Loyola University Chicago Loyola eCommons Master's Theses Theses and Dissertations 1974 Adaptability of Muscles and Hence Hyoid Position Following Forced Distal Repositioning of the Tongue in Open Bite Patients David Manning Gobeille Loyola University Chicago Follow this and additional works at: https://ecommons.luc.edu/luc_theses Part of the Dentistry Commons Recommended Citation Gobeille, David Manning, "Adaptability of Muscles and Hence Hyoid Position Following Forced Distal Repositioning of the Tongue in Open Bite Patients" (1974). Master's Theses. 2754. https://ecommons.luc.edu/luc_theses/2754 This Thesis is brought to you for free and open access by the Theses and Dissertations at Loyola eCommons. It has been accepted for inclusion in Master's Theses by an authorized administrator of Loyola eCommons. For more information, please contact [email protected]. This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License. Copyright © 1974 David Manning Gobeille ( ADAPTABILITY OF rtUSCLES AND HEriCE HYOID POSITION FOLLOVIH1f1 FORCED DISTAL REPOSITIONING OF THE TOiJI1UE IN OPEtl CITE PATIEriTS by David il. Gobeille D.D.S. l\ Thesis Submitted to the Faculty of tile Graduate School of Loyola University in Par·1 ial Fulfillment o-F the Requirements for the D~0ree. of Master of Science June 1974 I • l.ltarr • loyoli Uaitersity Medical Centei. ACK;lOt-ILEOGr !EilTS ~1y sincere appreci.at'i on is ext~nded to a 11 those \·tho have in any way aid~d in making th.is investigation possible,~ I No,ul4 .. lJ,k~. ' . : •: .· '} . ' . • ..' i • .l, .. : t;. to extend pa.rti c..ulpr grati t~"de to the folJ oyti ~9 persons: ',, ,· ,' ' ' . : i . '; ' I wish to extend my gratitude, first and foremost,· to Or. ,1 ~ ! ' ' •: : ' I ·~ ~·; .~ ~ ' ' '; ' Douglas ~ot-nnan, Professor of Physiology, who as.my advisor. offered ,, ·}. '' ; j • 1., ' k • ' '· '; \ l ··.' inyaluable guidance and interest during. the ~o!Jrse of. thi~ inyes.~i~, \.; gation. i' '.•, .. I vto,uld, al~p like to thank the other members ofpw t~.'?Sit board, Or. Josepfl Gowgiel and Dr, nernard Pav1lowski for the.ir i.nterest ' . ' .. l and guidance. , I am e;<tremely grateful to Dr. Gary .Cupzzo \.,hose the~is preceded mine, !lnd Nllose interest in the subject sparked my curiosity · · · · ., ·:: .·!v·.• · · · · . ; . ·. · :r an.d he 1ped deve 1op my design. ! r •. " , .., . ' Appr~ci.atipn isalso extended to L9yola Uniyersity.and Dr~_.., Suriano, ~·1adonia., Hilgers, ~m.d JensenJor making,my graduate ~dy,cation possible. I sinFercly appt~eciate the guidance, support and enco\,Jrag~ment of my parents v;ho have made me what I am. The most profound gratitude I can express qoes to my wife, Carolyn, for having offered the greatest support and encouragement through r.JY last six yeal~s of education and ~Jho has blessed me \'lith t't-10 fantastic sons. I also thank my farlily for beina unrlerstandin9 of my frequent absen~~ due to the ~reat denands 'of my rrofessional life. ,\ I I .. AUTOBIOGRAPHY David t·1anning Gobeille vtas born in San Francisco, California ' : I, • ' ' • ·, · , ,, , , t •f on December' '• ,. 13,•, 1945. He v;as the first of four children, with bro.:thers_, .~cq~t. and Tom, and a sister, Suzanne, vtho is the younges,t ' ' . child .. He .