Myofascial trigger points in patients with temporomandibular joint disc displacement with reduction: a cross-sectional study

Abstract Objective The objective of this retrospective study was to evaluate the impact of myofascial trigger points (MTrPs) in patients with articular disc displacement with reduction (DDWR) and to identify which clinical variables are associated with the concomitant presence of DDWR and MTrPs. Material and Methods 130 patients were selected that sought treatment due to joint pain, with ages ≥18 years, of both genders, with DDWR confirmed by magnetic resonance imaging. The sample was divided into two groups: Group 1, patients with DDWR and MTrPs (N=101); and Group 2, patients with DDWR and no MTrPs (N=29). Information on gender, age, pain duration, pain scores, and maximal interincisal distance (MID) were collected. The logistic regression model was used and the odds ratios (OR) was calculated (p<0.05). Results Group 1 presented statistically significant higher mean pain scores (p=0.007), and smaller MID (p=0.0268) than Group 2. OR were significant for the pain scores (1.429), MID (0.937) and gender (women) (2.810). Conclusions Patients with DDWR and MTrPs had increased pain scores and a MID decrease compared to patients with DDWR and no MTrPs. The variables pain scores, MID, and gender (women) showed a significant association with the concomitant presence of DDWR and MTrPs.

Pressure pain threshold in the craniocervical muscles of women with episodic and chronic migraine: a controlled study / Limiar de dor por pressão de músculos craniocervicais em mulheres com migrânea episódica e crônica: um estudo controlado

OBJECTIVE: To estimate the pressure pain threshold (PPT) of the craniocervical muscles in women with episodic migraine (EM) n=15 and chronic migraine (CM) n=14, and in healthy volunteers (C) n=15. METHOD: A blinded examiner obtained the PPT bilaterally, by pressure algometry, for the following muscles: frontalis, temporalis, masseter, trapezius and sternocleidomastoid. ANOVA (p<0.05) was used for statistical purposes. RESULTS: Contrasted to controls, individuals with EM had significantly decreased PPT values for frontal muscle (EM: 2.01±0.67 vs. C: 2.85±0.71), posterior temporalis bilaterally (right and left, respectively) (EM: 2.72±0.89 vs. C: 3.36±0.72 and EM: 2.60±1.00 vs. C: 3.35±0.85), upper trapezius bilaterally (EM: 2.69±1.00 vs. C: 3.49±0.83 and EM: 2.54±0.93 vs. C: 3.32±0.97) and women with CM: on frontal muscle bilaterally (CM: 2.16±0.52 vs. C: 2.79±0.71 and CM: 2.01±0.67 vs. C: 2.85±0.71) and upper trapezius (CM: 2.66±0.84 vs. C: 3.32±0.97), however, it was not verified differences between PPT values between EM and CM groups. CONCLUSION: PPT is decreased in women with migraine relative to controls. Future studies should explore this parameter as a biological marker of the disease and a predictor of treatment.

OBJETIVO: Estimar os valores de limiar de dor por pressão (LDP) dos músculos craniocervicais de mulheres com migrânea episódica (ME) n=15 e crônica (MC) n=14, e em voluntários controles saudáveis (C) n=15. MÉTODO: O LDP foi obtido bilateralmente por examinadores cegos através da algometria de pressão nos seguintes músculos: frontal, temporal, masseter, trapézio e esternocleidomastóideo. Para análise estatística foi utilizada a ANOVA (p<0.05). RESULTADOS: Em relação aos controles, pacientes com ME apresentaram redução significativa do LDP para os músculos: frontal (ME: 2,01±0,67 vs. C: 2,85±0,71), temporal posterior bilateralmente (direito e esquerdo, respectivamente) (ME: 2,72±0,89 vs. C: 3,36±0,72 e ME: 2,60±1,00 vs. C: 3,35±0,85), trapézio superior bilateralmente (ME: 2,69±1,00 vs. C: 3,49±0,83 e ME: 2,54±0,93 vs. C: 3,32±0,97) e mulheres com MC: no músculo frontal bilateralmente (MC: 2,16±0,52 vs. C: 2,79±0,71 e MC: 2,01±0,67 vs. C: 2,85±0,71) e trapézio superior (MC: 2,66±0,84 vs. C: 3,32±0,97). Entretanto não foram verificadas diferenças entre os valores de LDP entre os grupos ME e MC. CONCLUSÃO: O LDP mostrou-se reduzido em mulheres com migrânea episódica ou crônica em relação aos controles. Em estudos futuros, esse parâmetro pode ser estudado como marcador da migrânea e indicador de efeito de tratamento.

