毫米波穴位辐射治疗颞下颌关节紊乱病疗效初探

颞下颌关节紊乱病即颞下颌关节紊乱综合征 ,1997年 10月全国第二届颞下颌关节紊乱综合征专题研讨会将该病统一命名为颞下颌关节紊乱病[1] 。我院采用毫米波穴位辐射方法 ,治疗颞下颌关节紊乱病 3 8例 ,现报告如下。我科收治颞下颌关节紊乱病患者 5 4例 ,已排除颞下颌关节器质性病变。随机分为两组 ,治疗组 3 8例 ,男 12例 ,女 2 6例 ;年龄 16～ 70岁 ,病程 1ｄ～ 1个月 ;对照组 16例 ,男 6例 ,女10例 ;年龄 18～ 70岁。治疗组采用长春产ＨＢＬ Ⅲ型毫米波治疗仪穴位辐射 ,该型毫米波治疗仪配有 2个辐射探头。患者侧卧位 ,患侧向上 ,分别将…     

内窥镜手术治疗颞下颌关节紊乱病的临床研究

目的评价关节内窥镜手术治疗颞下颌关节紊乱病的临床效果.方法应用关节内窥镜通过镜下各种微型手术器械,内窥镜直视下手术,通过灌洗、粘连松解、清扫等方法去除关节腔内各种病变和关节盘复位术,治疗113例(132侧关节)颞下颌关节紊乱病.结果随访6～84个月,随访期内,张口度增加0～16mm,平均9.6mm(P＜0.001),健侧侧向运动度增加2.5～7.8mm,平均4.8mm(P＜0.01);术后91.4%的患者疼痛缓解,疼痛缓解程度1.5～5.0,平均3.6(P＜0.001).62.5%的患者弹响消失.总的疗效评定为优良50例(44.2%),改善52例(46.0%),无效11例(9.7%),总有效率为90.3%(102/113).术后无严重并发症发生.结论内窥镜手术治疗颞下颌关节紊乱病是一种有效的方法.     

弱激光治疗颞下颌关节紊乱病的疗效观察

目的探讨弱激光治疗颞下颌关节紊乱病的临床应用和效果。方法对198例颞下颌关节紊乱病的患者进行弱激光局部照射,分析治疗效果。结果弱激光对各类型颞下颌关节紊乱病所致的关节或肌肉区疼痛皆有疗效。经1～3个疗程治疗,痊愈123例,有效31例,好转25例,无效19例,显效率为77.8%。咀嚼肌功能紊乱型(Ⅰ型)的显效率(91.5%)高于关节结构紊乱型(Ⅱ型)(75.0%)和关节器质性改变型(15.0%)(P均<0.05)。结论弱激光是一种简单有效、经济实用的治疗颞下颌关节紊乱病的方法。     

微波治疗颞下颌关节紊乱病疗效分析

目的:观察微波治疗颞下颌关节紊乱痛的临床疗效.方法:将67例颞下颌关节紊乱病患者随机分为2组,治疗组(40例)应用微波治疗,对照组(27例)应用中药局部湿热敷治疗,于治疗后3,6,12个月随访观察其疗效.结果:治疗组有效率分别达87.50%,84.21%,77.14%,疗效优于对照组(55.56%,40.00%,34.78%)(P<0.01).结论:微波治疗颞下颌关节紊乱病疗效明显.     

温针灸配合推拿治疗颞下颌关节紊乱病疗效观察

目的:观察温针灸配合推拿治疗颞下颌关节紊乱病的临床疗效。方法:将67例患者随机分为2组,治疗组35例采用温针灸配合推拿治疗,每日1次,10次为1个疗程;对照组32例用20m l普鲁卡因局部封闭,并配合周林频谱治疗仪治疗,隔日1次,10次为1个疗程。2组均2个疗程统计疗效。结果:治疗组治愈率与有效率明显优于对照组,2组间比较均有统计学意义(P<0.01或0.05)。结论:温针灸配合推拿治疗颞下颌关节紊乱病疗效优于西药局封与周林频谱治疗仪的疗效。     

