Ferrante A.1, Ferrante Al.2, Ferrante C.3
1Centro Terapia Miofunzionale, Italy.
2,3Casa di cura Hermitage Capodimonte, Italy.
Abstract
Purpose of the Study: To evaluate the importance of stimulating the naso-palatine receptors as controllers of physiological muscle tone and the potential effect of their stimulation on improving postural problems.
Methods: Blood tests were used to measure serotonin metabolites in urine, tools for assessing muscle tone (electromyograph), scoliosometer, and baro-podometric platform for postural evaluation. Fluorescein was used, according to the Payne technique, to assess swallowing.
Results: Stimulation of the naso-palatine trigeminal receptors showed improvement in the conducted tests, rebalancing of muscle tone, and a decrease in hypertonia, unlike tongue positioning in contact with other areas of the mouth, which did not show clear and appreciable changes.
Conclusion: Stimulation of the naso-palatine receptors has been shown to be the physiological mechanism for controlling general muscle tone. Lack of stimulation leads to an increase in muscle tone.
Keywords: Muscle Tone, Swallowing, Trigeminal, Naso-Palatine Receptors, Scoliosis.
Purpose Of The Study
In my research across various internet libraries seeking information on muscle tone control, I realized that there are publications on tone measurement (1), others evaluating the effects of various substances on tone variations (2, 3, 4), many studies on substances naturally secreted by the brain, as well as pharmacological substitutes regulating central tone (5, 6, 7). Studies on the relationship with posture and gait movement were found (8, 9). The only studies that we found interesting because they align with our view of the problem are those focused on the study of the effects of serotonin and norepinephrine at the hypoglossal nucleus (10, 11). We found nothing, and I believe that little or nothing has been written about the neurological control mechanism of general muscle tone in healthy individuals in everyday life. This led to the idea of sharing what we consistently observe daily in our work, which could aid in explaining the pathogenesis of some common bodily ailments and the targeted choice of their causal treatment. It all began with a study conducted to explain the postural improvements obtained “involuntarily” during the rehabilitation of lingual function in patients with impaired swallowing mechanisms.
A brief explanation is needed for those who are not fully aware of the swallowing mechanisms. The tongue is the first active organ in the human body (it is functional from the 51st day of pregnancy), and it is the only one related to six cranial nerves. It has a representation in the cerebral cortex far superior to any other organ, composed of eight pairs of muscles with specific functions in both speech and swallowing.
*Corresponding Author: Antonio Ferrante, Centro Terapia Miofunzionale, Italy.
International Journal of Research in Medical and Clinical Science
Volume 1, Issue 2, 2023, PP: 53-57
www.journalserapublications.com
Research Article
The Physiological Control of Muscle Tone: The Effects of Naso-Palatine Stimulation
Ferrante A.1, Ferrante Al.2, Ferrante C.3
1Centro Terapia Miofunzionale, Italy.
2,3Casa di cura Hermitage Capodimonte, Italy.
Abstract
Purpose of the Study: To evaluate the importance of stimulating the naso-palatine receptors as controllers of physiological muscle tone and the potential effect of their stimulation on improving postural problems.
Methods: Blood tests were used to measure serotonin metabolites in urine, tools for assessing muscle tone (electromyograph), scoliosometer, and baro-podometric platform for postural evaluation. Fluorescein was used, according to the Payne technique, to assess swallowing.
Results: Stimulation of the naso-palatine trigeminal receptors showed improvement in the conducted tests, rebalancing of muscle tone, and a decrease in hypertonia, unlike tongue positioning in contact with other areas of the mouth, which did not show clear and appreciable changes.
Conclusion: Stimulation of the naso-palatine receptors has been shown to be the physiological mechanism for controlling general muscle tone. Lack of stimulation leads to an increase in muscle tone.
Keywords: Muscle Tone, Swallowing, Trigeminal, Naso-Palatine Receptors, Scoliosis.
