Changes

{{q4|Then poor Mary Poppins is a TMD patient or she is not !!|let's see what Classical Language Logic tells us}}

{{q4|Then poor Mary Poppins is a TMD patient or she is not !!|let's see what Classical Language Logic tells us}}

In addition to the confirmations derived from the logic of medical language discussed in the previous chapter, the dentist colleague acquires other instrumental data that allow him to confirm his diagnosis. The latter tests concern the analysis of the axiographic traces performed with a paraocclusal fork which allow the visualization and quantification of the condylar traces in masticatory functions. As can be seen from Figure 4 the flattening of the condylar traces on the right side both in the mediotrusive masticatory kinetics (green colour) and the opening and protrusion cycles (gray colour) confirm the anatomical and functional flattening of the right TMJ in the dynamics chewing. In addition to the axiography, the colleague performs a surface electromyography on the masseters (Fig. 6) asking the patient to tighten to the maximum of his muscles force. This type of electromyographic analysis is called "EMG Interferential Pattern" due to the high frequency content of the spikes that undergo phase interference. In fact, Figure 6 shows the result of the test and shows an asymmetry in the recruitment of the motor units of the right masseter (upper trace) compared to those of the left masseter (lower trace).<ref>T Castroflorio , F Talpone, A Deregibus, M G Piancino, P Bracco. [https://pubmed.ncbi.nlm.nih.gov/15189308/?from_term=%22temporomandibular+disorders+AND+emg+%22&from_filter=simsearch2.ffrft&from_pos=1 Effects of a Functional Appliance on Masticatory Muscles of Young Adults Suffering From Muscle-Related Temporomandibular Disorders.] . 2004 Jun;31(6):524-9. doi: 10.1111/j.1365-2842.2004.01274.x.</ref><ref>Naoto Maeda , Naoki Kodama, Yosuke Manda, Shigehisa Kawakami, Kazuhiro Oki, Shogo Minagi. [https://pubmed.ncbi.nlm.nih.gov/31439959/?from_term=%22temporomandibular+disorders+AND+emg+%22&from_filter=simsearch2.ffrft&from_pos=2 Characteristics of Grouped Discharge Waveforms Observed in Long-term Masseter Muscle Electromyographic Recording: A Preliminary Study.] . 2019 Aug;73(4):357-360. doi: 10.18926/AMO/56938.</ref><ref>T E Rudy. [https://pubmed.ncbi.nlm.nih.gov/2085203/?from_term=%22temporomandibular+disorders+AND+emg+%22&from_filter=simsearch2.ffrft&from_pos=3 Psychophysiological Assessment in Chronic Orofacial Pain.] . Anesth Prog Mar-Jun 1990;37(2-3):82-7.<br /></ref><ref>Krzysztof Woźniak, Dagmara Piątkowska, Mariusz Lipski, Katarzyna Mehr. [https://pubmed.ncbi.nlm.nih.gov/23722255/?from_term=%22temporomandibular+disorders+AND+emg+%22&from_filter=simsearch2.ffrft&from_pos=4 Surface Electromyography in Orthodontics - A Literature Review.] Med Sci Monit. 2013 May 31;19:416-23. doi: 10.12659/ MSM.883927.</ref><center>'''2nd Clinical Approach'''

In addition to the confirmations derived from the logic of medical language discussed in the previous chapter, the dentist colleague acquires other instrumental data that allow him to confirm his diagnosis. The latter tests concern the analysis of the axiographic traces performed with a paraocclusal fork which allow the visualization and quantification of the condylar traces in masticatory functions. As can be seen from Figure 4 the flattening of the condylar traces on the right side both in the mediotrusive masticatory kinetics (green colour) and the opening and protrusion cycles (gray colour) confirm the anatomical and functional flattening of the right TMJ in the dynamics chewing. In addition to the axiography, the colleague performs a surface electromyography on the masseters (Fig. 6) asking the patient to tighten to the maximum of his muscles force. This type of electromyographic analysis is called "EMG Interferential Pattern" due to the high frequency content of the spikes that undergo phase interference. In fact, Figure 6 shows the result of the test and shows an asymmetry in the recruitment of the motor units of the right masseter (upper trace) compared to those of the left masseter (lower trace).<ref>{{cite res

| autore = Castroflorio T

| autore2 = Talpone F

| autore3 = Deregibus A

| autore4 = Piancino MG

| autore5 = Bracco P

| titolo = Effects of a Functional Appliance on Masticatory Muscles of Young Adults Suffering From Muscle-Related Temporomandibular Disorder

| url = https://pubmed.ncbi.nlm.nih.gov/15189308/

| anno = 2004

| DOI = 10.1111/j.1365-2842.2004.01274.x

}}</ref><ref>Naoto Maeda , Naoki Kodama, Yosuke Manda, Shigehisa Kawakami, Kazuhiro Oki, Shogo Minagi. [https://pubmed.ncbi.nlm.nih.gov/31439959/?from_term=%22temporomandibular+disorders+AND+emg+%22&from_filter=simsearch2.ffrft&from_pos=2 Characteristics of Grouped Discharge Waveforms Observed in Long-term Masseter Muscle Electromyographic Recording: A Preliminary Study.] . 2019 Aug;73(4):357-360. doi: 10.18926/AMO/56938.</ref><ref>T E Rudy. [https://pubmed.ncbi.nlm.nih.gov/2085203/?from_term=%22temporomandibular+disorders+AND+emg+%22&from_filter=simsearch2.ffrft&from_pos=3 Psychophysiological Assessment in Chronic Orofacial Pain.] . Anesth Prog Mar-Jun 1990;37(2-3):82-7.<br /></ref><ref>Krzysztof Woźniak, Dagmara Piątkowska, Mariusz Lipski, Katarzyna Mehr. [https://pubmed.ncbi.nlm.nih.gov/23722255/?from_term=%22temporomandibular+disorders+AND+emg+%22&from_filter=simsearch2.ffrft&from_pos=4 Surface Electromyography in Orthodontics - A Literature Review.] Med Sci Monit. 2013 May 31;19:416-23. doi: 10.12659/ MSM.883927.</ref><center>'''2nd Clinical Approach'''

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