Difference between revisions of "2° Klinischer Fall: Kavernom der Zirbeldrüse"

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   [[File:IMG0103.jpg|thumb|300x300px|'''Figura 1:''' The subject was a 32-year-old man suffering from pronounced nocturnal and diurnal bruxism and chronic bilateral Oorofacial pain   ]]Dystonie ist eine unwillkürliche, sich wiederholende, anhaltende (tonische) oder krampfartige (schnelle oder klonische) Muskelkontraktion. Das Spektrum der Dystonien kann verschiedene Körperregionen betreffen. Von Interesse für Mund-, Kiefer- und Gesichtschirurgen sind die kranial-zervikalen Dystonien, insbesondere die orofaziale Dystonie (OFD). OFD ist eine unwillkürliche, anhaltende Kontraktion der periorbitalen, Gesichts-, oromandibulären, pharyngealen, laryngealen oder zervikalen Muskulatur.<ref>Thompson PD, Obeso JA, Delgado G, Gallego J, Marsden CD. Focal dystonia of the jaw and differential diagnosis of unilateral jaw and masticatory spasm. J Neurol Neurosurg Psychiatry. 1986;49:651–656. doi: 10.1136/jnnp.49.6.651. [PMC free article][PubMed] [CrossRef] [Google Scholar][Ref list]</ref> OFD kann die Kaumuskulatur, die untere Gesichtsmuskulatur und die Zungenmuskulatur betreffen, was zu Trismus, Bruxismus, unwillkürlichem Öffnen oder Schließen des Kiefers und unwillkürlicher Zungenbewegung führen kann.   

File:SC-05-0021.jpeg|'''Figura 3:''' <math>\delta_2=0\longrightarrow</math>Eine axiographische Aufzeichnung, durchgeführt mit einer paraokklusalen Schiene, zeigt einen normalen translatorischen und mediotrusiven Trend des rechten Kondyls. Negativer Ergebnisbericht.

{{Q2|We could, paradoxically, have the same rationale in the neurological context

<math>\Im_n </math> ?|and it is precisely here that the contexts conflict or rather the results may not be so decisive}}

File:Bruxer MEP.jpeg|'''Figure 5:''' <math>{\gamma _{1}}=</math> Motor Evoked Potentials of the trigeminal roots

File:Bruxer Jaw jerk.jpeg|'''Figure 6:''' <math>{\gamma _{2}}=</math> Jaw jerk detected electrophysiologically on the right (upper traces) and left (lower traces) masseters. The morphology and duration of the silent periods called 'Esteroceptive Suppression' appear to be symmetrical.

File:Bruxer SP2.jpg|'''Figure 7:''' <math>\gamma _3=</math> Electrical silent period detected electrophysiologically on the right (upper superimposed traces) and left (lower superimposed traces) masseters

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

As we described in the chapter '1st Clinical case: Hemimasticatory spasm' the <math>\tau</math> is a representative clinical specific weight, complex to research and develop because it varies from discipline to discipline and for pathologies, essential in order not to collide the logical assertions <math>\Im_o</math> and <math>\Im_n</math> in diagnostic procedures and fundamental to initialize the decryption of the machine language code. Basically it allows you to confirm the coherence of a union <math>\Im\cup\{\delta_1,\delta_2.....\delta_n\}</math> versus another <math>\Im\cup\{\gamma_1,\gamma_2.....\gamma_n\}</math>and vice versa, giving greater weight to the seriousness of the allegations and the report in the appropriate context.

 

The demarcation weight <math>\tau</math>, therefore, gives more significance to the more serious assertions in the clinical context from which they derive and therefore beyond the greater or lesser positivity of the assertions <math>0\leq\delta_n\leq1</math> or <math>0\leq\gamma_n\leq1</math> which in any case are always verified and respected, these must be validated according to the intrinsic clinical severity by multiplying the average of the assertions <math>\bar{\delta_n}</math> and <math>\bar{\gamma_n}</math> for a <math>\tau=[0|1]</math> where <math>\tau=0</math> indicates 'low severity' while <math>\tau=1</math> 'high severity'.

 

To summarize in our case 'Bruxer' 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}=0</math>

<math>{\bar\gamma_n}=</math> average of the value of clinical statements in the neurological context and therefore <math>{\bar\gamma_n}=0,33</math>

<math>\tau_o=0</math> reporting of low severity of the dental context

<math>\tau_n=1</math> reporting of high severity of the neurological context

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

As can be seen in our clinical case 'Bruxer' we have a very slight diagnostic slope towards the neurological context which allows us, however, to glimpse more of a neurological component rather than a dental one.

Once the myriad of normative data reported positively, which generate conflict between contexts, has been washed away, thanks to the coherence demarcator <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 ( CNS) than in our clinical case ' Bruxer' appears somewhat intrigued by the low diagnostic weight derived from the neurological assertions <math>\Im_n\cup0,33

This average figure derives primarily from a hypothetical jaw jerk amplitude anomaly labeled with an asterisk (*). We will talk about it in the section dedicated to this trigeminal reflex.

Consequently we can concentrate on intercepting the tests necessary to decrypt the machine language code that the CNS sends outwards converted into verbal language which at first sight would seem to concern a sort of hyperreflexia of the tendon reflexes. and specifically the jaw jerk.<ref>S Watanabe , H Mochizuki, I Nakashima, Y Itoyama. A case of primary Sjögren's syndrome with CNS disease mimicking chronic progressive multiple sclerosis.Rinsho Shinkeigaku. 1998 Jul;38(7):658-62.

</ref> To confirm this hypothetical intuition, a brainstorming of the type 'Cognitive Neural Network' abbreviated as 'RNC' presented for the diagnosis of the case of our 'Mary Poppins' in the chapter 'Encrypted code: Ephaptic transmission' is necessary.

However, through this first diagnostic process we have made progress because, contrary to the codified process in dental disciplines, we are undertaking a neurophysiological process to decrypt the machine language code of 'bruxism'.<blockquote>In order not to weigh down the discussion, we will deal with the second diagnostic step of the Masticationpedia model in the following chapter entitled '[[Encrypted code: Hyperexcitability of the trigeminal system]]'</blockquote>