~oye 1d,YJ,i.thhis family to Hih1aukee, Hisconsin, in 1947, ' 1' ' ' !, .. ~ • • • ' • • ' ' and then to Park Ridge, Illinois in 1953. In 1957, his family moved to f·1t. Prospect., I 11 i noi s, vthere he was graduated from Prospect High School in 1964. That same ~ear, he began attendance at r1iami Univer­ sity, Oxford,, Ohio, vthere he graduated with an A.B. degree in 1968. '., ., ' ' . In July of 1968, the author was married to Carolyn Lo!Jise Dudley. In the fall of l968, he began studies atthe University of Illino.is;., College of Dentistry itJflere he recei:ved a B.S. degree in dent4stry in 1970 ·at.d the de§ree of Doctor of Denta·l SLwgery ·in 1972. Qn. AprH''6, 1972, the author•s first son, Hatthe\·1 David, was born. The fo.11otting ' . .July, he began his studies· at the Graduate; School of Orthodontics, Loyola University, School of Dentistry~ and in the Postoraduate program in Oral Biology .. On Febru-ary B, 197·1·, Todd Hilliam, the author•s second s<>n \'tas born~ I I TABLE OF CO:JTEiiTS '. Page · ACKflOHLEDGi1E~JTS :i1f•:;·: AUTOBIOGRAPHY • • • . iii i LIST: OF TABlES .' ' I . ·~ . ~ v I LIST OF ILLUSTR/\TIOi!S . vi i i Chapter I .· l. INTROBtJCTlOM ·• • • • • • 1 I II. REVIEH OF THE LITERATURE • . l I / ~ o J '· '', '"• . '"• ~ " • '\ , ~ ' ' Tongi.fe Thrust lind Open Bite D:=fined ·• ,.;.;,-'+"'1 Description of llyoid Gone, Hyoid f'\tsculature l.. and Tongue flusculature . • ••• 8 Cineflourographic Literature •••• 13 tlyometdc Literature • • • . .•. 20 Svtallovling and Hyoid Cycie . 23· III. r1ATERI/\LS lVlD f1ETI!OOS 30 Selection of Subjects . • . • . • • • 30 Genera 1 Procedures. • • • • • • • • 30 Tongue !)res sure Recording by the f'lyometri c r 1ethod • . • . • 32 ·. Hyoid Position Recorded by Cinefl ourography 33 IV. RESULTS 35 V. DISCUSSIQ:I • . SUi1:1/\RY A;m CO~lCLUSifYI 54 REFERENCES ........ • .. 56 iv•/ LIST OF' fABlES' Ta:ble Av~rage f·1axfmum Tongue l"htust .1\gai nst ;Th1nsdt:ieer 7 During S\\fa ll mli ng as :1.ecorded on the Phys i ograph . ~ ~9 . ; ' ·' . ' .. ; ' .. , l: II. Rest Posi.tion 9f f,lyoid at Tllree)1ea~ut:"ecJ ~et:"iods •. • ,• .. ·:~5 I III. r·1o~t Ante~for-Superio~ Position 1of Hyoid ~t Three Ji · ~leasur.ement Periods • • ..... , ... ,, ~-· •.•• . ' '•, ... ' :~ ' . :'' ' ' ,. ' 46 I' I' • \,t ' I •' ~ ,.. < •: :: • l (. , ! :' : l IV. Sur:l!narited·Cor~~posite of ·Results·.·.·.·.·.·.·. ~ i 'I, !. I ) I I ~ .:J~F::"'' LIST' OF ILLUSTRATIOfiS : Page :·i,; Figure· l. Representativ,e Open !3ite, Tongue Thrust Subject 7 i • ~ ': '•, ''l t" I t 2. Extrinsic and Associated Tongue t-'iusculatu,re . 11 3. Hyoid tiusculature . 12 .I ~ ,. ' 4. Appliance Used to Distally Reposition the Tongue 31 5. Tracings of Subjects and Hyoid Position Before , Placing Appliance and 24 Hours After Placing Appl i a~ce ..." . 40-44 ...< .. ';' I I I~lTRO:JUCTORY REill\r:l(S Jl,:·m ST/\TU1EiH OF Tf!E P~nDLP1 ·; Jhe P4~P9~e of. thi.s study was, tp deterr.1Jf1rr to '.:1!1at, 1 e~tf!ffi the byofd bone ·pnd t!1us .the tonaue re-adapt$ its PO?ition dltring .theJ h.1 ' .., ' . ! . • ' •• ~ ·,, ., •• suall.ovli.ng.. pattern in an, anterior op,en bite, .ton<Jue thr~st patJ~n~ : ' '· ' • . • . '... ',. ', '. ,,j, .:,. ···'~ vthen the. t~~guc .is forc.e.d tp. a neu dista,1, positjon in th~~ 9ral cavity .. ' ' . " ' ' ~ . ' , . ..... ··~ "' ., ' . Th~, tongu~ positi.