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Alleviating respiratory problems in a muscular dystrophy patient
Surgical prosthesis
Alleviating
respiratory
muscular Howard
dystrophy Jay
University
of
problems
in
a
patient
Greene,
D.D.S.,
Illinois,
College
and of
Bruce
Dentistry,
1. Douglas,
Chicago,
D.D.S.,
M.A.,
M.P.H.*
Ill.
A
19-year-old man had been suffering from muscular dystrophy since early childhood. His spine was displaced ventrally, and his diaphragm and intercostal muscles had deteriorated. Since the diaphragm is responsible for 60 per cent and the intercostal and scaleni muscles for 40 per cent of the force or inhalation,l there was a decided decrease in his vital capacity. In addition, the facial musculature was significantly weakened and was unable to maintain tension from contraction for prolonged periods. A marked malocclusion was present which, although unrelated to the primary disease process, provided an additional problem. As a result of his ventilatory problem, the patient suffered from chronic hypercarbia, which caused elevated bicarbonate concentration and a decrease in oxygen tension in the arterial blood plasma. There was significant danger of carbon dioxide narc0sis.l Since his problem was too advanced for palliative medication, mechanical respiratory therapy was required. A positive-pressure respirator was constructed for the mouth, because the patient had a marginal breathing problem with a small breathing reserve.2 The portability of the respirator made his confinement to a hospital and an “iron lung” unnecessary. However, his weakened facial muscles were unable to maintain a tight grasp around the mouthpiece of the respirator. As a result, the air which was being forced through the tube and into the mouth escaped between the lips (Figs. I to 4). TREATMENT
A prosthesis was needed which would allow the facial muscles to time, would block escaping air. An acrylic-resin appliance was designed to fit into the labial vestibules, extending posteriorly to the each side. An air hole was placed in the center of the restoration same
*Professor
of Community
relax and, at the constructed and canine teeth on which, by pre-
Dentistry.
565
566
Greene
J. Pros. Dent. December, 1968
and Dougin,
measurement, allolved a tight fit for the resI,irator’s niouthl.)ic:cr. ‘I’x+vo wings of acrylic resin extended lingually from the lingual side of the prosthesis along the plane of occlusion to maintain sufficient opening of the jaws for thr, passage of air. Thus, tilt: patient was able to bitt. OIL the wings and maintain the appliance in a stable pition while keeping the jax\3 open j Fig. 5 : ‘l’fw \,rosthcsis t\ as ~onifortable. and ir coqlet~ly blocked the air whrn in placr. Sinw the tn0utlipif~c.c~ ‘~1’;~smobile, permittin,g nioxw1~cnt arltl allo\\-ing air to ~scqw, it ~vas incorlxwatt~d into the: lxosthesis. This sealed ofI’ cxafjing air and n~ad~ the nloutlq)iwc+ stable* (Figs. 6 and 7). lxovidcd and ‘I’hc patient wwi~cd the. id bc%ilc+it ot’ tlic t)ressure tlic% rcy,irator was able to kwp tht> posthcsis in his moutll as long as TV~S necessary to build up the l)atient an adequate stow of air and to rshaltt adequately. After ;I Trial lwriod. \vas discharged from the hospital \vith tlrc. ljortablc prwxux’ unit.
Fig. 1
Fig.
2
Fig. 1. The patient’s teeth arc in centric occlusion. Fig. 2. The mouthpirce is in position with the facial musculature
relaxed.
Fig. 3. Diagnostic
casts
indicate
the
occlusal
relationships
while
the
mouthpiece
respi
is
in pl lace.
Fig.
Fig.
Fig. 4. The facial betw reen the lips.
muscles
are
Fig. 5. The unfinis hed appliance
under
marked
is in place
duress
in the mouth.
in an attempt
to pr
leakage
of air
.i. Pros. Dent. December. 1968
Greene and lloqla~
568
Fig.
6
Fig. 6. The mouthpircv Fig. 7. The ncrylil,-resin
is attached extrnsions
to the finishttd permit
applianctr.
stabilization
of the appliam
c by thus twth
References 1. 2.
Montero, J. Cl., Wassermann K.. and Feldman, D. ically Ill, Arch. Phys. Med. 46: 386-390. 196.5. Dail, C. W.: Respiratory Aspects of Rehabilitation Phys. Med. 46: 655-675. 1965. DR.
GREENE
:
8023 WOODGATE APT.
BALTIMORE, DR.
MD.
DOUGLAS
UNIVERSITY COLLEGE
808
CouKT
I’
SOUTH
CHTCAGO,
21L?O7
: OF
ILLINOIS
OF DENTISTRY WOOD
ST.
II I.. 60680
J.: Respiratory in
Neuromuscular
Problems
of the Clhron-
Conditions,
Arch.
