Nasal specific technique as part of a chiropractic approach to chronic sinusitis and sinus headaches.
Faculty, Western States Chiropractic College, Portland, OR, USA.
OBJECTIVE:To demonstrate the use of nasal specific technique in conjunction with other chiropractic interventions in managing chronic head pain. CLINIC FEATURES: A 41-yr-old woman was treated for chronic sinusitis and sinus headaches. She had suffered weight loss and pain over a 2-month period.
INTERVENTION AND OUTCOME:
Chiropractic manipulation and soft tissue manipulation administered 2-6 times per month for approximately 1 yr had minimal long-term effect on the patient’s head pain. When additional interventions (nasal specific technique and light force cranial adjusting) were added to the treatment regimen, significant relief of symptoms was achieved after the nasal specific technique was performed. The duration of the relief increased with successive therapeutic sessions, with minimally persistent symptoms after 2 months of therapy.
The nasal specific technique, when used in conjunction with other therapies, may be useful in treating chronic sinus inflammation and pain. Further investigation is needed to identify the usefulness of the nasal specific technique as an independent intervention, the use of the technique in other types of patients and presentations, and the mechanism of therapeutic benefit.
Ear Infections or Otitis Media
Lamm L, GinterL, Otitis Media: A Consevative Chiropractic Management Protocol, Topics in Clinical Chiropractic 1998 Mar; (5)1:18-28.
This article reviews current knowledge of otitis media and proposes conservative interventions for this disorder that are within the scope of practice foremost chiropractors. Presented are alternative interventions that are supportable by the literature, are appropriate for chiropractic practice, and could diminish the severity as well as the frequency of repeated infections. The article suggests that nasal specific is one of the procedures that can help prevent future episodes of otitis media, facilitate the healing.
Cranio. 2002 Jan;20(1):34-8.
Radiographic evidence of cranial bone mobility.
Oleski SL, Smith GH, Crow WT.
Philadelphia College of Osteopathic Manipulative Medicine, PA 19131, USA.
The purpose of this retrospective chart review was to determine if external manipulation of the cranium alters selected parameters of the cranial vault and base that can be visualized and measured on x-ray. Twelve adult patient charts were randomly selected to include patients who had received cranial vault manipulation treatment with a pre- and post-treatment x-ray taken with the head in a fixed positioning device. The degree of change in angle between various specified cranial landmarks as visualized on x-ray was measured. The mean angle of change measured at the atlas was 2.58 degrees, at the mastoid was 1.66 degrees, at the malar line was 1.25 degrees, at the sphenoid was 2.42 degrees, and at the temporal line was 1.75 degrees. 91.6% of patients exhibited differences in measurement at 3 or more sites. This study concludes that cranial bone mobility can be documented and measured on x-ray. For full study click here.
Eur J Orthod. 1998 Dec;20(6):701-12.
Adolescent female craniofacial morphology associated with advanced bilateral TMJ disc displacement.
Nebbe B, Major PW, Prasad NG.
TMD Investigation Unit, Faculty of Dentistry, University of Alberta, Edmonton, Canada.
The aim of this study was to determine if cephalometric measurement differences occurred between two groups of similarly aged female adolescents which differed with respect to their diagnoses of temporomandibular joint disc position on magnetic resonance images (MRI). One group consisted of 17 female adolescents exhibiting complete bilateral disc displacement affecting the temporomandibular joints (TMJ), while the second group of 17 female adolescents was diagnosed as having bilateral normal disc position on MRI. Independent sample t-tests identified statistically significant differences in cephalometric measurements between the two groups, but no age difference between the two groups was evident. The group with bilateral total disc displacement exhibited the following significant angular differences from the group with normal disc position: an increased mandibular and palatal plane relative to sella-nasion; posterior rotation of the mandible as illustrated by an increased angle between the posterior border of the mandibular ramus and sella-nasion; and a decrease in Rickett’s facial axis. Significant differences in linear cephalometric variables were also evident between the two groups. Total posterior facial height and ramus height were reduced in the totally disc displaced group. Furthermore, a slight increase in the middle anterior facial height was noted, with a decrease in the posterior cranial base vertical height in the totally disc displaced group.
Relationship between internal derangement of the temporomandibular joint and dentofacial morphology in women with anterior open bite.
Byun ES, Ahn SJ, Kim TW.
Department of Orthodontics, College of Dentistry, Seoul National University, Korea.
INTRODUCTION: Anterior open bite is known to be associated with internal derangement of the temporomandibular joint (TMJ). This study examined the relationships between internal derangement and dentofacial morphology in women with anterior open bite. METHODS: Fifty-one women with anterior open bite were enrolled in this study. The sample was divided into 3 groups based on magnetic resonance imaging of bilateral TMJs: normal disk position, disk displacement with reduction, and disk displacement without reduction. One-way analysis of variance was used to compare the 3 groups with respect to the cephalometric variables, and Duncan’s multiple comparisons were performed at the 95% confidence level to identify the differences among the 3 groups. RESULTS: Internal derangement of the TMJ was much more prevalent in subjects with a more posteriorly rotated mandibular ramus, a smaller mandible, and a greater tendency for a skeletal Class II pattern, although all subjects had an anterior open bite. These patterns were more severe as the internal derangement progressed to disk displacement without reduction. CONCLUSIONS: Some cephalometric characteristics, such as a decrease in posterior facial height, decrease in ramus height, and backward rotation and retruded position of the mandible, are associated with TMJ internal derangement in women with anterior open bite.
Am J Orthod Dentofacial Orthop. 2005 Nov;128(5):583-91.
