Dissertations / Theses on the topic 'Maximum opening of the mouth'

A articulação temporomandibular (ATM) representa a ligação da mandíbula com o crânio, ela é uma das articulações mais complexas do corpo humano, devido aos complicados mecanismos envolvidos em seu funcionamento, podendo levar a alta incidência de disfunção temporomandibular (DTM). As DTMs envolvem o sistema mastigatório, afetando músculos, articulações e estruturas relacionadas. São classificadas em DTM muscular, DTM articular e DTM mista (muscular e articular). Subdividindo a DTM articular encontramos a hipermomibilidade condilar ou subluxação, caracterizada pelo deslocamento da cabeça da mandíbula além da eminência articular durante a abertura bucal, condição que predispõe a ATM à sobrecarga mecânica e instabilidade de suas estruturas. Portanto, o objetivo deste estudo foi analisar a relação entre hipermobilidade condilar e abertura bucal máxima, através de radiografias transcranianas. Foram traçadas 57 radiografias transcranianas da ATM, totalizando 114 traçados de articulações temporomandibulares. Sobre o traçado foram confeccionadas retas verticais e paralelas que passaram pelo ponto mais convexo da cabeça da mandíbula na posição de boca aberta e pelo ponto mais convexo da eminência articular. A distância entre as duas retas foi obtida através de paquímetro digital, assim como a medida da abertura bucal máxima durante a tomada radiográfica. Os dados foram analisados estatisticamente através de análise descritiva, teste de correlação e regressão. Foi encontrada uma moderada correlação entre abertura bucal máxima e deslocamento condilar, a média entre as medidas de máxima abertura bucal foi 42,5mm e de deslocamento condilar 5,3mm. Concluindo, o aumento na medida de abertura bucal promove o aumento no deslocamento da cabeça da mandíbula para além do ápice da eminência articular durante o movimento de máxima abertura bucal.
The temporomandibular joint (TMJ) is the link between the mandible and skull. The TMJ is considered one of the most complex joint in the human body due to the complex mechanisms involved in its joint function, which may cause the high incidence of temporomandibular disorder (TMD). The TMDs involves the masticatory system, affecting muscles, joints and related structures. The TMDs are classified in muscular TMD, joint TMD and mixed TMD (muscle and joint). In the subdivision of the joint TMD, we can find the condylar hypermobility or subluxation, which is characterized by head of the mandible displacement jointly with the articular eminence during mouth opening, predisposing the TMJ to mechanical overload and structural instability. Furthermore, the aim of this study was to analyze the relation between condylar hypermobility and maximum mouth opening, using transcranial radiographs. Fifty-seven transcranial radiographs of TMJ and one hundred and fourteen temporomandibular joint were traced. Vertical and parallel straight were made through the most convex point of head of the mandible with maximum mouth opening and the most convex point of articular eminence. The distance between straights and the maximum mouth opening during radiographic were measured by digital caliper. The data were analyzed through descriptive analysis, correlation test and regression test. The results indicated a moderate correlation between maximum mouth opening and condylar displacement. The mean value of maximum mouth opening was 42,5mm, and the mean value of condylar displacement was 5,3mm. In conclusion, the increase in the measurement of mouth opening caused increase in displacement of the head of mandible, which is beyond of the articular eminence apex during maximum movement of mouth opening.

The mechanical engineering department at the University of Idaho is conducting a project with the purpose of developing a complete system for investigating creep-, creep-fatigue- and fatigue properties of metallic materials at elevated temperatures up to 650 ˚C with Compact Tension (CT) specimens. Considerable efforts have been made to study and understand these phenomena, although numerous problems still exist. It is important to explore more extensively the complicated phenomena of creep, fatigue and of creep-fatigue interactions. The Direct Current Potential Drop (DCPD) method is a common method used to investigate, for example, the initiation of cracks, crack growth rates and to monitor crack growth. The technique utilizes the fact that the electrical resistance of a CT specimen changes with crack growth. By applying a constant current over the specimen and measuring the resulting voltage over the crack, the crack length can be related to the voltage, and the difference in crack length with difference in voltage. Standards from the American Society for Testing of Materials (ASTM) were used as guidance when designing the DCPD system and CT specimen. The development and implementation processes were divided into an analytical and an experimental stage. The final product consisted of a high temperature extensometer, to measure crack mouth opening displacement (CMOD), and a DCPD system, to measure crack growth, controlled by separate control units. The DCPD system consisted of a DC supply and a nano voltmeter along with Constantan wire and NiCr60 wire respectively, that were mechanically fastened. The DCPD system delivered overall satisfying results and was able to generate sufficient data to produce a crack growth curve, da/dN vs. ΔK. Although, by taking advantage of resistance welding equipment to attach the DCPD wires, along with implementing one shared control unit for the DCPD system and the extensometer, more accurate and accessible measurements and correlations could be extracted.
Mechanical engineering avdelningen på University of Idaho genomför just nu ett utvecklingsprojekt med syftet att utveckla ett komplett system för undersökning av krypnings, krypnings-utmattnings- samt utmattnings- egenskaper av metalliska material vid höga temperaturer upp till 650 ˚C med hjälp av kompakta spänningsprovstavar (CT specimens). Betydande ansträngningar har gjorts för att undersöka och förstå dessa fenomen, men flera problem kvarstår. Det är viktigt att djupare undersöka kopplingen mellan krypnings- och utmattningsegenskaper. Direct Current Potential Drop (DCPD) metoden är en vanlig metod vilken används för att undersöka, exempelvis, sprickinitiering, spricktillväxthastigheter och spricktillväxt. Tekniken utnyttjar faktumet att den elektriska resistansen i en provstav ändras med spricktillväxt. Genom att föra en konstant ström genom provstaven och sedan mäta den resulterande spänningen över sprickan, kan spricklängden relateras till uppmätt spänning. På samma sätt kan spricktillväxt relateras till spänningsförändringar. Standarder från American Society for Testing of Materials (ASTM) användes för att designa ett DCPD system samt en CT provstav. Utvecklings- och implementeringsprocessen var uppdelad i en analytisk och en experimentell del. Den slutgiltiga produkten bestod av en extensometer, för mätning av spricköppning vid höga temperaturer, och ett DCPD system, för mätning av spricktillväxt vid höga temperaturer, vilka kontrollerades av separata kontrollenheter. DCPD systemet bestod av en strömkälla och en nanovoltmeter tillsammans med Constantan kablar respektive NiCr60 kablar, vilka fastsättes mekaniskt. DCPD systemet levererade generellt sett tillfredställande resultat och hade kapacitet att generera tillräckligt precisa data för att producera en spricktillväxtkurva, da/dN vs. ΔK. Däremot, genom att utnyttja en resistanssvets, för att fastsätta DCPD-kablarna, tillsammans med en gemensam kontrollenhet för extensometern och DCPD systemet, kan det tänkas att bättre och mer tillgängliga resultat kunde åstadkommas.

