CORRECTION OF THE SIGNS OF MYOFASCIAL DYSFUNCTION IN PERSONS WITH THE CONSEQUENCES OF FRACTURE OF THE JAW BY MEASURES OF PHYSICAL THERAPY
Authors: Sayenko O.V. 
Published: October 2024

Purpose: to evaluate the effectiveness of the developed physical therapy program based on the dynamics of myofascial dysfunction parameters of the neck and orofacial area in patients with the consequences of a mandibular fracture.
Methods. 77 people were examined. The control group consisted of 32 people without the consequences of injuries of the maxillofacial area and burdened dental status. Group 1 consisted of 24 people who underwent rehabilitation according to the general principles of rehabilitation of patients of the dental profile. Group 2 consisted of 21 people with the consequences of a fracture of the lower jaw, who underwent rehabilitation using therapeutic exercises for the muscles of mastication, face, neck, cervical collar zone, back , shoulder girdle; a course of massage (intraoral and classical) of the masticatory muscles, temporomandibular joint, neck, cervical collar zone; thermal procedures (dry heat) on the area of the temporomandibular joint; postisometric relaxation of masticatory muscles, neck muscles; kinesiological taping of the temporomandibular joint, masticatory muscles, neck; training (education) of the patient (reception of soft food, restriction of wide opening of the mouth, elimination of dental bad habits). Rehabilitation lasted three months. Effectiveness was assessed by complaints, examination results, palpation, measurement of chin-sternum distance, "Hamburg test", manual muscle test.
Results. During the re-examination, no such complaints were found in people of group 2, such as complications in swallowing, sound phenomena and pain in the temporomandibular joint, pain in the masticatory muscles, complications in nasal breathing, and pain in the neck. Complications when chewing food were found only in 28.6%, restriction of mouth opening - 28.6%, "uncomfortable" position of the jaw - 9.5%. The psycho-emotional state and sleep improved; corresponding complaints were found in 14.3% and 23.8%. The expression of visual manifestations of dysfunction decreased in both main groups with an advantage in individuals of the group.
Pathological palpable changes were not detected in the temporal, masticatory, bifidus and hypoglossal muscles in individuals of group 2. Other changes were detected in a small number of individuals - in the lateral pterygoid in 14.3%, medial pterygoid in 9.5%, sternoclavicular-mammoid in 14.3%, trapezoid in 28.6%.
In people of group 2, the distance between the chin and sternum when the neck was bent decreased from 4.82±0.42 cm to 2.16±0.23 cm (p<0.05). The decrease in manifestations of dysfunction in the temporomandibular joint during the "Hamburg test" was 11.9% in group 1, 38.3% in group 2, p<0.05. There was an improvement in the strength of the masticatory muscles according to manual muscle test during the movements of raising and lowering the lower jaw, its deviation and protrusion. Group 1, which underwent rehabilitation with the use of independent classes and passive use of preformed physical factors, did not demonstrate an effect on indicators of myofascial dysfunction of the neck; the achieved improvement according to the studied parameters of the orofacial zone were statistically significantly worse than the parameters of group 2.
Conclusions. The obtained result is a justification for the need to apply programs of active functional physical therapy for the correction of myofascial dysfunction of the orofacial zone and the neck area in patients with injuries of the jaw.