咀嚼肌疼痛患者的定量感觉功能研究

目的 采用定量感觉测试分析咀嚼肌疼痛患者咬肌区的感觉功能特征。方法 选择初次就诊的单侧咬肌疼痛患者以及健康志愿者各20名,测量双侧咬肌区及患侧手背部的冷感觉阈值（cold detection thresholds,CDT）、热感觉阈值（warm detection thresholds,WDT）、冷痛觉阈值（cold pain thresholds,CPT）、热痛觉阈值（hot pain thresholds,HPT）和压力疼痛阈值（pressure pain threshold,PPT）,采用独立样本t检验进行统计分析。结果 两组受试者手背部的CDT/WDT/CPT/HPT/PPT均无明显差异。两组受试者咬肌区温度感觉阈值CDT及WDT无明显统计学差异。患者双侧温度痛觉阈值HPT及CPT较正常人敏感。患者患侧咬肌区PPT显著低于正常人对应侧（P=0.001）,患者患侧咬肌区PPT低于健侧咬肌区。结论 咀嚼肌疼痛患者对温度痛觉和机械疼痛较为敏感。     

A型肉毒毒素治疗颞下颌关节紊乱病的临床研究

目的 评价A型肉毒毒素局部注射治疗颞下颌关节紊乱病（TMD）的临床疗效。方法 对11例经保守治疗无效的TMD患者，给予局部注射A型肉毒毒素150U，双侧嚼肌各50U，双侧颞肌各25U。分析治疗前后不同时期患 者的最大张口度、疼痛值、口颌功能及局部压值的变化。结果 治疗徨不同时期患者最大张口度、疼痛、口颌功能及局部压均较治疗前有显著改善（P＜0.05）。结论 A型肉毒毒素局部注射治疗TMD，能有效改善患者的张口度，缓解疼痛。     

口颌面痛激光照射与Myomonitor治疗的比较研究

目的：比较激光照射（A法）与Myomonitor（B法）治疗口颌面痛的疗效。方法：TMD疼痛病例70例,分A、B治疗组,分别用A法和B法治疗。疼痛视觉分析指数（VAS）评价疼痛,记录牙尖交错位最大紧咬时双侧颓肌前束（TA）及咬肌（MM）肌电,以咬合膜片记录咬合接触。结果：①治疗后两组VAS值均降低,但B法慢性组显效率较高（P〈0.05）。②A法治疗后急性组TA及MM,B法治疗后急性组TA、MM及慢性组MM电位对称性增高（P〈0．05）。③咬合接触点数仅B法治疗后急性组有所增加（P〈0．05）。结论：激光照射与myomonitor治疗均可缓解TMD疼痛,但对慢性疼痛Myomonitor疗效更明显。TMD疼痛与双侧肌功能不协调有关。     

稳定型咬合板治疗颞下颌关节紊乱病疼痛症状的研究

目的：探讨稳定型咬合板治疗颞下颌关节紊乱病（TMD）疼痛的疗效。方法：TMD疼痛患者61例，急性组28例（男11例，女17例）；慢性组33例（男18例，女15例）。记录治疗前后疼痛指数，双侧颞肌前束（temporal anterior，TA）和咬肌（masseter muscle，MM）牙尖交错位最大紧咬时电位及最大紧咬时咬合接触情况。结果：（1）2组治疗后1月疼痛指数均明显低于治疗前（P〈0．05），治疗前后疼痛强度差值及显效率2组之间无显著差异（P〉0．05）。（2）治疗后无论是急性组还是慢性组TA及MM最大紧咬电位症状侧均较治疗前明显升高（P〈0．05），而非症状侧治疗前后无明显差异（P〉0．05）。（3）治疗后急性组TA和MM肌电不对称指数与治疗前相比均明显降低（P〈0．05）。治疗后肌电不对称指数TA慢性组明显高于急性组（P〈0．05），而MM无明显差异（P〉0．05）。（4）2组治疗前后左、右两侧咬合接触点数、以及咬合接触不对称指数无明显差异（P〉0．05）。结论：稳定型咬合板治疗可以明显缓解TMD疼痛，但对急、慢性疼痛的缓解程度无明显差异。其机制可能与肌功能活动情况易于得到明显改善等生理学基础有关。     

