Masticationpedia

Difference between revisions of "2° Clinical case: Pineal Cavernoma"

2° Clinical case: Pineal Cavernoma (view source)

Revision as of 17:54, 19 October 2024

2,916 bytes removed ,  11 months ago
no edit summary
 
(2 intermediate revisions by the same user not shown)
Line 1: Line 1:
{{main menu}}
{{main menu}}
[[File:Bruxer SP2.jpg|left|300x300px]]
Bruxism, characterized by involuntary teeth grinding or clenching, often occurs during sleep and is influenced by neurophysiological factors. This condition can lead to Orofacial pain (OP) and is often treated without a full understanding of its underlying causes. Recent studies have explored the roles of neurotransmitters and the pharmacological impacts on bruxism, suggesting that the sensitization of the trigeminal nociceptive system and neural hyperexcitability may play significant roles in its pathophysiology.
Bruxism is more than just a dental issue; it involves complex neurophysiological processes. This article expands on traditional views by discussing dystonic phenomena and their relation to orofacial pain, moving beyond dental aspects to a broader neurophysiological perspective.
Dystonia in the cranial-cervical region, often manifesting as orofacial dystonia (OFD), can lead to various involuntary muscle contractions, impacting speech and eating. Bruxism is linked to genetic factors, central nervous system disorders, and even certain medications. Notably, the relationship between painful temporomandibular disorders (TMDs) and bruxism highlights a significant overlap with conditions like migraines and tension-type headaches.
The treatment of bruxism varies, focusing on alleviating pain and preventing dental damage. However, understanding the basic knowledge about its etiology is crucial, which includes dismissing morphological factors while emphasizing psychological and pathophysiological factors. Investigations into the neurobiological aspects of bruxism have shown that neurotransmitter systems like dopamine, serotonin, and norepinephrine play pivotal roles. Medications affecting these neurotransmitters can exacerbate or suppress bruxism, indicating a direct link between drug therapy and bruxism activity.
Furthermore, electrophysiological studies have provided insights into how pain influences mandibular reflexes, suggesting that orofacial pain could modify jaw reflexes through central mechanisms, affecting muscle responses during episodes of bruxism.
From a clinical perspective, understanding the basic knowledge of bruxism’s underlying mechanisms helps in formulating more effective treatment strategies. The role of the trigeminal nociceptive system in orofacial pain associated with bruxism is crucial for developing targeted therapies that address the neural aspects of the disorder.
The case study of a 32-year-old man, referred to as 'Bruxer', illustrates the complex interplay of neurological and dental factors in diagnosing and managing bruxism. This case emphasizes the need for a holistic approach in treating bruxism, one that incorporates both dental and neurophysiological insights to address the root causes of the disorder effectively.<blockquote>
== Keywords ==
'''Bruxism''' - Refers to the medical condition characterized by the involuntary grinding or clenching of teeth, typically during sleep, which can lead to jaw pain and damage to teeth.
'''Orofacial Pain''' - Describes pain felt in the face and mouth area, often associated with conditions like bruxism, and includes symptoms such as jaw muscle pain and headaches.
'''Neurobiological Factors of Bruxism''' - Focuses on the underlying neurophysiological causes of bruxism, emphasizing how neurotransmitters and neural pathways contribute to involuntary teeth grinding.
'''Trigeminal Nociceptive System''' - Pertains to the part of the nervous system involved in transmitting pain from the face to the brain, crucial in understanding the pain associated with bruxism.
'''Dopaminergic Medication and Bruxism''' - Involves the impact of medications affecting dopamine levels in the body, which can influence the occurrence and severity of bruxism.
'''Mandibular Stretch Reflexes''' - Deals with reflex actions of the jaw muscles, which are affected by bruxism and can lead to changes in jaw muscle activity and tension.
'''Sleep Bruxism''' - Specifically refers to bruxism that occurs during sleep, distinguishing it from bruxism that might occur during waking hours, with different etiological factors and treatment approaches.
'''Treatment of Bruxism''' - Encompasses various strategies and interventions used to manage and alleviate the symptoms of bruxism, including dental guards, medication, and behavioral therapy.
'''Temporalmandibular Joint Dysfunction (TMD)''' - Relates to disorders of the jaw joint and chewing muscles, often linked to bruxism, causing pain and dysfunction in the jaw joint and surrounding tissues.
'''Pharmacological Effects on Bruxism''' - Describes how certain drugs can either exacerbate or suppress bruxism, indicating the importance of medication management in treating bruxism.</blockquote>
[[Category:Pathology of temporomandibular joints, muscles of mastication and associated structures]]
[[Category:Pathology of temporomandibular joints, muscles of mastication and associated structures]]
[[Category:Sleep disorders]]
[[Category:Sleep disorders]]
Line 48: Line 12:
| autore6 =  
| autore6 =  
| }}
| }}
== Introduction to the bruxist case report==
 
'''Abstract:'''This chapter focuses on the clinical case of a 32-year-old man suffering from severe nocturnal and diurnal bruxism, coupled with chronic bilateral orofacial pain (OP), predominantly on the left side. Unlike the traditional approach that views bruxism solely as a dental issue, this case study adopts a broader neurophysiological perspective. It introduces the phenomenon of dystonia and its connection to bruxism, highlighting the overlapping effects of temporomandibular disorders (TMDs), headaches, and neurological factors such as hyperexcitability of the central nervous system (CNS).
 