Introdução: A região da face corresponde a parte do corpo mais atingida em casos de traumas. Isso ocorre por ser uma área sem proteção e de localização favorável. Traumas nessa região tem como principais causas acidente de trânsito, quedas ou agressões. A consequência mais prevalente é a fratura na região mandibular. Em decorrência disso, é possível perceber diversos prejuízos, dentre eles a limitação na abertura bucal. No entanto, para que seja definido um dano é necessário que se conheça o padrão de normalidade. O Código Civil brasileiro aponta que todo o dano causado por ato ilícito deve ser reparado proporcionalmente ao prejuízo criado na vítima. A utilização de tabelas na quantificação do dano corporal tem sido um elemento importante para a unificação da linguagem e dos critérios, permitindo que uma mesma situação seja avaliada e entendida de forma semelhante. Objetivo: a) Obter a média de abertura bucal de uma população brasileira associando com sexo, idade, estatura e perfil facial; b) Correlacionar a média de abertura bucal de pacientes considerados dentro do padrão de normalidade e pacientes com fratura mandibular; c) Correlacionar os valores de abertura bucal obtidos na pesquisa com a Tabela Nacional de Avaliação de Incapacidades Permanentes em Direito Civil da legislação portuguesa, a tabela brasileira SUSEP e a tabela DPVAT; d) Elaborar uma fórmula para a determinação da redução de abertura bucal. Metodologia: Um questionário relacionado a percepção de dor foi aplicado em pacientes do grupo controle e pacientes analisados em um hospital de São Paulo com fratura de mandíbula. Na sequência, foi verificada a abertura bucal máxima com um paquímetro e tomadas as medidas do terço médio e inferior para determinação do tipo de perfil facial. Além disso, através de um estadiômetro, foi medida a estatura. Os dados foram analisados estatisticamente e relacionados com as três tabelas citadas. Resultados: A média de abertura bucal no sexo masculino foi de 51,71 mm enquanto no sexo feminino foi de 47,94 mm onde foi encontrada correlação positiva entre sexo e abertura bucal. Entretanto não foi possível estabelecer significância com as demais variáveis. Quanto aos pacientes com fratura de mandíbula, a média de abertura bucal para homens foi de 38,91 mm e em mulheres de 41 mm, a etiologia mais prevalente foi acidentes automobilísticos e o local mais acometido foi na região condilar. Conclusão: Foi possível encontrar associação positiva com o sexo, onde homens tendem a ter uma abertura bucal maior que mulheres; Não foi encontrada relação significativa com idade, estatura e perfil facial; Pacientes com fratura mandibular possuem uma amplitude de abertura menor que pacientes considerados dentro dos padrões de normalidade; As tabelas brasileiras, DPVAT e SUSEP são insuficientes para valorar danos odontológicos e a tabela da legislação portuguesa necessita de adaptações e com base nas médias de abertura bucal obtidas, foram elaborada as seguintes fórmulas para o cálculo de redução de abertura bucal, onde para pacientes do sexo masculino usa-se RA=[100-(A.1,93) ] .0,3 e para o sexo feminino RA=[100-(A.2,08) ] .0,3 .
Background: The face is the body part most commonly affected in cases of trauma, since it is an unprotected and vulnerable area. Facial traumas are caused mainly by traffic accidents, falls, or physical assault. Mandibular fracture is the most prevalent consequence of these events. This type of fracture causes some damage, including limited mouth opening. However, in order to define this damage, it is necessary to know what the normal pattern is. The Brazilian Civil Code establishes that any harm caused by the practice of an illicit act must be repaired proportionately to the injury inflicted on the victim. The use of rating charts for quantification of bodily harm has played an important role in standardizing both the language and criteria, thus allowing one to assess and understand the same situation in a similar fashion. Objective: a) To estimate the mean jaw range of motion of the Brazilian population by associating it with sex, age, height, and facial profile; b) to correlate patients with a normal jaw range of motion with those with mandibular fracture; c) to correlate jaw range of motion in the Portuguese National Rating Chart for Permanent Disability Assessment with that in the Brazilian SUSEP and DPVAT charts; d) to develop a formula for limited mouth opening estimation. Method: A pain perception questionnaire was applied to patients from the control group and to those with mandibular fracture assessed at a hospital in the city of São Paulo, Brazil. Maximum mouth opening was measured with a caliper, whereas middle and lower third measurements were made to determine the type of facial profile. Height was measured using a stadiometer. The data were analyzed statistically and compared with those described in the three rating charts. Results: The mean jaw range of motion was 51.71 mm in male patients and 47.94 mm in female patients, and there was a positive correlation between sex and mouth opening. It was not possible to determine the significance of mouth opening relative to the other variables. In patients with mandibular fracture, the mean jaw range of motion was 38.91 mm for men and 41 mm for women; vehicle motor accidents were the major cause of the trauma; and the mandibular condyle was the most frequently affected site. Conclusion: There was a positive correlation with sex, as men tend to have a greater jaw range of motion than women. There was no significant correlation with age, height, and facial profile. Patients with mandibular fracture have a smaller jaw range of motion than those who fall into normal standards. Brazilian charts, DPVAT and SUSEP, are inefficient in rating dental damage, whereas the Portuguese chart requires some adaptations. The following formulas were developed based on the mean jaw range of motion measurements, and they allow estimating limited mouth opening: LMO=[100-(MO x 1.93)] x 0.3 for men and LMO=[100-(MO x 2.08)] x 0.3 for women.