肌电分析在TMD临床疗效评价中的应用

目的:探讨3种不同方法治疗伴有磨牙症TMD的咀嚼肌肌电特征差异,评价3种治疗方法的效果.方法:30例伴有磨牙症的TMD患者被随机分为3组,每组10例.A组进行内毒杆菌毒素A(BTX-A)双侧咬肌肌内注射治疗,B组进行功能训练治疗,C组进行弹性颌垫治疗.对3组研究对象在治疗前、治疗1、3、6个月分别采集双侧咬肌(MM)和颞肌前束(TA)在下颌姿势位(MPP)以及牙尖交错位(ICP)最大紧咬牙时的肌电图(EMG),采用SAS 5.0统计学软件分析比较3组的峰值电位(Amp)之间是否存在统计学差异.结果:横向比较中各个治疗时间段A组患者疼痛视觉模拟评分(VAS)显著低于B组和C组(P＜0.05),肌电显示MPP中A组在治疗过程中能显著降低双侧咬肌肌力(P＜0.05),ICP时A组在1、3个月时显著降低双侧咬肌肌力(P＜0.05),同时双侧颞肌肌力显著增强(P＜0.05).纵向比较中3组在治疗过程中均能明显降低疼痛(P＜0.05),但3组时间点不同,A组缓解疼痛时间较长,肌电图显示3组均可显著降低咬肌MPP肌力(P＜0.05),A、C组可降低ICP咬肌肌力(P＜0.05),A组双侧颞肌肌力可代偿增强(P＜0.05),B、C组颞肌肌力治疗前后均无统计学差异(P＞0.05).结论:临床症状与肌电图的结合使用能够对口颌系统行使功能过程中咀嚼肌的表现进行很好地观测,对TMD患者的咀嚼肌生物力学和结构方面有很好地理解.BTX-A肌内注射方法治疗伴有磨牙症的TMD可显著缓解患者疼痛,疗效持续时间较长.BTX-A肌内注射可显著降低咀嚼肌力,使目标肌肉(咬肌)疲劳得到缓解,促进咀嚼肌力平衡重建,较传统方式存在潜在优势.     

不同性别单侧咀嚼运动后咀嚼肌mfMRI分析

目的：利用肌肉功能磁共振成像（Muscle Functional MRI,mfMRI）定量记录受试者单侧咀嚼口香糖后双侧咬肌、翼内肌、翼外肌的活动,对比不同性别受试者咀嚼肌活动后mfMRI图像T2值变化有无统计学意义。方法：选取16名（男、女各8名）健康志愿者按性别分组,分别在咀嚼口香糖前、单侧持续咀嚼5min后行咀嚼肌区轴位mfMRI扫描,观察双侧咬肌、翼内肌和翼外肌平均质子横向弛豫时间（T2）的变化,利用Image-ProPlus6．0软件测量各咀嚼肌及相应脑脊液平均灰度值,求得咀嚼肌及相应脑脊液平均灰度值的比值,用比值进行两组间及肌肉咀嚼前后t检验,α=0．05。结果：男性组与女性组各组咀嚼肌在咀嚼口香糖前后平均灰度值比值t检验P〉0．05,差异无统计学意义。咀嚼后同侧咬肌的活动最强,其次是同侧翼内肌、对侧翼外肌和对侧咬肌。结论：根据本实验结果证实了同侧咬肌、同侧翼内肌、对侧翼外肌在单侧咀嚼过程中的重要作用,而性别对单侧咀嚼后咀嚼肌T2值变化的影响没有统计学意义。     

稳定型咬()板治疗颞下颌关节紊乱病疼痛的疗效观察

作者应用稳定型咬板治疗302名颞下颌关节紊乱病(TMD)患者(其中207人单侧,95人双侧,总共397例).该疗法对TMD疼痛的总有效率为80.3%,对嚼肌、颞肌、翼外肌疼痛的平均总有效率为86.1%.认为稳定型咬板通过阻断干扰的激惹因素,缓解肌痉挛,从而解除疼痛.它对治疗颞下颌关节紊乱病肌功能紊乱所造成的疼痛具有较好的疗效.     

