title: Reduced mandibular range of motion in Duchenne Muscular Dystrophy: predictive factors.
abstract: Patients with Duchenne muscular dystrophy (DMD) experience negative effects upon feeding and oral health. We aimed to determine whether the mandibular range of motion in DMD is impaired and to explore predictive factors for the active maximum mouth opening (aMMO). 23 patients with DMD (mean age 16.7 ± 7.7 years) and 23 controls were assessed using a questionnaire about mandibular function and impairments. All participants underwent a clinical examination of the masticatory system, including measurement of mandibular range of motion and variables related to mandibular movements. In all patients, quantitative ultrasound of the digastric muscle and the geniohyoid muscle and the motor function measure (MFM) scale were performed. The patients were divided into early and late ambulatory stage (AS), early non-ambulatory stage (ENAS) and late non-ambulatory stage (LNAS). All mandibular movements were reduced in the patient group (P < 0.001) compared to the controls. Reduction in the aMMO (<40 mm) was found in 26% of the total patient group. LNAS patients had significantly smaller mandibular movements compared to AS and ENAS (P < 0.05). Multiple linear regression analysis for aMMO revealed a positive correlation with the body height and disease progression, with MFM total score as the strongest independent risk factor (R(2) = 0.71). Mandibular movements in DMD are significantly reduced and become more hampered with loss of motor function, including the sitting position, arm function, and neck and head control. We suggest that measurement of the aMMO becomes a part of routine care of patients with DMD.
authors.affiliation: Department of Oral Function and Prosthetic Dentistry, College of Dental Science, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; Department of Oral-Maxillofacial Surgery, Prosthodontics and Special Dental Care, University Medical Center, Utrecht, The Netherlands.
authors.forename: H W
authors.initials: HW
authors.lastname: van Bruggen
authors.forename: L
authors.initials: L
authors.lastname: Van Den Engel-Hoek
authors.forename: M H
authors.initials: MH
authors.lastname: Steenks
authors.forename: E M
authors.initials: EM
authors.lastname: Bronkhorst
authors.forename: N H J
authors.initials: NH
authors.lastname: Creugers
authors.forename: I J M
authors.initials: IJ
authors.lastname: de Groot
authors.forename: S I
authors.initials: SI
authors.lastname: Kalaykova
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D006801:Humans; D016014:Linear Models; D008297:Male; D008334:Mandible / Q000503:physiopathology*; D008410:Masticatory Muscles / Q000503:physiopathology*; D020388:Muscular Dystrophy, Duchenne / Q000503:physiopathology*; D016059:Range of Motion, Articular / Q000502:physiology*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Duchenne muscular dystrophy; mandibular range of motion; masticatory muscles; masticatory system; motor function measure; quantitative ultrasound