~n :and adaptabj} ity are Jntimately r~l~'hed to . thehyoid position and adaptabilit,y, duei to the muscular an,p l~aY+~­ tous: atta.dments prov.i ding, a pre9i s ion ba 1ance betv1een these bto anato~:1i ca J structures. If the dimensious of.the oral environplent;.~~fl .. ' . ' . ' ' ~ ~ ... ,,. ''" I . altered.• as vlith orthodontic tlt~rapy, these structures r:n.tst ~tthe,r.:+ .,.. • , o , ~ • , ' ' ' } ,, • I • ' •-f '• ) t .. adapt or da1:~age thems~ lves. and/or the.. surroundi t~9 .$tructures. : i > ' ,: ' , \ > ~ • ; 1' , • \ '' ' Tt·Jo basic an9,lysis,0 tecb1;liques. were .used to, perforn thi. .s. ,,st,ug.y;;r. 0 ~ l ' ' • ·' ,0 C F "• \ ' < ' 0 < \ O O' \ • ,, "·~:1: "'>'~" , ' . Ci ne:ftl ou;ro~waphi c. fjlms ~(~re tak?n, anq r.e0;surene~ts of.. the· ton,gu~~f ' ' ' ' ., .. ' ; . ' .• '. } . ,J "' •. , pressure .\'Jas, recorded by the myometri c method. These propedures ... ~l~r~ .. , :'• • , , , ~ r.. .t • V · ~" '"- done on. the. se lee ted .open bite subjects before and ·immediate ly after 1 placing an applianc;e \·Ihich forced th~ tongue: to. a nore; ctiistalP?pj,tion. These Saffle peasurem~nt;; yere also taken: 24 hours after ~1aci~:9,J/l~, applian~e>- a time vthi.ch,Has deenedapple for r.1uscle adaptaNor1.: 1 I ·/ ' REVIEU OF THE LITERATURE I. Tongue Thrust~and Open Bite Defined: . i All informed authors vtill agree that closing the open bite orthodontically is a clinically significant problem. The difficulty , . ' \ .\ ' .. 1 \ ' -. ·~ seems to r.est }'li.th maintaining the .desired overbite. !1usculature Js ' ; . l ' ~. ' • ·~, . •· \ -· '. • ~ ' ' ' .i ' ' : -~-··. ' :·~. -~. s : ·. t : ) '. ! the main culprit of relaryse in ooen bite cases, consequently, in , • ': ' -~ , ', ;' 1. ; : i I ! , !' ' ; '! ~ \ • • fl!UGh at~entian sriv~n ~o as,tang~: recent years -h,as b_een_ 1ar.eps stfFh, _thrust and the 11 perverted11 ;swal~m·Jing h.f\bi.t, ~·!hich a\e. qupteq,.as oft,_n ~ontributing to.the op~n hite problem. Open bite as related to tOn!:,HJe thrus:t. is .defined by. tp:i S; au~hrir :as pcc!Jrti ng \>then ~he lm·;er ,i nd sors :do not contact .fin¥ opposi-ng_ .s:qft <. · .the •, or' J hard• ' • ,tiss~e~ when• • J ' ' bucca.l• teeth• are• in oc-clusf·on. '; Jann (1960) described the tongue. thrust hab_it- as a neurptJ~s~;tilr synqrone_ t~at ·is largely overloqk:eJL and_ ~nr~cognizeq :in :~he .fie};ds P.f sreech thera;Jy ~ pediatrics·~, and dentistry. Jle postulated' th"t ·pf;1·rverted S\·;all.m·Jin~ ,anp tongue thru~t hp!{its in children. j1a·~c a direct C;fl}tsal relation?l1iP vtJ,th- op~n. bit~: '!:type of maloc~l;us,i.on . .The neur;or.u~SCI4hr dynamJcs .af t,he basic: bi_ologi)cal speech fur1ctions of the .oral ca¥:icy, have much to do with its formation., indicating, the .. need· -to ·e..x~mine 1tq~,n mouth .pn:th dynamically .as \·Jel"l as ,stat;ically·. Fletcher, CastE!e1, and Bradley (19pl) descl"'i bed the dev-i~te S\·Iallm·ring pattern to include t:1ese clinical c:1<:1racteristics: a. extrcnc tension ill the ·~r.ioraL lil-USculature ·, f - I 1 "- i I ! t b. dec~ease in the. !Jalpahl~ ~ont~action of the muscles of mastication during the act of svtallov:ing .., .