O conhecimento das características funcionais da Síndrome de Down (SD) é importante para a ciência odontológica, pois indivíduos com SD apresentam alterações craniofaciais e dentárias que alteram o desempenho do sistema estomatognático. O objetivo deste estudo foi determinar padrões de referência da força de mordida molar direita (FMMD) e esquerda (FMME) máximas de indivíduos com SD analisando a influência da idade, além de compará-los com indivíduos sem síndrome de Down. A abertura bucal, estalo na ATM, ranger dos dentes (sono e vigília) foram avaliados nos indivíduos com SD. Participaram 100 indivíduos com SD que foram distribuídos em quatro grupos: crianças entre 8 e 12 anos (GSDI, n=28); adolescentes entre 13 e 20 anos (GSDII, n=30); adultos jovens entre 21 e 40 anos (GSDIII, n=29) e adultos entre 41 e 60 anos (GSDIV, n=13). Os GSD (I, II, III e IV) foram pareados sujeito a sujeito com seus respectivos controles sem síndrome (GCI, GCII, GCIII e GCIV) por idade, gênero e IMC. Os registros da FMMD e FMME foram captados pelo dinamômetro digital. O estalo sem dor (ESD), ranger dos dentes no sono (RS) e na vigília (RV) foram analisados por meio de questionário anamnésico. A abertura sem auxílio e sem dor (A), abertura máxima sem auxílio (MSA) e abertura máxima com auxílio (MCA) foram mensuradas por régua milimétrica. Os dados de FMM máximas, abertura bucal foram tabulados e submetidos à análise estatística (SPSS 22.0, p ≤0,05). Os dados de ESD, RS e RV em indivíduos com SD foram demonstrados em valores percentuais. Houve diferença estatística significante (ANOVA, p ≤ 0,05) para FMME no GSD ao longo dos anos (p=0,00) registrando maior força para o GSDII. Na comparação dos Grupos etários com os Grupos controles houve diferença estatística significante (teste t de student, p ≤ 0,05) para FMMD: GSDII X GCII (p=0,00), GSDIII X GCIII (p=0,00), GSDIV X GCIV (p=0,00) e FMME: GSDI X GCI (p=0,00), GSDII X GCII (p=0,00), GSDIII X GCIII (p=0,00) e GSDIV X GCIV (p=0,00). As FMMD e FMME dos Grupos etários com SD foram menores quando comparados aos GC (I, II, III e IV). Na abertura bucal ocorreu diferença estatística significante (ANOVA, p ≤ 0,05) ao longo dos anos: A (p=0,00), MSA (p=0,00) e MCA (p=0,00) com maior A no GSDII e maior MSA e MCA no GSDIII. O GSDIII apresentou maior valor percentual de ESD e RDV e o GSDI maior de RDS. Os resultados deste estudo determinaram padrões referenciais de FMM ao longo dos anos em indivíduos com SD, com maior força para os adolescentes, diminuição gradual durante o envelhecimento, menor força máxima quando comparado aos indivíduos sem síndrome, influência da idade na abertura bucal e presença de ESD, RS e RV.
Knowledge of the functional characteristics of Down Syndrome (DS) is important for dental science, since individuals with DS present craniofacial and dental alterations that alter the performance of the stomatognathic system. The aim of this study was to determine reference patterns of maximal right (RMBF) and left (LMBF) molar bite force of SD individuals by analyzing the influence of age, as well as comparing them with healthy individuals. The mouth opening, clicking in the TMJ, teeth grinding (sleep and wakefulness) were evaluated in individuals with DS. A total of 100 individuals with DS were divided into four groups: children aged 8 to 12 years (DSGI, n = 28); Adolescents between 13 and 20 years old (DSGII, n = 30); Young adults aged between 21 and 40 years (DSGIII, n = 29) and adults between 41 and 60 years (DSGIV, n = 13). GDSs (I, II, III and IV) were paired subject to their respective healthy controls (CGI, CGII, CGIII and CGIV) by age, gender and BMI. RMBF and LMBF records were captured by the digital dynamometer. The painless popping (PP), teeth grinding in sleep (GS) and wakefulness (W) were analyzed by means of an anamnestic questionnaire. The pain free opening (PFO), maximum unassisted opening (MUO), maximum assisted opening (MAO) mouth opening were measured by millimeter rule. Maximum MBF data, mouth opening were tabulated and submitted to statistical analysis (SPSS 22.0, P≤0.05). The PP, GS and W data in individuals with SD were demonstrated in percentage values. There was a statistically significant difference (ANOVA, P ≤ 0.05) for LMBF in GDS over the years (P = 0.00), registering the highest force for DSGII. In the comparison between age groups and control groups without SD, there was a significant statistical difference (Student t test, P ≤ 0.05) for RMBF: DSGII X CGII (P = 0.00), DSGIII X CGIII (P = 0.00), DSGIV X CGIV (P = 0.00) and LMBF: DSGI X CGI (P = 0.00), DSG II X CGII (P = 0.00), DSGIII X CGIII (P = 0.00) and DSGIV X CGIV (P = 0.00). The RMBF and LMBF of the age groups with SD were smaller when compared to the CG (I, II, III and IV). In the mouth opening, there was a significant statistical difference (ANOVA, P ≤ 0.05) over the years: PFO (p = 0.00), MUO (P = 0.00) and MAO (P = 0.00) In DSGII and higher MUO and MAO in DSGIII. The DSGIII had the highest percentage of PP and W and the highest DSGI of GS. The results of this study determined reference patterns of MBF over the years in individuals with DS, with greater strength in adolescents, gradual decrease during aging, lower maximum strength when compared to healthy individuals, influence of age on mouth opening and presence of PP,GS and W.

