Theme 1. Physical
rehabilitation at fractures of the jaws and facial bones of the skeleton.
2. Physical rehabilitation in diseases and contracture temporo-mandibular
joints.
Fractures of the jaws belong to the common injuries (
over 15% of all bodies fractures ). From all facial bones of
the skull the most frequent take place
the mandibular fractures (more than 85%
of cases), fractures of the maxilla ,in
combining with other injuries facial bones’ middle zone
,are approximately in the 10% of cases.
Law’s damage
is accompanied of physiological equilibrium mimic muscle
disorders,disorganizing of brathing
functions , swallowing, chewing and speech. As a result of the pituitary-adrenal
system reaction ,at the jaw’s fractures
,arising the hemo-dynamic , thermo-regulation changes and other physiological
processes, which lead to poor general condition of patients .
Damage of
maxillo-facial area has some features, due not only anatomic and
physiological importance located I this
place vital value organs, but also emotional and mental changes, that often
occure due to distortion of the face. Functional
violation of eating, speech defects and
changes of external respiration at the jaw’s
fractures lead to the capacity lowering
and the patient’s mental
condition is worsening.
However, the
tissues of the maxillofacial area have the increased
capacity for regeneration and high level of
resistance to infection due to good blood supply and innervation.
Therefore, even in large face damages
at the right treatment usually have the
happy final.
Complex treatment of patients with the jaw’s fractures provides timely and reliable
fixing of bone fragments, medicamental
and dietary treatment, use of functional
therapy methods (TE , mechanical therapy, massage, etc.).
A
very important factor, which affects on
the TE methods on the classes at the
jaws’ fractures , is the mode
of bone’s fragments
consolidation.
Relatively , two basic methods for fixing of jaws’ fragments we can distinguish:
orthopedic or conservative, and surgery (osteo-synthesis). In some cases the
combined –conservative-surgical methods
of jaws’ fragments consolidation are
used . For example, at maxilla fractures , put the teeth thewire splints
with wire loops on the jaws
(conservative method) and make rapid fixation (suspension) fragment of maxilla
fragments to the immobile zygomatic
appendixes of frontal bone. In
last years for the fixation of mandibular fragments the plastic splints on
teeth are used ; thir splints are quickly hardening.
Regardless of the method of permanent fixation of
mandibular fragments , the most
early terms the functional therapy is appointed. It should be accaunt that forced limitation of
physical activity, prolonged jaws’ immobilisation , the possibility of damage’s at the fracture soft tissues
scarring ,may lead to serious complications such as mandible’s contracture, temporal-ankylosis of mandibular
joint , pneumonia, etc..
Therefore, the TE use for the prevention of
complications, accelerated consolidation of bone fragments, the most frequent
restoration of jaws’ functions and period of patient’s disability reducing , is
the important element of complex treatment. Successful completion of these
tasks is depevd greatly of well-timed of
the functional treatment and whether it
properly is perfomed.
Basic requirements for the TE methods
on the occupations at the jaws’ fractures is necessity keep the immobilizing
conditions of primary bone’s callus formation (first period of the TE application ). Just breach hopestion of bone’s fragments fixation
is the cause of various complications and increasing of the treatment
terms. To avoid complications, to create the most favorable conditions for the
blending of fractures is possible only when the
rest (immobilization) and functional loading (TE ) is used correctly .
The final aim of jaws’s fractures
treatment is not only in restoring of
the anatomical continuity and damaged bones’form, but also full-fledged
normalization, as soon as possible, functions of chewing.
Methods of medical gymnastics at the jaws’ fractures
depends on the periods of bone’s healing, accepting in traumatology,
immobilization features (one-moment or 2-moment jaws’ splintage, osteo-sythesis) and patient’s clinical condition .
Each lesson should include medical gymnastics of
general-strengthenining and breathing exercises in the following sequence and
dosage, to ensure the overall effect on the body and achieve of improvements in
thetissues’ local processes in damaged pllaces. Character
of general-strengthening and breathing exercise depends on the movement mode
and functional stateof respiratory and
cardio-vascular system of patient.
The use of special exercises to mimic and chewing
muscle depends of the immobilixtion method .
When the conservative (orthopedic) treatment, which
applies almost 80% of patients with jaws’ fractures, bone fragments are fixed
in two main ways: 2-jaws stretching and immobilization with the help of
aluminum wire and hooktraction rubber,
plastic and kaps aparatus, 1-jaw splintage,
using into-oral splints, with offensive hooks, and devices of various designs.
At the surgical (operative) treatment, the
osteosynthesis of a damaged jaw’s fragments is perfomed with a special wire, knitting needles,suturing
apparatus and other devices, which are not limited the temporo-mandibular joint
function.
c
At 2-3-day after immobilization a medical gymnastics
is appointed afrer the method of the first period of occupations. Temporary
contraindications to the use of TE should be considered: a) bad general condition of the patient , b)
fever more than
Tasks of the TE in the first periodi of occupation:
- Improving the general patient’s condition ;
- Promoting of bone fragments’ consolidation and
postoperative wound healing (at the osteo-synthesis);
- Prevention of complications
associated with hypodynamia and immobilization of temporo-mandibular joint;
- Facilitate the restoration of coordinated muscles’
work ,which take part in acts of swallowing, chewing and speech.
Solving of these problems is provided by the
appropriate selection exercise: the general -
developing and breathing exercises, that would strengthen the activity of the
respiratory and circulatory functions adequately to the organism’s functional
possibility are included. Because of
bones fragments fixation’s disruption fears are not allowed to make
the dramatic inclinations of trunk
,jumps , heads’turning and so on.
During the first 3-.4 days of
patient’s treatment with the fractures of maxilla and mandible the
half-bed(ward) and then free regimens are
appointed . Starting position for
general-development and breathing
exercises - lying or sitting on the bed. Young patients with good general
state, in most cases can do the exercises standing.
In appointing the special exercises in the first
lesson period should bear in mind thatin the case of double -jaws’ splintage,
the exercises for the chewing muscles are not used, because of the
inability to open the mouth and the risk of bone fragments’ displacement . You
can send impulses to reducing of chewing muscles contraction at the closing
teeth and slow tempo (interval 1-2 sec.) without much effort.
Due to the increased chewing muscles tonus on the side
of the fracture and increasing its influence of it under the immobilization’s
influence, should contribute of fully
mimic muscles relaxation . For this purpose, widely used the exercises to mimic
muscles ,tongue and neck , that help to improve tissues blood and lymph circulation in the area of fracture
. All exercisesare conducted in the
position , sitting in front of a mirror.
If there is no acute inflammatory processes in the
damage’s area , on the 7-8-day, you can
proceed to massage of face and and neck. Applying the techniques of stroking, rubbing and kneading
in the direction of the face’s middle line upward to the ear and temporal pits.
