title: Dystrophic changes in masticatory muscles related chewing problems and malocclusions in Duchenne muscular dystrophy.
abstract: Dysphagia in Duchenne muscular dystrophy (DMD) worsens with age, with increasingly effortful mastication. The aims of this study were to describe mastication problems in consecutive stages in a group of patients with DMD and to determine related pathophysiological aspects of masticatory muscle structure, tongue thickness, bite force and dental characteristics. Data from 72 patients with DMD (4.3 to 28.0 years), divided into four clinical stages, were collected in a cross sectional study. Problems with mastication and the need for food adaptations, in combination with increased echogenicity of the masseter muscle, were already found in the early stages of the disease. A high percentage of open bites and cross bites were found, especially in the later stages. Tongue hypertrophy also increased over time. Increased dysfunction, reflected by increasingly abnormal echogenicity, of the masseter muscle and reduced occlusal contacts (anterior and posterior open bites) were mainly responsible for the hampered chewing. In all, this study shows the increasing involvement of various elements of the masticatory system in progressive Duchenne muscular dystrophy. To prevent choking and also nutritional deficiency, early detection of chewing problems by asking about feeding and mastication problems, as well as asking about food adaptations made, is essential and can lead to timely intervention.
authors.affiliation: Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: Lenie.vandenEngel-Hoek@radboudumc.nl.
authors.forename: L
authors.initials: L
authors.lastname: van den Engel-Hoek
authors.affiliation: Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: I J M
authors.initials: IJ
authors.lastname: de Groot
authors.affiliation: Department of Pediatric Neurology, Juliana Children's Hospital/Haga Teaching Hospital, The Hague, The Netherlands.
authors.forename: L T
authors.initials: LT
authors.lastname: Sie
authors.affiliation: Department of Cariology, Endodontology & Pedodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.
authors.forename: H W
authors.initials: HW
authors.lastname: van Bruggen
authors.affiliation: Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: S A F
authors.initials: SA
authors.lastname: de Groot
authors.affiliation: Donders Centre for Neuroscience, Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: C E
authors.initials: CE
authors.lastname: Erasmus
authors.affiliation: Donders Centre for Neuroscience, Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: van Alfen
mesh_terms: D000293:Adolescent; D001732:Bite Force; D002648:Child; D002675:Child, Preschool; D006801:Humans; D008297:Male; D008310:Malocclusion / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D008409:Mastication / Q000502:physiology*; D008410:Masticatory Muscles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D020388:Muscular Dystrophy, Duchenne / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D011795:Surveys and Questionnaires; D014463:Ultrasonography; D055815:Young Adult
keywords: Chewing problems; Duchenne muscular dystrophy; Malocclusion; Masticatory muscles; Tongue hypertrophy