综合疗法治疗颞下颌关节紊乱病85例

目的探讨综合疗法治疗颞下颌关节紊乱病的临床疗效。方法对山东省桓台县人民医院2006年至2010年收治的85例非器质性病变型颞下颌关节紊乱病患者进行综合治疗,具体包括药物治疗、局部微波治疗、针刺治疗,并对其疗效进行观察和分析。结果治疗10 d后评定疗效,痊愈69例,占81.18%;显效10例,占11.76%;好转5例,占5.88%;无效1例,占1.18%。总有效率为98.82%。结论综合疗法治疗颞下颌关节紊乱病安全简便,疗效显著,有较高的实用价值,不失为治疗颞下颌关节紊乱病的一种有效方法。     

高压电穴位刺激配合超短波治疗颞下颌关节紊乱病疗效观察

我科采用高压电穴位刺激配合超短波治疗颞下颌关节紊乱病(temporomandibular join tdisorder，TMJD)患者45例，疗效较好，现报道如下。     

局部封闭治疗颞下颌关节紊乱病

采用局部封闭疗法对36例患颞下颌关节紊乱病的患者进行治疗,治愈率为67%,总有效率为89%,说明局部封闭疗法治疗颞下颌关节紊乱病具有很好的疗效。     

冲击波疗法治疗颞下颌关节紊乱病的疗效观察

目的 观察冲击波疗法结合康复训练治疗颞下颌关节功能紊乱的临床效果。 方法 60例颞下颌关节功能紊乱病患者分成治疗组和对照组,每组30例,治疗组给予冲击波治疗+常规康复训练,对照组给予常规康复训练。治疗2周后,应用颞下颌关节功能评价（Friction指数法）分别评定两组患者治疗前后颞下颌功能状况,目测类比法（VAS）疼痛评分评价疼痛程度,SF-36量表评估生活质量。 结果 治疗2周后,两组颞下颌关节功能评价和VAS疼痛评分均较治疗前明显下降（P<0.05）,治疗组患者的下颌运动分、关节弹响、关节触压痛、肌肉触压诊分、肌肉触压痛指数、功能障碍指数及颞下颌关节紊乱指数明显低于对照组（P<0.05）。VAS疼痛评分治疗组与对照组相比差异有统计学意义（P<0.05）。SF-36量表中社会功能治疗组较对照组相比差异有统计学意义（P<0.05）。 结论 冲击波疗法结合常规康复治疗可明显改善颞下颌关节紊乱病的功能障碍。     

延续性护理对颞下颌关节紊乱病患者健康管理依从性及知识知晓程度的效果

目的 观察延续性护理对颞下颌关节紊乱病患者健康管理依从性及知识知晓程度的效果。方法 选择2021年1月至2022年12月就治于南京医科大学附属口腔医院的颞下颌关节紊乱病患者100例为观察样本,2021年1月至12月的50例患者设为对照组,2022年1月至12月的50例患者设为观察组。遵循颞下颌关节紊乱病咬合板治疗,给予对照组患者常规护理;于此基础之上给予观察组患者延续性护理。对干预后的两组患者各项观察指标进行比较。结果 观察组患者疾病不确定感评分低于对照组,健康管理知识知晓度评分、健康管理依从性评分高于对照组,疼痛评分低于对照组,张口度高于对照组（P＜0.05）。结论 对于颞下颌关节紊乱病患者给予延续性护理,有利于其疾病不确定感的减低、健康管理知识知晓度与依从性的提升、疼痛度的减低与张口度的增大。     

Differential brain activity in subjects with painful trigeminal neuropathy and painful temporomandibular disorder