Then massage the front and. side of the neck. The final part of massage is the
stroking .
Classes of medical gymnastics in the first days
continues to average 10-15 minutes, and at the finish of the first period - up
to 20-25 minutes. During the day, patients
should be 3-4 times independently perform the individual tasks from medical
gymnastics, which consists of complex of special exercises (5-7) with the individual dosing. Multiple of special exercises promotes the faster resorption of edema andincresing
the tissue’s regeneration in locus of
damage.
At 1-jaw splinting methods and osteosynthesis in the
first period of the TE application ,the patient is already on 2-3-day can open
and close your mouth, do the lateral moves of mandible , make chewing
movements.
Thus, 1-jaw’s splintage and osteosynthesis allow
assign the exercises for chewing muscles
after the pain decreasing, which creates better conditions for anatomical and
functional restoration, than at the
2-jaws’ immobilization.
Duration of the
medical gymnastics’ application
first period , take about two
weeks.
Delivr the
training scheme of classes’ first period (duration - 12-14 days) using
of medical gymnastics for patients with fractures of tmaxilla and mandible.
Scheme of medical gymnastics classes at the
fractures of maxilla and nandible ( the first period of the Te application )
Initial part (2 - 5 min)
IP (Initial position) - sitting or standing.
Exercises for upper extremities and
humeral belt, dynamic breathing exercises. Turn torso to the parties, swinging
movements alternately right and left hand, dynamic breathing exercises. Turn
torso to the parties, swinging movements alternately left and right legs in
different directions. Turns ,inclinations and
circular head movements . The performance’s
tempo – slow or medium. Amplitude
of extremities’ movements is not full. Avoid sudden movements of the head and torso.
The main part (10 -12 min)
The final part (2-3 min)
IP - sitting or standing. Exercises to relax the
muscles of the upper extremities and humeral belt and mimic muscles in the
connection with the deep breath. Tempo- slow, watch for the complete muscles’
relaxation of patient .
Approximate complex
for class of medical gymnastics by the method of the first period of the
TE application .
Initial part
IP - the basic stand.
1. Hand on the sides, breaths through the nose, slowly
lowering hands down – rxpiration on the
three accounts; 4-6 times. Tempo – slow’ expiration through the closed lips.
2. Arms ahead ,
palms - upwards, crossing movements of direct arms (20-30 sec.). Average tempo,
respiration isn’t delaying
3. Hands behind of
head, breaths through the nose, turn to the right, arms to the sides –
expiration . The same in the other
direction, 6-8 times. Arms are not lowering, breathing- freely. Tempo - slow .
The main part
IP - sitting in front of a mirror.
1. ircular head movements in each direction (30-40
sec.). Tempo – slow , no delay the breath.
2. Imitation a smile, cheeks inflated by one, 10-15
times.
Tension of muscles 2- 3 sec., 3 - 5 sec.
- rest. Breathing - freely.
3. Knitting of eyebrows, its lifting p (imitation of surprise) stretching of the lips in tube and mouth angles’drawing out to the sides, 10-12 times. Tempo-slow
.
4. Head turning head to sides, inclinations forward
and back, 6-8 times. Tempo - slow . 5.
Simultaneously and alternately eyes’screwing up with the cheeks’ blowing up and
drawing in (20-30 sec.). Muscles tension (3-4 sec.), rest (2-3 sec.).
6. Pulses’ sending to the chewing muscles
contraction (30-40 sec.). Tempo of
contraction - 2 sec., breathing - freely.
7. Mixing in the mouth of water ‘s gulp with the blowing cheeks (20-30 sec.),
gradually increasing of movement’s speed.
8. Movement of the tongue in the oral cavity
with simultaneous nominations of head
forward and returning to the I.P.(20-30
sec.). Slow and average tempo.
Final part
IP - The basic stand.
1. Walking in place, lifting knees high and wide with
the sweeping arms’ movements (30-40 sec.). Average tempo, wach for the
carriage.
2. Turn torso to side with the free movements in the
lowering relaxed arms, 6-8 times. Slow tempo.
3. Lifting of arms upwards - breath through the nose into 2 accounts,
lowering arms down – exhalation out on 4 accounts 5-6 times. Slow tempo. .
In addition to daily classes of medical gymnastics
gymnastics in the TE study , patient independently should do for 5 times per
day such complex of special exercises:
1. Cheeks’ stroking in the direction from the external
auditory duct to the corners of mouth (30-40 sec.).
2. Simultaneously cheeks’ blowing and turns (40-60
sec.).
3.
Pulling away of the mouth corners to the
sides and lips’ and drawing in tubes (40-50 sec.).
4.
Massage with the tongue of gums and hard palate (20-30 sec.).
5. Rhythmic static contraction of chewing
muscles with the closing teeth (20-30
sec).
6. Fast mixing of air at the relaxed cheecks’
muscles closedand mouth , head
inclinated forward (30-40 sec.).
Duration of the first period of the TE application for
patients with the uncomplicated jaws’
fractures is in the middle-age – 2-3 weeks. At
this time, the formation of primary osteoid callus is finished.
Further
development of bones’ tissue
regeneration process is associated with the seepage of primary
callus of calcium phosphate. transform it into a full bone.
Since the
beginning of the 3 week immobilization,
the inter-jaws fixation is weakened ,or removable splint, at 2-jaws
splintage is imposed, so you can use active exercises for chewing muscles,
involved in movements of the mandible, to prepare it to work.In this
time the second period of the TE using is beginning
In this period the training methods are slightly
different: to the complex are included exercises exercises for chewing
muscles. Exercises to be done very
carefully, slowly with low amplitude,
not prove to pain.
Mechanical therapy and passive movements of
the mandible at jaw’s splintage in this
period does not apply.
At the 1-jaw splintage recommend more vigorous
and active exercise for the chewing
muscles ,second nature, but limited use the passive movements and elements of
mechanical therapy.
Duration of
medical gymnastics in the 2 period increased to 20-30 minutes
instead of general- development and
special exercises. Improves overall intensity of physical loading: increasing
the number of exercises’ repetitions, tempo and amplitude of movements,
often the I.P. are changing.
The main task of TE in the 2 period : - fighting with
the development of contractures and hard
mobility in the temporal-mandibular
joint and patient’s preparation to leavinng hospital for home. This increases
the general duration of functional loading
by increasing of individual tasks from medical gymnastics repetitions (from 7
to 12 during the day). To individual tasks along
with special exercises we recommend
including of 3-4 general - developing
exercises for large muscle groups.
After the immobilizations removing, transferred to the
3, rehabilitation period of fractures treatment ,that coincides, usually, with
the patient leaving of hospital and sending it to the clinic to complete the
treatment. At this
stage of treatment should be the complete
medical of patients.
