MYOFASCIAL PAIN AMONG WAR VETERANS TREATED FOR POSTTRAUMATIC STRESS DISORDER

Istraživanje je analiziralo učestalost miofascijalene boli u populaciji branitelja liječenih od PTSP-a. Svrha istraživanja bila je utvrditi utjecaj ratom uvjetovanog stresa na pojavnost miofascijalne boli u području glave i vrata u populaciji hrvatskih branitelja liječenih od PTSP-a. Hipoteza je bila da postoji asocijacija izmeñu PTSP-a i miofascijalne boli u smislu učestalije pojavnosti miofascijalne boli kod ispitanika s PTSP-om u odnosu na ispitanike kontrolne grupe. U istraživanju su sudjelovala 202 ispitanika, podijeljena u dvije grupe. Prvu grupu je činio 101 hrvatski branitelj s dijagnozom PTSP-a. Kontrolnu grupu od 101 ispitanika činili su dobrovoljci iz skupine osoba koje dolaze na sistematske preglede. Analizirani su bilateralno slijedeći mišići: maseter, temporalni mišić, tetiva temporalnog mišića, medijalni pterigoidni mišić, lateralni pterigoidni mišić, sternokleidomastoidni mišić, splenius capitis i trapezius. Utvrñena je značajno veća učestalost miofascijalne boli glave i vrata kod branitelja liječenih od PTSP-a (58,4%) u odnosu na ispitanike kontrolne grupe (8,9%). Triger točke su najčešće bile lokalizirane u splenius capitisu (12,9%), desnom temporalnom mišiću (11,9%), lijevom temporalnom mišiću (7,9%) i desnom maseteru (5,9%). Kod ispitanika kontrolne skupine, s obzirom na manju pojavnost miofascijalne boli (8,9%), triger točke zabilježene su samo u lijevom temporalnom mišiću, i to kod 4% ispitanika i u spleniusu capitisu kod 5% ispitanika. Istraživanjem je utvrñeno da postoji potreba za uključivanjem doktora dentalne medicine educiranog za liječenje poremećaja žvačnog sustava i bolnih poremećaja glave i vrata u multidisciplinarni tim koju sudjeluje u liječenju hrvatskih branitelja oboljelih od PTSP-a.INTRODUCTION: The aim of this research was to analyze the incidence of myofascial pain among war veterans treated for posttraumatic stress disorder (PTSD). Myofascial pain affects muscles and fasciae. The head and neck region with its muscels is a high frequency area for developing of myofascial pain. Myofascial pain is characterized by the presence of trigger points, which can be defined as descrete hyperirritable spots in muscle fibres. Trigger points can be either active or latent. In addition to the occurence of trigger points, limited function and pain are also characteristic in affected muscles. AIMS OF THE RESEARCH: The aim of this research was to determine the influence of war-induced stress on the occurence of myofascial pain in the head and neck region among Croatian war veterans treated for PTSD. Hypothesis was that there is a correlation between PTSD and myofascial pain. According to this hypothesis, myofascial pains occurs more often among examinees that suffer from PTSD than among members of the control group. It was assumed furthermore that myofascial pain influences the symptomatology of patients with PTSD, as well as that there is a need to engage a doctor of dental medicine educated for treating disorders of the temporomandibular joint and other painful disorders of the head and neck region in the treatment of those patients. The aim of this research was to: determine the degree of attention that war veterans with PTSD devote to their own health and their attitudes towards it, and compare their results with the control group; compare, determine and test the influence of PTSD and eventual traumatization of the stomatognathic system during intubation as two possible etiologic factors for the emergence of myofascial pain in war veterans treated for PTSD; analyze the incidence of oral parafunctions and inappropriate habits among war veterans treated for PTSD and the control group; compare the incidence of pain and temporomandibular joints sounds among war veterans treated for PTSD and the control group; analyze and compare the incidence of muscle pain in the head and neck region among war veterans treated for PTSD and the control group; determine the incidence of myofascial pain among war veterans treated for PTSD; determine the localization of trigger points; present conclusions about the incidence of myofascial pain among war veterans treated for PTSD and define the exact role of doctors of dental medicine in the treatment of those patients. PATIENTS AND METHODS: 202 examinees, divided into two groups, took part in the research. The first group