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

   [[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.   

{{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.