Efeitos da pressão positiva expiratória nas vias aéreas sobre a atividade eletromiográfica da musculatura acessória da inspiração em portadores de DPOC / Effects of expiratory positive airway pressure on the electromyographic activity of accessory inspiratory muscles in COPD patients

OBJETIVO: Avaliar a atividade eletromiográfica (AE) dos músculos esternocleidomastoideo (ECM) e escaleno durante e após a aplicação de expiratory positive airway pressure (EPAP, pressão positiva expiratória nas vias aéreas) em portadores de DPOC. MÉTODOS: Ensaio clínico simples cego com 13 indivíduos hígidos como controles e 12 pacientes com DPOC estável. No momento basal, foram determinados a AE em respiração espontânea, parâmetros da função pulmonar e a força muscular respiratória. Posteriormente, foi aplicada EPAP de 15 cmH2O com uma máscara facial durante 25 min, com o registro do sinal eletromiográfico dos músculos ECM e escaleno a cada 5 min. Um último registro foi obtido 10 min após a retirada da máscara. RESULTADOS: Observamos que o comportamento da AE dos músculos ECM e escaleno foi semelhante nos controles e pacientes com DPOC (p = 0,716 e p = 0,789, respectivamente). Porém, ao longo da aplicação de EPAP, ambos os músculos mostraram uma tendência ao aumento da AE. Além disso, houve uma redução significativa da AE do ECM entre o momento final e basal (p = 0,034). CONCLUSÕES: A aplicação de EPAP promoveu uma redução significativa da AE do músculo ECM tanto nos controles quanto nos portadores de DPOC estável. Porém, isso não ocorreu em relação à AE do músculo escaleno.

OBJECTIVE: To evaluate the electromyographic activity (EA) of sternocleidomastoid (SCM) and scalene muscles during and after the use of expiratory positive airway pressure (EPAP) in patients with COPD. METHODS: This was a clinical single-blind trial involving 13 healthy subjects as controls and 12 patients with stable COPD. At baseline, we determined EA during spontaneous respiration, lung function parameters, and respiratory muscle strength. Subsequently, EPAP at 15 cmH2O was applied by means of a face mask for 25 min, during which the EA of the SCM and scalene muscles was recorded every 5 min. A final record was obtained 10 min after the mask removal. RESULTS: We found that the behavior of the EA of SCM and scalene muscles was comparable between the controls and the COPD patients (p = 0.716 and p = 0.789, respectively). However, during the use of EPAP, both muscles showed a trend toward an increase in the EA. In addition, there was a significant decrease in the EA of the SCM between the baseline and final measurements (p = 0.034). CONCLUSIONS: The use of EPAP promoted a significant reduction in the EA of the SCM in the controls and in the patients with stable COPD. However, this did not occur regarding the EA of the scalene muscle.