On the eve of patient’s leaving of a
hospital , the patient let know in need
to continue the restoration treatment to
full normalization of temporal mandibular joint
function.
Methods of the TE occupations
at the jaws’ fractures in 3 period -
using of special exercise. . Apply the active,
active and passive and active with the
resistance exercises for the chewing muscles are used. Its are perfomed in
the average tempo with the maximal amplitude, emphasizing the open mouth,
mandible’s movements to the side and forward. According
to the indications, the mechanical therapy
and massage can be assigned .
In the first days of treatment in
the policlinic , with the patient’s
participation, the program of
functional loading is produced. After the
patient is learning it , he go in for TE
at home, attending the policlinic once a
week for the to determining of the home classes effectiveness and making of
correctives to the program.
One of the gravest violations of the chewing function
apparatus is the contracture temporal-mandibular joint . Pathologic changes in soft tissues surrounding joints,
resulting from trauma or inflammatory processes , long hypo-dynamia at the 2-jaws’ splintage, and later
specialized in treatment too. Often the contracture caused by scar changes in
the temporal-mandibular joint that in
further leads to its total immobility (ankylosis).
After the the degree of mouth
opening distinguish some kinds of extra-joints contractures: hard -
opening of mouth to
For patients with contracture is using the
surgical, orthopedic, and complex methods of treatment (required complementary appointment of TE as a means of functional therapy ).
Indications for TE appointment at contracture of temporal – mandibular joint:
a) Reduction of acute manifestations
of the process that was causing the contracture;. b) operations (lancing of the abscess or phlegmon, removal of
scars or plastic colliding triangular chunks of skin, coronary appendix
resection or amputation of the mandible’s chewing muscle , etc.)
c) mandible’s redressation , which is bloodless
forcibly restoring of joint mobility;
d) Operational repositon with the aim to section scar, adhesions and muscle for transform
of hard mobile mandible’s fragments in the mobile and then the applaing
of wire 1-jaw splint .
TE application prevent the contracture
reccurence and improve the functional efficiency of operations or orthopedic
treatment.
Surgical intervention, which is
the radical removing of scar tissue and replaceof the the skin defects (with a help of Filatov’s sterm or other ways to skin
plastic), creates the objective
conditions for the functions of temporal-mandibular joint restoration.
Effectiveness of surgical treatment depends on the
active attitude of the patient to medical gymnastics classes. Early and energetic multiple implementaion of special
exercices in the postoperative
period is crucial for sustaining a
positive functional outcome of the operation.
Immediately after the operation (1
period of the TE application ) not more than 2
-3 h rubber pad, between large molar teeth to the maximum possible
opening of the mouth, with the repetition of this procedure over the same
interval of rest should enter.
If there is swelling and postoperative pain syndrom
(usually in the first 2-3 days), assign the respiratory exercises and simple
movements for small muscles groups of extremities in the slow tempo.
Already on the 4-5-days, patient transferred from the
bed regimen on the half-bed (ward) or freemode . Medical
gymnastics classes include breathing and general-development exercises for all muscle groups in an amount that
causes no acceleration of pulse more than 20-30% compared to the rest condition
.
If there are no contraindications, using the exercises
to mimic and chewing muscles. At
the time of course the rubber pad removed, then inserted , according to the above recommendations.
Special series of exercises, performed on 5-10 to
repetitions at a slow tempo with intervals of
rest 1-2 min. Opening of mouth, jaw’s
nomination forward, side and circulator moves it in the first days of
classes do carefully with a small amplitude
of motions, avoiding the pain and fatigue resulting in chewing muscles.
Exercises’ complex for self-use patient
has to repeat every day at least 8-10 times.
Active and passive mechanical therapy with
the Darssiaka, Limberha, Oxman, Solomon and others apparatus using ,
may. start with a 6-8-th days after the operation. Effectiveness of mechanical
therapy increases after heat physiotherapy and massage procedures.
In the second period, theTE using ie after removal of stitches
(usually on the 10-12 days after
operation), increases the duration and intensity of general-development
(general - hardening), and special breathing exercises, which connects with massage heat- and mechanical therapy.
Scheme of medical gymnastics occupations at the
scars’ contracture of the mandible in the 2 period the TE using
Initial part (3-5 min)
IP - sitting or standing. Exercises for coordination
and attention. General-development exercises for major muscle groups. Average
tempo, amplitude of
theextremities’motions is complete.
The main part (10-15 min)
IP - sitting in front of a mirror. Exercises for muscles of the neck (turns, circular
movements and head inclinations ) in connection with exercises for mimic muscle
. Stroking of buccal and temporal
area, active mouth opening , movements
of mandible in the sagittal and frontal
planes.
IP - standing. General-development gymnastic exercises with sticks, dumb-bells, etc.. Exercises
to mimic muscles to relax faster the
chewing muscles. Rotate of general-development
exercises with special in ratio of 2: 3.
Final part(2-3 min)
IP - sitting or standing. Practice relaxing of upper exremities, humeral belt and mimic
muscles. Deep breathing and reprimanding of
sounds "fu". Slow tempo;
achievement of complete muscles’ relaxation.
After each class of
medical gymnastics it is
necessary to control the dynamics of
mandibular joint functions’
restoration.
In addition to the medical gymnastics training, the patients designate the special set of exercises for inepending
multiple perfoming during the day. It should be explained to the patient that the restoration of
mandible movements in the complite
volume is possible only at the
systematic functional loading of
temporal –nmandibular joint.
Approximate complex of special
exercises for the independent conducting (the second period of the TE ).
1. slow opening and closing of the mouth (20 - 30 times). .
2. Mouth opening mouth with the simultaneous extension of head and putting
tongue out (20-30 times).
3. Circular moves of mandible , alternately left and
right , with the closing lips ( 10-15 times in each
direction).
4. The nomination of the mandible forward -
first with closed lips, then with open
mouth (20 - 30 times).
5. The lateral movement of mandible with a change of
tempo -from slow to fast (15-20 times in
each side).
6. Imitation of yawning with simultaneous extension of
head and a deep breath. Extended expitation
through lips ,drawning in pipe, at
the lowered on chest head (10-12 times in a slow tempo).
7. Fast mouth
opening and closing ,with the pronunciation
of sounds "pa-pa-pa" (20-30 times).
Perform series of exercises, that are repeated several
times with rest intervals from 35 to 45 sec.. In brackets indicate the number of movements in
this series . Exercises should not cause the
pain feelings in the field of
temporal-mandibular joint.
In the 3 of the TE using the main task is to restore fvolume of motion in
the temporal- mandibular joint. With this aim
increase the number of special exercises and increase the load,
including to the classes the exercises
on resistance to mouth opening and closing , with lateral movement mandible . Every special
exercise is repeated 30-40 times on average and a fast tempo.