consisted of 101 Croatian war veterans with PTSD. All the examinees were being hospitalized in the Psychiatric Hospital Vrapče. The diagnosis of PTSD was issued in accordance to the International Statistical Classification of Diseases and Related Health Problems, 10th edition (ICD-10), and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). The control group consisted of 101 examinees volunteers that visit the hospital in order to perform a systematic health examination. Individuals with psychiatric or neurological disorders, rheumatic diseases (rheumathoid arthritis), collagenosis, orofacial pain, hormonal disorders, odontogenic abscesses, developmental anomalies and maxillofacial traumas were not included in the control group. Individuals that therapeutically use analgesics and opiates were eliminated from the control group. An analysis of the following muscels was performed bilaterally: masseter muscle, temporal muscle, temporal muscle tendon, medial pterygoid muscle, lateral pterygoid muscle, sternocleidomastoid muscle, splenius capitis and trapezius muscle. RESULTS: The research showed that war veterans treated for PTSD asses their health condition as generally poor (72,3%) or extremely poor (18,8%), the condition of the mouth as poor (47,5%) or extremely poor (17,8%), the attention devoted to their health as deficient (26,7%) and extremely deficient (6,9%). This results are to a considerable extent worse than the results of examiness in the control group. In comparison with the control group, a significantly higher comorbidity with the following diseases among war veterans with PTSD was determined: rheumatoid arthritis, collagenosis and psoriasis (35,6%), depression (99%), hearing impediments and problems with ears (51,5%), vertigo (58,4%), frequent headaches (64,4%), high blood pressure (41,6%), hormonal disorders (18,8%), problems with concentration (93,1%), sleeping disorders (100%), problems with sinuses (51,5%) and problems with cervical spine (80,2%). There was no difference between the two groups as far as the use of heart drugs is concerned, whereas other drugs, like tranquilizers, analgesics, sleeping medications and medicaments againts hypertension were considerably more frequently used by examinees with PTSD. The analyzed sample showed that there is no statistically significant difference between the incidence of myofascial pain in veterans who had been intubated and those who had not undergone intubation. The following symptoms were determined to be significantly more frequent in war veterans than in the control group: limited ability to open the mouth in the morning (29,7%) and in the evening (22,9%), a sideways shift when opening the mouth (20,8%), clenching of the teeth during the day (73,3%), teeth grinding while sleeping (47,5%), pain and tension in the jaws in the morning (37,6%) discomfort and instability when closing the mouth (54,5%). Inappropriate habits parafunctions (41,6%), and the sensation of tension and stiffness in jaw muscles (64,3%) are also significantly more frequent in the population of war veterans. Furthermore, the sound of the temporomandibular joints and pain in those joints were determined to be more frequent among war veterans with PTSD (left joint 31.7%, right joint 34,7%) than in the examinees from the control group. At the same time, war veterans display a greater incidence of muscle pain than examinees from the control group. Trigger points are mostly located in the following muscles: splenius capitis (12,9%), right temporal muscle (11,9%), left temporal muscle (7,9%) right masseter muscle (5,9%). In the control group the overall incidence of myofascial pain was much lower (8,9), and trigger points were detected only in the left temporal muscle (4%) and in the splenius capitis (5% ). A significantly higher incidence of myofascial pain in the head and neck region among war veterans with PTSD (58,4%) than in the control group (8,9%) was determined, what confirms the initial hypothesis. CONCLUSION: In accordance to the results obtained during the research, there exist a mutually enhancing relationship between PTSD and chronic pain myofascial pain. Because of that, there is a need to engage a doctor of dental medicine, educated for treating stomatognatic system disorders as well as painful disorders in the head and neck region, in a multidisciplinary team that treats Croatian war veterans with PTS

