关节镜上腔灌洗术治疗中老年颞下颌关节紊乱病的临床研究

目的：评价应用颞下颌关节镜上腔灌洗术治疗临床表现为张口受限合并关节区疼痛的中老年颞颌关节紊乱病患者的临床疗效。方法：对保守治疗无效的16例颞下颌关节紊乱病引起张口受限合并关节疼痛的中老年患者,行颞下颌关节镜上腔灌洗术,分析治疗前后不同时期患者的疼痛值（疼痛直观模拟标尺VAS）、张口度和健侧侧向运动度变化,并通过MRI检测治疗前后关节盘位置的变化。结果：治疗后张口度35mm、健侧侧向运动≥6mm的患者占87．5％（14／16）,不同时期的张口度均较治疗前有显著差异（P〈0．001）,特别在治疗后1个月内增加明显,疼痛亦有显著缓解（P〈0．001）,无并发症的发生。MRI显示,有1例患者的关节盘部分复位。结论：颞下颌关节内窥镜下的上腔灌洗术直视下操作准确,能有效治疗颞下颌关节紊乱病的患者,明显改善张口度和缓解疼痛。颞下颌关节镜治疗技术安全有效,有临床应用价值。     

Counseling and cognitive behavior therapy as a part of integrated treatment for TMJ dysfunction and chronic orofacial pain

Dysfunction of temporomandibular joint (TMJ) and chronic orofacial pain are not separate clinical entities, but keep close relations within them and interchange symptoms. Need of treatment for this picture is higher to requirement, since it is autoperpetuating, it does not cure by itself and grows worse progressively; trends to be chronic. There are risk factors such as cranio-facial skeletal structure, psychosomatic predisposition and emotional load. It is necessary to approach the treatment with a holistic criterium, based on an integral therapeutical diagnosis. Cognitive behavioral therapy and Counseling are very important therapeutical methods of emotional tension and must be part of managerial baggage of the expert professional in these problems.     

Severe retrognathia as a risk factor for recent onset painful TMJ disorders among adult females

OBJECTIVE: To evaluate the importance of severe retrognathia as a risk factor for the development of recent onset painful TMJ disorders among adult females. DESIGN: Case-control study. SETTING: This study was conducted in a large health maintenance organization between 1998 and 1999 [Kaiser Permanente Northwest (KPNW), Portland, OR, USA]. PARTICIPANTS: Adult females with recent onset painful TMJ disorders (n=29) and normal controls (n=104). METHODS: Cases were recruited from the TMD clinic at Kaiser Permanente Northwest (KPNW). Controls were recruited from a dental clinic at KPNW. Case status was determined using a questionnaire; mandibular sagittal position was determined by measuring a research angle on facial photographs. The mean research angle for cases was compared to the mean for controls. Multivariable exact conditional logistic regression analysis was used to examine the demographic characteristics of cases and controls, and to determine the strength of association between recent onset painful TMJ disorders and severe retrognathia. The population attributable risk percentage (PAR%) and the attributable risk percentage (AR%) were calculated to further evaluate severe retrognathia as a risk factor. RESULTS: The mean research angle among cases (67.7 degrees; 95% CI=66.0-69.4) was smaller than among controls (71.6 degrees; 95% CI=70.7-72.5, P<0.001). The odds ratio for the association between case status and the presence or absence of severe retrognathia was elevated (OR=6.3; 95% CI=1.1-47.5, P=0.039). The PAR% and AR%, associated with severe retrognathia, were 13.3 and 84.1%, respectively. CONCLUSIONS: Severe retrognathia is strongly associated with recent onset painful TMJ disorders (OR=6.3). Only a small proportion of these disorders are attributable to severe retrognathia among the total population of adult females (PAR%=13.3%). However, a large proportion of these TMJ disorders are potentially attributable to severe retrognathia among adult females with severe retrognathia (AR%=84.1%).     

Severe retrognathia as a risk factor for recent onset painful TMJ disorders among adult females

Abstract

Objective: To evaluate the importance of severe retrognathia as a risk factor for the development of recent onset painful TMJ disorders among adult females.

Design: Case-control study.

Setting: This study was conducted in a large health maintenance organization between 1998 and 1999 [Kaiser Permanente Northwest (KPNW), Portland, OR, USA].

Participants: Adult females with recent onset painful TMJ disorders (n=29) and normal controls (n=104).

Methods: Cases were recruited from the TMD clinic at Kaiser Permanente Northwest (KPNW). Controls were recruited from a dental clinic at KPNW. Case status was determined using a questionnaire; mandibular sagittal position was determined by measuring a research angle on facial photographs. The mean research angle for cases was compared to the mean for controls. Multivariable exact conditional logistic regression analysis was used to examine the demographic characteristics of cases and controls, and to determine the strength of association between recent onset painful TMJ disorders and severe retrognathia. The population attributable risk percentage (PAR%) and the attributable risk percentage (AR%) were calculated to further evaluate severe retrognathia as a risk factor.

Results: The mean research angle among cases (67.7°; 95% CI=66.0–69.4) was smaller than among controls (71.6°; 95% CI=70.7–72.5, P<0.001). The odds ratio for the association between case status and the presence or absence of severe retrognathia was elevated (OR=6.3; 95% CI=1.1–47.5, P=0.039). The PAR% and AR%, associated with severe retrognathia, were 13.3 and 84.1%, respectively.

Conclusions: Severe retrognathia is strongly associated with recent onset painful TMJ disorders (OR=6.3). Only a small proportion of these disorders are attributable to severe retrognathia among the total population of adult females (PAR%=13.3%). However, a large proportion of these TMJ disorders are potentially attributable to severe retrognathia among adult females with severe retrognathia (AR%=84.1%).     

Low-level laser therapy for management of TMJ osteoarthritis

Aims:

This study investigated the efficacy of low-level laser therapy (LLLT) for the management of temporomandibular joint (TMJ) osteoarthritis.

Methodology:

In a double-blind clinical trial, 20 patients with TMJ osteoarthritis were randomly divided into laser and placebo groups. The patients in the laser group received irradiation from an 810 nm low-level laser (Peak power 80 W, average power 50 mW, 1500 Hz, 1 μs pulse width, 120 seconds, 6 J, 3·4 J/cm² per point), which was applied on four points around the TMJs and on painful muscles three times a week for 4 weeks. In the placebo group, the treatment was the same as that in the laser group, but with laser simulation. The patients were evaluated before laser therapy (T1), after 6 (T2) and 12 (T3) laser applications and 1 month after the last application (T4), and the amount of mouth opening and the pain intensity were recorded.

Results:

No significant differences were found in mouth opening either between the study groups or between the different evaluation times in each group (P>0·05). There was no significant difference in pain symptoms of the masticatory muscles and TMJ between the laser and the placebo groups (P>0·05), but some significant within-group improvements were present for Visual Analogue Scale (VAS) scores of the body of the masseter and TMJ in both groups.

Conclusions:

LLLT using the present laser parameters was no more effective than the placebo treatment for reducing pain and improving mouth opening in patients with TMJ osteoarthritis.     

Physiotherapy in the management of temporomandibular disorders

A bstract :  Physiotherapy is concerned with the relief of pain and the restoration of function in the musculoskeletal system following trauma, disease, and dysfunction. This paper presents a review of the different forms of physiotherapy and their application to temporomandibular problems.