Individual tasks the
patients perform 10-15 times per day,
with the mechanical therapy using. In the break between the classes the
chewing gum’s using is
recommended .
Shown description of individual tasks for independent
conducting of special exercises (the 3period of the TE using ).
1. Open and close mouth
in a slow and average tempo (20-30 times).
2. Open mouth with the fingers, which are
enclosing the mandible (20-30 times).
3. The lateral mandible’s movements at the half - open mouth
and closed your teeth with the fingers or fists, pressed from the cheeks to the
mandible (20 - 30 times).
4. Circular moves of
mandible ,alternately left and right, changing the tempo and amplitude
of movements (10-15 times in both directions).
5. Mouth opening with
oral extenders , imposed from both sides between the teeth (5-10 times
for 1-2 min). During the rest - stroking and
grinding of tissues around the joint.
6. The nomination of
the jaw with a closed mouth and closed chewing surfaces of teeth (20-30 times).
7. Maximum extension of
the head and opening mouth with the
fingers, located between the dental series (20-30 times).
8. Rinsing of the mouth with warm water (40 - 60 sec.) for the relaxing of muscles and fatigue removing
Before performing an individual task , the patients
should be explained that only persistent classes of TE for a long
time can provide the effective
functional results.
For orthopedic treatment of mandible’s contractures
the scars stretching and restore
movements are reached with the help of the
mechano-therapeutic apparatus , blades, screws made of wood or plastic, elastic rubber bands of
different thickness and etc..
Active-passive mechanial therapy performs
15 - 20 minutes 3-4 times daily.
However, mechanic training only complements the
medical gymnastics’ classes, as the majority of movements with the use
of machines and devices iare conducting
in the same plane and limited
of the mandible’s lowering . The restoration of complete function of the
temporal-mandibular joint ,requires of various mandible’s movements ( to the sides , front- back, circular , etc.), that are possible only the
conducting of special exercises for chewing muscles.
Therapeutic
physical culture at the JAWS’ dislocations
Some teaching methods therapeutic exercises with dental patients have
some features due to clinical manifestation of disease. First of all it
concerns the method of application specific exercises. They perform in front of
a mirror as a visual control facilitates proper development exercises and
allows you to monitor the amplitude of movement. The special features include
therapeutic exercises classes also need multiple repetition of specific
exercises for the day itself.
The proper selection and reasonable inclusion complex gymnastics, special
exercises should be guided by information about the facial muscles.
Solo is the most rational method during gymnastics classes with dental
patients.
In a classroom therapeutic exercises than typical equipment to be mirrors of
individual tables and screens for specific exercises mechanotherapeutic
apparatus and devices for additional actions by organs and tissues in maxillo-facial
area. For mechanotherapy used rubber spacers, stoppers, wooden wedges, spoon
Limberg, wavering, zhomov devices Balloon Expanders, boards that heartwood
ranges and other appliances and devices. However, functional recovery of facial
and chewing muscles can not be limited to using only one mechanotherapy. It is
a kind of passive exercise, does not allow to reproduce the variety of
movements in the temporomandibular joint, carried out with the active
(volitional) exercise.
Mechanotherapy shown mostly during the elimination of residual effects - when
pos-timmobilization contracture, fibrous ankylosis, stiffness of joints,
pulling scars, paresis, paralysis and other selected states.
Indications for the appointment of physiotherapists in dentistry: dysfunction
of mastication, speech and facial expressions, resulting from injuries,
inflammatory diseases or birth defects.
Timing of application of physical therapy is usually coincide with the end of
the acute period of the disease.
Contraindications: general grave condition of the patient, the body temperature
above 38 ° C, acute inflammation, incrased ESR, septic condition, pain that
increases the performance of specific exercises, the risk of secondary bleeding
due to the finding of a foreign body near vessels, insufficient immobilization
fragments of damaged bone.
Jaw fractures
Among all the damage the facial skeleton mandibular fractures account for more
than 70%.
Timely application of exercise therapy eliminates adverse effects hypokinesia,
prevents the development of complications associated with prolonged
immobilization of jaw (chewing muscles
atrophy, scarring facial soft tissues, contracture TMJ etc.).
Methods based physiotherapist considering periods of callus formation, features
immobilization (splinting odnoschelepne or bucket, osteo-synthesis) and the
clinical condition of the patient. The first (introductory) period usually
begins classes on 2-3rd day after the imposition of a permanent patient
immobilization and lasts until initial signs of callus formation. The duration
of this period for fractures of the mandible 3.4 weeks., The optimal time
mizhschelepnoyi fixing fragments up to 5 weeks.
The task of the physiotherapist in the first period classes: improving the
patient's general condition, stimulation of reparative processes in the damaged
bone and soft tissues of the maxillofacial region, prevention of complications
associated with immobilization and hypokinesia of TMJ.
Methods medical gymnastics classes provides individual selection bracing,
respiratory and special exercises against motor mode, the patient adequately.
Typically, the first 3-4 days of treatment for patients with jaw fractures
recommended half-bed (ward), and future - free driving mode.
Bracing and breathing exercises prescribed at a dosage that provides
amplification of cardio-respiratory system, proper functionality of the
patient. Initial conditions for the exercises, lying or sitting in bed, in good
general condition of most of the exercises can be done standing.
When the special exercises should not be allowed landslides mapped bone
fragments as violation immobilization causes of complications and longer
fracture. Therefore, when 2-jaws splinting
take place, the exercises for masticatory muscles in the first period of classes do not apply. Allowed only prudent
assumption impulses to the reduction of masticatory muscles during tooth of
closed ranks. In this period also recommended restorative exercise-related
sudden torso, head rotation, jumping, etc., due to the risk of violation of
fixing the damaged bone fragments.
At 1-jaw splinting or fixation with osteosynthesis between jaws , patients
already at 2-3-day permit careful moves the lower jaw in various directions.
This term is widely used exercises for facial muscles, tongue and neck muscles
that improve local blood circulation and reduce the tone of masticatory
muscles. Exercises for facial muscles do sitting in front of a mirror.
Duration of employment therapeutic exercises for 10-15 minutes. In addition,
patients should be several times a day to perform self 5.10 special exercises.
In patients with single mandibular fractures (for smooth flow of the healing
process) by an average of 8-9th day after dvohschelepnoho splinting permitted
to shoot rubber rings on the meal. This fact allows the active movement of the
mandible in of closed lips, avoiding pain in the temporo-mandibular joint. The
patient was advised at every meal to perform a series of exercises, consisting
of 4-5 movements of the mandible (opening and closing the mouth, lateral and
circular motion of the jaw), repeating 5-10 times each of them.