Reflejo C evocado en el músculo digástrico: un nuevo método para evaluar actividad wind-up trigeminal aplicable a principios activos de plantas medicinales / C-reflex evoked in the digastric muscle: a new method for evaluating trigeminal wind-up activity applicable to active principles of medicinal plants

Wind-up is a measure of nociceptive neurons synaptic potentiation and constitutes an important mechanism in the generation of central sensitization in chronic pain. At the spinal level, the C-evoked reflex in the bicep femoris muscle, by low frequency repetitive stimulation of the sural nerve, has enabled us to evaluate the wind-up of nociceptive neurons of the dorsal horn, and also the effect of antinociceptive drugs with a possible potential therapeutic value in chronic pain. In the present work, we electrophysiologically evaluated the trigeminal wind-up activity, utilizing as an experimental paradigm the evoked C-reflex in the Sprague-Dawley rat digastric muscle. The results obtained indicate that: (a) It is possible to evoke an electromyographic reflex in the digastric muscle by stimulation of C-fibers belonging to the third trigeminal branch; (b) It is possible to potentiate the trigeminal C-reflex with low frequency stimuli (wind-up) and (c) it is possible to depress the trigeminal wind-up with the μ-opioid agonist morphine and with the NMDA receptor antagonist, ketamine. We can conclude that the simple measurement of the trigeminal wind-up will facilitate future studies on the analgesic efficacy of new drugs in oro-facial chronic pain syndromes like migraine and with special emphasis on medicinal plant active principles.

El wind-up refleja la potenciación sináptica en neuronas nociceptivas y constituye un importante mecanismo en la generación de sensibilización central en dolor crónico. A nivel espinal, el reflejo C evocado en el músculo bicep femoris por estimulación repetitiva de baja frecuencia del nervio sural ha permitido evaluar la actividad wind-up en neuronas nociceptivas del cuerno dorsal, así como el efecto de drogas antinociceptivas con un posible potencial terapéutico en dolor crónico. En el presente trabajo evaluamos electrofisiológicamente la actividad wind-up trigeminal, utilizando como paradigma experimental el reflejo C evocado en el músculo digástrico de ratas Sprague-Dawley. Los resultados obtenidos indican que: (a) es posible evocar un reflejo electromiográfico en el músculo digástrico de la rata por estimulación de fibras C de la tercera rama del trigémino; (b) es posible potenciar el reflejo C trigeminal con estímulos de baja frecuencia (wind-up) y (c) es posible deprimir el wind-up trigeminal con el agonista μ-opioide morfina y con el antagonista NMDA, ketamina. Podemos concluir que la medición simple del wind-up trigeminal mediante el reflejo C evocado en el músculo digástrico facilitará futuros estudios sobre eficacia analgésica de nuevos fármacos en cuadros de dolor orofacial crónicos, como la migraña, con especial énfasis en los principios activos de plantas medicinales.

Activación neuromuscular normal y disfuncional de la musculatura flexora cervical en desórdenes dolorosos cervicales / Normal and dysfunctional neuromuscular activation of cervical flexor muscles in cervical pain

Los desordenes dolorosos cervicales han aumentado su prevalencia en la sociedad y representan un elevado costo socioeconómico. Estudios randomizados han reportado que los desordenes dolorosos cervicales, independiente de su causa, estén asociados a una inhibición de la musculatura flexora cervical profunda y a sobre actividad de los músculos flexores cervicales superficiales y axioescapulares. El desarrollo de test clínicos que evalúan la capacidad contráctil de la musculatura flexora cervical han contribuido en poder comprender de mejor forma los procesos neuromecánicos y neurofisiológicos desarrollados a nivel del sistema neuro artro músculo esquelético cervical y su implicancia en el control motor espinal de columna cervical, donde la estabilidad vertebral es dependiente de la integridad del sistema sensorio motriz. Evidencia irrefutable de la literatura señalan que los sujetos con desordenes dolorosos cervicales presentan un deterioro en la activación de la musculatura flexora cervical, tanto espacial como temporal. Estudios de electrofisiología neuromuscular han reportado que los sujetos asintomáticos de dolor cervical presentan un patrón de activación de los músculos flexores cervicales profundos independientes del sentido del movimiento, Sin embargo, los sujetos con desordenes dolorosos cervicales desarrollan un patrón de activación dirección dependiente asociado a un retardo en el timig de activación y de fatigabilidad precoz en tareas de baja carga. La sobre actividad muscular a nivel de los flexores cervicales superficiales y a nivel de la musculatura axioescapular, ha sido interpretada como nuevo patrón de reorganización neuromuscular, programado, planificado y desarrollado por el SNC para intentar compensar el déficit en el control motor generado por la inhibición de los flexores cervicales profundos.