Human brain imaging investigations have revealed that acute pain is associated with coactivation of numerous brain regions, including the thalamus, somatosensory, insular, and cingulate cortices. Surprisingly, a similar set of brain structures is not activated in all chronic pain conditions, particularly chronic neuropathic pain, which is associated with almost exclusively decreased thalamic activity. These inconsistencies may reflect technical issues or fundamental differences in the processing of acute compared with chronic pain. The appreciation of any differences is important because better treatment development will depend on understanding the underlying mechanisms of different forms of pain. In this investigation, we used quantitative arterial spin labeling to compare and contrast regional cerebral blood flow (CBF) patterns in individuals with chronic neuropathic orofacial pain (painful trigeminal neuropathy) and chronic nonneuropathic orofacial pain (painful temporomandibular disorder). Neuropathic pain was associated with CBF decreases in a number of regions, including the thalamus and primary somatosensory and cerebellar cortices. In contrast, chronic nonneuropathic pain was associated with significant CBF increases in regions commonly associated with higher-order cognitive and emotional functions, such as the anterior cingulate and dorsolateral prefrontal cortices and the precuneus. Furthermore, in subjects with nonneuropathic pain, blood flow increased in motor-related regions as well as within the spinal trigeminal nucleus.     

Neurological influences of the temporomandibular joint

This study reviews recent advances in temporomandibular joint (TMJ) or masticatory system related neurology, and suggests the TMJ as a neurological window and lever.The TMJ is integrated with the brainstem centers via the sensorimotor system, including the body balance and coordination control systems. A dysfunctioning TMJ may reflect not only local problems, but also the underlying remote or systemic problems. Neurological examination, including balance testing, for example, may reveal the contributing imbalances and provide an additional evaluation of the appropriateness of TMJ therapeutics being attempted.Repetitive or tonic sensory stimulations involving the TMJ may be related to therapeutic interventions, contributing to neural plasticity, which may be adopted as a therapeutic approach in treatment of neurological disorders, including dystonia and movement disorders.TMJ related therapeutics, such as use of an occlusal splint, cranial manipulation, muscle/myofascial therapy, and acupuncture, ideally need to be practiced along with neurological monitoring, to ensure neurologically desirable effects.     

应用上颌全牙弓牙合垫治疗颞下颌关节紊乱病的效果分析

目的观察应用上颌全牙弓牙合垫治疗颞下颌关节紊乱病的临床效果。方法选取2011年1月至2012年1月颞下颌关节紊乱病患者94例,随机分成两组,治疗组和对照组各47例。治疗组利用上颌全牙弓牙合垫进行治疗,对照组只给予药物治疗,定期检查两组治疗前后的咀嚼肌疼痛、关节弹响以及张口度的变化情况。结果经过5~10个月的治疗,治疗组29例痊愈,16例症状减轻,总有效率95.74%,与对照组80.85%比较,具有显著性差异(P0.05)。结论应用上颌全牙弓牙合垫治疗颞下颌关节紊乱病疗效显著。     

Myofascial pain in temporomandibular disorders: Updates on etiopathogenesis and management

ObjectivesTemporomandibular disorders (TMDs) are an umbrella term encompassing disorders of both the temporomandibular joint (TMJD) and masticatory musculature (MMD). The objective of this review is to provide an overview of the etiopathogenesis, clinical features and diagnosis of MMD, and to summarize the current trends in the therapeutic management.MethodsA review of the literature was performed from 1985 to 2020. The keywords included were “temporomandibular disorders OR temporomandibular joint disorders” AND “myofascial pain OR masticatory myofascial pain OR trigger point”. A total of 983 articles were screened with abstracts and approximately 500 full text articles were included in the review based on their relevance to the topic.ResultsMMD's present significant challenges in diagnosis and treatment. Effective treatment requires a clear diagnosis based on an understanding of pathophysiologic mechanisms, a detailed history with assessment of predisposing local and systemic factors, perpetuating factors, a comprehensive clinical evaluation and a diagnostic workup.ConclusionA thorough history and clinical examination are the gold standards for diagnosis of MMD. Serological testing may help identify underlying co-morbidities. Recent diagnostic modalities including ultrasound sonoelastography and magnetic resonance elastography (MRE) have shown promising results. The treatment goals for MMD are to control pain, restore mandibular function and facilitate the return to normal daily activity and improve the overall quality of life of a patient. Conservative modalities including home care regimens, pharmacotherapy, intraoral appliance therapy, local anesthetic trigger point injections, physiotherapy and complementary modalities may be beneficial in patients with MMD's.     