When double fractures of the mandible occurring without complications
mizhschelepnu fixation shot on eating for 3-4 days later compared with single
fractures.
Therapeutic exercises for fractures of the
jaw bones (the first period of 2-jaws splinting)
Background
part
Sitting or standing
Exercises for the muscles of shoulder girdle and upper limb dynamic breathing
exercises. Turns body to the side, alternate movements underneath the lower
limbs in different directions. Rotate, skew and circular movements of the head
2-3min.
Air slow or medium. Amplitude motions limbs are not in full. Avoid sudden
movements of the head and torso
Sitting in front of a mirror
Exercises for facial muscles, muscles of speech, combined with breathing
through the nose. Exercises in sending impulses to the actual reduction in
masticatory muscles of closed teeth. Exercises for the muscles of the neck and
upper extremities 8-10min.
Air doing exercises for facial muscles slow, each exercise is repeated 5-10
times. Follow in the absence of pain at a voltage of masticatory muscles
Final
part
Sitting or standing
Exercises in relaxation of muscles of shoulder girdle, upper extremities and
facial muscles, combined with deep breathing 2-3min.
Air slow, watch full muscle relaxation. Measure the degree of opening of the
mouth
Functional load should also be conducted with great care and supported the
appointment of an appropriate diet.
When osteosynthesis of the mandible at 3-5-day ill be carried out sparing
movements in temporo-mandibular joint. Even at 7-8 day at smooth fracture
healing movement in the joint performed with full amplitude.
The task of the physiotherapist in the second period classes: prevent the hard
moving of temporomandibular joint and
prepare the patient for discharge from hospital; For this purpose, increasing
the duration of therapeutic exercises classes by appointment larger number of
bracing and specific exercises. Functional load TMJ increase by assigning of individual tasks, consisting of several
special exercises performed by patients themselves 7-10 times during the day.
When dvohschelepnomu mechanotherapy splinting and passive movements of the
mandible is not used because it can lead to the formation of a false joint.
After immobilization (before the formation of complete bone) go to the third
period of treatment of fractures. This stage of completing the restorative
treatment that provides full medical rehabilitation of the patient and his
return to work. A wide selection of special exercises for the masticatory
muscles (active, active-and passive resistance, the use of mechanotherapy)
carried out with the maximum amplitude of movements (even against moderate pain),
can remove existing restrictions on the function of temporomandibular joint.
ORTHOPEDIC TREATMENT of temporo-mandibular joints pathology.
Diseases of the temporo-mandibular joints occupy a special place because of the
difficulty in diagnosis and treatment is extremely diverse and sometimes
complex clinical picture.
No single classification of diseases of the joint. Various forms of pathology
of the body that are observed in the clinic, often do not fit in the
traditional diagnosis of "arthritis" and "arthrosis." There
prefabricated concept to describe diseases temporomandibular jaw joint unclear
etiology "arthropathy", "functional mioartropatiya",
"deforming arthropathy", "myofascial syndrome joint dysfunction,"
"joint neuralgia," "pathological syndrome bite" and
others., However, the introduction of such terms is not conducive to the
improvement of diagnosis.
The literature and clinical observations suggest that the etiology and
pathogenesis of temporomandibular joints are important occlusive disorders,
pathological processes in the dentition and masticatory muscles,
psycho-emotional and endocrine disorders, infectious diseases, injuries
(bruises, fractures, etc.). . It should be noted mutual conditionality of all
these etiological moments.
Y.A. Petrosov (1996) proposed a working classification, according to which
functional disorders and diseases of the TMJ are divided into 5 groups.
1) Disfunktsyonalne joint state:
a) neuromuscular dysfunctional syndrome;
b) occlusive syndrome-articulation;
c) habitual dislocation of joint (jaw meniscus).
2) Arthritis:
a) acute infectious (specific, nonspecific);
b) acute traumatic;
c) chronic rheumatism, rheumatic and infectious-allergic.
3) Osteoarthritis:
a) postinfection (neoartrosis);
b) posttraumatic (deformation) osteoarthritis
c) myohenic osteoarthrosis;
d) metabolic arthrosis;
e) Ankylosis (fibrous and bone).
4) The combined form.
5) Neoplasm (benign and malignant).
Methods for
evaluation of patients with diseases of the temporo-mandibular joint.
Survey. Should detail the symptoms, trying to figure out what came first, such
as pain or clicking in the joint. This is important because when subluxation
and habitual dislocations often appears first click, and then joins a pain, but
with arthritis and arthrosis appears first, usually pain, and then click in the
joint. Clarifies the nature of pain and the location (point, diffuse,
irradiyuyucha). Spot or strictly local pain typical of habitual dislocation and
subluxation, dysfunctional syndromes and osteoarthritis. Spills more often in
acute and subacute arthritis, myositis and other inflammatory processes around
the joint. Irradiyuyucha pain occurs during compression of the auditory nerve
twigs ear-temporal, trigeminal neuralgia, pulpitis. The examination is
necessary to determine whether the patient is lockjaw, gnashing of teeth,
muscle fatigue, feeling constant chewing and grinding food. These symptoms can
occur when parafunctions. Such patients should be further examined by a
psychiatrist.
Physical examination. For the diagnosis and treatment of diseases of the
temporal-mandibular joint conduct functional analysis of dentition, including
the assessment of occlusion and occlusal contacts dentition, occlusal height
measurement lower person articular noise analysis, palpation of the joint,
masticatory muscle pain points person, x-ray jaws, teeth and joints in central
occlusion, physiological rest of the mandible and the maximum opening of the
mouth as well as electromyography and arthrography. Conduct analysis of
movements of the mandible.
Review. The survey begins with a review of the face, where its define the proportions, symmetry, pay attention to the
muscles, branches of the jaw. This is followed by intraoral examination, which
primarily assess occlusion, the characteristics of resistance to diseases of
the joints which are:
1. maximum multiple contacts dentition in the center, front and side occluded;
2. smooth sliding dentition during the transition from one to another occlusion
without horizontal pushes on the teeth;
3. no decrease or overstatement inter-alveolar height;
4. absence of lateral displacement of the mandible during its transition from
the physiological rest position in central occlusion and minimal distal offset
this;
5. lack of soft tissue injuries of the oral cavity teeth.
Palpation of the joints hold the skin in front of tragus ear, placing your
index finger on the projection of the articular heads, or little finger through
the anterior wall of the external auditory canal at stulenni jaws in central
occlusion and during movement of the mandible. At the same time determine the
severity and time of articular noise. Palpation reveals tenderness of
masticatory muscles, compression, compression asymmetry of teeth in the central
occlusion.
Radiographic methods. Among the various methods of radiography of temporo-mandibular
joints most widely used methods Shyullera,
In prosthetic dentistry tomograms or zonography removed at close order jaws at
the central occlusion, as well as physiological rest mandible.