Cervical painful disorders have increased their prevalence in the society and represent a high socio-economic cost. Randomized studies have reported that cervical painful disorders, regardless of their origin, are associated to a superficial flexor-cervical musculature and axioscapular over activity. The development of clinical tests that evaluate the contractile capacity of the cervical flexor musculature have contributed to enabling us to understand in a better way the neuromechanic and neuro-physiologic processes developed at the level of cervical scheletic neuro-arthro-muscle and its implication of the spine motor control of the cervical column, where the vertebrae stability depends of the integrity of the motor sensorial system. Irrefutable evidence of the literature stated that cervical painful disorders present deterioration in the cervical flexor musculature activation, both spatial as well as temporal. Neuromuscular electro-physiology studies have I reported that the asymptomatic individuals of cervical pain present a pattern of cervical flexor muscles activation independent of the movement direction. Nevertheless, individuals with cervical painful disorders develop a dependent activation pattern associated to delay in the activation timing and of early fatigability in low load tasks. The muscular over-activity at the level of superficial cervical flexor and at the level or the axioscapular musculature has been interpreted as the new pattern of neuromuscular reorganization, programmed, planned and developed by the SNC to attempt compensating the deficit in the motor control generated by the inhibition of the deep cervical flexors.

Influence of psychopathologies on craniomandibular disorders

Psychopathologies play a role in the etiology and maintenance of craniomandibular disorders (CMD). In this study, the craniomandibular index was applied to valuate signs and symptoms of CMD in 60 dentate patients, who were assigned to 2 groups: symptomatic (n=35) and asymptomatic (n=25). An interview on psychopathologies was carried out with the aim to detect the presence of some mood disorders, such as depression, dysthymic and bipolar I disorders. Among these disturbances, depression was the most significant aspect to be reported (p<0.05) since it was present in most symptomatic patients. This important interaction was also significantly correlated (p<0.05) with the Palpation Index. These results suggest that psychopathological aspects could increase muscle tenderness and pain in addition to sleep dysfuntions and other physical complaints. Therefore, psychopathologies should be regarded as an important aspect in patients with orofacial pains.

Os transtornos psíquicos podem desempenhar um importante papel na etiologia e manutenção das desordens craniomandibulares (DCM). Desta forma, neste estudo, foi aplicado o índice craniomandibular (ICM), o qual permite detectar a presença de sinais e sintomas de DCM em 60 pacientes totalmente dentados. Estes pacientes foram divididos em dois grupos: sintomáticos (n=35) e assintomáticos (n=25). Um teste psiquiátrico foi administrado para diagnosticar patologias psíquicas pertencentes ao DSM-IV, como a depressão e os transtornos distímico e bipolar I. Das patologias psíquicas relacionadas aos transtornos de humor, a depressão mostrou uma relação estatisticamente significante (p<0,05) com os pacientes sintomáticos para DCM. Ao analisar o índice de palpação separadamente, essa relação se manteve significante (p<0,05) numa escala crescente de valores, demonstrando a ação destes transtornos sobre a sintomatologia dolorosa muscular. Assim sendo, os transtornos mentais exerceriam uma influência considerável na etiologia da DCM, na medida em que potencializariam a dor. Isso ocorreria em função do aumento da tensão muscular, dos distúrbios do sono e de outras alterações fisiológicas advindas destes transtornos.