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It is necessary for the body’s development that its function is perfect. Unfortunately, many factors can affect its mobility: anatomical factors (short frenulum, ankylosed tongue), functional factors (issues related to birth and, especially, artificial feeding methods). In normal swallowing, a newborn learns to swallow after an initial fetal phase in which it begins to move, sucking milk from the mother’s nipple. During this movement, the nipple is compressed and squeezed against the palate to stimulate milk ejection. The point of contact of the nipple with the palate is right at the emergence of the naso-palatine nerve. Agglomerates of all exteroceptors related to postural control function were found at this point, present diffusely on the soles of the feet and, instead, gathered in an area of about ½ cm2 (12). Artificial feeding and the use of pacifiers (necessary to stimulate palatine receptors once the tongue becomes ineffective) increasingly keep the tongue away from the palate and, by reducing the activity of elevator muscles, make it unable to stimulate palatine receptors. In re-educating swallowing, the lingual musculature is tonified in a balanced way (requiring 3 to 4 months), restoring tone to the elevator muscles. In a second phase, the correct swallowing movement is taught, and in the final phase, the new swallowing engram is consolidated. It was incredible for us that many patients who came to our attention for orthodontic reasons, where orofacial muscle imbalance was considered the primary cause of orthodontic damage, unexpectedly improved their postural attitudes and scoliotic curves, if present, within a few months, by practicing only lingual re-education exercises. The idea that the change could be attributed to changes in the tone of paravertebral muscles was clear to me, as I teach in posturology master’s programs, but I come from a dental background. My lack of specific knowledge led me to involve a physiatrist specialist and delve into the issue with a completely fresh perspective, without biases from past knowledge, often unconfirmed by science. The use of laboratory tests as a means to quantify the damage came from a study I conducted to verify the reliability of surface electromyography in measuring muscle tone. I found papers by Machida and others (13, 14, 15, 16), which explained idiopathic scoliosis with a deficiency of serotonin and melatonin. Receptors for these neurotransmitters were found along the entire spinal column, and 5-hydroxyindoleacetic acid, a serotonin metabolite, was found to be low, explaining the tone alterations and muscle imbalance. This observation indirectly suggested that the improvements observed in our patients could probably be attributed to improved serotonin and melatonin production. We then conducted theses (17, 18) at the Posturology master’s program at Sapienza University of Rome to understand if the re-education of swallowing function with the restoration of tongue contact with naso-palatine receptors could increase serotonin production. The results were very encouraging. Three months of placing the tongue apex in contact with palatine receptors for 3 minutes three times a day were able to normalize urinary 5-hydroxyindoleacetic acid values in approximately 70% of the subjects tested, along with postural improvements (19). We also conducted research on a new interpretation of fibromyalgia, considered the result of persistent hypertonicity leading to muscle fiber alterations but accompanied by symptoms unexplainable with previous knowledge (20). At this point, we wanted to understand if all improvements could be attributed to the effects of neurotransmitter production and whether there was an instant effect on the cerebellum, whose paramedian parts receive indirect trigeminal innervation of a reflex nature, due to the central response to naso-palatine receptor stimulation. For this purpose, we conducted tests on the scoliosometer with the tongue in its usual position and then in contact with the receptors (in myofunctional therapy, this point is defined as the “Spot”) (scoliosometer figure). We then tested a group of 10 healthy subjects with incorrect swallowing, no short frenulum, no orthodontic problems treated in any way, aged between 14 and 35 years. Another group of similar subjects in terms of age and dysfunction served as a control group.
Methods
The tools used in the research were as follows:
• For Serotonin Measurement : Control of 24-hour urine 5-hydroxyindoleacetic acid excretion
• For Evaluating Lingual Movement During Swallowing : 1% fluorescein was used, placed at the tongue apex and at two lateral points in the middle part of the tongue (19). The points of contact between the tongue and various oral areas were highlighted using a Wood lamp that causes fluorescein to fluoresce, making the points where the tongue made contact with the oral areas visible.