MYOFASCIAL PAIN AMONG WAR VETERANS TREATED FOR POSTTRAUMATIC STRESS DISORDER

Istraživanje je analiziralo učestalost miofascijalene boli u populaciji branitelja liječenih od PTSP-a. Svrha istraživanja bila je utvrditi utjecaj ratom uvjetovanog stresa na pojavnost miofascijalne boli u području glave i vrata u populaciji hrvatskih branitelja liječenih od PTSP-a. Hipoteza je bila da postoji asocijacija izmeñu PTSP-a i miofascijalne boli u smislu učestalije pojavnosti miofascijalne boli kod ispitanika s PTSP-om u odnosu na ispitanike kontrolne grupe. U istraživanju su sudjelovala 202 ispitanika, podijeljena u dvije grupe. Prvu grupu je činio 101 hrvatski branitelj s dijagnozom PTSP-a. Kontrolnu grupu od 101 ispitanika činili su dobrovoljci iz skupine osoba koje dolaze na sistematske preglede. Analizirani su bilateralno slijedeći mišići: maseter, temporalni mišić, tetiva temporalnog mišića, medijalni pterigoidni mišić, lateralni pterigoidni mišić, sternokleidomastoidni mišić, splenius capitis i trapezius. Utvrñena je značajno veća učestalost miofascijalne boli glave i vrata kod branitelja liječenih od PTSP-a (58,4%) u odnosu na ispitanike kontrolne grupe (8,9%). Triger točke su najčešće bile lokalizirane u splenius capitisu (12,9%), desnom temporalnom mišiću (11,9%), lijevom temporalnom mišiću (7,9%) i desnom maseteru (5,9%). Kod ispitanika kontrolne skupine, s obzirom na manju pojavnost miofascijalne boli (8,9%), triger točke zabilježene su samo u lijevom temporalnom mišiću, i to kod 4% ispitanika i u spleniusu capitisu kod 5% ispitanika. Istraživanjem je utvrñeno da postoji potreba za uključivanjem doktora dentalne medicine educiranog za liječenje poremećaja žvačnog sustava i bolnih poremećaja glave i vrata u multidisciplinarni tim koju sudjeluje u liječenju hrvatskih branitelja oboljelih od PTSP-a.INTRODUCTION: The aim of this research was to analyze the incidence of myofascial pain among war veterans treated for posttraumatic stress disorder (PTSD). Myofascial pain affects muscles and fasciae. The head and neck region with its muscels is a high frequency area for developing of myofascial pain. Myofascial pain is characterized by the presence of trigger points, which can be defined as descrete hyperirritable spots in muscle fibres. Trigger points can be either active or latent. In addition to the occurence of trigger points, limited function and pain are also characteristic in affected muscles. AIMS OF THE RESEARCH: The aim of this research was to determine the influence of war-induced stress on the occurence of myofascial pain in the head and neck region among Croatian war veterans treated for PTSD. Hypothesis was that there is a correlation between PTSD and myofascial pain. According to this hypothesis, myofascial pains occurs more often among examinees that suffer from PTSD than among members of the control group. It was assumed furthermore that myofascial pain influences the symptomatology of patients with PTSD, as well as that there is a need to engage a doctor of dental medicine educated for treating disorders of the temporomandibular joint and other painful disorders of the head and neck region in the treatment of those patients. The aim of this research was to: determine the degree of attention that war veterans with PTSD devote to their own health and their attitudes towards it, and compare their results with the control group; compare, determine and test the influence of PTSD and eventual traumatization of the stomatognathic system during intubation as two possible etiologic factors for the emergence of myofascial pain in war veterans treated for PTSD; analyze the incidence of oral parafunctions and inappropriate habits among war veterans treated for PTSD and the control group; compare the incidence of pain and temporomandibular joints sounds among war veterans treated for PTSD and the control group; analyze and compare the incidence of muscle pain in the head and neck region among war veterans treated for PTSD and the control group; determine the incidence of myofascial pain among war veterans treated for PTSD; determine the localization of trigger points; present conclusions about the incidence of myofascial pain among war veterans treated for PTSD and define the exact role of doctors of dental medicine in the treatment of those patients. PATIENTS AND METHODS: 202 examinees, divided into two groups, took part in the research. The first group