Electromyographic activity of sternocleidomastoid and masticatory muscles in patients with vestibular lesions

This study evaluated the electromyographic characteristics of masticatory and neck muscles in subjects with vestibular lesions. Surface electromyography of the masseter, temporalis and sternocleidomastoid muscles was performed in 19 patients with Ménière's disease, 12 patients with an acute peripheral vestibular lesion, and 19 control subjects matched for sex and age. During maximum voluntary clenching, patients with peripheral vestibular lesions had the highest co-contraction of the sternocleidomastoid muscle (analysis of covariance, p=0.02), the control subjects had the smallest values, and the patients with Ménière's disease had intermediate values. The control subjects had larger standardized muscle activities than the other patient groups (p=0.001). In conclusion, during maximum voluntary tooth clenching, patients with vestibular alterations have both more active neck muscles, and less active masticatory muscles than normal controls. Results underline the importance of a more inclusive craniocervical assessment of patients with vestibular lesions.

Soft occlusal splint therapy in the management of myofascial pain dysfunction syndrome: a follow-up study.

BACKGROUND AND OBJECTIVES: Myofascial Pain Dysfunction Syndrome (MPDS) has been recognized as the most common, nontooth-related chronic orofacial pain condition that confronts dentists. A variety of therapies has been described in literature for its management. The present study is a prospective study carried out to evaluate the efficacy of occlusal splint therapy and compare it with pharmacotherapy (using analgesics and muscle relaxants) in the management of Myofascial Pain Dysfunction Syndrome. MATERIALS AND METHODS: Forty patients in the age range of 17-55 years were included in the study and randomly assigned to one of two equally sized groups, A and B. Group A patients received a combination of muscle relaxants and analgesics while Group B patients received soft occlusal splint therapy. All the patients were evaluated for GPI, VAS, maximum comfortable mouth opening, TMJ clicking and tenderness during rest and movement as well as for the number of tender muscles at the time of diagnosis, after the 1 st week of initiation of therapy and every month for three months of follow-up. RESULTS: There was a progressive decrease in GPI scores, number of tender muscles, TMJ clicking and tenderness with various jaw movements and significant improvement in mouth opening in patients on occlusal splint therapy during the follow-up period as compared to the pharmacotherapy group. CONCLUSION: Occlusal splint therapy has better long-term results in reducing the symptoms of MPDS. It has better patient compliance, fewer side effects, and is more cost-effective than pharmacotherapy; hence, it can be chosen for the treatment of patients with MPDS.

Atividades de fala e não-fala em gagueira: estudo preliminar / Speech and non-speech activities in stuttering: a preliminary study

BACKGROUND: stuttering. AIM: to compare muscle activation in fluent and stuttering individuals during speech and non-speech tasks. METHOD: six adults divided in two groups: G1 - three fluent individuals; G2 - three stuttering individuals. Muscle activity (surface electromyography) was captured by disposable electrodes fixed in four regions. Testing situations: muscle rest tension, speech reaction time, non-verbal activity, verbal activity. RESULTS: There was no significant statistical difference between the groups for the rest tension; G2 present longer speech reaction times; G2 presented muscle activity during the non-verbal task similar to that observed during rest; Muscle activity of G1 and G2 during the verbal task demonstrated to be similar. CONCLUSION: these results suggests that for G2 there is a poor control of timing for the coordination of motor processes.

TEMA: gagueira. OBJETIVO: comparar a ativação muscular em indivíduos fluentes e gagos durante tarefas de fala e não-fala. MÉTODO: seis adultos foram divididos em dois grupos: G1 - três indivíduos fluentes; G2 - três indivíduos com gagueira. A atividade muscular (eletromiografia de superfície) foi captada por eletrodos fixados em quatro regiões. Situações testadas: tensão muscular de repouso, tempo de reação da fala; atividade não verbal e atividade verbal. RESULTADOS: não houve significância estatística entre os grupos para a tensão de repouso; G2 apresentou tempo de reação de fala mais longo; G2 apresentou atividade muscular durante a tarefa não verbal semelhante a observada durante o repouso; a atividade muscular de G1 e G2 durante a tarefa verbal foi similar. CONCLUSÃO: estes resultados sugerem que G2 apresenta um pobre controle temporal para a coordenação dos processos motores.