Graphic methods. Drawing methods function dentition include recording movements
of the mandible, miography, based (mehanohraphy, electromyography), arthrography.
Medical treatment of temporo-mandibular joints should be integrated. After a
detailed analysis of clinical and research findings begins with the definition
of the plan and features of the patient. Complex therapeutic measures may include:
1. physiotherapy
2. massage
3. miogymnastic
4. medication
5. orthopedic treatment
6. orthodontic treatment before prosthetic
7. surgery
8. physiotherapy and hydrotherapy at the joints contractures
2000 is the lower jaw movements per day. Hard mouth opening observed at
the inflammatory contractures: abscess of pterygoid-mandibular space, hard
eruption 8 lower teeth, broken jaw, fractured of zygomatic bone, with trismus masticatory
muscles (tetanus, hysteria, cerebro-vascular accident), because such patients
come to neurologists, otolaryngologists, psychiatrists and infectious disease.
With existing species approach to joint most cosmetic section is for Rauerom.
This section has a length of
Ankylosis.
Ankylosis of temporomandibular joints - fibrous or bone fusion of the articular
surfaces and the associated partial or complete lack of mobility in the joint.
Classification.
Etiology: infectious, traumatic and others.;
For morphological substatom process: bone, fibrous;
Localization process: one-sided, two-sided;
The degree of prevalence of adhesions: incomplete, or partial, full, or
extended;
By the nature of accompanying changes facial bones: from microhenia, without microhenia.
Etiology. The cause of ankylosis are acute joint, septic arthritis,
osteomyelitis joint head of the mandible, articular fractures germ.
Pat. Anatomy. Bone fusion of articular surfaces - bony ankylosis. Cicatricial
adhesions between the articulated surfaces - fibrous ankylosis. Unlike
children, which often develop bone Ankylosis (in childhood articular surfaces
covered with periosteum and have no cartilage cover) in adults more often
defined fibrous fusion of the joint.
Unilateral Ankylosis are more common than bilateral. Development of ankylosis
in children involving violations of growth affected half of the mandible,
leading to deformation of the face. In adults, these deformations do not occur
or are less pronounced. The earlier the patient developed a pathological
process in the joint, the more pronounced deformation of the whole mandible,
especially in a sick way.
Clinical picture. The main features of symptomatic ankylosis is stable partial
or complete restriction mouth opening and full nature of horizontal movements
in the affected joints. There is a mouth opening within 0.5 -
When unilateral bone ankylosis chin and nose shifted in a sick way, conch on
the affected side is lower than in healthy. The affected side shortened and
looks more convex and healthy zmischayuchys in a sick way, sinks and flattened.
For bilateral ankylosis, developed in childhood, N / underdeveloped jaw on both
sides, chin shifted backwards / bird face / movement in the joint sharply
limited, preventing the examination and treatment of the oral cavity, pharynx.
Often there are disorders of speech, breath and mind, reducing power.
In fibrous ankylosis unlike bone pain frequently observed.
The main features of the initial manifestations of fibrous ankylosis are:
slight crackling in the joint, masticatory fatigue "muscles and zatrudnene
mouth opening in the morning. These symptoms occur against a background of
rheumatic process, which is already available in other joints as well as
phenomena revmakardytu in the acute stage.
Typically, TMJ struck on both sides, just as rheumatism affects even large
joints. Body temperature grade, accelerated ESR, leukocytosis observed. In
acute rheumatic process can be marked to show the flushing of the skin,
hrypuhlist, sharp pain in the joint, limited mouth opening. Limited movement in
the joint contributes to further development of ankylosis. The diagnosis is
proposed with regard to etiological factors and the dynamics of the disease, on
the basis of clinical and radiological examination.
Surveying the area of the joints, you need to pay attention to
skin scarring / be injured due to otitis media operations, mastoidytu /
purulent discharge from the external auditory canal, the position of the chin,
the form n / jaw.
Characteristic features of partial bone ankylosis is the lack of joint space on
some areas of the head and neck thickness articular sprout reduction clippings l
/ jaw. At full bone ankylosis synovium no. On the face of marked joint bone
fusion n / jaw with the temporal and zygomatic bone, branch l / jaw shortened,
on the back edge of the angle of the jaw features a "spur" in front
of the angle - notching.
Unlike kutkovoho fibrous ankylosis in the joint space is preserved, but a
smaller width and clearly marked, "zauvalovana." Blanking l /jaw
deformed, head and neck joint petiole slightly thickened.
Bone ankylosis that emerged in childhood, accompanied microhenia. Pathogenesis
of underdevelopment l / jaw about the same and is closely connected with
congenital or acquired changes in the articular heads l / jaw. Only in some
rare cases mikroheniya caused by inborn formation of the jaw and can be
attributed to a group of congenital malformations of the jaws. Underdevelopment
n / jaw in such patients is always combined with impaired bone formation, which
lie at the same time the lower jaw, often temporal bone, as well as partial or
complete absence of the ear. The reason mikroheniyi in such cases is the
retention of embryonic differentiation mezenoymy of underdevelopment elements
TMJ, which provides mandible’s bone.
Conclusion of communication mikroheniyi with that or other pathology TMJ /
congenital or acquired / is consistent with data on the characteristics of
growth and morphogenesis n / jaw. Growth l / jaw bone is provided superimposition
of bone in the area of fibro-cartilage covering the articular
head. After 16-18 years, when cambial elements fibro-hryaschevoho coating heads
replaced by bone growth l / jaw in length stops and various lesions or joint
injury underdevelopment l / jaw is not accompanied.
Ankylosis be distinguished from inflammatory contraction of masticatory
muscles, in which are inflammatory tissue changes, and increased tenderness of
lymph nodes, as well as tumors, fractures and fractures of the articular sprout
without displacement of fragments.
Treatment: with fibrous ankylosis used "bloodless" method of breaking
fibrous adhesions - "redresatsiya" which is as follows. In soft
tissues surrounding the joint, and the joint is injected 1% solution
trimecaine. Then in the region of molars set gag, which gradually extend the
jaw. gap fibroznyk adhesions feel sick, catching "crackling" in the
joint. then you must enter drug or steroid lidasa to prevent the formation of
yet more adhesions. If this method does not work, then perform operation
excision of adhesions in the joint with removal rozrushenoho and deformed disk.
Once opened his mouth freely between moramy put spacer rather than tires with
aggressive loops - rubber ring. 7-10 days spacer and rubber traction remove and
appoint active gymnastics. hydrocortisone injected into the joint cavity
through 1 ml. 05.03 per course injections. intervals between injections - 2-3
days. Following the treatment stiffness in the joint passes, fades, or
disappears altogether crunch.
