USE OF A NEW MECHANICAL FIXATION OF THE MANDIBLE FOR OPENING THE MOUTH WHEN CARRYING OUT DYNAMIC MAGNETIC RESONANCE IMAGRAPHY
OF THE TEMPOROMANDIBULAR JOINTS
Khomutova E.Yu.1, Savchenko R.K.1, Khomutov A.D.1, Badamshin A.M.2
1 - Federal state budgetary educational institution of higher professional education "Omsk state medical University"
Ministry of healthcare of the Russian Federation. Omsk, Russia.
2 - Federal state autonomous educational institution of higher education "Omsk state technical university". Omsk, Russia.
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he temporomandibular joints (TMJ) are the most complex in their structure and set of functions among the joints of the human body. Functional disorders of the TMJ account for up to 80% of all articular pathology of the human osteoarticular apparatus (developmental anomalies, post-traumatic, inflammatory and age-related changes). The number of TMJ pathologies in children and young patients is growing. Magnetic resonance imaging (MRI) of both TMJs requires research in the position of occlusion of the jaws and in the position of the open mouth (up to maximum amplitude), for which a device for fixing the lower jaw (a clamp of various amplitudes of the open mouth) should be used for various, including asymmetrical, pathologies of the joints, compatible with MRI; comfortable and safe for use by the patient; effective for conducting a full cycle of programs for dynamic and pseudodynamic research of both TMJs.
Purpose. Present your own experience in optimizing dynamic (and pseudodynamic) MRI of the TMJ, demonstrating ways to create models and an algorithm for using a new mechanical clamp for opening the mouth with different amplitudes (primarily with the mouth as open as possible).
Results. The presented new device is a mandibular fixator for opening the mouth during dynamic (pseudodynamic) MRI in reusable and disposable versions. A study group of patients (68 people) was determined, which included patients with various manifestations of dysfunction of one or both TMJs, aged from 12 to 73 years. Exceptions were patients with total contracture (or supertricism) of the masticatory muscles, with severe tics or obsessive movement’s syndrome, in an excited state, and with general contraindications for MRI. After MRI of both TMJs, patients were given a questionnaire, in particular determining the degree of comfort and convenience of the device.
The stages of creation and the algorithm for using a new mechanical fixator of the lower jaw for dynamic and pseudodynamic MRI are described, as well as the features of using the device in patients of different ages, with different pathologies of the TMJ. A block diagram is indicated for conveniently attaching a mechanical clamp to the desired amplitude of mouth opening (even with
asymmetric TMJ dysfunction), to effectively reduce pain when using the device (up to 98-99%) and the absence of the need for active swallowing of accumulated saliva during the study (100%). The choice of option and the proven step-by-step algorithm for using a low-pass filter made it possible to perform MRI of the TMJ in full, obtaining high-quality images - with a full set of MR programs in occlusion and with an open mouth - and with maximum comfort and safety for patients with various pathologies of both TMJs.
Discussion. When developing and manufacturing the presented lower jaw fixator for MRI of the TMJ, the issue of correcting the shortcomings of previous technological analogues (positioners, mouth gags) was primarily addressed, including the lack of a disposable version of the device - as an additional safety factor for MRI of the TMJ during mass respiratory viral and bacterial infections and/or for patients with an increased level of anxiety. Another solved problem was finding the best material for a disposable version of the device with absolute biodegradability during disposal (with a tendency to recycling) and to reduce financial costs (eliminating the need to purchase antiseptics for processing with a reusable version of the device).
Conclusion. Optimization of dynamic and pseudodynamic MRI of the TMJ, in the form of the creation of an original mechanical fixation of the lower jaw for maximum mouth opening (and with a less pronounced amplitude) and with the correct methodology for using the device, allows you to safely and easily conduct full MRI studies for patients with various pathologies both TMJs. The technical simplicity and cost-effectiveness of the device made it possible not only to successfully conduct pilot tests of the fixator, but also with a high probability to predict the speedy introduction of the device into everyday medical practice. The stages of creation and the algorithm for using a new mechanical fixator of the lower jaw for dynamic and pseudodynamic MRI are described, as well as the features of using the device in patients of different ages, with different pathologies of the TMJ. Convenient fastening of the mechanical clamp to the desired amplitude of mouth opening (even with asymmetric TMJ dysfunction), effective reduction of pain when using the device and the absence of the need for active swallowing of accumulated saliva during the study made it possible to perform MRI of the TMJ in full, with high-quality images.
Keywords: temporomandibular joints, TMJ, magnetic resonance imaging, MRI, mechanical fixation, lower jaw, polymers.
Corresponding author: Khomutova E.Yu., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript
For citation: Khomutova E.Yu., Savchenko R.K., Khomutov A.D., Badamshin A.M. Use of a new mechanical fixation of the mandible for opening the mouth when carrying out dynamic magnetic resonance imagraphy of the temporomandibular joints. REJR 2024; 14(3):131-144. DOI: 10.21569/2222-7415-2024-14-3-131-144.
Received: 25.04.24 Accepted: 11.09.24