Relief of primary cervical dystonia symptoms by low frequency transcranial magnetic stimulation of the premotor cortex: case report

OBJECTIVE: To evaluate the effect of low-frequency repetitive transcranial magnetic stimulation (rTMS) on the symptoms of a patient with primary segmental dystonia (PSD). METHOD: 1200 TMS pulses at a frequency of 1Hz, over the premotor cortex, with an intensity of 90 percent of the motor threshold (MT), using an eight-shaped coil; a total of 5 sessions were carried out. RESULTS: A reduction of 50 percent in the neck subset of the Burke, Fahn and Marsden torsion dystonia scale (BFM) was observed in our patient. CONCLUSION: The reduction in the BFM scale supports the concept that rTMS of the premotor cortex may reduce specific motor symptoms in PSD.

OBJETIVO: Investigar o efeito da estimulação magnética transcraniana repetitiva (EMTr) de baixa freqüência nos sintomas de um paciente com distonia segmentar primária (DSP). MÉTODO: 1200 pulsos a uma freqüência de 1Hz, sobre o córtex pré-motor, a uma intensidade de 90 por cento do limiar motor (LM), usando uma bobina em forma de 8. Foram realizadas 5 sessões. RESULTADOS: Uma redução de 50 por cento no sub-item "pescoço" na escala de distonia de torção de Burke, Fahn e Marsden (BFM) foi observada no paciente em questão. CONCLUSÃO: A redução na escala BFM corrobora a idéia de que a EMTr sobre o córtex pré-motor pode reduzir sintomas motores específicos na DSP.

Síndrome da cabeça caída em doença do neurônio motor / Dropped head syndrome in motor neuron disease

A síndrome da cabeça caída é causada por diminuição de força nos músculos extensores do pescoço sendo encontrada em diversas doenças neuromusculares, bem como, na esclerose lateral amiotrófica. Descrevemos o caso de três mulheres com diagnóstico de doença do neurônio motor com quadro clínico de disfagia e diminuição de força em músculos cervicais que evoluiu com queda da cabeça. A investigação mostrou ressonância magnética de crânio e coluna cervical normais; e a eletromiografia de agulha com desinervação ativa e crônica em músculos bulbares e dos segmentos cervical, torácico e lombo-sacro. Discutimos as características da doença, especialmente suas manifestações clínicas e os achados eletroneuromiográficos, dando ênfase à necessidade de investigação da cabeça caída na suspeita de doença do neurônio motor.

Dos potenciais evocados miogênicos vestibulares nas orelhas comprometida e assintomática na Doenca de Ménière unilateral / Vestibular evoked myogenic potentials in affected and asymptomatic ears in unilateral Ménière's Disease

Verificar se os potenciais evocados miogênicos vestibulares podem apresentar anormalidades na orelha comprometida e na orelha assintomática em pacientes com hipótese diagnóstica de doenca de Ménière definida unilateral. FORMA DE ESTUDO: Transversal coorte. MATERIAL E MÉTODO: Foram avaliados os potenciais evocados miogênicos vestibulares de 20 pacientes com doenca de Ménière definida unilateral. A selecão dos indivíduos baseou-se na história e na avaliacão clínica sugestivas de doenca de Ménière definida unilateral, e eletrococleografia com anormalidades na orelha comprometida. Os potenciais evocados miogênicos vestibulares foram avaliados em ambas as orelhas de cada paciente por meio da latência absoluta de p13 e n23, diferenca interaural da latência dos picos p13 e n23 e índice de assimetria da amplitude de p13-n23. RESULTADO: Os potenciais evocados miogênicos vestibulares estavam alterados em 35,0 por cento das orelhas comprometidas e em 25,0 por cento das orelhas assintomáticas. As alteracões foram: ausência de resposta em sete casos, aumento da latência absoluta de p13 em três casos, e aumento do índice de assimetria da amplitude em um caso. CONCLUSAO: Os potenciais evocados miogênicos vestibulares podem apresentar anormalidades nas orelhas comprometida e assintomática de pacientes com hipótese diagnóstica de doenca de Ménière definida unilateral.