The thesis focuses on the computational simulation of wedge splitting test of a concrete specimen by using finite element method. Different levels of numeric model for different notch depth and for different position of support are solved. Depending on the depth of a notch and difference of configuration, the crack paths and responses to an exterior load on a crack mouth opening displacement are evaluated.

A hiperplasia do processo coronóide é uma afecção que causa uma limitada mobilidade mandibular e conseqüente limitação de abertura da boca. Não apresenta sintomatologia dolorosa, e tem progressão lenta, levando o paciente a procurar por tratamento somente se a limitação de abertura for severa a ponto de prejudicar as funções mastigatórias normais. Muitos casos levam clínicos a tratarem o paciente como portador de disfunção da articulação têmporo mandibular (DTM). Este trabalho se propõe a avaliar a tomografia computadorizada (TC) como método para auxiliar na elaboração do diagnóstico e no planejamento cirúrgico desta anomalia, estudando a presença da hiperplasia do processo coronóide pela observação de imagens obtidas por meio da Tomografia Computadorizada Helicoidal, considerando as imagens volumétricas multiplanar e 3D, e as suas associações. Foram utilizadas imagens de arquivo dos exames de tomografia computadorizada helicoidal de 152 pacientes que apresentavam sinais e sintomas de Disfunção Têmporo Mandibular (DTM) encaminhados para a Unidade de Diagnóstico Dento-Maxilo-Facial da Clínica Félix Boada, na cidade de Caracas - Venezuela, para exame tomográfico da ATM. Dos 152 pacientes, foram selecionados 20 casos, que eram de portadores de sinais e/ou sintomas de Disfunção Têmporo Mandibular, mas que, ao exame realizado, constatou-se a presença da hiperplasia do processo coronóide. Os dados dos 20 pacientes foram comparados, de maneira a identificar as possíveis diferenças entre as opiniões de 5 cirurgiões dentistas radiologistas e de 5 cirurgiões dentistas buco-maxilo-faciais. Utilizou-se a técnica da Análise de Médias (Analysis of Means - ANOM), que calcula uma média geral entre os 5 observadores de cada especialidade, e um intervalo que indica quais observadores tiveram opiniões semelhantes e quais tiveram opiniões diversas. Depois foi feita a comparação entre os dois grupos, utilizando o teste das proporções. Em conclusão, os observadores acharam as imagens MPR mais esclarecedoras que as reconstruções volumétricas 3D, na maioria dos casos de hiperplasia do processo coronóide, quando esses recursos foram avaliados separadamente. Contudo, acharam imprescindível a utilização de ambas as imagens, em associação ou não, indicando-as para o estudo da hiperplasia do processo coronóide. A hipomobilidade foi observada na articulação temporomandibular, no lado acometido pela hiperplasia do processo coronóide, em 55,2% dos casos
The Coronoid Process Hyperplasia is an affection that causes a limited mandibular mobility and a consequent limitation in mouth opening. It doesn’t present any painful symptomatology and has a slow progression, leading the patient to look for treatment only when the opening limitation is severe to the point of impairing regular masticatory functions. Many cases lead clinicians to treat the patient as he had a temporomandibular dysfunction. This work proposed an evaluation of the CT as an auxiliary method in the elaboration of the diagnosis and in the surgical planning of that anomaly by studying the presence of the Coronoid Process Hyperplasia through the observation of images obtained by means of the Helicoidal Computerized Tomography, considering the volumetric multiplane and 3D images and their associations. Filed images of Helicoidal Computerized Tomography were used, belonging to the examination of 152 patients who presented symptoms of temporomandibular dysfunction and were all directed to the Dento-Maxillo-Facial Diagnosis Unit of the Clinica Felix Boada in the city of Caracas – Venezuela for TMA tomographic examination. Of the 152 patients 20 were selected who showed signs or symptoms of TMA dysfunction and Coronoid Process Hyperplasia was detected. Data of the 20 patients were compared in order to identify possible differences among the opinions of 5 radiologist specialists and 5 buco-maxillo -facial specialists. The Analysis of Means – ANOM was used to calculate a general average among the 5 specialists in each specialty and a gap that opinions and which ones had different opinions. Afterwards the comparison between the 2 groups was made using the Proportion Test. The observers concluded that the MPR images were more clarifying than the 3D images in most of the cases of coronoid process hyperplasia, especially when those resources were evaluated separately. Although they found vital the utilization of both images in association or not and indicated them to the study of the Coronoid Process Hyperplasia. Hypo mobility was observed in the TMA in the affected side in 55,2% of the cases

Specified topic of the thesis is a multilevel evaluation of brittleness of selected building composites. The work deals with the opinions of fracture parameters of test specimens of lightweight and ordinary concrete. Specimens further differed fibres content in concrete mixtures, their type and length. The work is divided into two parts, theoretical and practical. The theoretical part conceives composite materials and introduction to fracture mechanics. The practical part describes the different steps for fracture-mechanical parameters evaluation using StiCrack and Excel Visual Basic software. The main part of the work is to evaluate the brittleness of different test specimens, taking into account the type of concrete mix and type of fibres.