Alleviating
respiratory
muscular Howard
dystrophy Jay
University
of
problems
in
a
patient
Greene,
D.D.S.,
Illinois,
College
and of
Bruce
Dentistry,
1. Douglas,
Chicago,
D.D.S.,
M.A.,
M.P.H.*
Ill.
A
19-year-old man had been suffering from muscular dystrophy since early childhood. His spine was displaced ventrally, and his diaphragm and intercostal muscles had deteriorated. Since the diaphragm is responsible for 60 per cent and the intercostal and scaleni muscles for 40 per cent of the force or inhalation,l there was a decided decrease in his vital capacity. In addition, the facial musculature was significantly weakened and was unable to maintain tension from contraction for prolonged periods. A marked malocclusion was present which, although unrelated to the primary disease process, provided an additional problem. As a result of his ventilatory problem, the patient suffered from chronic hypercarbia, which caused elevated bicarbonate concentration and a decrease in oxygen tension in the arterial blood plasma. There was significant danger of carbon dioxide narc0sis.l Since his problem was too advanced for palliative medication, mechanical respiratory therapy was required. A positive-pressure respirator was constructed for the mouth, because the patient had a marginal breathing problem with a small breathing reserve.2 The portability of the respirator made his confinement to a hospital and an “iron lung” unnecessary. However, his weakened facial muscles were unable to maintain a tight grasp around the mouthpiece of the respirator. As a result, the air which was being forced through the tube and into the mouth escaped between the lips (Figs. I to 4). TREATMENT
A prosthesis was needed which would allow the facial muscles to time, would block escaping air. An acrylic-resin appliance was designed to fit into the labial vestibules, extending posteriorly to the each side. An air hole was placed in the center of the restoration same
*Professor
of Community
relax and, at the constructed and canine teeth on which, by pre-
Dentistry.
565
566
Greene
J. Pros. Dent. December, 1968
and Dougin,
measurement, allolved a tight fit for the resI,irator’s niouthl.)ic:cr. ‘I’x+vo wings of acrylic resin extended lingually from the lingual side of the prosthesis along the plane of occlusion to maintain sufficient opening of the jaws for thr, passage of air. Thus, tilt: patient was able to bitt. OIL the wings and maintain the appliance in a stable pition while keeping the jax\3 open j Fig. 5 : ‘l’fw \,rosthcsis t\ as ~onifortable. and ir coqlet~ly blocked the air whrn in placr. Sinw the tn0utlipif~c.c~ ‘~1’;~smobile, permittin,g nioxw1~cnt arltl allo\\-ing air to ~scqw, it ~vas incorlxwatt~d into the: lxosthesis. This sealed ofI’ cxafjing air and n~ad~ the nloutlq)iwc+ stable* (Figs. 6 and 7). lxovidcd and ‘I’hc patient wwi~cd the. id bc%ilc+it ot’ tlic t)ressure tlic% rcy,irator was able to kwp tht> posthcsis in his moutll as long as TV~S necessary to build up the l)atient an adequate stow of air and to rshaltt adequately. After ;I Trial lwriod. \vas discharged from the hospital \vith tlrc. ljortablc prwxux’ unit.
Fig. 1
Fig.
2
Fig. 1. The patient’s teeth arc in centric occlusion. Fig. 2. The mouthpirce is in position with the facial musculature
relaxed.
Fig. 3. Diagnostic
casts
indicate
the
occlusal
relationships
while
the
mouthpiece
respi
is
in pl lace.
Fig.
Fig.
Fig. 4. The facial betw reen the lips.
muscles
are
Fig. 5. The unfinis hed appliance
under
marked
is in place
duress
in the mouth.
in an attempt
to pr
leakage
of air
.i. Pros. Dent. December. 1968
Greene and lloqla~
568
Fig.
6
Fig. 6. The mouthpircv Fig. 7. The ncrylil,-resin
is attached extrnsions
to the finishttd permit
applianctr.
stabilization
of the appliam
c by thus twth
References 1. 2.
Montero, J. Cl., Wassermann K.. and Feldman, D. ically Ill, Arch. Phys. Med. 46: 386-390. 196.5. Dail, C. W.: Respiratory Aspects of Rehabilitation Phys. Med. 46: 655-675. 1965. DR.
GREENE
:
8023 WOODGATE APT.
BALTIMORE, DR.
MD.
DOUGLAS
UNIVERSITY COLLEGE
808
CouKT
I’
SOUTH
CHTCAGO,
21L?O7
: OF
ILLINOIS
OF DENTISTRY WOOD
ST.
II I.. 60680
J.: Respiratory in
Neuromuscular
Problems
of the Clhron-
Conditions,
Arch.