SUBSTANTIATION OF THE SEQUENCE OF CLINICAL FUNCTIONAL ANALYSIS OF THE MAXILLOFACIAL SYSTEM IN PATIENTS WITH SUSPECTED TEMPOROMANDIBULAR DISORDERS

Makeyev V., Telishevska U., Kulinchenko R., Telishevska O.

CONTENTS

Scentific article

This article presents a sequence of clinical functional analysis of the maxillofacial system before the prosthetic rehabilitation of the patient and the use of algorithms for diagnostics of temporomandibular disorders. Complex approach to diagnosis and treatment of temporomandibular disorders with creation of algorithms of diagnostics of such disorders is actual nowadays. The aim of study is to substantiate an integrated approach to the diagnosis of temporomandibular disorders by creating algorithms for differential diagnosis, involving x-ray investigation methods. The algorithms of diagnostics of temporomandibular disorders are based on organ and nosology principles. The degree of necessity and sequence of application of methods of radial investigation of temporomandibular disorders is taken into account using these algorithms. The algorithm based on organ principle unites information of different radial investigation methods in detecting structural disorders in soft tissue and bone tissue elements of the joint. The algorithms based on nosology principle unite information from the patient’s complaints, results of clinical examination and additional methods of investigation. Complex clinical examination of patients with right choice of additional investigation methods allow to diagnose the temporomandibular disorders competently and assign an adequate treatment plan. Especially important is the objective differential diagnosis with other pathologies that may «masquerade» as various forms of temporomandibular disorders. The results of examination of 235 patients revealed that variety of temporomandibular disorders were detected in 197 individuals (83. 83%) and “masqueraded” versions of disorders were detected in 38 individuals (16. 17%). None of the temporomandibular disorders has been identified in 15 individuals (39.47%). That may indicate the overdiagnosis of the pathology of temporomandibular joints by other doctors, who have directed these patients for consultation. Most often «difficult eruption of the third molars» – 7 persons (18,42%) «masqueraded» as temporomandibular disorder. The next in frequency «masqueraded» versions were: «pathology of the spine (osteochondrosis of the cervical spine )» – 4 persons ( 10.53%); «bruxism», «pulpit of the third molars», «the Eagle’s syndrome» and «neuropathology» – 2 persons (5,26%). Such disorders as «periodontitis of the third molars», «fracture of styloid process», «contracture of the muscles of mastication», «hypoplasia of the condyle» have been more rarely observed – 1 person (2,63%). For a definitive diagnosis of temporomandibular disorder thorough clinical examination of the patient by a quali-fied technician is needed, using additional methods of examination. Especially important is the multidisciplinary cooperation between different physicians, since a significant number of pathologies can «masquerade» as tem-poromandibular disorders.

temporomandibular joint, temporomandibular disorder

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