This final thesis is divided into two parts. The first, theoretic part is focused on issue about industrial concrete floors, their production and adjustment. Special attention is paid to the mineral shakes, steel fibres and concrete, which is used to these constructions. There are more information about specific standardized tests of steel fibre concrete and some damages of concrete floors in other chapters. Second part of the diploma thesis is practical. Theoretical knowledge are applied to the actual construction. Survey methodology and diagnostic work are also desribed. Data processing and evaluation with the commentary is also attached to this part. The conclusion summarizes the results and selected findings relating to the issue are also included there.

Au cours du traitement du syndrome d’apnées obstructives du sommeil (SAOS) par pression positive continue (PPC), les fuites non-intentionnelles sont un des effets indésirables les plus fréquents mais leur étiologie est mal comprise. Les objectifs de cette thèse étaient d’identifier les facteurs déterminants des fuites non-intentionnelles au cours du traitement du SAOS par PPC et de proposer des stratégies pour le choix du masque et la gestion des fuites.Dans notre revue de la littérature, nous avons arbitrairement classifié les déterminants potentiels à l’origine de fuites non-intentionnelles en deux catégories. 1) les déterminants non évolutifs au cours de la nuit : l’obstruction nasale, l’âge, un indice de masse corporel élevé, une distribution centrale des masses adipeuses et le genre masculin étaient des déterminants potentiels des fuites non-intentionnelles. Le masque naso-buccal était également associé à des fuites non-intentionnelles plus élevées que le masque nasal ; et 2) les déterminants évolutifs au cours du sommeil tels que les stades de sommeil, la position, l’ouverture buccale. Nous avons étudié ces déterminants évolutifs dans une population de 74 patients SAOS traités par PPC auto-pilotée : l’ouverture buccale, le niveau de pression de la PPC, la position du sujet et le sommeil paradoxal contribuaient au risque de fuite non-intentionnelle. Nous avons également mis en évidence que le masque naso-buccal réduisait le risque de fuite non-intentionnelle en cas d’ouverture buccale et au cours du sommeil paradoxal. Puisque le niveau de pression est un déterminant des fuites non-intentionnelles, nous avons évalué par une analyse ancillaire d’un essai randomisé contrôlé, si le mode de PPC (fixe versus autopiloté) pouvait contribuer aux fuites : nous n’avons pas montré d’association entre le mode et le niveau de fuites après 4 mois de traitement. Le mode PPC n’influençait pas le type de masque utilisé par les patients. Enfin, au cours d’une étude prospective incluant de 214 patients, nous avons évalué l’intérêt du questionnaire Nasal Obstruction Syndrom Evaluation (NOSE) comme outil pour guider le choix du masque. Un score NOSE > 50/100 à l’initiation de la PPC était indépendamment associé à l’utilisation d’un masque naso-buccal après 4 mois de traitement. Ce score est un outil simple pour évaluer objectivement les symptômes d’obstruction nasale et faciliter le choix de l’interface la plus appropriée. En conclusion, au cours de cette thèse nous avons développé une méthode innovante d’analyse des déterminants des fuites non-intentionnelles dont l’application clinique pourrait permettre la mise en place des stratégies de corrections individualisées des fuites. Cela devra faire l’objet d’une évaluation prospective, tout comme l’intérêt clinique de l’utilisation en routine du score NOSE pour guide le choix du masque.Mots clés : syndrome d’apnées obstructives du sommeil, pression positive continue, fuites, masque, interface, obstruction nasale, sommeil
Continuous Positive Airway Pressure (CPAP) is the first-line treatment for moderate to severe Obstructive Sleep Apnea (OSA) syndrome. Unintentional leakage and its annoying consequences are the most frequently reported adverse effects. However, the causes of unintentional leaks are poorly understood. This thesis aimed at identifying the determining factors of unintentional leaks during CPAP treatment in OSA and developping innovative strategies for the selection of masks and leaks management.In our systematic review we have arbitrarily split the potential determining factors of leaks into two categories: 1) the non evolving factors overnight: nasal obstruction, age, high body mass index, central fat distribution and male sex were potential contributing factors associated with unintentional leakage. The oronasal mask was associated with higher unintentional leaks than the nasal mask; and 2) the evolving factors overnight such as sleep stages, body position, mouth opening and CPAP level. We studied these evolving factors in 74 OSA patients treated with auto-adjusting CPAP: mouth opening, CPAP level, body position and REM sleep were independently associated with an increased risk of unintentional leakage. We also highlighted that oronasal masks reduced the risk of unintentional leaks in cases of mouth opening and REM sleep. Since the CPAP level is a determining factor of leakage we evaluated through an ancillary analysis of a randomised controlled trial whether the type of CPAP (fixed versus auto-adjusting) could contribute to leakage. In this study, there was no effect of type of CPAP on leaks or the type of interface used after 4 month of treatment. Finally, in 214 patients, we prospectively evaluated the relevance of the Nasal Obstruction Syndrom Evaluation (NOSE) score as a simple decision-making tool to guide the choice of mask during CPAP initiation. A NOSE score > 50/100 at the initiation was independently associated with the use of an oronasal mask at 4 month. This score could be a simple tool for the objective assessment of nasal obstruction related to symptoms, facilitating the choice of an appropriate interface. As a conclusion, during this thesis we have developed a novel methodology to characterise and analyse the overnight determinants of unintentional leakage. Its clinical application could lead to individualised corrective measures of leaks. Further studies are needed to prospectively validate this model, as well as the clinical relevance of the NOSE score to guide the choice of mask in daily practice

