical examination, a preliminary diagnosis was made: right-sided palatine occlusion, deep transverse occlusion, anomaly of the position of teeth 1.2, 1.1, 2.1, 2.2, 3.2, 3.1, 4.1, 4.2.

Next, to clarify the preliminary diagnosis and develop a comprehensive treatment plan, the patient underwent an ultrasound examination of the tongue at rest and during swallowing.

Analysis of B- and M-mode sonograms revealed incomplete adhesion of the tongue to the dome of the palate in the posterior third and an asymmetrical position. During voluntary swallowing and on command, alternating movements of the tongue tip and genioglossus muscle of varying amplitude were recorded, characteristic of infantile lateral swallowing (Fig. 6).

Based on the obtained diagnostic data of the functional component of the occlusal disorder, the final diagnosis was: right-sided palatine occlusion, deep transverse occlusion, anomaly of the position of teeth 1.2, 1.1, 2.1, 2.2, 3.2, 3.1, 4.1, 4.2, infantile type of swallowing in the lateral direction.

The patient was offered a comprehensive treatment plan aimed at normalizing the function and morphology of the occlusal joint, which will subsequently ensure a stable result in the correction of the occlusion anomaly.

Claims (3)

1. A method for ultrasound diagnostics of the leading type of swallowing in children during the period of tooth change, including conducting an ultrasound examination of the tongue at rest and during the act of swallowing, characterized in that a sensor is installed in the sagittal plane along the midline of the floor of the oral cavity, sonograms are recorded in B- and M-modes, in which the position of the tongue relative to the palate is assessed in real time and the ascending or descending movement of the tip of the tongue and the genioglossus muscle is determined; with an ascending movement of the tip of the tongue and the genioglossus muscle and complete adhesion of the tongue to the dome of the palate, a normal somatic type of swallowing is determined; with a descending movement of the tip of the tongue and the genioglossus muscle and incomplete adhesion of the tongue to the dome of the palate, a pathological infantile type of swallowing is determined. 2. The method according to paragraph 1, characterized in that the examination is carried out in a dental chair using a portable ultrasound device LOGIQe with a linear, broadband, multi-frequency 12L sensor. 3. The method according to claim 1, characterized in that the study is carried out on a stationary ultrasound device “Philips EPIQ 7”, with Pure Wave visualization technology and the use of Tissue Specific Imaging software using an ultra-wide-area sensor with an eL18-4 PureWave linear matrix.