Effects of cervical traction and exercise therapy in cervical spondylosis.

A randomised clinical trial was conducted in the Department of Physical Medicine, Chittagong Medical College Hospital from July, 2001 to June, 2002. The objectives of the study were to find out the effects of cervical traction (CT) and exercise on the patients with chronic cervical spondylosis. A total of 199 patients with cervical spondylosis were included in the clinical trial. One hundred patients were treated with cervical traction plus exercise and 99 patients were treated with non-steroidal anti-inflammatory drug (NSAID). Posture correction advice was given to all patients. The patients were treated for 6 weeks. There was a marked improvement in both the groups after treatment (P<0.001). But there was nearly significant difference regarding improvement in treatment with CT plus exercise than with NSAID (P = 0.06). The results indicate that the improvement of the patients with chronic cervical spondylosis was more in CT plus exercise than analgesics. So, CT & neck muscle strengthening exercise may have some more beneficial effects than NSAIDs on chronic cervical spondylosis.

Proceso estiloideo elongado y síndrome de Eagle / Elongated styloid process and Eagle syndrome

El proceso estiloideo elongado y/o calcificado es una causa de dolor craneofacial y cervical. La incidencia y patogénesis del síndrome estiloideo son discutidas. Esta condición está caracterizada por dolor faríngeo, sensación de cuerpo extraño, odinofagia y palpación dolorosa en la fosa tonsilar. Además, por su localización entre las arterias carótida externa e interna, puede chocar con ellas produciendo carotidinia. Esta condición es más frecuentemente encontrada en pacientes amigdalectomizados y en el sexo femenino. El diagnóstico se hace con el examen físico por la palpación digital del proceso estiloideo en la fosa tonsilar. La demostración radiológica de la elongación estiloidea es hecha fácilmente en muchos casos. El único tratamiento efectivo es el acortamiento quirúrgico del proceso estiloideo. Después de confimar clínica y radiológicamente el diagnóstico, con tomografía computarizada del proceso estiloideo, se realiza reseccion quirúrgica parcial uni o bilateral de los procesos estiloideos, lo que ha mostrado resolución de los síntomas

Disfonía espasmódica en abducción: reporte de un caso / Abducting spasmodic dysphonia: case report

Presentamos el caso de un paciente con disfonía espasmódica en abducción por superposición de bandas ventriculares, con larga evolución y acompañado de distonía cervical. El paciente fue manejado con toxina botulínica, obteniendo buenos resultados.

Avaliaçäo eletromiográfica de paciente portador de mordida cruzada posterior unilateral / Eletromiographic evaluation of the crossed unilateral bite

Este trabalho foi realizado com o intuito de se avaliar as condiçöes da musculatura do temporal (fibras anterior e posterior), musculatura do masseter, musculatura do supra hioídeos, musculatura do esternocleidomastoideo e musculatura de trapézio, antes e imediatamente após correçäo da mordida cruzada unilateral, através da Técnica Funcional Gomes. Poderemos observar a correlaçäo das alteraçöes musculares com a maloclusäo de mordida cruzada unilateral, ficando patente o desvio mandibular com conseqüente resposta muscular. O exame nos permitiu avaliar a açäo da Aleta Unilateral Gomes sobre a musculatura, bem como o grau de sucesso da intervençäo

O músculo trapézio e o desequilíbrio funcional craniomandibular / The trapezium muscle and the craniomandibular functional unbalance

Neste estudo fizemos uma descriçäo evolutiva do músculo trapézio (MT), sua morfologia, origem e inserçäo e uma análise de sua inervaçäo. O objetivo deste trabalho é estabelecer uma relaçäo anátomo-funcional entre o mt e as disfunçöes da atm e de outras estruturas da cabeça e do pescoço.