碩士
高雄醫學大學
牙醫學研究所
97
Objective: Maximal mouth opening can reflect the function of the dentofacial musculature and joint system, and should be included in routine oral examination. We should realize the normal range of maximal mouth opening before diagnosing the abnormality, but there were few researches considering this topic in Taiwan. The purposes of this study are to investigate the maximal mouth opening of 3-5 preschool children in Kaohsiung city and to analyze the correlation between mouth opening and related factors（height, weight and closed mouth angle width）. Materials and Methods: We examined the interincisal distance in 518 preschool children with 3 to 5 year-old by a plastic sliding caliper. The interincisal distance is defined as the range between upper and lower incisor edges. The measurements were conducted on both sides during the maximal opening and closed mouth angle width for 3 times. Results: No differences in maximal mouth opening were found between the sexes, and the interincisal distance was 37.47 mm（±4.11）for boys, and 36.93mm（±3.85）for girls while the mean maximal mouth opening was 37.21 mm（±3.99）. Maximal mouth opening increased as age increased, and the mean value of maximal mouth opening was 35.31mm（±4.03）in 3 year-old children, 36.61 mm（±3.79）in 4 year-old children, and 38.31 mm（±3.88）in 5 year-old children. Mouth opening correlated with weight and closed mouth angle width. Maximal mouth opening increased 0.19 mm per increased weight and 0.37 mm per increased mouth angle width. Conclusions: The mean value of maximal mouth opening of 3-5 year-old preschool children in Kaohsiung city was 37.21 mm（±3.99）. Maximal mouth opening in 3-5 year-old preschool children increased as age increased and correlated with weight and closed mouth angle width.

PALAVRAS CHAVE: Disfunção Temporomandibular; Fisioterapia; Terapia Manual; ‘Nof- 1 trial’; Abertura Máxima da Boca; Escala Numérica da Dor; Jaw Functional Limitation Scale 20; Escala de Perceção Global de Mudança. INTRODUÇÃO: A Disfunção Temporomandibular (DTM) constitui um importante problema de saúde pública, afetando 10 a 25% da população. Tem grande impacto na qualidade de vida e elevados custos sociais e económicos. A Terapia Manual (TM) tem sido uma abordagem proposta mas com efetividade ainda por demonstrar. OBJETIVO: Verificar qual o beneficio acrescido da inclusão da TM no protocolo base de intervenção de pacientes com DTM por Artralgia. METODOLOGIA: Foi utilizado um estudo do tipo ‘Nof- 1 trial’, onde foram administrados 4 ciclos de tratamento emparelhados a 8 pacientes, cada ciclo constituído pela aplicação exclusiva da goteira oclusal (GO), fase A, ou a GO + protocolo de TM, fase B. Cada ciclo teve a duração de 2 semanas, uma para cada fase. A ordem dos tratamentos foi atribuída aleatoriamente: sequência 1 (AB BA BA AB) e sequência 2 (BA AB AB BA). Foi medida a abertura máxima da boca (AMB) em mm, a intensidade de dor pela Escala Numérica da Dor (END), a limitação funcional pela Jaw Functional Limitation Scale 20 (JFLS-20) e a perceção de mudança pela Escala de Perceção Global de Mudança (PGIC). RESULTADOS: Dos 7 participantes que concluíram os 4 ciclos de tratamento, não verificamos uma tendência ou padrão no efeito obtido com a introdução ou retirada da TM na AMB, na END, na JFLS nem na PGIC. A abertura média da boca foi ligeiramente superior nas fases de introdução da TM (37.79± 4.086 mm) relativamente às fases exclusivamente com GO (37.32± 4.423 mm), mas as diferenças observadas (0.464) não são estatisticamente significativas (IC95%: -0.350-1.278, p=0.252). A redução da intensidade da dor foi ligeiramente superior nas fases de introdução da TM (2,89± 2.2) comparativamente às fases de utilização exclusiva de GO (2.82± 2.28), mas as diferenças observadas (0.071) não são estatisticamente significativas (IC95%: -0.308-0.451, p=0.702). Relativamente à redução da limitação funcional, a redução media foi ligeiramente superior nas fases de introdução da TM (26.96± 30.51) comparativamente às fases de utilização exclusiva de GO (28.96± 32.77), mas as diferenças observadas (-2.0) não são estatisticamente significativas (IC95%: -6.19- 2.19, p=0.336). CONCLUSÃO: Os resultados mostram que não há diferenças estatisticamente significativas em nenhum dos outcomes entre tratamento A e B, pelo que a hipótese de estudo não se confirma.
INTRODUCTION: Temporomandibular Disorder (TMD) is an important public health problem, affecting 10 to 25% of the population. It has a major impact on quality of life and high social and economic costs. Manual Therapy (TM) has been a proposed approach but with effectiveness yet to be demonstrated. OBJECTIVE: To verify the added benefit of including TM in the base intervention protocol of patients with TMD due to Arthralgia. METHODOLOGY: It was used an 'N-of-1 trial', where 4 paired treatment cycles were administered to 8 patients, each cycle consisting of the exclusive application of occlusal splint (GO), phase A, or the GO + TM protocol, phase B. Each cycle lasted 2 weeks, one for each phase. The order of treatments was randomly assigned: sequence 1 (AB BA BA AB) and sequence 2 (BA AB AB BA). Maximum mouth opening (AMB) was measured in mm, pain intensity by Numerical Pain Scale (END), functional limitation by Jaw Functional Limitation Scale 20 (JFLS-20) and perception of change by the Patient Global Impression of Change (PGIC). RESULTS: Of the 7 participants who completed the 4 treatment cycles, we did not find a trend or pattern in the effect obtained with the introduction or withdrawal of TM on AMB, END, JFLS-20, or PGIC. The average mouth opening was slightly higher in the TM introduction phases (37.79 ± 4,086 mm) compared to the GO-only phases (37.32 ± 4,423 mm), but the observed differences (0.464) are not statistically significant (IC95%: - 0.350-1.278, p=0.252). The pain intensity reduction was slightly higher in the TM introduction phases (2.89 ± 2.2) compared to the GO-only phases (2.82 ± 2.28), but the observed differences (0.071) are not statistically significant (IC95%: -0.308-0.451, p=0.702). Regarding the reduction of functional limitation, the mean reduction was slightly higher in the TM introduction phases (26.96 ± 30.51) compared to the GO-only phases (28.96 ± 32.77), but the observed differences (-2.0) are not statistically significant. (IC95%: -6.19- 2.19, p=0.336). CONCLUSION: The results show that there are no statistically significant differences in either outcome between treatment A and B, so the study hypothesis is not confirmed.