Recovering branches n / jaw by the method Titova / I962 / carried submaxillary
access with free bone grafting autorebrom and the creation of a new joint at
scales of the temporal bone. After clearing the remnants of scars and branches
crossing coronary petiole N / y falls down and mixed doperedu to establish
ortohnatychnoho bite. During the zygomatic arch tunnel is created where
injected bone graft from the patient's rib cartilage from the ends up to the
scales of the temporal bone at the level or in front of the articular tubercle.
By the angle of the jaw is fixed the other end of the graft. To keep the jaw in
position, apply pozarotove pulling within 10-12 days.
"Harness" by V.S.Yovchevym arthroplasty (1963) also used to extend
the branches n / jaw with the formation of joint. This after excision scars,
lowering and shifting n / ni forward osteotomy performed coronary stem.
Autorebro fixed to the angle of the jaw, and by the end of his second stitched
osteotamovanyy coronal germ peak which then serves as the head of the joint. To
the rear edge of the newly formed branch record fragment allohenic cartilage.
In cases where bilateral ankylosis SNSCH joints combined with lower
mikrohnatieyu and open bite, N.A.Plotny-ing / I966 / offered two options
arthroplasty using canned dried allotranplantatu the branches l / jaw with
articular head.
In passive bony growths, when articular and coronal shoots form a single bone
conglomerate transverse osteotomy is made in the upper third of the branches.
Bone is removed by an array rolling. With spherical cutters shaped articular
hollow semioval shape, and the front it - articular tubercle. Thread n / jaw
drops down, mixed doperedu, the teeth of the upper and lower jaws are fixed in
position ortohnatychnoho bite. On the outer surface of the branches removed lefting
compact layer to expose the spongy substance. The inner surface of lyophilized
graft branches n / jaw also removed a compact disc. The resulting defect in the
upper third of the jaw replaced with a graft so that its articular head were
located created in the hollow joints. Thread with articular head graft is fixed
to the residual branches patient using wire suture. Tendons medial alary and
proper chewing muscles attached to the rear edge of the branches l / jaw.
In cases where ankylosis due to interpenetration of only joint heads held
kondylectomiya, just as in the first embodiment, is formed perceiving bed for
lyophilized allograft, jaw moves in the correct position and then you
nakistkova and mandible’s fixation.
H.P.Myhaylyk, Yu.Y.Bernadskyy / I979 / proposed a new original way SNSCH
plastic joint with ankylosis and mikroheniyi. Its essence is to increase the
height of the branches, shifting n / u down and forvard, as well as creating
new SNSCH joint. This no bone grafting or replanting cartilage is not required,
which is an important advantage of the method. With this method performed
osteotomy at the base of coronary sprout, remove excess bone conglomerate in
the area semilunar notch and articulate stem.l / jaw drops down and doperedu.
Osteotomoized coronal germ upper-back fixed to the edge of the branch, he is a
new articular sprout.
N / jaw drops
down and doperedu. Osteotomo-ized coronal germ upper-back fixed to the edge of
the branch, he is a new articular sprout. Clinical experience removing SNSCH
joint ankylosis and microheniai using of autolohic coronar sprout and
xenogeneic sclero-corneal membrane allowed the authors to conclude whether
widespread use of this method.
Dislocation (luxatio) bone - is damaged when one of the
bones of movable joints comes from the joint capsule and, coming to his natural
position remains in the tissues surrounding the joint. The cause dislocation in
most cases a mechanical violence, and to break the joint capsule,
communications and distribution connection ends of the bones need more
strength.
Dislocations are congenital and acquired. Among acquired
dislocations isolated traumatic and pathologic and separately isolated habitual
dislocations.
By degrees violation distinguish complete dislocation, the
joint surfaces of both bones forming the joint completely lose connection with
one another, and partial dislocation (subluxation) when the articular surface
displaced bones are partly conjugated.
Dislocations involving damage to the skin in the area of
joint (wound penetrating into its cavity), called the open, while
maintaining the integrity of the skin is closed dislocation.
Traumatic dislocation usually occurs from excessive or
unusual for this joint motion by impact or pressure on the joint. This
dislocation may be accompanied by compression and even rupture of blood vessels
and nerves. Dislocations, still, there are less than other traumatic injuries,
such as broken bones, bruises and sprains, dislocations often exposed joints of
the limbs as the most moving and the most exposed external influences. Cases
dislocations often occur while taking heavy work, after falling from a height,
for this reason they are more common in men than in women (according to the
Kiev hospital for 274 men had 63 women) in middle-aged persons more often than
in children and seniors. In traumatic external violence, sprains occur (but
very rarely) even spontaneously during strong muscular contraction, such as
seizures during epilepsy. By involuntary dislocations can be classified and
pathological dislocations observed in lesions of the joint and the surrounding
parts (hydrops joint, tubercular, funhozni, carious processes, etc.).
Congenital dislocations are observed (luxationes congenitae) mainly in the hip
joint, the reason they - or the wrong anatomical development, or various
disease processes at the very beginning of life.
Looking for the character of dislocations, changes in the
joint seem different. When deviations from external violence is always a gap
joint capsule, bone dislocated end, based on the joint, tearing the tissue
surrounding the joint, causing sometimes severe bleeding, and it happens that
the gap tissue is complete and the end of the bone protrudes outward. Affected
tissues become inflamed bone that is in them, causing cellular elements in
severe irritation, stimulates the vital functions, and as a result - around the
bones gradually formed a real voloknyste - connective tissue. Prolonged
dislocation of the bone grows around like a new joint capsule of fibrous
tissue, which then is doing more solid so that the bone becomes able to move,
finding resistance in it, in the end vyvyhnenoyi bones in the head, there are
also significant changes, and formed the so-called "false joint. "
Rapid reduction of dislocation and restore normal joint is presented in the
form above conditions, a matter of critical importance.
Dislocations that systematically repeated in the same
joint, called commonplace. This generally occurs due to errors that assumption
in the treatment of first on account of traumatic dislocation (inept conducted
no specialist reduction, lack of immobilization after reduction, started too
early jaw movements) as well as in connection with a late appeal to the doctor
when vpravyty joint is difficult to be found, but this is rare. Dislocation,
accompanied by significant damage connection joint can become familiar even
with proper treatment. In all these cases, after the first dislocation remains
insufficient connection obligatory joint staff, which leads to repeat
dislocations, rarely from the most minor reasons.
Common symptoms of dislocation of the mandible following:
change in the form of joint;
significant complications and even complete inability
active movement;
severe pain;
swelling around the joint parts, sometimes bruising.
Affected joint is certainly thicker and wider than
healthy, it prominent recess and performances where for healthy joints do not.
