Difference between revisions of "1° Cas clinique : Spasme hémimasticatoire"

From what has been exposed in the previous chapters from the 'Introduction' to the '[[Logic of medic language]]' chapters, beyond the complexity of the arguments and the vagueness of the verbal language, we found ourselves faced with a dilemma that of the context in which the patient is referred and in these cases for our poor Mary Poppins it seems to dominate the dental context, given the positive assertions reported by the clinical and laboratory tests performed on the patient.

{{Q2|then the dentist triumph!|it would seem apparently but ......}}

The clinical case of our poor Mary Poppins shows all the physiopathological and clinical complexity but above all a phenomenon of overlapping of propositions, statements and logical phrases in the dental and neurological context in which, one context obtains compatibility and coherence while the other incoherence.  

Basically, given the compatibility and consistency of sentence {{:F:Imo}} (dental context) with the assertions derived from the clinical test reporting {{:F:Delta series}}, consistently say that Orofacial Pain is caused by a Temporomandibular Disorder could become incompatible if another set of clinical statements <math>(\gamma_1,\gamma_2,.....\gamma_n \ )</math> were consistent with sentence <math>\Im_n</math> (neurological context) and contextually opposite, from a diagnostic point of view, to {{:F:Imo}}<blockquote>Therefore, there would be a source of logistical conflict between the two specialist contexts with inevitable diagnostic delay, also polluting the decryption process of the signal in the machine language of the Central Nervous System (CNS).</blockquote>What will determine the access key for decoding the encrypted code in machine language (SNC) and will allow us to intercept a demarcation line will be an irrefutable clinical and / or laboratory data called {{:F:Tau}}, which will confirm or exclude the consistency of an assertion than the other. It is essential, at this point, a <math>\Im_d</math> sentence (demarcation sentence) of the type will be:  <blockquote>Does Mary Poppins have a neuromotor disorder or a Temporomandibular Disorder? </blockquote>We explain this step in detail:

Remember that da '[[The logic of classical language - en|The logic of classical language]]' this shows :  

*A set of {{:F:Im}} sentences, and a <math>n\geq1</math> number of other <math>(\delta_1,\delta_2,.....\delta_n \ )</math> statements they are logically compatible if, and only if, the union between them <math>\Im\cup\{\delta_1,\delta_2.....\delta_n\}</math> it is consistent

*A set of {{:F:Im}} sentences, and a <math>n\geq1</math> number of other <math>(\gamma_1,\gamma_2,.....\gamma_n \ )</math> statements they are logically incompatible if, and only if, the union between them <math>\Im\cup\{\gamma_1,\gamma_2.....\gamma_n\}</math> it is inconsistent

Now, for the '''dental context''' we will have the following sentences and assertions to which we give a numerical value to facilitate the treatment and that is <math>\delta_n=[0|1]</math> where <math>\delta_n=0</math> indicates' normality' and <math>\delta_n=1</math> 'abnormality' and therefore positivity of the report:

{{:F:Delta1}} Positive radiological report of the TMJ in Figure 2, <math>\delta_1=1\longrightarrow</math> Abnormality, positivity of the report

{{:F:Delta2}} Positive CT report of the TMJ in Figure 3,<math>\delta_2=1\longrightarrow</math> Abnormality, positivity of the report

 

{{:F:Delta4}} Asymmetric EMG interference pattern in Figure 5, <math>\delta_4 =1\longrightarrow</math> Abnormality, positivity of the report

File:Spasmo emimasticatorio ATM.jpg|'''Figure 2:'''  <math>\delta_1=</math> Patient TMJ stratigraphy showing signs of condylar flattening and osteophytes

File:Atm1 sclerodermia.jpg|'''Figure 3:''' <math>\delta_1=</math> Computed tomography of the TMJ showing flattening of the TMJ

File:1600px-Spasmo emimasticatorio assiografia.jpeg|''' Figure 4:''' <math>\delta_1=</math> Axiography of the patient showing a flattening of the chewing pattern on the right condyle

File:EMG2.jpg|'''Figure 5:''' <math>\delta_2=</math> EMG interference pattern. Overlapping upper traces corresponding to the right masseter, lower to the left masseter.

The sentence {{:F:Imo}} (dental context) with a number <math>n\geq1</math> of other logically compatible <math>(\delta_1,\delta_2,.....\delta_n \ )</math> assertions determine the union and coherence between them <math>\Im_o\cup\{\delta_1,\delta_2.....\delta_n\}</math> and are represented with a mathematical formalism to facilitate the diagnostic dialectic in the following way:             

The result in this case is <math>\delta_n=1</math> and at the same time it derives the coherent statement of the sentence <math>\Im_o</math> in which it is argued that the symptomatology of the patient Mary Poppins is determined by the presence of a DTMs.

