Difference between revisions of "3° Clinical case: Meningioma"

This comprehensive summary delves into the innovative diagnostic approaches discussed in the Masticationpedia, particularly emphasizing the shift from traditional deterministic models to a quantum-like approach in understanding and diagnosing neuromotor responses related to occlusal and postural disorders. The quantum-like approach accepts the probabilistic uncertainty of medical diagnoses, recognizing the complex interplay between various biophysical effects and neuromotor responses.

The summary introduces the main themes of the Masticationpedia, focusing on the limitations of traditional deterministic approaches in medical diagnostics. It highlights the necessity of considering a broader, more probabilistic approach to understanding patient symptoms and conditions, especially in relation to occlusal and postural disorders.

 

The summary discusses the application of these concepts through clinical cases, illustrating how traditional methods might lead to misdiagnosis or oversimplified treatment plans. It uses the example of a patient, referred to as "Balancer," who presents with symptoms of postural and gait disturbances following prosthetic rehabilitation. This case serves as a practical example of how quantum-like diagnostic approaches can be applied to real-world medical scenarios.

 

 

The summary outlines various diagnostic tools and techniques used to assess and treat occlusal and postural disorders, including the use of stabilization splints to achieve neuromuscular balance. It critically evaluates the effectiveness and limitations of these tools, encouraging a more nuanced approach to treatment that considers each patient's unique neuromuscular condition.

 

A significant portion of the discussion is dedicated to the concept of the Centric Relationship in dental diagnostics. The narrative questions the traditional views on this concept, suggesting that a more dynamic and patient-specific approach might yield better diagnostic and treatment outcomes. It also points out the discrepancies between manual methods used in orthognathic surgery and those derived from neuro-evoked responses, illustrating the complexities involved in defining a true "centric" position.

 

The summary concludes with reflections on the need for continued innovation in diagnostic methodologies in the field of neuromuscular dentistry. It calls for a shift towards more integrative, patient-centered approaches that recognize the inherent uncertainties and complexities of diagnosing and treating neuromuscular and postural disorders.

 

This summary not only provides insights into the theoretical underpinnings of advanced diagnostic approaches in neuromuscular dentistry but also illustrates their practical implications through detailed case studies. It serves as a valuable resource for clinicians seeking to adopt more holistic and precise approaches to patient care.<blockquote>

'''Quantum-like Diagnostic Approach''' - Refers to an innovative method in medical diagnostics that embraces the probabilistic nature of conditions rather than trying to limit uncertainty through traditional deterministic models. This approach is particularly relevant for complex cases involving neuromuscular and postural disorders.

 

 

 

 

 

 

 

'''Masticationpedia''' - The platform or collection being referenced which provides comprehensive insights into advanced diagnostic and treatment approaches in the field of neuromuscular and dental health.

 

 

'''Diagnostic Tools and Techniques''' - Refers to the methods and devices used to assess, diagnose, and treat conditions within the neuromuscular and dental fields, highlighting the importance of choosing the right tools for effective patient care.</blockquote>

===Introduction===

As now implicit, this clinical case too, which from now on we will call with a fancy name <u>Balancer</u>' due to its related symptoms of postural and gait disturbance after being prosthetically rehabilitated, will follow the presentation model of the previous clinical cases. The introduction will present topics relating to the diagnostic model in question on which we will make the first conceptual reflections highlighted by our dear and thoughtful Linus. A recent article by Minervini et al.<ref>Giuseppe Minervini, Rocco Franco, Maria Maddalena Marrapodi, Salvatore Crimi, Almir Badnjević, Gabriele Cervino, Alberto Bianchi, and  Marco Cicciù. Correlation between Temporomandibular Disorders (TMD) and Posture Evaluated trough the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD): A Systematic Review with Meta-Analysis. J Clin Med. 2023 Apr; 12(7): 2652. Published online 2023 Apr 2. doi: 10.3390/jcm12072652.PMCID: PMC10095000.PMID: 37048735

</ref> asserts the following: TMD has ligament and muscle connections with the cervical area, therefore these connections have led to the hypothesis that posture problems may influence the development of TMD, <ref>An J.-S., Jeon D.-M., Jung W.-S., Yang I.-H., Lim W.H., Ahn S.-J. Influence of temporomandibular joint disc displacement on craniocervical posture and hyoid bone position. Am. J. Orthod. Dentofac. Orthop. 2015;147:72–79. doi: 10.1016/j.ajodo.2014.09.015.</ref><ref>Lee W.Y., Okeson J.P., Lindroth J. The relationship between forward head posture and temporomandibular disorders. J. Orofac. Pain. 1995;9 </ref><ref>Minervini G., Mariani P., Fiorillo L., Cervino G., Cicciù M., Laino L. Prevalence of temporomandibular disorders in people with multiple sclerosis: A systematic review and meta-analysis. CRANIO® 2022:1–9. doi: 10.1080/08869634.2022.2137129.</ref><ref>Minervini G.D., Del Mondo D.D., Russo D.D., Cervino G.D., D’Amico C.D., Fiorillo L.D. Stem Cells in Temporomandibular Joint Engineering: State of Art and Future Persectives. J. Craniofacial Surg. 2022;33:2181–2187. doi: 10.1097/SCS.0000000000008771.</ref><ref>Crescente G., Minervini G., Spagnuolo C., Moccia S. Cannabis Bioactive Compound-Based Formulations: New Per-spectives for the Management of Orofacial Pain. Molecules. 2022;28:106. doi: 10.3390/molecules28010106.</ref> therefore masticatory cycles should be balanced as unilateral chewing could alter the postural balance of the body. Stabilization splints can bring about neuromuscular balance, removing posterior interference and providing a stable occlusal relationship and an optimization of the centric relationship. The relationship between craniometric posture and TMD has been studied, however, despite the huge number of studies, clinicians and academics still remain unconvinced.<ref>Abe S., Kawano F., Matsuka Y., Masuda T., Okawa T., Tanaka E. Relationship between Oral Parafunctional and Postural Habits and the Symptoms of Temporomandibular Disorders: A Survey-Based Cross-Sectional Cohort Study Using Propensity Score Matching Analysis. J. Clin. Med. 2022;11:6396. doi: 10.3390/jcm11216396.</ref><blockquote>'''''[[File:Question 2.jpg|50x50px|link=https://wiki.masticationpedia.org/index.php/File:Question_2.jpg|left]]'''''