稳定性咬合板治疗颞下颌关节紊乱病的咀嚼肌肌电图研究

目的：通过对颞下颌关节紊乱病（Temporomandibular disorders,TMD）患者进行稳定性咬合板的可逆性咬合治疗,然后利用肌电图仪测量治疗前后患者的咀嚼肌（TA和MM）的肌电情况,分析探讨用稳定性咬合板对颞下颌关节紊乱病患者咀嚼肌肌电图的影响。方法：选取来我院就诊的10例咀嚼肌功能紊乱患者,在稳定性咬合板治疗前和治疗后3个月时,分别用肌电图仪对其咀嚼肌（TA和MM）进行肌电检查,并通过比较治疗前后的咀嚼肌活动不对称指数情况。结果：戴入稳定性咬合板3个月后,颞肌前束与咬肌的MPP和ICP高电位降低（P〈0.05）;最大紧咬时双侧咀嚼肌总体不对称性指数（Astot）、双侧颞肌不对称性指数（ASTA）和双侧咬肌不对称性指数（ASMM）均降低（P〈0.05）。结论：颞下颌关节紊乱病患者通过稳定性咬合板进行咬合治疗后,使患者双侧咀嚼肌的MPP和ICP高电位较治疗前有明显的降低,最大紧咬时双侧咀嚼肌活动不对称性得到明显的改善。     

单侧有一种症状的TMD患者双侧关节CBCT对比研究

目的：探讨单侧有一种症状的颞下颌关节紊乱病（ TMD）患者双侧颞下颌关节（ TMJ）在CBCT成像上可能存在差异的参考层面。方法：选取仅单侧有症状的TMD患者29例,通过CBCT三维成像和重建,观察两侧TMJ重建后横断面的水平角;平行于髁突长轴的斜位关节间隙、髁突长轴径值、髁突垂直角;垂直于髁突长轴的斜位与矢状位的关节结节斜度、关节窝深度和关节间隙,采用SPSS13．0软件对各测量指标做两样本配对t检验。结果：两侧TMJ在垂直位60°关节间隙时的测量值差异有统计学意义（P＜0．05）,其余测量值均无统计学意义（P＞0．05）。结论：对于单侧有一种症状的TMD患者,接近矢状位是较易观察到左右两侧有差异的位置,并可观察到患侧前间隙增大,在此层面重建对诊断和对比研究更有参考价值。     

稳定型咬板治疗颞下颌关节紊乱病疼痛的疗效观察

作者应用稳定型咬板治疗 30 2名颞下颌关节紊乱病 ( TMD)患者 (其中 2 0 7人单侧 ,95人双侧 ,总共 397例 )。该疗法对 TMD疼痛的总有效率为 80 .3% ,对嚼肌、颞肌、翼外肌疼痛的平均总有效率为 86 .1 %。认为稳定型咬板通过阻断干扰的激惹因素 ,缓解肌痉挛 ,从而解除疼痛。它对治疗颞下颌关节紊乱病肌功能紊乱所造成的疼痛具有较好的疗效     

Clinical significance of T2 mapping MRI for the evaluation of masseter muscle pain in patients with temporomandibular joint disorders

Objectives

Masticatory muscle pain is one of the typical symptoms of temporomandibular joint disorders (TMD). T2 mapping (distribution of T2 values) is a notable MRI technique for evaluating water contents in tissues. We investigated the clinical significance of T2 mapping for the evaluation of masticator muscle conditions by comparing the difference in the T2 values between the painful and pain-free sides of the masseter muscle in patients with TMD.