consisted of 101 Croatian war veterans with PTSD. All the examinees were being hospitalized in the Psychiatric Hospital Vrapče. The diagnosis of PTSD was issued in accordance to the International Statistical Classification of Diseases and Related Health Problems, 10th edition (ICD-10), and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). The control group consisted of 101 examinees volunteers that visit the hospital in order to perform a systematic health examination. Individuals with psychiatric or neurological disorders, rheumatic diseases (rheumathoid arthritis), collagenosis, orofacial pain, hormonal disorders, odontogenic abscesses, developmental anomalies and maxillofacial traumas were not included in the control group. Individuals that therapeutically use analgesics and opiates were eliminated from the control group. An analysis of the following muscels was performed bilaterally: masseter muscle, temporal muscle, temporal muscle tendon, medial pterygoid muscle, lateral pterygoid muscle, sternocleidomastoid muscle, splenius capitis and trapezius muscle. RESULTS: The research showed that war veterans treated for PTSD asses their health condition as generally poor (72,3%) or extremely poor (18,8%), the condition of the mouth as poor (47,5%) or extremely poor (17,8%), the attention devoted to their health as deficient (26,7%) and extremely deficient (6,9%). This results are to a considerable extent worse than the results of examiness in the control group. In comparison with the control group, a significantly higher comorbidity with the following diseases among war veterans with PTSD was determined: rheumatoid arthritis, collagenosis and psoriasis (35,6%), depression (99%), hearing impediments and problems with ears (51,5%), vertigo (58,4%), frequent headaches (64,4%), high blood pressure (41,6%), hormonal disorders (18,8%), problems with concentration (93,1%), sleeping disorders (100%), problems with sinuses (51,5%) and problems with cervical spine (80,2%). There was no difference between the two groups as far as the use of heart drugs is concerned, whereas other drugs, like tranquilizers, analgesics, sleeping medications and medicaments againts hypertension were considerably more frequently used by examinees with PTSD. The analyzed sample showed that there is no statistically significant difference between the incidence of myofascial pain in veterans who had been intubated and those who had not undergone intubation. The following symptoms were determined to be significantly more frequent in war veterans than in the control group: limited ability to open the mouth in the morning (29,7%) and in the evening (22,9%), a sideways shift when opening the mouth (20,8%), clenching of the teeth during the day (73,3%), teeth grinding while sleeping (47,5%), pain and tension in the jaws in the morning (37,6%) discomfort and instability when closing the mouth (54,5%). Inappropriate habits parafunctions (41,6%), and the sensation of tension and stiffness in jaw muscles (64,3%) are also significantly more frequent in the population of war veterans. Furthermore, the sound of the temporomandibular joints and pain in those joints were determined to be more frequent among war veterans with PTSD (left joint 31.7%, right joint 34,7%) than in the examinees from the control group. At the same time, war veterans display a greater incidence of muscle pain than examinees from the control group. Trigger points are mostly located in the following muscles: splenius capitis (12,9%), right temporal muscle (11,9%), left temporal muscle (7,9%) right masseter muscle (5,9%). In the control group the overall incidence of myofascial pain was much lower (8,9), and trigger points were detected only in the left temporal muscle (4%) and in the splenius capitis (5% ). A significantly higher incidence of myofascial pain in the head and neck region among war veterans with PTSD (58,4%) than in the control group (8,9%) was determined, what confirms the initial hypothesis. CONCLUSION: In accordance to the results obtained during the research, there exist a mutually enhancing relationship between PTSD and chronic pain myofascial pain. Because of that, there is a need to engage a doctor of dental medicine, educated for treating stomatognatic system disorders as well as painful disorders in the head and neck region, in a multidisciplinary team that treats Croatian war veterans with PTS

