Postural balance impairment of the trunk in adolescents with mesial ratio of dentition before and after surgical treatment in the presence and absence of congenital cervical spine abnormalities

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Abstract

BACKGROUND: In the presence of mandibular malformations and malocclusion, an abnormal morphology of the cervical spine is often detected. Latent neurological abnormalities in patients with possible disorders of spinal cord conduction function are promising in assessing the degree of postural balance impairment, which is well diagnosed by stabilometry.

AIM: To evaluate the dynamics of postural stability in adolescents with the mesial ratio of dentition, with and without congenital cervical spine abnormalities, before and after reconstructive operations on the jaws with a constructive bite.

MATERIALS AND METHODS: Clinical, radiographic, and two-platform stabilometric studies were conducted in 31 patients aged 15–17 years with combined dentomaxillofacial anomalies, having a mesial ratio of dentition. The main group included 10 adolescents with various congenital cervical spine abnormalities detected by multispiral computed tomography (CT). The control group included 21 patients who did not have CT signs of cervical spine abnormalities. The stabilometric parameters of the movement of the general body pressure center and the pressure centers of the contralateral lower extremities were evaluated in these patients before surgical correction of the bite and from 1 month to 1 year after it.

RESULTS: In the main group, postural balance impairment was noted, which was more pronounced before surgical treatment than those in the control group. This was manifested by frontal–sagittal violations of postural stability, pathological increase in the areas of statokinesiograms, linear velocities of the centers of pressure, and abnormally severe asymmetry of stabilometric parameters between the contralateral lower extremities. After the surgical correction of the bite, signs of postural balance deterioration were recorded in the control group: a significant increase in the coefficient, i.e., a sharp change in the direction of movement of the general center of pressure from 18% [15%–20%] to 23% [15%–31%], and the asymmetry of the linear velocities of the centers of pressure of the contralateral lower extremities significantly increased from 0.9 [0.3–1.6] to 2.2 [0.9–4.4] mm/s. In the main group, a positive trend was observed—a change in these parameters toward normalization: that is, a tendency to decrease the coefficient and a significant decrease in the rate of the centers of pressure.

CONCLUSIONS: To improve the quality of comprehensive diagnostics and medical rehabilitation of adolescents with congenital and combined dentomaxillofacial anomalies, additional radiographic examination of the cervical spine in combination with stabilometric and kinematic assessment of posture is necessary.

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About the authors

Igor E. Nikityuk

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: femtotech@mail.ru
ORCID iD: 0000-0001-5546-2729
SPIN-code: 5901-2048

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Sofia A. Botsarova

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery; North-Western State Medical University named after I.I. Mechnikov

Email: Dr.Botsarova@mail.ru
ORCID iD: 0000-0002-4675-8517
SPIN-code: 4930-8561

MD, PhD student

Russian Federation, Saint Petersburg; Saint Petersburg

Mikhail G. Semenov

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery; North-Western State Medical University named after I.I. Mechnikov

Email: sem_mikhail@mail.ru
ORCID iD: 0000-0002-1295-1554
SPIN-code: 2603-1085

MD, PhD, Dr. Sci. (Med.), Professor

Russian Federation, Saint Petersburg; Saint Petersburg

Tatyana V. Murashko

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: popova332@mail.ru
ORCID iD: 0000-0002-0596-3741
SPIN-code: 9295-6453

MD, radiologist

Russian Federation, Saint Petersburg

Sergei V. Vissarionov

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery; North-Western State Medical University named after I.I. Mechnikov

Author for correspondence.
Email: vissarionovs@gmail.com
ORCID iD: 0000-0003-4235-5048
SPIN-code: 7125-4930

MD, PhD, Dr. Sci. (Med.), Professor, Corresponding Member of RAS

Russian Federation, Saint Petersburg; Saint Petersburg

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Supplementary files

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2. Fig. 1. Multispiral computed tomography of patient K, 17 years old (preoperatively, study group): volumetric visualization (a, b); axial section (c); multiplanar reconstructions in the sagittal (d) and frontal (e) planes. A combined maxillofacial anomaly and mesial malocclusion with malformation of the cervical spine and craniovertebral junction: basilar impression with clivus hypoplasia and cranial insertion of the apex of the axis tooth, complete blockage of CII–III, right-sided atlanto-occipital assimilation, and nonenlargement of the posterior arch of the atlas

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3. Fig. 2. Multispiral computed tomography of patient B, 16 years old (preoperatively, control group): volumetric visualization (a) and multiplanar reconstructions in the sagittal (b) and frontal (c) planes, demonstrating a combined maxillofacial anomaly and mesial malocclusion without pathology of the cervical spine and craniovertebral junction

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4. Fig. 3. Bilateral stabilometry using the two-platform method: a, registration of trajectories of movement of the centers of pressure; b, scheme of the subject’s foot placement. TCOP, total body center of pressure; COPL, center of pressure of the left foot; COPR, center of pressure of the right foot; X, displacement of TCOP in the frontal plane; ΔY, difference in displacement between the centers of pressure of contralateral lower extremities in the sagittal plane

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5. Fig. 4. Graphical representation of the displacement of the centers of pressure (COP) of healthy children and patients before surgery: a, diagram of the body COP displacement in the frontal plane; b, diagram of 95% intervals of the mean values of the COP displacement of the contralateral lower extremities in the sagittal plane. L and R, left and right lower extremities

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6. Fig. 5. Examples of the dependence of the general center of pressure trajectory direction on the coefficient of sudden change in the direction of movement (SCC): a, in a healthy child; b, in a control group patient without cervical spine anomalies before and after surgery; c, in a study group patient with cervical spine anomalies pre- and postoperatively

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7. Fig. 6. Asymmetry of the statokinesiograms of contralateral lower extremities: a, in a healthy child (ΔS = 0.1 mm2); b, in a control group patient without anomalies of the cervical spine before surgery (ΔS = 0.6 mm2); c, in a study group patient with anomalies of the cervical spine before surgery (ΔS = 8.2 mm2). Red, separate statokinesiograms; blue and yellow, combined statokinesiograms

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