The patient, after 15 years of bruxism treatment involving bite planes, presented with a worsening condition that included trunk and limb muscle stiffness, visual disturbances, and neurological abnormalities such as diplopia, nystagmus, and polykinetic tendon reflexes. The chapter contrasts dental and neurological findings, using a formal logical diagnostic framework to clarify the dominance of neurological over dental factors in this case.
 
Key diagnostic tools included electromyography (EMG), motor evoked potentials (MEPs), and jaw jerk reflex testing, which indicated trigeminal system involvement. The coherence demarcator (<math>\tau</math>), previously applied to the case of hemimasticatory spasm, was employed here to resolve conflicts between dental and neurological assertions, leading to a stronger focus on neurophysiological abnormalities.
 
The chapter concludes by proposing a neurophysiological path to decode the "machine language" of the CNS in bruxism, aiming to understand the condition not merely as a dental issue but as a possible manifestation of hyperreflexia and CNS hyperexcitability. The next diagnostic step will be elaborated in the following chapter, "Encrypted Code: Hyperexcitability of the Trigeminal System."
==Introduction to the bruxist case report==
As anticipated in the chapter '[[Bruxism - en|Bruxism]]' we will avoid indicating this disorder as an exclusive dental correlate and will seek a broader and essentially more neurophysiological description by making a brief excursus on dystonic phenomena, on 'Orofacial Pain' and only then will we consider the phenomenon 'bruxism' true and own. Subsequently we will move on to the presentation of the clinical case.   
As anticipated in the chapter '[[Bruxism - en|Bruxism]]' we will avoid indicating this disorder as an exclusive dental correlate and will seek a broader and essentially more neurophysiological description by making a brief excursus on dystonic phenomena, on 'Orofacial Pain' and only then will we consider the phenomenon 'bruxism' true and own. Subsequently we will move on to the presentation of the clinical case.   


   [[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  ]]Dystonia is an involuntary, repetitive, sustained (tonic), or spasmodic (rapid or clonic) muscle contraction. The spectrum of dystonias can involve various regions of the body. Of interest to oral and maxillofacial surgeons are the cranial-cervical dystonias, in particular, orofacial dystonia (OFD). OFD is an involuntary, sustained contraction of the periorbital, facial, oromandibular, pharyngeal, laryngeal, or cervical muscles.<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 can involve the masticatory, lower facial, and tongue muscles, which may result in trismus, bruxism, involuntary jaw opening or closure, and involuntary tongue movement.
   [[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  ]]Dystonia is an involuntary, repetitive, sustained (tonic), or spasmodic (rapid or clonic) muscle contraction. The spectrum of dystonias can involve various regions of the body. Of interest to oral and maxillofacial surgeons are the cranial-cervical dystonias, in particular, orofacial dystonia (OFD). OFD is an involuntary, sustained contraction of the periorbital, facial, oromandibular, pharyngeal, laryngeal, or cervical muscles.<ref>Thompson PD, Obeso JA, Delgado G, Gallego J, Marsden CD. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1028846/ 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 can involve the masticatory, lower facial, and tongue muscles, which may result in trismus, bruxism, involuntary jaw opening or closure, and involuntary tongue movement.