Methods

Seventy-three patients clinically diagnosed with TMD were enrolled in this study. We divided the patients into two groups: a unilateral pain group (patients with unilateral masseter muscle pain) and a painless group (patients without muscle pain). There were 29 patients in the unilateral pain group and 44 patients in the painless group. We compared the difference in the mean T2 values between the painful and pain-free sides of the masseter muscle in the unilateral pain group and between the right and left sides in the painless group.

Results

The mean T2 values of the masseter muscle on the painful side were significantly higher than those on the pain-free side in the unilateral muscle pain group (p < 0.01). In the painless group, there was no significant difference in the mean T2 values between the right and left sides.

Conclusions

It is suggested that T2 mapping is a promising method for evaluating masseter muscle pain caused by edematous change related to TMD through monitoring of the T2 values.     

Glutamate-evoked jaw muscle pain as a model of persistent myofascial TMD pain?

OBJECTIVE: Compare pain-related measures and psychosocial variables between glutamate-evoked jaw muscle pain in healthy subjects (HS) and patients with persistent myofascial temporomandibular disorder (TMD) pain. DESIGN: Forty-seven female HS and 10 female patients with persistent myofascial TMD pain participated. The HS received an injection of glutamate into the masseter muscle to model persistent myofascial TMD pain. Participants filled out a coping strategies questionnaire (CSQ), the symptom checklist 90 (SCL-90) and McGill pain questionnaire (MPQ). Pain intensity was assessed on an electronic visual analogue scale (VAS). Pain-drawing areas, numerical rating scale (NRS) scores of unpleasantness, pressure pain thresholds (PPTs) and pressure pain tolerance (PPTOL) were measured. Unpaired t-tests and correlation tests were used for analyses. RESULTS: The groups were significantly different when comparing the CSQ scores of control, decrease, diverting attention, increase of behavioural activities and somatization. The peak VAS pain, NRS of unpleasantness and MPQ scores were not significantly different between groups, but PPT and PPTOL were significantly lower in the TMD patients. Significant positive correlations were found in the TMD patients between peak VAS pain and CSQ catastrophizing score and SCL-90 somatization. The scores of PPTs and PPTOLs, in patients showed positive correlations with CSQ reinterpreting pain sensations scores and PPTs correlated with CSQ praying/hoping scores. CONCLUSIONS: Glutamate-evoked pain responses in HS and persistent myofascial TMD pain have similar sensory-discriminative and affective-unpleasantness components but differ in psychosocial features. This study suggests that experimental designs based on glutamate injection into muscle can provide an appropriate model for elucidating persistent myofascial pain conditions.     

The craniocervical connection: a retrospective analysis of 300 whiplash patients with cervical and temporomandibular disorders

Because the concept of whiplash as a causative factor for temporomandibular disorders (TMD) is highly controversial, we decided to do a retrospective analysis of patients treated in our office who had sustained whiplash injuries and were treated for cervical and temporomandibular disorders. The records of 300 patients with TMD preceded by a motor vehicle accident were examined retrospectively. The most common presenting symptoms, in order, were: jaw pain, neck pain, post-traumatic headache, jaw fatigue, and severe temporomandibular joint (TMJ) clicking. The most common TMD diagnoses were: masseter trigger points, closing jaw muscle hyperactivity, TMJ synovitis, opening jaw muscle hyperactivity, and advanced TMJ disk derangement. Based primarily on the physical examination, we concluded that the TMJ and surrounding musculature should be examined similarly to other joints, with no preconceived notion that TMD pathology after whiplash is unlikely.     

