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Therapeutic response of benzodiazepine, orphenadrine citrate and occlusal splint association in TMD pain.

Loss of function, muscle inflammation, and pain are some of the signs and symptoms of temporomandibular dysfunction (TMD). Pharmacological strategies to minimize the clinical manifestation of these disorders often focus on blocking or inhibiting the pain-causing symptom. Resources such as muscle-relaxants, anxiety-relief drugs, and splint therapy are often used to reduce muscular hyperactivity related to TMD muscle pain. This study compares the effect of a randomly ordered association of occlusal splint therapy (S), nonsteroid anti-inflammatory with a muscle-relaxant drug (orphenadrine citrate) (O), and an anxiety-relief drug (benzodiazepine) (B), to ease painful TMD muscle symptoms. Clinical and anamnestic analyses were recorded in accordance with the Helkimo TMD index and applied before and after treatments. Twenty-one group two Helkimo TMD adult female patients were treated, all of whom were subjected to the three random therapeutic associations proposed: SBO, BOS, and OSB. The same operator applied the three specific associations over a period of 21 days in the proposed sequence, seven days for each therapy. The results show that all the groups presented the best results in terms of relief from pain after the therapeutic association (28.5% showed a decrease and 47.6% showed an absence of symptoms). No significant difference was observed among association therapeutic protocols.

Adult↗

Dental and occlusal changes during mandibular advancement splint therapy in sleep disordered patients.

The aims of this longitudinal, observational study were two-fold: first, to determine in adults with sleep disorders the extent of dental and occlusal changes following the use of a mandibular advancement splint (MAS) and, second, to determine the time course of these changes. One hundred adult subjects (87 males, 13 females) diagnosed with obstructive sleep apnoea (OSA) and/or asymptomatic snoring were treated with non-adjustable MAS. At the outset each subject was randomly assigned to a group and reviewed 6, 12, 18, 24 or 30 months after placement of a splint. There were 20 subjects in each group. Craniofacial changes were measured on lateral cephalometric radiographs taken at the initial and review appointments. When the changes in all subjects were examined, the SNA, ANB angles, ANS-PNS length and face height increased, and the mandibular first molars and the maxillary first premolars significantly overerupted. Significant retroclination of the maxillary incisors and proclination of the mandibular incisors were accompanied by reductions in maxillary arch length, overbite and overjet. When the changes over time were determined, the mandibular symphysis was significantly lower at all review periods. An increase in face height and reductions in overbite and overjet were evident at 6 months, and over-eruption of the maxillary first premolars and mandibular first molars, and proclination of the lower incisors were found at 24 months. Significant positive correlations were also found between the amount of anterior opening by the appliances and changes in overbite at 24 and 30 months. The appliance used produced small, unpredictable changes in the occlusion that tended to occur after 24 months' wear. It is postulated that the changes in overbite might be lessened by keeping the bite opening to a minimum.

Adult↗

Dynamic splinting after extensor hallucis longus tendon repair. A case report.

Surgery often is recommended to prevent the symptomatic hallux flexus and equinus deformity that may result from traumatic laceration of the extensor hallucis longus (EHL) tendon. Surgical repair of the EHL tendon, however, may cause scarring and adhesion formation that results in a loss of EHL tendon function. Dynamic splinting may be used during rehabilitation to prevent these complications. The purpose of this case report is to describe the use of dynamic splinting in the treatment of a patient after EHL tendon laceration and surgical repair.

Adult↗

Effect of air-splint application on soleus muscle motoneuron reflex excitability in nondisabled subjects and subjects with cerebrovascular accidents.

We investigated the effect of air-splint pressure on soleus muscle motoneuron reflex excitability in 18 nondisabled subjects with no history of neurological disease and 8 subjects with cerebrovascular accidents (CVAs). Motoneuron reflex excitability was assessed by measuring the percentage of amplitude (peak-to-peak measurement) change in the Hoffman reflex (H-reflex). Pressure was applied for 5 minutes, after which the air-splint was deflated. Ten H-reflexes were recorded and averaged for each subject before pressure application to obtain a baseline value. H-reflexes were also recorded at set intervals during and after pressure application. Two-way analyses of variance for repeated measures were used to compare each group's pressure and postpressure measurements with the baseline value. Significant F tests were followed by post hoc t tests. Analyses of variance were used to compare the nondisabled subjects' H-reflex recordings with those obtained for the subjects with CVAs. The nondisabled subjects demonstrated reductions of 55% at 1 minute, 52% at 3 minutes, and 40% at the fifth minute of pressure application. The postpressure measurements showed increases in the reflex amplitude at 1 and 3 minutes postpressure; however, by the fifth minute, the amplitude was not different from the baseline value. The subjects with CVAs demonstrated reductions of 41% at 1 minute, 48% at 3 minutes, and 52% at 5 minutes of pressure application. None of the postpressure measurements, however, were statistically different from the baseline value. A statistically significant difference was demonstrated between the nondisabled subjects and the subjects with CVAs at the first minute of pressure release.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Aquaplast for nasal splinting.

