Trigeminal Electrophysiology: a 2 × 2 matrix model for differential diagnosis between temporomandibular disorders and orofacial painReportar como inadecuado




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BMC Musculoskeletal Disorders

, 11:141

First Online: 01 July 2010Received: 16 November 2009Accepted: 01 July 2010

Abstract

BackgroundPain due to temporomandibular disorders TMDs often has the same clinical symptoms and signs as other types of orofacial pain OP. The possible presence of serious neurological and-or systemic organic pathologies makes differential diagnosis difficult, especially in early disease stages. In the present study, we performed a qualitative and quantitative electrophysiological evaluation of the neuromuscular responses of the trigeminal nervous system. Using the jaw jerk reflex JJ and the motor evoked potentials of the trigeminal roots bR-MEPs tests, we investigated the functional and organic responses of healthy subjects control group and patients with TMD symptoms TMD group.

MethodThirty-three patients with temporomandibular disorder TMD symptoms and 36 control subjects underwent two electromyographic EMG tests: the jaw jerk reflex test and the motor evoked potentials of the trigeminal roots test using bilateral electrical transcranial stimulation. The mean, standard deviation, median, minimum, and maximum values were computed for the EMG absolute values. The ratio between the EMG values obtained on each side was always computed with the reference side as the numerator. For the TMD group, this side was identified as the painful side pain side, while for the control group this was taken as the non-preferred masticatory side non-preferred side. The 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles were also calculated.

ResultsAnalysis of the ratios expressed as percentages between the values obtained on both sides revealed a high degree of symmetry in the bR-MEPs in the control 0.93 ± 0.12% and TMD 0.91 ± 0.22% groups. This symmetry indicated organic integrity of the trigeminal root motor fibers and correct electrode arrangement.

A degree of asymmetry of the jaw jerk-s amplitude between sides ipJJ%, when the mandible was kept in the intercuspal position, was found in the TMD group 0.24% ± 0.14% with a statistically significant difference in relation to the control group 0.61% ± 0.2%. This asymmetry seemed to be primarily due to a failure to facilitate the reflex on the painful side in intercuspal position.

ConclusionsIn this 2 × 2 matrix diagnostic model, three different types of headache may be identified: 1 those due to organic pathologies directly and indirectly involving the trigeminal nervous system denoted as -Organic Damage-; 2 those in TMD patients; 3 other types of orofacial pain in subjects who could erroneously be considered healthy, denoted as Orofacial Pain -OP-. This category of patient should be considered at risk, as organic neurological pathologies could be present and yet not directly affect the trigeminal system, at least in the early stages of the disease.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2474-11-141 contains supplementary material, which is available to authorized users.

Gianni Frisardi, Giacomo Chessa, Gianfranco Sau and Flavio Frisardi contributed equally to this work.

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Autor: Gianni Frisardi - Giacomo Chessa - Gianfranco Sau - Flavio Frisardi

Fuente: https://link.springer.com/







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