Relationship between temporomandibular joint internal derangement and facial asymmetry in women.
Ahn SJ, Lee SP, Nahm DS.
Department of Orthodontics, Dental Research Institute, College of Dentistry, Seoul National University, Seoul, South Korea.
INTRODUCTION: Internal derangement (ID) of the temporomandibular joint (TMJ) can cause facial asymmetry. The purposes of this study were to analyze the relationship between facial asymmetry and TMJ ID by using posteroanterior cephalometric variables, and to compare the findings with the results of magnetic resonance imaging (MRI). METHODS: The sample consisted of women seeking orthodontic treatment at Seoul National University Dental Hospital who had routine posteroanterior cephalograms and bilateral MRIs of the TMJ. To eliminate the influence of condylar hyperplasia on facial asymmetry, only those with SNB angles less then 78 degrees were selected (n = 63). They were classified into 5 groups according to the results of the MRI: bilateral normal disk position, unilateral normal TMJ and contralateral disk displacement with reduction (DDR), bilateral DDR, unilateral DDR and contralateral disk displacement without reduction (DDNR), and bilateral DDNR. Fourteen variables from posteroanterior cephalograms were analyzed with 1-way ANOVA to evaluate differences among the 5 groups. RESULTS: Subjects with TMJ ID of greater severity on the unilateral side had shorter ramal height compared with those with bilateral normal or bilateral DDR or bilateral DDNR. In addition, the mandibular midpoint deviated toward the side where the TMJ ID was more advanced. CONCLUSIONS: Subjects with a more degenerated TMJ on the unilateral side might have facial asymmetry that does not come from condylar or hemi-mandibular hyperplasia.
J Oral Maxillofac Surg. 2005 Mar;63(3):419.
Anthropometric analysis of mandibular asymmetry in infants with deformational posterior plagiocephaly.
St John D, Mulliken JB, Kaban LB, Padwa BL.
Harvard School of Dental Medicine, Boston, MA, USA.
PURPOSE: The incidence of deformational posterior plagiocephaly has increased dramatically since 1992. We tested the hypothesis that mandibular asymmetry, associated with this condition, is secondary to anterior displacement of the ipsilateral temporomandibular joint. The response to molding helmet therapy was also evaluated. PATIENTS AND METHODS: A caliper was used to measure mandibular dimensions in 27 infants (16 boys and 11 girls) with deformational posterior plagiocephaly; the mean age was 6.2 months (range, 3 to 12 months). Anthropometric measures included ramal height (condylion-gonion), body length (gonion-gnathion), and condylion-gnathion. Gonial angle was calculated from the law of cosines: C(2) = A(2) + B(2) – 2AB cos c. The position of the temporomandibular joint was accepted as corresponding to auricular position and measured from tragion to subnasal. Cranial asymmetry was measured, in the horizontal plane, from orbitale superius to the contralateral parieto-occipital point at the level of inion. Ten of 27 patients were remeasured 5 months after beginning helmet therapy to evaluate change in mandibular dimensions. RESULTS: Two thirds of infants (67%) had right-sided and one third (33%) had left-sided deformational posterior plagiocephaly. The mean auricular anterior displacement was 79.7 mm on the affected side and 83.4 mm on the unaffected side. The mean difference of 3.8 mm between the sides was statistically significant (P <.001). Transverse cranial dimension averaged 136.0 mm on the affected side and 146.8 mm on the unaffected side; this was also significant (P <.001). There was a significant positive correlation between auricular displacement and cranial asymmetry [R(23) =.59, P <.01). Auricular (temporomandibular joint) displacement also resulted in an apparent mandibular asymmetry with rotation of the jaw to the affected side. Mean mandibular measurements on the affected and unaffected sides were ramus height of 35.2 and 36.4 mm, body length of 59.0 and 60.3 mm, and gonial angle of 127.1 degrees and 126.8 degrees, respectively. Comparison of the affected with the unaffected sides, using a paired-samples t test, was not statistically significant. Improvement in cranial asymmetry occurred with helmet therapy, but there was no correction of auricular and temporomandibular joint position. CONCLUSIONS: This study supports the clinical observation that the mandibular asymmetry in deformational posterior plagiocephaly is secondary to rotation of the cranial base and anterior displacement of the temporomandibular joint (quantified by anterior auricular position) and not the result of primary mandibular deformity.
Cleft Palate Craniofac J. 2002 Nov;39(6):582-6.
Deformational posterior plagiocephaly: diagnosis and treatment.
Teichgraeber JF, Ault JK, Baumgartner J, Waller A, Messersmith M, Gateño J, Bravenec B, Xia J.
Division of Plastic Surgery, University of Texas-Houston Medical School, Houston, Texas 77030, USA.
OBJECTIVE: This study was designed to evaluate the effectiveness of helmet therapy (DOC band) in the correction of patients with moderate to severe posterior deformational plagiocephaly. DESIGN: In this prospective study, the infants were evaluated using 18 anthropometric measurements. PATIENTS: The charts of 248 patients seen between August 1, 1995, and July 31, 1999, were reviewed, and 125 met the criteria for inclusion in the study. All the patients had posterior deformational plagiocephaly with no other craniofacial deformities or medical conditions. Treatment was instituted prior to 1 year of age, and all patients were compliant with DOC band usage and had complete anthropometric measurements. RESULTS: The study recorded a 41.56% (p < .001) reduction in cranial vault asymmetry and a 40.23% (p <.001) reduction in cranial base asymmetry. Orbitotragial asymmetry was improved 18.72% (p = .0738). The age at which treatment was begun was not a significant factor in predicting treatment outcomes.