Evaluation of integral electromyographic values and median power frequency values in women with myogenous temporomandibular disorder and asymptomatic controls

Background

Surface electromyography (EMG) has been used as a reliable tool for the evaluation of electrical muscle activity.

Short-term efficacy of exercise therapy for temporomandibular disorders: a case control study

[Purpose] This study compared the short-term outcomes of manual therapy performed by a dentist and home exercises performed by patients as a single exercise therapy program for temporomandibular joint anterior disc displacement without reduction. [Participants and Methods] In this study we included seventeen patients with temporomandibular joint anterior disc displacement without reduction, moderate or greater temporomandibular joint functional impairment, and no treatment interventions. Patients receiving treatment underwent exercise therapy at the time of their first visit, whereas those in the non-treatment group received only an explanation of the condition. We evaluated the clinical symptoms (maximum painless opening distance, pain on motion and mastication, and degree of difficulty in daily life) at the first visit and at the two-week follow-up visit. [Results] For both groups, maximum painless opening distance and degree of difficulty in daily life improved significantly. For the treatment group, the pain on motion and mastication values significantly improved throughout the assessment period. [Conclusion] An exercise therapy program may be useful for the early treatment of temporomandibular joint anterior disc displacement without disc reduction.     

Naturalistic changes in insomnia symptoms and pain in temporomandibular joint disorder: A cross-lagged panel analysis

An increasing number of prospective studies suggest a bi-directional association between the pain and sleep quality. Few of these investigations have controlled for synchronous correlations, an important source of extraneous variance in lagged associations, which may have confounded conclusions of prior investigations. Despite high rates of insomnia in temporomandibular joint disorders (TMD), no studies have examined temporal associations between naturalistic fluctuations in insomnia and pain in TMD. We conducted cross-lagged panel analysis to examine reciprocal temporal associations between 1-month changes in insomnia symptom severity and self-reported pain over 3 months among 53 TMD patients. This rigorous analytic strategy represents a comprehensive method to explore possible reciprocal temporal associations between insomnia and pain that controls for both auto- and synchronous correlations. Analyses revealed that initial-month increases in insomnia were associated with next-month increases in average daily pain, but not vice versa. The direction of the effect was such that initial-month increases in insomnia symptom severity were associated with next-month increases in average daily pain. These data suggest that naturally occurring fluctuations in insomnia symptom severity are prospectively associated with fluctuations in daily pain experience for persons with TMD. Potential mechanisms by which insomnia might influence pain in TMD and therapeutic implications of these findings are discussed.     

Evidence for indirect effects of pain catastrophizing on clinical pain among myofascial temporomandibular disorder participants: the mediating role of sleep disturbance

Sleep disturbance and pain catastrophizing are important mediators of the chronic pain experience. To date, these factors have not been considered concurrently despite compelling theoretical rationale to do so. In the present study, we examined whether pain catastrophizing not only has direct effects on clinical pain and pain-related interference, but also indirect effects through its association with sleep disturbance. We evaluated this hypothesis using a cohort (n=214) of myofascial temporomandibular disorder participants using a statistical bootstrapping technique recommended for tests of indirect effects. Results suggested that pain catastrophizing was associated with greater sleep disturbance, and that a significant portion of variance in clinical pain severity and pain-related interference attributable to pain catastrophizing was mediated by sleep disturbance. Supplementary analyses revealed that the rumination component of catastrophizing seemed to be indirectly related to clinical outcomes through sleep disturbance. No evidence for indirect effects was observed for helplessness and magnification components. These results suggest that rumination about pain may contribute to clinical pain indirectly through alterations in sleep. Prospective studies are needed to examine lagged associations between these constructs. These findings have important theoretical and clinical implications. Critically, interventions that reduce pain catastrophizing may concurrently improve sleep and clinical pain.