POSSIBILITIES FOR DIAGNOSIS AND CURATION OF TEMPOROMANDIBULAR JOINT PATHOLOGY GIVEN THE MASTICATORY MUSCLES HYPERTONICITY IN PERSONS WITH SYSTEMIC CONNECTIVE TISSUE DYSPLASIA

Systemic dysplasia is a formation pathology of the connective tissue structures. With a high prevalence of systemic connective tissue dysplasia (SCTD), the insufficient awareness of doctors about the possibilities of its early diagnosis and correction, starting from the stage of pediatric care, draws attention. Progressive asymmetries of the skeleton already from childhood lead to additional trauma of all genetically determined, but at the same time defective connective tissue structures. The aim of the work was to improve the efficiency of diagnosis and treatment of diseases of the temporomandibular joint (TMJ) in persons with SCTD. The results of a study of 507 patients of different ages are presented. Comparative radiography of the lower extremities reveals a row of pathological changes in the hip and knee joints, the difference in the length of the femurs, lower legs; the height of the iliac wings, scoliosis of the lumbar spine, allowing us to consider them as a complex of Short Leg Syndrome in the framework of SCTD. Asymmetries of the bone structures of the lower jaw are often aggravated by hypertonicity of the masticatory muscles. According to the results of radiological examination, various bone asymmetries of the maxillofacial region (MFR), of the lower extremities within 5–15 mm of relative length, centric jaw relation abnormalities, pathological changes in the masticatory muscles, dislocation of the TMJ articular disc, positional asymmetry of the external auditory canals were revealed. The information obtained allows us to construct a diagnostic algorithm. Ultrasound of the heart, abdominal organs, and kidneys in a standing position were performed to diagnose visceral signs of SCTD. The methods of diagnosis of skeletal asymmetries include: orthopantomography (OPTG) of the MFR, transoral radiography of C1-C2, comparative radiography of the lower extremities, computed tomography and conebeam computed tomography of the MFR capturing the structures of the joint and three upper cervical vertebrae, magnetic resonance imaging of the TMJ. Bone asymmetries are combined with asymmetries of muscle structures, increasing postural imbalance. Multiple anatomical incongruences are aggravated by muscular imbalance in the TMJ biomechanics, which, in the context of systemic connective tissue dysplasia, significantly complicates standard treatment tactics, and worsens the prognosis and remote catamnesis.