碩士
高雄醫學大學
牙醫學研究所
99
Background: Elastic deformation happens during forced movements of the mandible and it may affect the clinical success of extensive bilateral prostheses in the mandible. Objective: The purposes of this study are to investigate the mandibular deformation of maximum mouth opening, and to search for affected factors. Materials and Methods: Seventy two dental students volunteered for this study. Eligibility criteria included complete mandibular dentition (facultative presence of third molars) and subjects were excluded if they had a history of maxillofacial surgery, mandibular trauma, or orthodontic treatment within the previous two years; for presence of active periodontal disease with tooth mobility, bruxism, osseous or neuromuscular diseases. Bite registrations at mandibular both contralateral first molar were recorded when maximum and minimum mouth opening. Proposed factors such as mandibular length, symphyseal width and height, the angle of condyle head, the direction and width of lateral pterygoid muscle were measured by using conebeam CT. After the data were collected, they were analyzed with two sample t-test and regression analyses to evaluate the influence of the affected factors. Results: The results show that the mean value of the changes in width between the mandibular first molars of the total sample was 0.17 ± 0.09 mm, and 0.17 ± 0.09 mm, 0.18 ± 0.08 mm for the male and female individually. The measurements from the deformation of mandible was significantly correlated to the angle of condyle head . Conclusions: The results showed that mandible width narrowed in maximum opening ; and there were wide variations between subjects. The angle of condyle head is closely related to mandibular deformation on mouth opening.

碩士
國立中央大學
客家語文研究所
100
abstract The caracteristics of Xie She (蟹攝) opening mouth (開口) of Hakka are the contrast of front and back vowel between the division Ⅰand Ⅱ、the division Ⅲ and Ⅳ do not merge、and there are still broad sound (洪音)in the division Ⅳ. The caracteristic of front and back vowel between the divisionⅠ and Ⅱ is not quite the same in different dialect points in different province. Most of dialect points present it as the contrast of 〔?〕 and 〔?〕. The 〔?〕and〔?〕 are both diphthong， 〔?〕is 〔??〕 existing in the division Ⅰ，and 〔?〕is 〔??〕existing in the division Ⅱ . But there are different kinds of variant of the diphthong〔??〕， it turn to be〔???〕 in Wuping(武平)，〔??〕 in Changting(長汀)，〔???〕in Ningdu(寧都) . No matter the diphthong 〔??〕 would be，it always showing as a dipthong headed by back rounded vowel. This dipthong headed by back rounded vowel has great performance in Southern dialets. Especially a part of dialect points of Gan(贛語) have the same caracteristic of the contrast of 〔?〕 and 〔?〕between the divisionⅠ andⅡ. We can say that Hakka and Gan dialect are very similar in the performance of the division Ⅰ and Ⅱ Though most of the rhymes of the division Ⅲ of Xie She opening mouth in Hakka are the so call find sound (細音)—〔?〕， same as Mandarin language，there are still existing broad sound including 〔??〕and the dipthong headed by back rounded vowel in the division Ⅳ. Most of these broad sound are kept in oral commonly used words like“?泥”(mud)“犁?”(plough)“?弟” (brother)“低”(low)“雞?”(chicken)，and the dipthong headed by back rounded vowel almost only kept in a word“梯??(ladder). The situation of the divion Ⅳ of Min dialect is same as Hakka. Min dialect also kept board sounds --〔??〕 in the divion Ⅳ， and the word “梯??”is also the dipthong headed by back rounded vowel. The dipthong headed by back rounded vowel is〔??〕in some dialect points in Min Nan(閩南)、Shaxian(潮汕)、and the provice of Guangdong (廣東)、 Guangxi(廣西)，and it turn to be 〔??〕in Jianyang(建陽)，〔??〕in Jiangle(將 樂) . In short，the caracteristics of Xie She opening mouth in Hakka can also be found in sourther dialects. However the dipthong headed by back rounded vowel can not be found in Sinoxenic materials(域外譯音) which are considered to be rather older dialect by Karlgren，Bernhard(高本漢) . Except one word “貝” (shell) of Sino-Annamese (安南譯音) is 〔??〕，the rhymes of Xie She opening mouth of Sinoxenic materials are almost front vowels，like 〔?〕、〔?〕or 〔??〕.So a large number of the dipthong headed by back rounded vowel existing in the Xie She opening mouth in southern dialects can not find the same layer of the corresponding in Sinoxenic materials. The dipthong headed by back rounded vowel not only existing in Hakka， it is visible from Cantonese to Min dialect、Kan dialect and Hsiang dialect . Even at Taishun(泰順) 、Cangnan(蒼南)，the dialect point of east Fujian (福建)in southern Zhejiang(浙江)， and Wu dialect、Hui dialect in nourthern Jiangxi， all can see the dipthong .But across the northeastern Jiangxi the dipthong headed by back rounded vowel never can been seen again. That is across the north of the thirty degree north latitude it can be seen nowhere. So the dipthong headed by back rounded vowel apparently is belonging to southern China. And the dipthong can not been found in Sinoxenic materials，so we may say it is older than any of Sinoxenic materials，including the oldest Sino-Japenese(日譯吳音) whose existing era is considered to be the fifth to sixth centuries. The above situation is just like what M. Hashimoto(橋本萬太郎) said：the southern dialects of modern Chinese is historical projection of ancient Chinese. Although the ancient Chinese can not be found its traces in today''s modern north Chinese，but the ancient Chinese relics are retained in more conservative sourthern dialects whose evolution are relatively slow in speech. Such a conclusion we have find the evidence in the words of Xie She opening mouth in sothern dialects.