The etiology of OFD is varied and includes genetic predisposition, injury to the central nervous system (CNS), peripheral trauma, medications, metabolic or toxic states, and neurodegenerative disease. However, in the majority of patients, no specific cause can be identified. An association was found among painful temporomandibular disorders (TMDs), migraine, tension-type headache, and sleep bruxism, although the association was only significant for chronic migraine. The association between painful TMDs and sleep bruxism significantly increased the risk for chronic migraine, followed by episodic migraine and episodic tension-type headache.<ref>Fernandes G, Franco AL, Gonçalves DA, Speciali JG, Bigal ME, Camparis CM. Temporomandibular disorders, sleep bruxism, and primary headaches are mutually associated. J Orofac Pain. 2013;27(1):14–20. [PubMed] [Google Scholar] [Ref list]</ref>
The etiology of OFD is varied and includes genetic predisposition, injury to the central nervous system (CNS), peripheral trauma, medications, metabolic or toxic states, and neurodegenerative disease. However, in the majority of patients, no specific cause can be identified. An association was found among painful temporomandibular disorders (TMDs), migraine, tension-type headache, and sleep bruxism, although the association was only significant for chronic migraine. The association between painful TMDs and sleep bruxism significantly increased the risk for chronic migraine, followed by episodic migraine and episodic tension-type headache.<ref>Fernandes G, Franco AL, Gonçalves DA, Speciali JG, Bigal ME, Camparis CM. Temporomandibular disorders, sleep bruxism, and primary headaches are mutually associated. J Orofac Pain. 2013;27(1):14–20. [PubMed] [Google Scholar] [Ref list]</ref>
Line 67: Line 39:
As anticipated we will take up the same diagnostic language presented for the patient Mary Poppins so that it becomes an assimilable and practicable model, and we will try to superimpose it on the present clinical case called 'Bruxer'.<blockquote>The subject was a 32-year-old man suffering from pronounced nocturnal and diurnal bruxism and chronic bilateral OP prevalent in the temporoparietal regions, with greater intensity and frequency on the left side.  The patient came to our observation after being treated for 15 years by dental colleagues with a biteplane. A sort of muscular stiffening of the trunk and legs had recently been added to bruxism and orofacial pain. Come to our observation beyond the clinical signs of bruxism the patient, to neurological examination, showed a contraction of the masseter muscles with pronounced stiffness of the jaw, diplopia and loss of visual acuity in the left eye, left gaze nystagmus with a rotary component, papillae with blurred borders and positive bilateral Babynski’s, and polykinetic tendon reflexes in all four limbs. </blockquote>   
As anticipated we will take up the same diagnostic language presented for the patient Mary Poppins so that it becomes an assimilable and practicable model, and we will try to superimpose it on the present clinical case called 'Bruxer'.<blockquote>The subject was a 32-year-old man suffering from pronounced nocturnal and diurnal bruxism and chronic bilateral OP prevalent in the temporoparietal regions, with greater intensity and frequency on the left side.  The patient came to our observation after being treated for 15 years by dental colleagues with a biteplane. A sort of muscular stiffening of the trunk and legs had recently been added to bruxism and orofacial pain. Come to our observation beyond the clinical signs of bruxism the patient, to neurological examination, showed a contraction of the masseter muscles with pronounced stiffness of the jaw, diplopia and loss of visual acuity in the left eye, left gaze nystagmus with a rotary component, papillae with blurred borders and positive bilateral Babynski’s, and polykinetic tendon reflexes in all four limbs. </blockquote>   


From what has been exposed in the previous chapters from the '[[Introduction/en|Introduction]]' to the chapters '[[Logic of medical language: Introduction to quantum-like probability in the masticatory system - en|Logic of medical language]]' and the last chapter '[[Bruxism - en|Bruxism]]', in addition to the complexity of the arguments and the vagueness of the verbal language, we could find ourselves faced with a clinical situation in which seems to dominate one of the contexts considered.   
From what has been exposed in the previous chapters from the '[[Introduction]]' to the chapters '[[Logic of medical language: Introduction to quantum-like probability in the masticatory system - en|Logic of medical language]]' and the last chapter '[[Bruxism - en|Bruxism]]', in addition to the complexity of the arguments and the vagueness of the verbal language, we could find ourselves faced with a clinical situation in which seems to dominate one of the contexts considered.   
      
      
{{Q2|does the tennis match start again?|it looks like it but....}}
{{Q2|does the tennis match start again?|it looks like it but....}}
Line 75: Line 47:
====Significance of contexts====
====Significance of contexts====


===== Dental Contest significance =====
===== Dental Contest significance=====




Line 96: Line 68:
<math>\Im_n </math> ?|and it is precisely here that the contexts conflict or rather the results may not be so decisive}}
<math>\Im_n </math> ?|and it is precisely here that the contexts conflict or rather the results may not be so decisive}}


===== Neurophysiological Contest significance =====
=====Neurophysiological Contest significance=====
In the '''neurological context''' we will therefore have the following sentences and statements to which we give a numerical value to facilitate the treatment, i.e. <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:
In the '''neurological context''' we will therefore have the following sentences and statements to which we give a numerical value to facilitate the treatment, i.e. <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:


Line 104: Line 76:


<math>\gamma_3=</math> Electrical silent period and contextual symmetry Figures 7, <math>\gamma_3=0\longrightarrow</math> Normality, negativity of the report
<math>\gamma_3=</math> Electrical silent period and contextual symmetry Figures 7, <math>\gamma_3=0\longrightarrow</math> Normality, negativity of the report




Gianni
Editor, Editors, USER, admin, Bureaucrats, Check users, dev, editor, founder, Interface administrators, member, oversight, Suppressors, Administrators, translator
11,563

edits

Retrieved from "https://www.masticationpedia.org/index.php/Special:MobileDiff/19269...19648"