OPTIMIZATION OF EARLY DIAGNOSIS OF INTERNAL DISORDERS OF THE TEMPOROMANDIBULAR JOINT

Аннотация

Axiography is an objective method of examining the trajectory of the articular pathway, which allows us to assess the nature of the function in normal and functional disorders of the temporomandibular joint.To carry out the method of axiography, an Arcus digma axiograph (KaVo, Germany) was used, which was connected to a personal computer. Arcus digma (KaVo, Germany) is an electronic system for recording movements of the lower jaw, which allows for three-dimensional ultrasonic recording of movements of the lower jaw and registering angles to adjust the articulator to an individual function. An ultrasonic transmitter and a receiver mounted on a measuring arc were connected to the main device of the device. Data was saved directly during measurements on a connected computer, and the selection of workspaces and workflow management were carried out through the main device or using a pedal. The holder of the paraocclusive plug, which was fixed using Structur 2 SC (VOCO) to the vestibular surface of the teeth of the lower jaw, was connected to the transmitter. The selection of the required measuring program was carried out from the touch screen of the basic device. If necessary, all the measurements carried out could be reproduced in dynamic mode many times. All movements were performed while maintaining contact between the teeth of the upper and lower jaw. In this study, we used the proposed method of combined use of the Littmann electronic stethoscope and the Arcus digma axiograph (Fig.5) (innovation proposal No. 1600 dated 11.02.2016, authors: Geletin P.N., Morozov V.G., Mishutin E.A., Ginali N.V., Karelina A.N.). the combined application of axiography and auscultation of the temporomandibular joint is as follows: In preparation for the study, the doctor shows the patient what movements to make - slowly open and close his mouth (1 time for 15 seconds). At the same time, it is recommended that the patient repeat the movements several times, first with the help of a doctor, and then independently, so as not to make any mistakes already during the registration process. In the computer program of the Littmann electronic stethoscope (3M ESPE), the "joint front view" mode is set and the patient is asked to slowly open his mouth after a beep from 1 time for 15 seconds. When a click or crepitation occurs, a computer program records the time of their occurrence, duration and intensity level (in dB). At the same time, an axiogram of the movement of the lower jaw in the vertical plane (when opening and closing the mouth) and a phonogram of noises in the TMJ on the right are recorded. The stethoscope sensor is installed on the outer surface of the zygomatic process near the tragus of the ear on the other side (left) and the technique of combined axiography and audio diagnostics using the Littmann electronic stethoscope (3M ESPE) is repeated. When a click or crepitation occurs, a computer program records the time of their occurrence and the intensity level (in dB). At the same time, an axiogram, movements of the lower jaw in the vertical plane and a phonogram of noise in the TMJ on the left are recorded. The axiograms and phonograms obtained during the study were stored in a computer database, the phonogram was converted into a wav sound file and analyzed using the computer program "Diagnosis of diseases of the temporomandibular joint" (certificate No. 2015662495, authors Mishutin E.A., Korshunova K.P., Geletin P.N.), then the data they were printed out for registration in the patient's medical history. The diagnosis was made based on the analysis of axigrams (deviation of the trajectories of opening and closing the mouth from the norm in the sections of the axiogram corresponding to the initial, middle and final phase of opening and closing the mouth and computer analysis of phonogram recordings according to the main characteristics of sound (sound strength and frequency) and the phase of opening and closing the mouth, in which sound phenomena occur. 8. The diagnosis was made based on the analysis of axigrams (deviation of the trajectories of opening and closing the mouth from the norm in the sections of the axiogram corresponding to the initial, middle and final phase of opening and closing the mouth and computer analysis of phonogram recordings according to the main characteristics of sound (sound strength and frequency) and the phase of opening and closing the mouth, in which sound phenomena occur.