ATM, rachis cervical et astme chez l'enfant

[Marc]

J Clin Pediatr Dent. 2005 Summer;29(4):287-92. Related Articles, Links

Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children.

Chaves TC, Grossi DB, de Oliveira AS, Bertolli F, Holtz A, Costa D.

Orthopedics, Traumatology and Rehabilitation program at University of Sao Paulo Ribeirao Preto - USP.

Neck accessory respiratory muscles and mouth breathing suggest a direct relationship among asthma, Temporomandibular (TMD) and Cervical Spine (CSD) Disorders. This study was performed to evaluate and correlate TMD, CSD in asthmatic and non-asthmatic. Thirty asthmatic children (7.1 +/- 2.6 years old), 30 non-asthmatic predominantly mouth breathing children (Mouth Breathing Group - MBG) (8.80 +/- 1.61 years) and 30 non-asthmatic predominantly nasal breathing children (Nasal breathing Group - NBG) (9.00 +/- 1.64 years) participated in this study and they were submitted to clinical index to evaluate stomatognathic and cervical systems. Spearman correlation test and Chi-square were used. The level of significance was set at p < 0. 05. Significant frequency of palpatory tenderness of temporomandibular joint (TMJ), TMJ sounds, pain during cervical extension and rotation, palpatory tenderness of sternocleidomastoids and paravertabrae muscles and a severe reduction in cervical range of motion were observed in AG. Both AG and MBG groups demonstrated palpatory tenderness of posterior TMJ, medial and lateral pterygoid, and trapezius muscles when compared to NBG. Results showed a positive correlation between the severity of TMD and CSD signs in asthmatic children (r = 0.48). No child was considered normal to CSD and cervical mobility. The possible shortening of neck accessory muscles of respiration and mouth breathing could explain the relationship observed between TMD, CSD signs in asthmatic children and emphasize the importance of the assessment of temporomandibular and cervical spine regions in asthmatic children.

PMID: 16161392 [PubMed - indexed for MEDLINE]

[Marc]

J Orthop Sports Phys Ther. 2004 Sep;34(9):535-48. Related Articles, Links

Effectiveness of manual physical therapy, therapeutic exercise, and patient education on bilateral disc displacement without reduction- of the temporomandibular joint: a single-case design.

Cleland J, Palmer J.

Department of Physical Therapy, Franklin Pierce College, Concord, NH 03301, USA. clelandj@fpc.edu

STUDY DESIGN: Single-case A1-B-A2 design. OBJECTIVE: To determine if manual physical therapy, therapeutic exercise, and patient education would be an effective management strategy for a patient with a disc displacement without reduction of both temporomandibular joints. BACKGROUND: A number of conservative management strategies have been proposed for the treatment of temporomandibular disorders. However, little evidence exists to indicate the effectiveness of physical therapy interventions in patients with bilateral disc displacement without reduction. METHODS AND MEASURES: Phase A1 of the study consisted of a baseline condition in which no intervention was initiated. Phase B included manual physical therapy, therapeutic exercise, and patient education focusing on the temporomandibular joint and cervical spine. Phase A2 consisted of withdrawal of the intervention. The Steigerwald/Maher disability questionnaire was used to collect data relative to function. A visual analog scale was used to collect pain data and maximal mouth opening measurements were obtained as an indicator of range of motion. Visual analysis and the 2 standard deviation band method of statistical analysis were used to compare data. RESULTS: Following the implementation of the intervention phase, the patient demonstrated significant reductions in pain and improvements in maximal mouth opening and function as measured by the Steigerwald/Maher disability questionnaire. These observed improvements were maintained at the time of a 3-month follow-up. CONCLUSIONS: The results of our study suggest that manual physical therapy, therapeutic exercise, and patient education may have been an effective management strategy for a patient with bilateral disc displacement without reduction of the temporomandibular joints. Further outcome studies in the form of randomized controlled trials are needed to determine the clinical utility of this treatment approach in a larger population.