{{Q2|But, paradoxically, in the neurological context

<math>\Im_n </math>  we will have the same rational process:|and it is precisely here that the contexts conflict}}

In the '''neurological context''', therefore, we will have the following sentences and assertions to which we give a numerical value to facilitate the treatment and that is <math>\gamma_n=[0|1]</math> where <math>\gamma_n=0</math> indicates 'normality' and <math>\gamma_n=1</math> 'abnormality' and therefore positivity of the report:

<math>\gamma_1=</math> Absence of jaw jerk in Figures 6, <math>\gamma_1=1\longrightarrow</math> Abnormality, positivity of the report

<math>\gamma_2=</math> Absence of the silent masseterine period in Figures 7, <math>\gamma_2=1\longrightarrow</math> Abnormality, positivity of the report

<math>\gamma_1=</math> Hypertrophy of the right masseter on CT in Figures 8, <math>\gamma_3=1\longrightarrow</math> Abnormality, positivity of the report

File:Spasmo emimasticatorio JJ.jpg|'''Figure 6:''' <math>{\gamma _{1}}=</math> Jaw jerk detected electrophysiologically on the right (upper traces) and left (lower traces) masseters

File:Spasmo emimasticatorio SP.jpg|'''Figure 7:''' <math>\gamma _2=</math> Mechanical silent period detected electrophysiologically on the right (upper overlapping traces) and left (lower overlapping traces) masseters

File:Spasmo emimasticatorio TC.jpg|''' Figure 8:''' <math>\gamma _3=</math> CT shows evident hypertrophy of the right masseter

Now consequently also sentence <math>\Im_n</math> with a number <math>n\geq1</math> of other logically compatible statements <math>(\gamma_1,\gamma_2,.....\gamma_n \ )</math> determine the union and coherence between them <math>\Im_n\cup\{\gamma_1,\gamma_2.....\gamma_n\}</math> and the formal representation will be similar to that of the dental context:

\Im_n\cup\{1,1.....1\}=1</math> with contextual coherent affirmation of sentence <math>\Im_n</math> in which it is argued that the symptomatology of the patient Mary Poppins has a neuromotor cause and the clinical consequences of a masticatory occlusal type are nothing other than a consequence of the neuropathic damage.

{{Q2|In this scenario both the statements <math>\Im_o </math> and <math>\Im_n </math> are compatible, consistent and therefore true until a 'demarcator of coherence' is found which we previously called <math>\tau</math>  

==== Demarcator of coherence <math>\tau</math>====

The <math>\tau</math> is a representative clinical specific weight, complex to research and fine-tune because it varies from discipline to discipline and for pathologies, essential in order not to make logical assertions collide <math>\Im_o</math> and <math>\Im_n</math> in the diagnostic procedures and essential to initialize the decryption of the logic communication code. Basically it allows you to confirm the consistency of a union <math>\Im\cup\{\delta_1,\delta_2.....\delta_n\}</math> with respect to another <math>\Im\cup\{\gamma_1,\gamma_2.....\gamma_n\}</math> and vice versa, giving greater weight to the severity of the statements and the report in the appropriate context.   

Sometimes the physician is faced with a series of positive reports to which to give due weight, he must consider the positivity of a report that highlights, for example, an osteoarticular remodeling of the TMJ cannot have the same weight as a positivity of a report confirming a latency delay of a trigeminal reflex.  

The weight of demarcation <math>\tau</math>, therefore, gives more significance to the most serious assertions in the clinical context from which they derive and therefore beyond the positivity of the <math>\delta_n=1</math> or <math>\gamma_n=1</math> assertions which in any case are always verified and respected, these must be multiplied by a <math>\tau=[0|1]</math> where <math>\tau=0</math> indicates 'Low severity' while <math>\tau=1</math> 'High severity'.   

In the neurological context, <math>\tau</math> concerns the presence of delays and/or latency absence of the jaw jerk, duration and/or absence of the masseterine silent period as well as other parameters that for the moment it is not necessary to describe. A delay greater than the normative value or an absence of the aforementioned tests is considered as a serious and absolute specific weight corresponding to a dominant valence with respect to the other clinical context.  

To recap we therefore have:

<math>{\bar\delta_n}=</math> average of the value of clinical statements in the dental context and therefore <math>{\bar\delta_n}=1</math>

<math>{\bar\gamma_n}=</math> average of the value of clinical statements in the neurological context and therefore<math>{\bar\gamma_n}=1</math>

<math>\tau_o=0</math> low severity performance of the dental context<math>\tau_n=1</math>reporting of high severity of the neurological context

where the 'coherence marker '<math>\tau</math>' will define the diagnostic path as follows

{{Q2|This formal logic syntax procedure allowed us to eliminate the interference of low clinical severity assertions and quickly define a neurological rather than dental diagnostic path through the definition of <math>\Im_d= \Im_n

Once we have washed away the myriad of positively reported normative data, which generate conflicts between contexts, thanks to the coherence marker <math>\tau</math> we have a much clearer and more linear picture on which to deepen the analysis of the functionality of the Central Nervous System. Consequently we can concentrate on intercepting the tests necessary to decrypt the machine language code that the SNC sends out converted into verbal language.