A nasal splint ideally should be sturdy, moldable, light, easy to apply, and inconspicuous. Plaster, dental compound, and aluminum are currently used but each has limitations. We have found that Aquaplast, a material softened by immersion in hot water, more closely conforms to the qualities of the ideal nasal splint. Aquaplast is sturdy, light, thin, very moldable, easy to apply, and allows for passage of air and moisture.

Female↗

Occlusion splint therapy in patients with craniomandibular disorders (CMD).

The etiology of craniomandibular disorders (CMD) is multi-factorial and the treatment should be selected with recognition of the different factors. The aim of the study was to investigate the influence of occlusion splint therapy (Michigan splint), physical exercises and transcutaneous nerve stimulation (TENS) on CMD symptomatology. At the Clinic of Maxillofacial Surgery in Belgrade, in the period from May, 2001-December, 2003, 168 patients were examined by the CMD working group. This group, comprised of different specialties (maxillofacial surgeon, prosthodontist, orthodontist, neurologist, psychiatrist and physiatrician), enabled multidisciplinary treatment of CMD patients according to the guidelines given by American Academy for Craniomandibular Dysfunctions. In all, a total of 30 patients with prevalent muscular tensions among other CMD symptoms were included in this study. The examination form according to Fricton and Shiffman for Craniomandibular Index (CMI) was used in order to evaluate the function of Craniomandibular system before and after therapy.A statistically significant difference (t = 8,735; P < 0,001) between the average values for CMI of patients before (0,2297 +/- 0,0827) and after therapy (0,1002 +/- 0,0479) was observed. Performed treatment resulted in complete response (pain relief and absence of CMD symptoms and signs) in over than 80% of patients and could be considered as a method of choice in reversible occlusal therapy.

Adult↗

Splinting the pediatric Palmar burn.

Children younger than 4 years of age who have sustained deep palmar burns pose a significant challenge to the burn care team. Flexion contractures of the palm and digits are all too common because the hand is maintained in flexion when at rest and while engaged in functional activities. A splint that positions the wrist in extension and the metacarpophalangeal joints of digits 2 to 5 in some hyperextension was evaluated. Nine patients with acute burns and two patients who required palmar reconstruction were studied. (The total number of hands was 15.) With this splinting technique, we have successfully maintained the antideformity position in patients with acute injuries and in those who have undergone reconstructive procedures.

Acute Disease↗

Splinting electrical burns of the mouth in children.

A mouth splint has been designed tp be worn through the healing period of an electrical burn of the mouth. The splint is custom-fitted for each child, and it is easily removed. Six children have been so treated and followed up for 4 years. The results to date have been excellent in preventing microstomia.

Burns, Electric↗

Adjustable dynamic external splint for control of first web contracture.

A method is presented to overcome problems of first web space contracture by means of a dynamic, continuously adjustable, wedge-shaped splint. The device is easily constructed of inexpensive material by physician or hand therapist. The splint is custom-tailored to the individual patient and is lightweight and comfortable, promoting good patient compliance. Its continuously adjustable nature maximizes its effects throughout therapy, and the even distribution of the pressure makes for a high surface area of patient/splint contact for even pressure distribution and eliminates the problems of skin necrosis, even with lengthy applications.

Contracture↗

The paperclip splint for finger injuries.

A splint for finger injuries is constructed using a paperclip and tape. It is inexpensive, compact, and simple to make. Underlying lacerations are readily accessible, and there is minimal interference with neighboring digits. Furthermore, it provides effective dynamic extension splinting for interphalangeal injuries.

Adult↗

Augmentation of the nostril splint for retaining the corrected contour of the cleft lip nose.