Publication Types:

* Case Reports


PMID: 15493521 [PubMed - indexed for MEDLINE]

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[Marc]

Cranio. 2001 Jan;19(1):26-32. Related Articles, Links

An investigation of the effectiveness of exercise and manual therapy in treating symptoms of TMJ osteoarthritis.

Nicolakis P, Burak EC, Kollmitzer J, Kopf A, Piehslinger E, Wiesinger GF, Fialka-Moser V.

University Department of Physical Medicine & Rehabilitation, Vienna, Austria. Peter.Nicolakis@AKH-Wien.AC.AT

The background and purpose of this investigation was to evaluate the use of a treatment protocol which included active and passive jaw movements, manual therapy techniques, correction of body posture, and relaxation techniques for the treatment of temporomandibular joint (TMJ) osteoarthrosis (OA). Twenty consecutive patients suffering from TMJ OA participated in this study. Inclusion criteria: a. pain in the temporomandibular region; b. symptoms lasting at least three months; and c. radiologically proven OA. All patients were assigned to a waiting list, serving as a no treatment control period. Nineteen patients completed the study. No adverse effects occurred. During the control period (mean duration 35 days), the parameters did not change significantly. After treatment (mean duration 46 days) pain, impairment, and incisal edge clearance improved significantly (Wilcoxon test p < 0.001). At follow-up, pain and impairment were further reduced. The number of patients experiencing no pain at rest (80%), chi-square test p = 0.02) and stress (47%), chi-square test p = 0.03), and no impairment (37%), chi-square test p = 0.05) increased significantly. This therapeutic treatment protocol seems to be useful treatment for the symptoms of clinical dysfunction in OA of the TMJ.

PMID: 11842837 [PubMed - indexed for MEDLINE]

[bernard]

Marc,

Je ne vois pas la claire relation qui pourrait exister entre ces trois résumés ?

[Marc]

Chacun de ces articles mériterait effectivement un sujet complet.
Cependant ces articles mettent en relation:
- les articulations temporo-mandibulaires
- le disque temporo-mandibulaire
- la musculature du rachis cervical
- les muscles hyoïdiens
- les muscles respiratoires accessoires

et leurs relations avec l'asthme chez l'enfant, ainsi que les affets des traitements manuels sur les disfonctions de l'ATM.

En ostéo, on ne va pas traiter un asthme ou une disfonction de l'ATM. On va s'interesser à un patient qui se plaint de ... et si au décours de l'examen il s'avère que l'ATM doit être traitée on la traitera comme une des causes supposées de la plainte du patient.
Il est là le rapport: l'ATM peut être impliquée dans de nombreuses symptomatologies.

Un exemple: j'ai vu et revu un patient qui se plaignait de rachialgies (douleurs aléatoires, principalement cervicales et dorsales) et de céphalées. Ce patient avait subi des extractions dentaires. Chaque fois que je le rééquilibrais, il était soulagé pour à peu près un mois, puis il retombait dans ses rachialgies, et céphalées.
Je lui ai donc demandé de consulter un dentiste (pas celui qui avait extrait...).
Décision de reconstituer la denture. Une fois le dernier bridge posé, et uniquement à ce moment là, les douleurs et céphalées ont totalement disparues...

[bernard]

Marc,

La relation dentaire et/ou occulaire et/ou auditive est connue chez les kinés qui ne dormaient pas en cours.

Je ne vois rien d'ostéopathique là dedans.
Une assymétrie musculaire à cet étage est simplement moins visible qu'au niveau des membres inférieurs. C'est cette non visiblité qui laisse croire aux kinés/médecins qu'elle n'est pas importante.

[Marc]

Originally Posted by bernard

La relation dentaire et/ou occulaire et/ou auditive est connue chez les kinés qui ne dormaient pas en cours.
Je ne vois rien d'ostéopathique là dedans.

L'ostéopathie n'a jamais ni redécouvert, ni réinventé l'anatomie