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Difference between revisions of "2° Clinical case: Pineal Cavernoma"
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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. | 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. | 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. | ||
[[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]] | ||
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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> | ||
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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 '[[ | 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....}} | ||