Whatever method is used to correct the deformity of the cleft lip nose, it is important to maintain the corrected contour of the nose for a certain period postoperatively. For this purpose, moldable silicone rubber is used to add volume to a ready-made nostril splint. With this material it is easy to make a splint that fits the individual contour of the nostril. Clinical examples are presented.

Adult↗

A new dynamic lumbrical simulating splint for claw hand deformity.

The claw hand deformity, resulting from low ulnar or combined low ulnar and median nerve palsy, is an incapacitating situation. The splint described herein reverses the clawing by substituting for the lumbricals and interossei. If started early, it not only prevents the permanent stiffness of fingers in the claw position, but also effectively restores function without hampering day to day work because it is a surface splint.

Adolescent↗

A custom splint for zygomatic fractures.

In the past, various materials have been applied to the zygomatic region to serve as a protective splint during the healing phase. Traditionally, these have been bulky, cumbersome, and non-conforming. This technique involves the application of a precut thermoplastic splint that is site-specific, lightweight, adjustable, low profile and universal and adapts to the anatomy of each patient.

Equipment Design↗

Dynamic assist splinting for attenuated sagittal bands in the rheumatoid hand.

The extensor mechanism of the hand is complex, requiring effective functioning of all involved structures, including the sagittal bands. The sagittal bands function to maintain the extensor tendons in midline and to limit their distal excursion. Injury to the sagittal bands or sagittal band attenuation can cause instability and ulnar displacement/subluxation of the extensor tendons into the valleys between the digits and lead to a subsequent loss of active finger extension at the metacarpophalangeal joints. Secondary conditions may also develop, such as swan-neck deformity, as is frequently observed in the rheumatoid arthritis population. To prevent or reduce an extension lag and secondary changes and to maintain the functional use of the hand, a dynamic metacarpophalangeal extension assist splint is necessary. This splint enables extension at the metacarpophalangeal joints, thus enabling the functional use of the hand. This article reviews the biomechanics of the sagittal bands and the corrections that enable finger extension at the metacarpophalangeal joints, thus preventing secondary conditions.

Arthritis, Rheumatoid↗

Tenodesis extension splinting for radial nerve palsy.

Injuries to the radial nerve or posterior interosseous nerve can lead to significant functional limitation. Inability to extend the wrist and/or digits prevents the hand from being positioned properly for functional tasks. Therapy after radial nerve injury is geared toward maintaining passive extension of the wrist and digits. Sensory reeducation can also be performed but often not necessary since the distribution of the nerve distally is on the dorsoradial surface of the hand. Since nerve regeneration is often a lengthy process and the extent of recovery is variable, splinting the involved extremity is used to prevent contractures and maximize function. This article introduces a new splint that allows patients to extend the fingers and thumb via a tenodesis effect at the wrist. In early trials, it has produced excellent results for enhancing functional use of the injured extremity while nerve regeneration occurs or until tendon transfers have been performed.

Equipment Design↗

Comparison of the Frejka pillow and the von Rosen splint in treatment of congenital dislocation of the hip.

In southern Finland between 1966 through 1975, 920 newborns were treated with a Frejka pillow for dislocation of the hip. The treatment failed in 55 patients. The pillow was then rejected and replaced with the von Rosen splint. One hundred eighty patients were treated with the new method between 1978 and 1981. The treatment failed in one girl. At 3 years of age, one boy had slight features of avascular necrosis. Temporary skin irritation was found in 19% of patients. In two patients, the splint had to be replaced with a pillow because of skin problems. A treatment device which parents are allowed to take off between outpatient visits is not recommended.

Female↗

The morbidity from nasal splints in 105 patients.

The results of a randomized prospective trial investigating the morbidity from intranasal splints in 105 patients, were analysed. Intranasal splints are associated with considerable morbidity (significantly greater post-operative pain and a higher incidence of septal perforation and vestibulitis) and although they significantly reduce the likelihood of developing intranasal adhesions, a similar benefit can be obtained by careful nasal toilet at one week.

Adult↗

Nocturnal electromyographic evaluation of bruxism patients undergoing short term splint therapy.

Eight confirmed bruxist subjects were investigated using portable electromyographic equipment. Nocturnal masseteric muscle activity, as measured by electromyography, was reduced immediately following the insertion of a full arch maxillary stabilization splint. It remained low until the splints were removed, at which time all but one subject's EMG values returned to pretreatment levels. Although the short-term spling therapy did not show a permanent reduction in EMG levels, a dramatic reduction has been demonstrated during treatment.

Adult↗