Temporomandibular joint disorder syndrome is one of the common disorders of the oral and maxillofacial region. Among temporomandibular joint disorders, this disease is the most common. It occurs in young adults, with the highest prevalence in the 20s and 30s. Its pathogenesis is not fully understood. The main features of this disease are painful and soreness in the joint area, popping during movement, and impaired mouth opening movement. Most of them are joint dysfunction and have a good prognosis; however, organic changes may occur in a very small number of cases.
I. Etiology.
1, trauma factors many patients have a history of local trauma. For example, acute trauma such as external impact, sudden biting of hard objects, excessive opening of mouth (such as yawning), frequent chewing of hard food, grinding of teeth at night and unilateral chewing habits. These factors may cause joint contusion or strain, masticatory muscle group dysfunction, which also has a certain impact on the occurrence of this disease.
2, occlusal factors Many patients have obvious disorders of occlusal relationship. For example, the tip of the teeth is too high, excessive wear of teeth, too many missing molar teeth, bad dentures, too low intermaxillary distance, etc. Disturbances in the occlusal relationship can disrupt the balance of function between the internal structures of the joint and contribute to the occurrence of the disease.
3, systemic and other factors neuropsychiatric factors and the disease can have a certain relationship. For example, some patients have emotional impatience, nervousness, easily agitated and so on. In addition, some patients have a history of rheumatism, and the onset of some is related to cold.
II. Clinical manifestations.
The main clinical manifestations of temporomandibular joint disorder syndrome include localized soreness or pain, popping and movement disorders. The pain may be in the joint area or around the joint; it may be accompanied by pressure pain of varying severity. The soreness or pain of the joint is especially pronounced when chewing and opening the mouth. The popping occurs during mouth opening activities. The ringing can occur at different stages of jaw movement, and can be a single crisp ringing sound or a broken continuous ringing sound. The common obstruction to movement is restricted mouth opening, but over-opening or jaw deviation during mouth opening may also occur. In addition, it may be accompanied by temporal pain, dizziness, and tinnitus.
III. Examination.
1.X-ray plain film (joint Xue’s position and condylar transpharyngeal lateral position) may reveal joint space changes and bone changes, such as sclerosis, bone destruction and hyperplasia, cystic changes, etc.
2, arthrography (upper cavity angiography is mostly used because it is easy to operate, but lower cavity angiography is less used in China) can reveal displacement of the joint disc, perforation, changes in the attachment of the joint disc and changes in the cartilage surface. In recent years, many scholars have used endoscopic examination of the joint to detect early changes in the disease, such as congestion, oozing, adhesions of the joint disc and synovial membrane, and “joint rats” formed by undifferentiated mature cartilage-like tissue. Since there are many types of the disease, the treatment varies. Therefore, a specific type of diagnosis should be made. For example, pterygoid spasm, reversible articular disc displacement or articular disc perforation.
IV. Diagnosis: Based on the medical history, it is not difficult to diagnose TMJ disorder syndrome with the presence of the main symptoms mentioned above.
Differential diagnosis.
Since many other diseases also often present the three main symptoms mentioned above, they must be differentiated from the following diseases.
1, tumor deep maxillofacial tumor can also cause difficulty in opening or closing the teeth, because the tumor is not easily detected in the deep part, and misdiagnosed as TMJ disorder syndrome, or even carried out inappropriate treatment, losing the good opportunity of early tumor eradication.
Therefore, when there is difficulty in opening the mouth, especially when it is accompanied by developmental cerebral neurological symptoms or other symptoms, the presence of tumors in the following areas should be considered.
(1) benign or malignant tumors of the temporomandibular joint, especially chondrosarcoma of the condyle.
(2) Tumors of the inferior temporal fossa.
(3) tumors of the pterygopalatine fossa
(4) Carcinoma of the posterior wall of the maxillary sinus
(5) malignant tumors of the parotid gland
(6) Nasopharyngeal carcinoma, etc.
2.Temporomandibular arthritis
(1) Acute septic temporomandibular arthritis joint area can be seen red and swollen, pressure pain is obvious, especially can not go up and down to the right, a little force can cause severe pain in the joint area.
(2) Rheumatoid temporomandibular arthritis is often accompanied by generalized wandering and multiple arthritis, especially the small joints of the extremities are most often involved, and joint ankylosis may occur in the late stage.
3. Otogenic diseases such as external ear boils and inflammation of the middle ear often cause pain in the joint area and affect opening and chewing.
4. Cervical spondylosis can cause pain in the neck, shoulders, back, postauricular region and lateral part of the face, which can be easily misdiagnosed. However, the pain has nothing to do with opening and chewing, but is often related to neck movement and posture. X-rays can assist in the diagnosis of cervical spine with or without bony changes for differentiation.
The diagnosis is easily confirmed by X-ray examination.
6, hysterical dentition hysterical dentition is easier to diagnose if it is accompanied by other muscle spasms or twitching symptoms throughout the body. This disease occurs mostly in young women, with a previous history of hysteria and unique personality traits, usually with psychiatric factors at the onset, followed by sudden onset of difficulty in speaking or clenching of the teeth. This disease is often effective with verbal suggestion or indirect suggestion (using other therapeutic methods combined with verbal suggestion).
V. Treatment.
1, correction of the occlusal relationship by the dental specialist examination and treatment.
2, closure therapy can be used 0, 25% ~ 0, 5% procaine 3 ~ 5ml for pterygoid muscle closure. Puncture point in the midpoint of the sigmoid notch, vertical needle, depth 2, 5 ~ 3cm, back to draw no blood when injecting drugs. Commonly used in patients with overly large open mouth.
3.Chloroethane spray with massage can relieve masticatory muscle spasm. When spraying chloroethane into a mist, intermittent spray, with massage to prevent frostbite. And pay attention to the protection of the eyes and ears, away from the source of fire.
4, acupuncture therapy points: xiaoguan, auditory gong, cheek car, hegu, with cataract, sun.
5, ultra-short wave, ion introduction, electrical excitation and magnetic therapy and other local physiotherapy has certain curative effect.
While treating, it is important to correct bad habits (such as unilateral chewing) and prevent over-open mouth, etc.