Angiomyoma – Angioleiomyoma of the Cheek

The authors present the case of an angiomyoma – angioleiomyoma of the cheek in a 58-year-old man. The tumour was palpable, although clinically not visible, and the only case of a tumour of smooth muscle treated in the Clinical Department of Oral Surgery over the last 40 years. The operation was performed in the Outpatient Department by intraoral procedure. The postoperative course passed without complications. Current literature on leiomyomas is cited in the Introduction, followed by presentation of the case and histological characteristics of the tumour. The example is presented as a rarity and one of the differential diagnostic possibilities in the diagnostics of soft tissue tumours in the oral cavity

Angiomyoma – Angioleiomyoma of the Cheek

The authors present the case of an angiomyoma – angioleiomyoma of the cheek in a 58-year-old man. The tumour was palpable, although clinically not visible, and the only case of a tumour of smooth muscle treated in the Clinical Department of Oral Surgery over the last 40 years. The operation was performed in the Outpatient Department by intraoral procedure. The postoperative course passed without complications. Current literature on leiomyomas is cited in the Introduction, followed by presentation of the case and histological characteristics of the tumour. The example is presented as a rarity and one of the differential diagnostic possibilities in the diagnostics of soft tissue tumours in the oral cavity

MYOFASCIAL PAIN OF THE HEAD AND NECK AMONG CROATIAN WAR VETERANS TREATED FOR DEPRESSION AND POSTTRAUMATIC STRESS DISORDER

Background: During the Croatian War of Independence, 1991-1995, Croatian soldiers were exposed to traumatic and stressful events. Certain number of soldiers who took part in the war, developed depression and posttraumatic stress disorder (PTSD). Stress is one of the etiological factors in the development of myofascial pain (MPS), although the mechanism of these processes is not entirely understood. The aims of this study were to determine the frequency of myofascial pain among Croatian war veterans with depression and PTSD, association between MPS and severity of depression, to describe the most common locations of trigger points in the region of head and neck, and to find out if there is any association in frequency between MPS and endotracheal intubation. Subjects and methods: A total of 101 Croatian war veterans suffering from PTSD and depression participated in the current study. Diagnosis of myofascial pain was based on detailed anamnestic history and careful clinical examination. Results: Our findings showed a high rate of myofascial pain among Croatian war veterans, with occipital region and right temporal region as the most common places of trigger points. Higher severity of depression was accompanied by a higher percentage of subjects with MPS. Finally, there was no significant association between endotracheal intubation and development of MPS among the war veterans. Conclusions: It can be concluded that the rate of myofascial pain among Croatian war veterans is high and therefore it must be considered in patients with depression and PTSD. Moreover, the severity of depressive symptomatology seems to be related to the presence of myofascial pain

Botrioidna cista – rijedak tip odontogene ciste

Botryoid cyst, a rare type of odontogenic cyst, is usually considered a multilocular variant of lateral periodontal cyst. It was first described in 1973, and up to the present less than a hundred cases have been reported in the literature. Botryoid cysts are characterized by a multilocular histologic finding and a higher risk of recurrence than lateral periodontal cysts. In this article, we present a case of botryoid cyst from our clinical practice, accompanied by literature review of previous cases reported in the literature so far. Study results showed that botryoid cysts mostly affected population in their fifties, with a slight female (53.5%) predominance over males (46.5%). The mandible was the most frequently affected region, accounting for 70 (83.3%) cases. Maxilla was only sporadically affected accounting for 14 (16.7%) cases. Radiographic appearance of botryoid cysts can be multilocular or unilocular. It is concluded that the recurrence rate is relatively high (30.1%), therefore long term follow up is needed.Botrioidna cista je rijedak tip odontogene ciste koja se uobičajeno smatra multilokularnom varijantom lateralne periodontne ciste. Prvi put je opisana 1973. godine, a do danas je u literaturi opisano manje od sto slučajeva. Botrioidne ciste su obilježene multilokularnim histološkim nalazom i većom učestalošću recidiva u odnosu na lateralne periodontne ciste. U ovom članku prikazujemo slučaj iz naše kliničke prakse. Rad je popraćen pregledom literature prethodnih slučajeva dosad opisanih u literaturi. Rezultati su pokazali da botrioidne ciste uglavnom zahvaćaju populaciju u pedesetim godinama života, s malo većom učestalošću kod žena (53,5%) u odnosu na muškarce (46,5%). Donja čeljust je najčešće zahvaćena regija sa 70 (83,3%) slučajeva. Gornja čeljust je povremeno zahvaćena s učestalošću od 14 (16,7%) slučajeva. Radiografski prikaz botrioidne ciste može biti multilokularan ili unilokularan. Zaključno može se utvrditi da je učestalost recidiva velika (30,1%) pa je potrebno dugotrajno praćenje

Trigeminal Neuralgia – Case and Treatment Analysis at the Department of Oral Surgery of the University Hospital Dubrava

