微波治疗颞下颌关节综合征39例报告

颞下颌关节综合征多系缺牙,龋齿,长期咀嚼硬物致下颌关节附近组织炎症所致.1999年10月起我们应用天津产LY-Ⅲ型微波多功能治疗机治疗颞下颌关节综合征39例,效果满意,报告如下.     

颞颌关节外伤骨折脱位的诊断与治疗

目的探讨颞颌关节外伤骨折脱位的诊断与治疗方法.方法回顾分析手术治疗颞颌关节外伤骨折48例的临床资料并文献复习.结果头面部外伤史,颞颌关节运动受限,张口困难,关系紊乱,耳颞区压痛及颅内非典型疼痛是本病常见的症状.耳颞部或颅底的X线断层及CT检查能明确诊断.单纯用髁状突切断或髁状颈切除术治疗的患者效果差且并发症和后遗症发生率高.采用以恢复颞颌关节功能为主的关节重建术,临床效果较理想.结论本病临床行颞下颌关节及颅底X线断层或CT检查有重要的诊断价值.治疗首选颞下颌关节重建术,同时早期诊断与正确选用手术治疗是防止和减少术后颞颌关节功能障碍与后遗症发生的关键.     

芬太尼透皮贴剂治疗鼻咽癌晚期癌痛的疗效观察

目的观察芬太尼透皮贴剂治疗鼻咽癌癌痛的效果及其不良反应 .方法鼻咽癌中、重度癌痛40例使用芬太尼透皮贴剂.采用多中心随机开放实验,初始剂量25μg/h或参照吗啡剂量折算确定剂量,3d更换1次.根据疼痛情况调整剂量,直至镇痛满意.结果 中度以上疼痛缓解率为100%,其中完全缓解6 2.5%,明显缓解37.5%.其主要不良反应有便秘、头晕、恶心、嗜睡、皮肤搔痒.未出现呼吸抑制等严重不良反应.结论芬太尼贴剂治疗鼻咽癌晚期癌痛疗效可靠.     

Tuberculosis of temporomandibular joint

Tuberculosis of the temporomandibular joint is a very rare disease. Its close relation to the parotid can cause diagnostic confusion. This case is being reported keeping this point in view.     

Chondrocalcinosis of the temporomandibular joint. Calcium pyrophosphate dihydrate deposition disease

A case of calcium pyrophosphate dihydrate (CPPD) arthropathy of the temporomandibular joint, seen in a 54-year-old woman, is reported. The patient presented an eight-year history of diffuse swelling with tenderness over the right preauricular region. Surgical exploration of the right temporomandibular joint disclosed calcified masses that were identified as CPPD crystalline materials by histologic and infrared spectrophotometric studies. The occurrence of CPPD arthropathy of the temporomandibular joint is very rare, and this is only the fourth report of such a case, to our knowledge.     

Managing temporomandibular joint syndrome

Pain in the temporomandibular joint is primarily responsible for the morbidity often associated with this syndrome. Of the 448 cases in this study, 48% presented as ear pain and 46% complained of either headache, sinus pain, or neck pain. Temporomandibular joint pain and mastication muscle tenderness elicited with palpation were frequent physical findings. In this review, temporomandibular joint syndrome was successfully managed in 75% of 448 cases with conservative treatment consisting of patient education, heat, massage, non-narcotic analgesics, and occlusal splints. Seventeen percent were referred to dentists for restorations or orthodontics. The success rate for the 6% who underwent diagnostic arthroscopy and/or open joint surgery with disc replacement was 67%. Therefore, patients with ear pain or head and neck pain require an objective evaluation of medical history and physical examination to obtain the correct diagnosis and subsequent correct treatment and pain relief. Early diagnosis helps to prevent changes in the joint that can become irreversible with intractable pain. Surgery is reserved for those patients who fail to respond to conservative management.     

Osteomyelitis of the temporomandibular joint

Osteomyelitis of the temporomandibular joint is very uncommon, and osteomyelitis as a result of Aspergillus niger infection has not previously been reported. A case report of skull base and condylar osteomyelitis is presented. Previously reported cases of temporomandibular joint osteomyelitis are reviewed, and management is discussed. Because of the significant morbidity possible with infections in this region, otolaryngologists should be familiar with the anatomy, diagnostic modalities, and therapeutic options. [Editorial comment: This unusual case presents unique aspects of the pathophysiology of osteomyelitis of the skull base.]     

Arthrography of the temporomandibular joint

In 1989, opaque contrast arthrography of temporomandibular joint is still seldom used. A brief historical review of the procedure is presented here, and the technique of puncturing the menisco-condylar and menisco-temporal compartments is discussed. The value of injecting opaque contrast material into the lower compartment and carrying out kinetic and tomographic studies as well as bilateral examinations is stressed. Normal aspects are described with their variants, as well as pathological ones (reducible and non-reducible luxations, perforations, distension of the bilaminar zone, adhesions, etc.). Both the place of arthrography in relation to other investigations (TDM, IRM) and its indications for visualization of menisco-condylar problems are discussed.