颞下颌开口指数在颞下颌关节紊乱病中的诊断价值

目的 评价颞下颌开口指数(Temporomandibular opening index,TOI)在以开口受限为主要症状的颞下颌关节紊乱病患者中的鉴别诊断价值.方法 收集开口受限患者43例,其中咀嚼肌紊乱疾病患者25例,不可复性盘前移位患者18例.正常对照组30例.临床测量指标包括最大开口度、被动开口度并计算TOI.其中,TOI=(最大主动开口度-被动开口度)/(最大主动开口度 被动开口度)×100%.统计方法采用两组独立样本t检验,年龄和性别用协方差分析.结果 咀嚼肌素乱疾病组TOI为14.62±5.23%,对照组TOI为3.45±1.20%,不可复性盘前移位组为5.55±2.61%.三组组间比较P＜0.05,有显著性差异.年龄、性别没有对观察结果造成显著影响.结论 TOI可以用于咀嚼肌紊乱疾病的鉴别诊断,不受年龄性别的影响,是一种较好的区别肌源性或物理性阻碍开口受限的临床指标.     

Myogenous temporomandibular disorder patients and the temporomandibular opening index

Limited mandibular movement is one of the cardinal signs of temporomandibular disorders, and is usually assessed by measurement of mouth opening. Linear measurement of mouth opening does not discriminate between diagnostic groups and has been shown to be influenced by gender, age and ramus length. A new temporomandibular opening index, however, can differentiate between diagnostic groups and is not influenced by the above variables. When patients with a myogenous temporomandibular disorder were examined, the temporomandibular opening index distinguished two subgroups, the first with values about the lower quartile and the second with values about the upper quartile. A similar identification of two subgroups was seen in electromyographic studies of myogenous temporomandibular disorder patients.     

Radiology of the temporomandibular joint. Diagnostic imaging of the temporomandibular joint

Diagnostic imaging plays an important role in the diagnosis of disorders of the masticatory system. The most frequent disorders are osteoarthrosis and internal derangements. The clinical diagnosis of these disorders may be confirmed by diagnostic imaging. In addition, diagnostic imaging contributes to the staging of the degenerative changes. Techniques for examination of the temporomandibular joint, including conventional (panoramic, transpharyngeal, transcranial) as well as more sophisticated techniques (tomography, fluoroscopy, arthrography, computed tomography, scintigraphy and magnetic resonance imaging) are briefly described. The interpretation of the radiological image of the joint in health and when affected by osteoarthrosis and internal derangement is presented.     

Subconscious temporomandibular dysfunction therapy: A new therapeutic approach for temporomandibular disorders

AIM: To evaluate a new therapeutic approach that may permanently address excessive involuntary muscle activity which causes temporomandibular disorders (TMD). METHODS: A cohort of 69 TMD patients (33 men and 36 women, age range 14-71 years) was treated with Subconscious Temporomandibular Dysfunction (STeDy) therapy. A thick awareness splint assisted patients to gradually recognize the interdependence between psychological pressure and subconscious muscle activity. The STeDy therapy lasted for one year and involved three stages: (1) data collection including medical history, clinical examination and psychological evaluation; (2) application of the awareness splint and consultation on a monthly basis; and (3) final evaluation. RESULTS: About 10% of patients (3 men and 4 women) quit the STeDy therapy within the first 3-6 mo due to severe health problems or psychosocial reasons. Based on the absence of objective and subjective clinical symptoms as well as on radiographic findings, the temporomandibular dysfunction treatment was successful in all remaining 62 patients that completed the year-long therapy. Symptoms, including recurrent headache, morning fatigue, clicking sound or painful temporomandibular joint disorders, were eliminated in all patients within the first six months. By completion of the STeDy therapy, all patients had learned to recognize stressful conditions and cognitively avoided displaying excessive bruxism or other subconscious activity of the stomatognathic muscles. A follow-up after at least one year indicated the permanent nature of the cognitive treatment in all patients, illustrating the fact that subconscious muscle activity due to stress plays a principal role in the great majority of TMD, at least in adults. CONCLUSION: The STeDy therapy successfully and permanently resolved TMD problems of all patients that completed the year-long treatment.     

Occlusion and temporomandibular dysfunction

The role of occlusion in the etiology of temporomandibular disorders is questionable. Therefore, preventive selective grinding is not advised. In the presence of signs and symptoms of overloading of structures of the masticatory system, grinding can be a therapy of choice. This procedure should be preceded by splint therapy in order to test the occlusal changes.     

Orthodontics and temporomandibular disorders

The presumed relationship between occlusal disharmonies and temporomandibular disorders has been the cornerstone of traditional orthodontic thinking about these disorders. Current research, however, indicates that temporomandibular problems are actually medical orthopedic diseases or dysfunctions that have little to do with occlusal morphology or maxillomandibular relationships. Therefore, orthodontists must discard some of their traditional beliefs and practices, replacing them with modern concepts of musculoskeletal pain and dysfunction, in order to provide appropriate care for patients suffering from temporomandibular disorders.     

颞下颌关节紊乱指数临床应用评价

目的 探讨如何采用客观定量的方法评价颞下颌关节功能障碍程度和颞下颌关节紊乱病（temporomandibular disorders,TMD）的治疗效果。方法 分别采用Fricton颞下颌关节紊乱指数和Helkimo临床检查功能障碍指数，定量计算每例患者（共60例）的颞下颌关节紊乱指数，评价不同检查者获得的各项指数的一致性，并应用Fricton颞下颌关节紊乱指数定量评价TMD急性不可复性盘前移位的临床治疗效果。结果 （1）不同检查者获得的各项Fricton紊乱指数值相近；（2）Fricton紊乱指数可明确反映TMD急性不可复性盘前移位治疗后临床功能的改善。结论 评价TMD功能障碍程度或评价TMD治疗效果宜避免使用非客观的、描述性的报告，Fricton紊乱指数是一方便且有效的客观定量指标。     

老年颞下颌关节疾病

颞下颌关节解剖生理和功能的复杂性、颞下颌关节疾病诊断和治疗的复杂性以及老年人生理和病理的特殊性，构成了老年颞下颌关节疾病及其诊治的困难。老年人颞下颌关节、下颌骨以及口颌系统肌肉都会发生增龄性改变，老年人颞下颌关节的各种疾病的发生、发展以及诊治都与年轻人有所不同，本文对此进行介绍。