Comparison of algometry and palpation in the recognition of temporomandibular disorder pain complaints

AIMS: To determine the construct validity of algometry and to compare it with that of palpation, and to compare tenderness of masticatory muscle sites and the temporomandibular joint (TMJ) on palpation and on algometry. Methods: Two hundred fifty subjects, 148 with temporomandibular disorder (TMD) pain complaints, underwent a standardized blinded physical examination that included pain-intensity measures on palpation and pressure pain threshold measures on algometry of masseter muscle sites, temporalis muscle sites, and the TMJ. Results: Logistic regression analysis indicated that the recognition of TMD pain complaints based on pressure algometry was comparable to that of palpation (R2 = 0.22 and R2 = 0.21, respectively). The masseter muscles were most tender to palpation and algometry, followed by the TMJs and the temporalis muscles. Conclusion: Construct validity of algometry in the recognition of TMD pain complaints is comparable to that of palpation, and differences in tenderness on palpation and on algometry are found between masticatory muscle sites and the TMJ.     

Oral parafunctions and association with symptoms of temporomandibular disorders in Japanese university students

We examined whether oral parafunctions are associated with symptoms of temporomandibular disorders (TMD) in 3557 Japanese university students, aged between 18 and 26 years. Participants completed a questionnaire regarding various oral parafunctions and subjective symptoms related to TMD, and underwent a dental examination. The prevalence of temporomandibular joint (TMJ) noise, TMJ pain and impaired mouth opening was 41.7, 16.0 and 16.3%, respectively. The most prevalent parafunction was sleeping on one side (60.2%), followed by supporting the jaw by leaning on the palm of the hand (44.8%). Mean age, decayed, missing and filled teeth, and number of teeth were not significantly different between TMD positive and negative groups according to unpaired t-test. The chi-squared test revealed that the ratio of females was significantly higher among students with TMD than without TMD. Multiple logistic regression models adjusted for age and gender demonstrated that chewing on one side caused an increased risk of TMJ noise [odds ratio (OR) = 1.52, P < 0.001], TMJ pain (OR = 1.54, P < 0.001), and impaired mouth opening (OR = 2.00, P < 0.001). Tooth clenching also increased the risk of TMJ noise (OR = 1.86, P < 0.001), TMJ pain (OR = 1.79, P = 0.001) and impaired mouth opening (OR = 1.88, P < 0.001). Further prospective cohort studies, including other potential risk factors, are required to clarify these relationships.     

Sonographic elastography for evaluation of masseter muscle hardness

Objectives

The aims were to investigate the relationship between the masseter muscle elasticity index (MEI) ratio obtained by sonographic elastography and the hardness measured by a hardness meter in healthy volunteers, and to clarify the characteristics of the masseter muscle hardness in temporomandibular disorder (TMD) patients with myofascial pain.

Methods

Sonographic elastography images were obtained using a LOGIQ E9 (GE Healthcare), and the MEI ratios were calculated using Elasto Q software. The relationship between the MEI ratio and the masseter muscle hardness measured using a hardness meter was examined in 35 healthy volunteers. The MEI ratio in 8 TMD patients with myofascial pain was compared with that of the healthy volunteers.

Results

The MEI ratio was significantly correlated with the masseter muscle hardness. There was a significant difference between the MEI ratios of the symptomatic and asymptomatic sides in the TMD patients with myofascial pain. The MEI ratio of the symptomatic side in the TMD patients was larger than that on the right side of the healthy volunteers.

Conclusion

Sonographic elastography can be used to express the muscle hardness. It can be selected as a modality for showing the features of muscles with pain.     

Prediction of TMJ arthralgia according to clinical diagnosis and MRI findings

PURPOSE: The aim of this study was to investigate the ability of clinical and magnetic resonance imaging (MRI) diagnoses to predict pain in the temporomandibular joint (TMJ). MATERIALS AND METHODS: One hundred forty-nine patients were examined by 2 calibrated examiners in strict accordance with the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). All patients who presented with a defined clinical RDC/TMD diagnosis were included and underwent bilateral coronal and sagittal MRI of the TMJ. Two raters blinded to the clinical diagnosis interpreted the MRI scans for TMJ pathology. The results were tested against the clinical diagnosis according to the RDC/TMD, including pain-related disability and psychosocial status, for associations to TMJ arthralgia using logistic regression analysis (GENMOD procedure, P < .05). RESULTS: MRI-depicted anatomic changes, such as joint effusions, disc displacement, and osteoarthrosis, were not significantly correlated with the presence of pain in the TMJ. However, a significant relationship between pain on palpation of the masseter muscle origin (P = .0050) and psychosocial factors (P = .0452) and pain in the TMJ was demonstrated. CONCLUSIONS: Pain in the TMJ caused by the anatomic proximity of the muscle masseter origin and the lateral TMJ pole and the possible existence of trigger points in the musculature may lead to a false-positive or a false-negative diagnosis of arthralgia. Additionally, clinicians must consider the psychosocial aspects of pain in ideal treatment planning.     