</ref> asserts the following: the cranial surface electromyography allows the evaluation of the occlusal state and the quantification of the neuromuscular postural balance, thus understanding the dental occlusion from a functional point of view. It therefore represents a diagnostic revolution because it allows you to see what until now was only perceptible by palpation, and therefore not quantifiable.<ref>Falla D., Dall’Alba P., Rainoldi A., Merletti R., Jull G. Repeatability of Surface EMG Variables in the Sternocleidomastoid and Anterior Scalene Muscles. Eur. J. Appl. Physiol. 2002;87:542–549. doi: 10.1007/s00421-002-0661-x</ref> A meta-analysis on the use of sEMG to evaluate the relationships between masticatory muscles and postural muscles found that the correlation between the masticatory system and the muscle activity of other parts of the body can be detected experimentally using sEMG, but this correlation has little clinic relevance .<ref>Perinetti G., Türp J.C., Primožič J., Di Lenarda R., Contardo L. Associations between the Masticatory System and Muscle Activity of Other Body Districts. A Meta-Analysis of Surface Electromyography Studies. J. Electromyogr. Kinesiol. 2011;21:877–884. doi: 10.1016/j.jelekin.2011.05.014.</ref> However, Julià-Sánchez et al. found that dental occlusion affects the biomechanical and viscoelastic properties of masticatory and postural muscles using the MyotonPRO® system.<ref>Julià-Sánchez S., Álvarez-Herms J., Cirer-Sastre R., Corbi F., Burtscher M. The Influence of Dental Occlusion on Dynamic Balance and Muscular Tone. Front. Physiol. 2020;10:1626. doi: 10.3389/fphys.2019.01626</ref> The influence of the occlusal state on stability was also demonstrated in an article by Heit et al. who found a significant increase in balance at rest rather than at maximal intercuspidation.<ref>Heit T., Derkson C., Bierkos J., Saqqur M. The Effect of the Physiological Rest Position of the Mandible on Cerebral Blood Flow and Physical Balance: An Observational Study. Cranio. 2015;33:195–205. doi: 10.1179/0886963414Z.00000000063.</ref> These results are consistent with previous studies that used sEMG to measure both the muscle balance of the masticatory muscles and its influence on the activity of some postural muscles. A substantial reduction in resting postural muscle activity (sternocleidomastoid, erector spinae, and soleus) was found in participants with dental malocclusions after balancing with a bite.<ref>Bergamini M., Pierleoni F., Gizdulich A., Bergamini C. Dental Occlusion and Body Posture: A Surface EMG Study. Cranio. 2008;26:25–32. doi: 10.1179/crn.2008.041.</ref><blockquote>[[File:Question 2.jpg|50x50px|link=https://wiki.masticationpedia.org/index.php/File:Question_2.jpg|left]]'''Simmetria:''' When we speak of neuromotor balance in reference to electromyographic procedures, terms such as synchronicity and symmetry are implicitly evoked. Side-to-side symmetry of EMG motor unit discharges is a complex procedure to record and interpret. Many factors come into play and not only the level of muscle contraction but also the type of electrode and electromyographic device used. If the concept of symmetry is focused referring to interferential EMG pattern then the situation is further complicated by the spatio-temporal summation of the motor units which discharge asynchronously and at variable frequency. This can lead to collisions and cancellations of the recordable potential on the skin. The only way to be able to extrapolate a significant data is the Fourier analysis<ref>Ishii T, Narita N, Endo H.Evaluation of jaw and neck muscle activities while chewing using EMG-EMGtransfer function and EMG-EMG coherence function analyses in healthy subjects.. Physiol Behav. 2016 Jun 1;160:35-42. doi: 10.1016/j.physbeh.2016.03.023. Epub 2016 Apr 5.PMID: 27059322 </ref> and the Wavelet model<ref>Sharma T, Veer K. EMG classification using wavelet functions to determine muscle contraction.. J Med Eng Technol. 2016;40(3):99-105. doi: 10.3109/03091902.2016.1139202. Epub 2016 Mar 4.PMID: 26942656</ref> which, with the usual limitations of indeterminacy and measurement uncertainty already discussed in other chapters (K_brain), tries to decompose the already complex signal due to its nature biochemistry and extrapolate information on biophysics. But the question that arises is:{{q2|Are we sure we are dealing with an 'Asymmetry'?|.... are we talking about a functional or organic asymmetry?}}Even with regard to this very delicate point of neuromuscular balance and symmetry, without going into specific topics referred to the reference chapters, we would like to highlight the inconsistencies encountered in statements of the 'symmetry/asymmetry' type between sides of the interferential EMG pattern. Figure 2a shows an interferential EMG trace (right and left masseter, upper and lower trace respectively) in which, obviously, an evident asymmetry can be recognized already at a first visual approach without further mathematical decompositions. In figure 2c, on the other hand, one can also appreciate, in other patient, a good symmetry of the sides. <gallery widths="240" heights="200" perrow="3" slideshow""="">

====3rd Clinical Case====

====Meaning of contexts====

 

 

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