※ overview

Temporomandibular joint disorder syndrome? It is one of the common diseases in oral and maxillofacial region. Among temporomandibular joint diseases, this disease is the most common. Common in young adults, the highest prevalence rate is 20 ~ 30 years old.

Diagnosis ※

According to the medical history and the above main symptoms, it is not difficult to diagnose temporomandibular joint disorder syndrome. Commonly used auxiliary diagnosis methods are as follows: ①X-ray plain film (Xue's position of joint and lateral position of condyle through pharynx) can find joint space changes and bone changes, such as sclerosis, bone destruction and hyperplasia, cystic changes and so on. ② Arthrography (superior vena cava angiography is widely used because of its simple operation, while inferior vena cava angiography is seldom used in China) can find the displacement, perforation, attachment changes and cartilage surface changes of articular disc. In recent years, many scholars can find the early changes of this disease through arthroscopy, such as congestion, exudation and adhesion of articular disc and synovium, and "joint rat" formed by undifferentiated mature chondroid tissue. Because there are many kinds of this disease, the treatment methods are different. Therefore, specific types of diagnosis should be performed. Such as lateral pterygoid muscle spasm, reducible disc displacement or disc puncture.

Treatment measures. ※. ※

Specific treatment measures are:

1. Correct the occlusal relationship through dental expert examination.

2. The lateral pterygoid muscle can be blocked with 0.25-0.5% procaine 3 ~ 5ml. The puncture point is at the midpoint of sigmoid notch, and the needle is inserted vertically, with a depth of about 2.5 ~ 3 cm, and the drug is injected when there is no blood in the back suction. Commonly used in patients with big mouth.

3. Chloroethane spray combined with massage can relieve masticatory muscle spasm. When spraying chloroethane, it should be atomized, sprayed intermittently and massaged to prevent frostbite. And pay attention to protect eyes and ears, away from fire.

4. Acupoints: Shimonoseki, Tinggong, Cheek Car, Hegu, Medical Wind and Sun.

5. Ultrashort wave, iontophoresis, electrical stimulation, magnetic therapy and other local physiotherapy have certain effects.

At the same time of treatment, we should correct bad habits (such as unilateral chewing) and prevent excessive mouth opening.

※ etiology

Temporomandibular joint disorder syndrome mostly occurs in young people. Its pathogenesis is not completely clear. The main features of this disease are pain in the joint area, clicking sound during exercise and dyskinesia when opening the mouth. Most of them are joint dysfunction and the prognosis is good. However, in rare cases, organic changes will also occur.

1. Traumatic factors Many patients have a history of local trauma. Such as acute trauma such as external impact, sudden biting of hard objects, excessive mouth opening (such as yawning); There are also habits of chewing hard objects, night grinding and unilateral chewing. These factors may cause joint contusion or strain, and the dysfunction of masticatory muscles also has a certain influence on the occurrence of this disease.

2. Occlusal factors Many patients have obvious occlusion disorder. For example, the cusp is too high, the teeth are excessively worn, the molars are missing too much, the dentures are not good, and the jaw spacing is too low. The disorder of occlusal relationship can destroy the functional balance between the internal structures of joints and promote the occurrence of this disease.

3. Systemic and other factors, neuropsychiatric factors may be related to this disease. For example, some patients are irritable, nervous and easily excited. In addition, some patients have a history of rheumatism, and some are related to colds.

Clinical manifestations ※

The main clinical manifestations of temporomandibular joint disorder syndrome are local soreness or pain, snapping and dyskinesia. The pain site can be in the joint area or around the joint; And may be accompanied by tenderness to varying degrees. Joint pain or pain is especially obvious when chewing and opening your mouth. When you open your mouth, snap your fingers. Sound can appear in different stages of mandibular movement, which can be crisp single tone or intermittent continuous tone. The common dyskinesia is limited mouth opening, but it may also occur that the mouth is too big or the jaw is deviated when the mouth is opened. In addition, it may be accompanied by symptoms such as temple pain, dizziness and tinnitus.

Differential diagnosis ※

Because many other diseases often have the above three main symptoms, they must be differentiated from the following diseases:

1. Tumor

Deep tumors in maxillofacial region can also cause difficulty in opening mouth or closing teeth, because the tumors are not easy to be found in the deep, misdiagnosed as temporomandibular joint disorder syndrome, and even given inappropriate treatment, which misses the opportunity of early radical treatment of the tumors. Therefore, when it is difficult to open your mouth, especially when accompanied by symptoms of cranial nerve dysplasia or other symptoms, we should consider whether there are tumors in the following parts: ① benign or malignant tumors of temporomandibular joint, especially chondrosarcoma of condyle. ② Subtemporal fossa tumor. ③ pterygopalatine fossa tumor. ④ Posterior wall carcinoma of maxillary sinus. ⑤ Malignant tumor of parotid gland. 6 nasopharyngeal carcinoma, etc.

2. Temporomandibular arthritis

① Acute suppurative arthritis of temporomandibular joint, the joint area is red and swollen, and the tenderness is obvious, especially not up and down. A little force can cause severe pain in the joint area. ② Rheumatoid arthritis of temporomandibular joint is often accompanied by systemic wandering and polyarthritis, especially in the small joints of limbs, and joint stiffness may occur in the later stage.

3. Otogenic diseases

Furuncle and otitis media of the external auditory canal also often radiate pain to the joint area, affecting opening and chewing. It is not difficult to distinguish them through careful otological examination.

4. Cervical spondylosis

It can cause pain in neck, shoulder, back, behind ear area and facial side, and it is easy to be misdiagnosed. But pain has nothing to do with opening and chewing, and is often related to neck movement and posture. Some people may have hand infections and abnormal movements. X-ray film is helpful to diagnose whether there is any bone change in cervical spine, so as to distinguish it.

5. Stem disease

In addition to pharyngeal pain and abnormal sensation when swallowing, it can often cause pain in the posterior condyle area and pain in the posterior joint area, behind the ear area and neck when chewing. X-rays are easy to diagnose.

6. Hysterical trismus

Hysterical fisting is easier to diagnose if it is accompanied by spasms or convulsions of other muscles in the whole body. This disease mostly occurs in young women, with a history of hysteria in the past and unique personality characteristics. Generally, there are mental factors at the onset, and then suddenly it is difficult to open your mouth or grit your teeth. Language suggestion or indirect suggestion (combining other treatments with language suggestion) is usually effective for this disease.

7. Ankylosing trismus.

Tetanus is an acute specific infection caused by tetanus Bacillus, which is characterized by paroxysmal muscle spasm and tonic contraction. Because the initial symptoms can be manifested as difficulty in opening mouth or closed teeth, it should be differentiated from temporomandibular joint disorder syndrome to avoid delaying the opportunity of early treatment. Closed jaw tetanus generally has a history of trauma. Spasms usually begin with the masticatory muscles. First, the masticatory muscles are a little nervous, that is, the patient feels that his mouth is limited; Then there is tonic spasm and teeth are closed; At the same time, facial expression is special because of the contraction of facial muscles, forming a "wry smile" face and may be accompanied by facial muscle twitching.