Distinguish anterior and posterior dislocation of the
mandible. Often occurs anterior dislocation, when the head of the mandible
moves doperedu and slips on the front slope of the articular tubercle. Very
rarely arises posterior dislocation. Anterior dislocation of the mandible can
result from excessive mouth opening (when yawning, during tooth extraction,
when a doctor does not support the lower jaw) injury inflicted in the area of
the chin down, gnaving of nuts. Distinguish unilateral,
bilateral, and habitual dislocation of the mandible.
When habitual dislocation patients themselves easily replaced
into it by moving the lower jaw.
In front duplex dislocation in patients with pain appear
in the joints; mouth is closed, slurred speech, chewing during the eating is
impossible. On examination, the patient's original appearance: mouth open, chin
forward put forward, the front teeth do not merge, mouth saliva flowing. Cheeks
flattened, stretched, no lateral movement of the mandible. Palpation of the
front of the tragus ear felt retraction (no head, which is easily detectable in
normal), and under the zygomatic arch, the anterior protrusion determined
(displaced head).
In unilateral dislocation mouth ajar patient and seemed
skewed.
In complex cases, when together with dislocation is a
fracture or blow with strong swelling or strained muscles, etc., determine the
dislocation can not be easy. The key in recognizing signs of fracture
dislocation is crackling, ie noise generated by friction against each other
over the perelomanyh bones and abnormal, easy mobility of fractured back bone
and limitation of movement and persistent preserve those provisions, even
unnatural, in the case of dislocation.
Treatment of acute dislocations should be in their
immediate reposition certainly experienced person. Reduction is easier if there
is a partial dislocation (subluxatio). Particularly severe reduction in
complication of bone fracture or hit soft tissues develop connections between
bones. When reposition bones usually applied contra-pulling. Big fingers of
both hands, wrapping with small layer of gauze or bandage should be put on the
large lower molars patient's fingers are placed from outside under the lower
jaw. Thumb to press down on the lower molars, while other fingers to move the
lower jaw forward and upward. Then, after click dramatically move your thumbs
on the front teeth to prevent them biting dental patient.
To date, experimental method of treatment proposed
dvohbichnoyi anesthesia on Bershe. Needle intoduced perpendicular integument
under the lower edge of the zygomatic bone, departing to the front of the
tragus of ear shells to two centimeters. Needle promoted horizontally to the
midline at a depth of 2 -
After surgery early application of physical therapy is
crucial for sustained functional outcome.
Special exercises for the masticatory muscles prescribed
for 3 to 4 days after surgery (first period), repeating each exercise 5-10
times at a slow pace with intervals for rest (1-2 minutes). Avoid increasing
pain and prevent fatigue of masticatory muscles. The complex of these exercises
the patient takes at least 8-10 times a day. Application of Mechano through
various devices and appliances can begin at 6-8th day after the operation,
combining it with heat treatments and massage.
After removing the stitches postoperative increase the
duration and intensity of the functional load on temporomandibular joints (the
second period). Open mouth, lateral, and circular movements of the mandible
perform with maximum amplitude until the pain in the joint. In class
therapeutic exercises include a large number of bracing and breathing
exercises.
In addition to training medical gymnastics patients
continue to perform their own set of special exercises.
Approximate range of special exercises for
self-fulfillment sick
1. Slow painless opening and closing the mouth (20-30
times).
2. Open mouth with simultaneous extension of the head and
sticking Language (15-20 times).
3. The circular movements of the mandible alternately in
the right and left sides of closed lips while (10-15 times).
4. Movement of the lower jaw back and forth at the
beginning of closed dental rows, then - at the maximum open mouth (15-20
times).
5. Lateral movements of the mandible with a gradual
increase in the rate and amplitude of the open and closed mouth (15-20 times).
6. Imitation zivanyya with simultaneous extension of the
head and a deep breath. Lower chin to your chest, make prolonged exhalation
through a narrow cleft lip (8-10), the pace is slow.
7. Quick opening your mouth with pronunciation labial
"dad-pa" (20-25 times).
Restoring full range of motion in the joints and prepare
the patient for employment is a major challenge in the third (final) period
physiotherapist. Technique classes in this period supplemented appointment of
special exercises with the resistance movement of the mandible in different
directions, using passive exercises with the fingers of the patient or
mechano-therapy appliances and devices. At the same time seeking to achieve
full (physiological) range of motion in the joint.
It is important to control the amount of daily opening
mouth.
Massage and thermal procedures preceding the lesson
therapeutic exercises, improve efficiency Rehabilitation.
Pri \ 'orthopedic treatment method contractures mandible
application of active and passive devices mehanoterapevtycheskyh, wedges,
screws, wood or plastic, elastic rubber bands of varying thickness and other
devices can effectively stretch scars and breed jaw. However, be aware that
when mechanotherapy usually all motions made in only one plane (lowering and
raising of the jaw). To restore full function joint is necessary and other
movements (side, front-nezadnye, circles, etc.), which are possible only when
the active exercises for the masticatory muscles. In this regard, studies using
mechanotherapeutic apparatus and appliances necessary supplemented by a set of
special exercises.
Contracture mandible accompanied by a sharp restriction of
mobility in temporomandibular joint nyzhnechelyustnom due to pathological
changes in the surrounding soft tissues it.
Causes of contractures can be traumatic or inflammatory
processes lasted adynamia arthroplasty in dvuhchelyustnom splinting, gunshot
and not shooting damage parotid region and oolasty neck.
Treatment of contractures should be pathogenic and
complex. Evidence for the purpose of medical physical culture in contracture
temporomandibular joint is mandible’s: subsiding acute events that caused the
occurrence of contracture; surgery (incision of abscess or cellulitis, scar
excision, etc.); redressation (bloodless forcible restoration of mobility)
mandible . The use of therapeutic physical training can prevent recurrence of
contracture and improved functional effect of surgery.
In I period when there is marked tissue swelling and pain
within 2-3 days prescribed respiratory and restorative exercises for small
muscle groups performed at a slow pace, at the 4-5-day (in the absence of
contraindications!) - Exercises for mymyc and chewing muscles against bracing
and breathing exercises. Special exercises should be done at a slow pace in
series of 5-10 repetitions with rest intervals of 2.1 min. Complex special
exercises, sets forth the individual characteristics of the patient, it is recommended
to perform at least 10-12 times a day. Active and passive mechanotherapy can
start with the 8-10th day after surgery.
In the second period, ie 10-12th day after the operation,
increase the duration and intensity of training, combining them with massage,
heat therapy and hydrotherapy. The main task of this period is to restore full
range of motion in the temporo-mandibular
joint. To address its increasing number of special exercises and increase the
load by applying resistance when opening and closing the mouth. Every special
exercises repeated 30-40 times in the middle and fast pace. Individual tasks
patients perform 15-20 times a day - this pledge receiving high functional
results.