: Stephan Klemm
: Interactions between the Craniomandibular System and Cervical Spine. The influence of an unilateral change of occlusion on the upper cervical range of motion
: Diplomica Verlag GmbH
: 9783836612029
: 1
: CHF 29.20
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: Klinische Fächer
: English
: 98
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This prospective, randomized, double-blind investigation evaluated the influence of a short-time artificial change of occlusion to the upper cervical spine mobility. Twenty 14-19 aged female dancers were investigated in a cross-over-design on head movement rotation in anteflexion with a three-dimensional ultrasonic measurement device, the Zebris 3D Motion Analyzer (CMS 70 P). A change of the occlusion was produced by positioning a 0.75mm foil of tin between premolar and first molar of the right side. Towards the current theory of convergence of cervical and trigeminal nerves the change of occlusion should enlarge tensions in the suboccipital muscles and consequently decrease the mobility of the upper spine. The results of this investigation are: There were no significant differences in measuring movements of the upper cervical spine in dependence of changes of the occlusion. Assessments of the probationers to the changes in tension or motion support these results.
Chapter 2.2.2.3, Functional interactions between the masticatory musculature and the anterior and posterior neck musculature:There is no direct muscular connection between the mandible and the CS. However, an indirect connection between the CS and CMS is revealed if the overlapping functions of the musculature of the CMS region with the posterior cervical musculature of the CS exists.This connection is important for the integrated functioning of the head and jaw. Muscular connections are due to a closed chain of muscles in the CMS. Anteriorly, muscles connect the skull to the mandible (the masticatory muscles, see above). Inferiorly, the mandible is anchored to the shoulder girdle via the hyoid (supra and infrahyoid muscles, see above). Posteriorly, the cervical muscles connect the cranium to the shoulder girdle. Therefore, contraction of one muscle will pull on the neighbouring muscle/bone and set up a chain of force disturbing the balance of the whole system. This demonstrates that disorders of the masticatory apparatus, e.g., hyper- or hypotonicity, can disturb the balance of the posterior cervical musculature and vice versa. Since dysfunction of the CMS or cervical spine can cause dysfunctions in related musculature and disturbance of the musculature can cause altered functioning in the joints, these two areas are quite intimately linked by virtue of this muscular chain. Within the framework of their study „Craniomandibular system and spinal column“, Stiesch-Scholz& Fink describe the interactions between CMS and CS musculature through the movements for extension and flexion. This includes the fact that when the CS is extended by the infra- and suprahyoid musculature as well as by the increased tension in the soft tissue of the anterior neck, retraction of the mandible occurs and the interocclusal distance is increased in the resting position. In contrast, a flexion of the CS and protrusion of the mandible results in a decrease in the interocclusal distance. Therefore, the integrated functioning of this chain model is also an important demonstration of interactions between CMS and the craniocervical system (CCS) (see Fig. 9, page 29).Functional connections between the CMS, CS and shoulder girdle regions:A description of the numerous neuroanatomical and biomechanical anatomical connections between the CMS and the cervical spine has been given and now the connections within the functioning system will be discussed. Much of the integrated functioning occurs because of the close anatomical relationships and the essential requirement for appropriate head movements whilst talking, eating, swallowing etc. It is doubtful if the human lineage would have got very far in its evolution if the heads had been allowed to bob up and down at the neck due to jaw movements every time the individual talked or chewed.Sherrington stated: „Posture is the basis of all movement and all movement begins and ends in posture”. In other words, if posture is faulty, then any subsequent movements will be faulty. It is therefore necessary to first describe the functional interactions between the postural/main musculature of the CMS and CCS according to different postures of the head. Then the effects of the mandibular position on the CCS region will be illustrated. Furthermore, the effects of occlusion on the CMS and CS regions will be highlighted.Head postu
Interactions between the Craniomandibular System and Cervical Spine The influence of an unilateral change of occlusionon the upper cervical range of motion1
I Acknowledgement3
Table of Contents4
III Abstract7
1. Introduction8
2. Theoretical background10
2.1. Embryology10
2.1.1. Biological development and evolution of the jaw, facial and cervicalregions11
2.1.1.1. The gill system11
2.1.1.2. Differentiation of tissues in human gill arches11
2.1.1.3. Gill arch innervation in humans14
2.2. Anatomy of the human temporomandibular joint17
2.2.1. Neuroanatomical relationships between the CMS and the upper portion ofthe CS18
2.2.1.1. The nervus trigeminus pathway18
2.2.1.2. The area innervated by the nervus trigeminus19
2.2.1.3. Nervus trigeminus convergences with other areas20
2.2.1.4. Plexus cervicalis and its relationship to the upper CS21
2.2.2. Musculature in the CMS region22
2.2.2.1. The CMS musculature23
2.2.2.2. Musculature in the CS region25
2.2.2.3. Functional interactions between the masticatory musculature and theanterior and posterior neck musculature.29
2.2.3. Functional connections between the CMS, CS and shoulder girdle regions30
2.2.3.1. Head posture31
2.2.3.2. Mandibular posture32
3. Empirical section33
3.1. Investigations on neuronal interactions between areas innervated by the trigeminus and the innervation of the upper cervical areas.33
3.1.1. Sensory neuronal interactions between the CMS and CS regions34
3.1.2. Neuronal motor interactions between the CMS and CS regions35
3.2. Craniomandibular dysfunction37
3.2.1. Historical background for CMD37
3.2.2. Definition and diagnostics for CMD38
3.2.3. Overview of investigations in cases of functional impairment of the CMS.40
3.3. Pathophysiology of the CMS and the upper CS region in humans42
3.4. Biomechanical connections between the CCS and CMS43
4. Aims of the current study and hypotheses46
5. Material and methods47
5.1. Definition of the exclusion criteria47
5.2. Sample48
5.3. Questionnaire and clinical investigation of the CS region50
5.3.1. Questionnaire A: Sociodemographic data, pain assessment and measurementof the maximum opening of the mouth50
5.3.2. Questionnaire B: Determination of the exclusion criteria (B1) andquestioning of the subjects on subjectively perceived tension (B2)50
5.4. Experimental design and measurements51
5.4.1. Experimental design51
5.4.2. Chronological sequence of the entire experimental design depicted using aflow chart53
5.4.3. Description of an individual measurement54
5.4.3.1. Introduction, fitting of the metal foil, warming up54
5.4.3.2. Conduct of analysis of mobility in the CS54
6. Results and interpretation60
6.1. Demographic data60
6.2. Intergroup comparison of demographic data60
6.3. General evaluation of the raw data on baseline measurements61
6.4. Evaluation of the baseline measurements for each group61
6.5. Statistical analysis of measurements made under experimental conditions63
6.6. Results from the questionnaires on subjective perception of tension67
6.7. Evaluation of the hypotheses68
7. Discussion69
7.1. Discussion of the findings with reference to the theoretical and empiricalresearch background and their clinical relevance69
7.2. Discussion of errors71
7.3. Comparisons with other studies73
8. Conclusions77
8.1. Study design77
8.2. Results of the current investigation77
9. References79
Appendix87