碩士
國立臺北護理健康大學
護理研究所
102
Patient with oral cancer after receiving excision treatment or radiation therapy, often complicated with mouth opening difficulty, either due to post operative scarring or temporomandibular joint and masseter muscle fibrosis caused by radiation therapy, the loss of ability to open mount properly is one of the most common post treatment complication in oral cancer patient. The reduction of jaw mobility, lead to influence the patient ability in bite, chew and grind food capacity, result in slurred speech and difficulty eating, consequently it had a great impact in the patient’s life quality. Thus, this complication cannot be ignored by clinical care provider. The purpose of this study is to test the efficacy of patient education with telephone follow up for enhancing oral exercise and improving postoperative mouth opening, oral function, and symptoms distress. This study was an experiment design with repeated measurements. From June 2012 to March 2014, a convenience sample of 60 oral cancer patients were recruited from a regional hospital in Southern Taiwan. Patients were randomly assigned to the experimental or the control group, with 30 patients in each group. Both groups received 2 sessions of 30 minutes of patient education on oral exercise, with one before the surgery and one right before discharge. Patients in the experimental group also received 6 follow-up phone calls to enhance their oral exercise. The interventionist called the experimental participants once a week during the first month, and once a month during the second and third month of the study. Patients in the control group did not receive any phone calls. Data on mouth opening, oral function, and symptoms distress were collected before the surgery, one month and three months after discharged. The distance of maximum mouth opening was measured with TheraBite Range-of-Motion scale The oral function and symptoms distress were measured with the study questionnaires, including Restriction of Mouth Opening, Mandibular Function Impairment Questionnaire, Difficulty of Food Intake and EORTC QLQ-H&N 35. Data were analyzed by using SPSS 19 statistic software. The Generalized Estimating Equations (GEE) were used to analyze intervention effects on the maximum mouth opening, oral function (restriction of mouth opening, mandibular function impairment, and difficulty of food intake), and symptoms distress (difficulty swallowing, lingual ability, diet problem, and mouth opening difficulty). The results of GEE showed significant group by time interactions in the maximum mouth opening (Wald X2 = 94.40, p < 0.001), restriction of mouth opening (Wald X2 = 22.75, p < 0.001), mandibular function impairment (Wald X2 = 86.67, p < 0.001), difficulty of food intake (Wald X2 = 44.20, p < 0.001), difficulty swallowing (Wald X2 = 11.25, p = 0.001), lingual ability (Wald X2 = 22.34, p < 0.001), diet problem (Wald X2 = 50.74, p < 0.001), mouth opening difficulty (Wald X2 = 35.92, p < 0.001). Results of the study support that individual patient education combined with telephone follow-ups can improve postoperative mouth opening, oral function, and symptoms distress.

A well formed embouchure and a good tone quality are vital for any flutist. This study is a detailed guide that includes general information, influences and perspectives on/about embouchure and tone for the flutist. Information is provided on how to form a proper embouchure, the relation between embouchure and tone, the purpose of the embouchure and the role of different body parts in a) forming a proper embouchure and b) manipulating the embouchure whilst playing. The anatomy of the human body and its relation to embouchure and tone is discussed. Pictures of the different muscles involved in flute playing, muscles of expression and the anatomy of body parts that influence embouchure and tone, are presented. Flute teachers‟, performers‟ and students‟ perspectives on aspects relating to embouchure and tone, are provided. Diseases, medical conditions, medicine, physical attributes and infections that can influence embouchure and tone are investigated. A discussion of the influences that flute options have on embouchure and tone is included. These options include open- or closed-hole, B or C footjoint, materials, wall thickness, split E or E ring, open- or closed-G#, pads, headjoint design and flute scales. There is also a short discussion about embouchure on big flutes. AFRIKAANS : 'n Goed gevormde embouchure en „n goeie klankkwaliteit is van kardinale belang vir enige fluitspeler. Die studie is „n gedetaileerde gids, en bevat algemene inligting, invloede en perspektiewe op/oor embouchure en klank, vir die fluitspeler. Informasie oor hoe om 'n goeie embouchure te vorm, die verband tussen embouchure en klank, die doel van die embouchure sowel as die rol wat verskillende liggaamsdele speel in a) die vorming van die embouchure en b) die gebruik van die embouchure tydens spel, word voorsien. Die anatomie van die menslike liggaam wat verband hou met embouchure en klank, word bespreek. Prente van verskillende spiere betrokke tydens fluitspel, spiere van ekspressie en die anatomie van die liggaamsdele wat 'n invloed het op embouchure en klank, word voorgestel. Fluit onderwysers, voordraers en studente se perspektiewe rondom aspekte wat verband hou met embouchure en klank, word voorsien. Siektes, mediese toestande, medisyne, fisiese eienskappe en infeksies wat embouchure en klank kan beïnvloed, word ondersoek. 'n Bespreking van die invloede wat fluitopsies op embouchure en klank het, is ingesluit. Hierdie opsies sluit in oop- of geslote-opening, B of C voetstuk, materiale, buis dikte, gesplete E of E ring, oop- of geslote-G#, kussings, kopstuk ontwerp en fluittoonlere. 'n Kort bespreking in verband met embouchure op groot fluite word ook ingesluit.
Dissertation (MMus)--University of Pretoria, 2010.
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