Palpation and pressure pain threshold: reliability and validity in patients with temporomandibular disorders

This study assessed the interexaminer reliability and validity of palpation (PA) and pressure pain threshold (PPT) of the temporomandibular joint (TMJ) and the masseter and temporalis muscles in patients with temporomandibular disorders (TMD) and asymptomatic controls. Eighty (80) subjects were distributed into two groups: Group 1 consisted of 40 TMD patients with muscular and joint pain selected by RDC/TMD Axis I; and Group 2 (control) with 40 asymptomatic individuals. Training and calibration of examiners was undertaken prior to testing. Mean reliability values were 0.64 and 0.78 (PPT), and 0.59 and 0.75 (PA), for patients and controls, respectively. Results showed statistically significant differences (p<0.001), for PA and PPT among TMD patients compared with the control. The results also showed acceptable specificity values (above 0.90), although sensitivity had low values. The tests had low diagnostic validity to discriminate between patients and controls, with low positive predictive values (PPV).     

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??Objective    To investigate the relationship between the depth of curve of Spee??COS?? and temporomandibular joint disorders??TMD?? in elderly patients. Methods    Eighty-nine elderly patients with TMD visiting the Hospital of Stomatology of China Medical University from January 2013 to June 2013 were recruited in the study by random number table. Muscle pain and temporomandibular joint??TMJ??sounds were examined according to Research Diagnostic Criteria for TMD??and the depth of COS were measured on the dental casts. The mean depth of COS of patients without muscle pain and patients with pain at all levels were compared??and the unilateral depth of COS of patients with and without TMJ sounds were compared. Related data were analyzed statistically with one-way analysis of variance and t-test. Results           The depth of ipsilateral COS of patients with TMJ sounds was significantly smaller than those of patients without TMJ sounds??left??P < 0.001??right??P = 0.008????while the depth of contralateral COS of patients with TMJ sounds had no significant differences with those of patients without TMJ sounds??left??P = 0.481??right??P = 0.905??. In addition??there were no significant differences between the mean depth of COS of patients without muscle pain and patients with pain at all levels??P = 0.327??. Conclusion    TMJ sounds are closely associated with COS??and the depth of ipsilateral COS of patients with TMJ sounds is smaller??and the COS is flatter. There is no significant association between the mean depth of COS and muscle pain.     

Ultrasonographic features of the masseter muscle in female patients with temporomandibular disorder associated with myofascial pain

OBJECTIVE: The purpose of the present study was to examine ultrasonographic appearances in female patients with temporomandibular disorder (TMD) associated with myofascial pain in comparison with healthy volunteers. STUDY DESIGN: The thickness of the masseter muscle in 25 female patients with TMD was measured at rest and at maximum contraction using ultrasonography. The visibility and width of the internal echogenic bands of the masseter muscle were also assessed and the muscle appearance was classified as 1 of 3 types: type I, characterized by the clear visibility of the fine bands; type II, thickening and weakened echo-intensity of the bands; type III, disappearance or reduction in number of the bands. RESULTS: There were significant differences in the thickness at rest and the increase ratio by contraction between the patient and control groups. The distribution of muscle types showed a significant difference between the 2 groups. CONCLUSION: The ultrasonographic features of the masseter muscle in TMD patients with myofascial pain were clarified and they might be related to muscle edema.