The aim of the study was to explore certain risk factors for trigeminal neuralgia (TN), assess the prevalence of misdiagnoses of TN made by primary care dentists, compare the treatment practice for TN at the Department of Oral Surgery with the guidelines, and the importance of interdisciplinary approach in TN treatment. The study included 237 patient records (70 men and 167 women, aged 5-91 years) referred to the Department under the diagnosis of TN. From their medical records, demographic data, referral diagnose, clinical diagnose, additional diagnostic procedures and treatment were analysed. Neuralgia of the trigeminal nerve affects predominantly elderly female population, while the impact of the season on the incidence of the disease has not been determined. The most common therapy used at the Department were blockades, carbamazepine or their combination. 63.3% patients were referred for further diagnostic tests following the first examination. The number of misdiagnosed cases referred by primary care dentists (33.6%) points that better training in diagnosing TN is needed for the dental practitioners. The treatment methods at the Department need to be harmonized with the latest guidelines on neuralgia treatment. Due to the complexity of etiological factors, an interdisciplinary approach is necessary

Razvoj procesa kompostiranja biorazgradive frakcije komunalnog otpada u laboratorijskom mjerilu

Porast stanovništva i ubrzana industrijalizacija svakodnevno dovode do nastanka velikih količina otpada čije zbrinjavanje predstavlja ekološki i ekonomski problem. Veliki udio otpada na odlagalištima čini biorazgradivi otpad, a kao prihvatljiv način zbrinjavanja takvog otpada smatra se process kompostiranja. Kompostiranje je proces razgradnje organskih tvari pomoću mikroorganizama u aerobnim uvjetima pri čemu kao produkt nastaje kompost, prirodan i koristan dodatak tlu. U ovom radu prikazani su rezultati provedbe procesa kompostiranja biorazgradive frakcije komunalnog otpada u laboratorijskom mjerilu na način da je proveden proces kompostiranja bez i proces kompostiranja s bioaugmentacijom, odnosno uz dodatak mikroorganizama izoliranih tijekom provedbe samog procesa kompostiranja. Tijekom procesa kompostiranja praćene su karakteristične procesne veličine poput C/N omjera, pH-vrijednosti, sadržaja vlage i hlapive tvari, a biorazgradnja je praćena i preko sastava eluate što je omogućilo usporedbu provedenih procesa. Postavljen je i matematički model procesa kompostiranja, a rezultati simulacije matematičkog modela procesa upotrijebljeni su za optimizaciju procesnih uvjeta

Razvoj procesa kompostiranja biorazgradive frakcije komunalnog otpada u laboratorijskom mjerilu

Porast stanovništva i ubrzana industrijalizacija svakodnevno dovode do nastanka velikih količina otpada čije zbrinjavanje predstavlja ekološki i ekonomski problem. Veliki udio otpada na odlagalištima čini biorazgradivi otpad, a kao prihvatljiv način zbrinjavanja takvog otpada smatra se process kompostiranja. Kompostiranje je proces razgradnje organskih tvari pomoću mikroorganizama u aerobnim uvjetima pri čemu kao produkt nastaje kompost, prirodan i koristan dodatak tlu. U ovom radu prikazani su rezultati provedbe procesa kompostiranja biorazgradive frakcije komunalnog otpada u laboratorijskom mjerilu na način da je proveden proces kompostiranja bez i proces kompostiranja s bioaugmentacijom, odnosno uz dodatak mikroorganizama izoliranih tijekom provedbe samog procesa kompostiranja. Tijekom procesa kompostiranja praćene su karakteristične procesne veličine poput C/N omjera, pH-vrijednosti, sadržaja vlage i hlapive tvari, a biorazgradnja je praćena i preko sastava eluate što je omogućilo usporedbu provedenih procesa. Postavljen je i matematički model procesa kompostiranja, a rezultati simulacije matematičkog modela procesa upotrijebljeni su za optimizaciju procesnih uvjeta

Angiomyoma--angioleiomyoma of the cheek [Angiomiom - angioleiomiom obraza]

The authors present the case of an angiomyoma--angioleiomyoma of the cheek in a 58-year-old man. The tumour was palpable, although clinically not visible, and the only case of a tumour of smooth muscle treated in the Clinical Department of Oral Surgery over the last 40 years. The operation was performed in the Outpatient Department by intraoral procedure. The postoperative course passed without complications. Current literature on leiomyomas is cited in the Introduction, followed by presentation of the case and histological characteristics of the tumour The example is presented as a rarity and one of the differential diagnostic possibilities in the diagnostics of soft tissue tumours in the oral cavity