• For Postural Evaluation: Scoliosometer, also known as a postural analyzer, was used to highlight changes
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produced by the correct positioning of the tongue on both the frontal and sagittal axes, along with a baro-stabilometric platform called Diagnostic Support.
• For Muscle Evaluation: Surface electromyograph K7 Myotronics
Results
Serotonin Level Examination The examination showed increases in 5-hydroxyindoleacetic acid levels in urine in both males and females, with small variations related to gender. This increase was particularly evident in patients who initially had low values. Improvement was observed in approximately 70% of the subjects, with the most significant result occurring in a female who saw her value increase from 56 micrograms/24 hours to 153 micrograms/24 hours.
Baropodometry
The results obtained from measuring plantar support using a baro-podometric platform are undoubtedly very interesting and conclusive. A sample of ten patients aged between 14 and 35 years was assessed in a static position, first with the tongue in its usual position and then with the tongue positioned at the palatine spot. Another sample of ten patients within the same age range was evaluated simultaneously in a static position with the tongue in its usual position. However, being a control group, they repeated the examination with the tongue not against the Spot but against the lower incisors. In this group, only one person had correct swallowing, and we indeed found deterioration in all parameters.
The parameters considered were
• The ratio of support on the hindfoot to support on the forefoot
• The ratio of support on the right foot to support on the left foot
Results for the Work group (tongue at the spot)
1. Hindfoot/forefoot ratio
Improvement in 10 out of 10 subjects
2. Load distribution ratio between the right foot and left foot
Improvement in 8 out of 10 subjects No improvement in 2 out of 10 subjects
Results for the Control Group (tongue against lower incisors)
1. Hindfoot/forefoot ratio
Improvement in 3 out of 10 subjects. No improvement in 2 out of 10 subjects. Deterioration in 5 out of 10 subjects.
2. Right foot/left foot support ratio
Improvement in 3 out of 10 subjects. No improvement in 2 out of 10 subjects. Deterioration in 4 out of 10 subjects
Electromyography
Through the use of surface electromyography, the resting activity of certain head and trunk muscles and the changes undergone as a result of repositioning the tongue at the palatine spot were evaluated. Subsequently, the same examination was performed on a control group, assessing muscle activity at rest and positioning the tongue against the lower incisors. Four pairs of muscles were assessed: the masseters, sternocleidomastoids, trapezii, and paraspinal muscles at the level of the third lumbar vertebra. Recordings were made with patients in a seated position, without them being informed about the expected outcome of the examination.
Figure 1. Electromyography with the Tongue in the usual position (away from the palate)
Figure 2. Electromyography with Tongue in contact with palatal receptors
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Reference values and standard deviations for each muscle, defining the degree of activity, will be reported later:
Muscle Reference
Standard Deviation Masseter 1.87 microVolts 1.46
Sternocleidomastoideo 1.98 microVolts 1.75
Trapezi 2.78 microVolts 3.03
Paraspinal L3 1.41 microVolts 1.62
All ten subjects in the active study group presented an improvement and rebalancing of muscle tone, as evidenced by a reduction in values measured during the test with the tongue in its usual position, when it was placed at the palatine spot (Fig 1, 2). The ontrol group subjects showed variable values, with no clear improvement.
Conclusion
The results of the research, consistent with what we have observed daily in our patients over the past thirty years, lead us to affirm that tongue stimulation of the naso-palatine receptors in a resting state and, even more so, during the act of swallowing, represents a natural and physiological means of rebalancing the body’s muscle tone.
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Cite this article: Ferrante A., Ferrante Al., Ferrante C. The Physiological Control of Muscle Tone: The Effects of Naso-Palatine Stimulation. International Journal of Research in Medical and Clinical Sciences. 2023;1(2): 53-57.
Copyright: © 2023. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
