手法复位辅助

目的 探讨关节腔扩张后手法复位辅助再定位垫治疗颞下颌关节紊乱病急性不可复性盘前移位.方法 2%局麻药2～3 ml 注入关节上腔,手法复位解除不可复性前移位的关节盘,复位后即刻戴用再定位垫保持良好的盘-突关系.结果近期临床观察表明①开口度恢复,最大开口度从治疗前的25.8 mm增大到46.6 mm;②疼痛症状消失,疼痛分值视觉模拟尺从治疗前的2.62下降到0.43; ③颞下颌关节功能改善,Fricton关节功能障碍指数和颞下颌关节紊乱指数分别从治疗前的0.337和0.185下降到0.021和0.011.结论颞下颌关节紊乱病急性不可复性盘前移位药物治疗和理疗无效的情况下,关节盘复位辅助定位垫是一有效的治疗方法.远期效果如何尚需进一步观察.     

手法复位辅助He垫治疗急性不可复性盘前移位的初步报告

目的：探讨关节腔扩张后手法复位辅助再定位He垫治疗颞下颌关节紊乱病急性不可复性盘前移位。方法：2％局麻药2－3ml注入关节上腔，手法复位解除不可复性前移位的关节盘，复位后即刻戴面再定位He垫保护良好的盘－突关系。结果：近期临床观察表明：（1）开口度恢复，最大开口度从治疗前的25．8mm增大到46．6mm;(2)疼痛症状消失，疼痛分值视觉模拟尺以治疗前的2．62下降到0．43；（3）颞下颌关节功能改善，Fricton关节功能障碍指数和颞下颌关节紊乱指数分别从治疗前的0．337和0．185下降到0．21和0．011。结论：颞下颌关节紊乱病急性不可复性盘前移位药物治疗和理疗无效的情况下，关节盘复位定位He垫是一有效的治疗方法。远期效果如果尚需进一步观察。     

手法复位辅助垫治疗急性不可复性盘前移位的初步报告

目的　探讨关节腔扩张后手法复位辅助再定位垫治疗颞下颌关节紊乱病急性不可复性盘前移位。方法　 2 %局麻药 2～ 3ml注入关节上腔 ,手法复位解除不可复性前移位的关节盘 ,复位后即刻戴用再定位垫保持良好的盘 突关系。结果　近期临床观察表明 :①开口度恢复 ,最大开口度从治疗前的 2 5 8mm增大到 46 6mm ;②疼痛症状消失 ,疼痛分值视觉模拟尺从治疗前的 2 6 2下降到 0 43;③颞下颌关节功能改善 ,Fricton关节功能障碍指数和颞下颌关节紊乱指数分别从治疗前的 0 337和 0 185下降到 0 0 2 1和 0 0 11。结论　颞下颌关节紊乱病急性不可复性盘前移位药物治疗和理疗无效的情况下 ,关节盘复位辅助定位垫是一有效的治疗方法。远期效果如何尚需进一步观察。     

急性和慢性不可复性盘前移位临床对比研究

目的　探讨颞下颌关节紊乱病不可复性盘前移位急性和慢性分类对临床诊断、治疗和预后的指导意义。方法　分析连续接诊的 10 0例不可复性盘前移位病例 (急性 4 5例、慢性 5 5例 ) ,比较两组之间临床主诉、开口度、颞下颌关节功能、髁突和关节盘的影像学改变。结果　急性不可复性盘前移位主诉开口受限 ,下颌运动功能严重障碍 ,大部分病例髁突骨质正常 ,关节盘形态良好 ;慢性不可复性盘前移位主诉多为开口痛和 (或 )咀嚼痛 ,下颌运动受限 ,部分病例伴有咀嚼肌疼痛 ,相当一部分病例髁突骨质吸收破坏 ,关节盘变形、变性 ,关节盘附着松弛、撕裂 ,甚至关节盘穿孔。结论　对急性不可复性盘前移位应早期采取积极的治疗 ,恢复良好的盘 突关系 ,阻止关节盘和髁突的进一步损伤。     

颞下颌关节疾病

20051974 颞下颌关节MR冠状影像测量与分析；20051975 关节液中IL-6、1L-8及IFNγ与TMJ病变的关系；20051976 IL-β与TMD患者关节病变程度关系的研究；20051977 下颌骨骨折后颞下颌功能紊乱的临床研究；20051978 医源性颞下颌关节紊乱症的临床治疗研究；20051979 急性和慢性不可复性盘前移位临床对比研究……     

Roth诊断垫治疗颞下颌关节紊乱病的初步探讨

目的:观察使用Roth诊断垫治疗颞下颌关节紊乱病(Temporom-andibular disorder,TMD)的疗效。方法:选取76名TMD患者,随机分成2组。治疗组患者24h佩戴Roth诊断垫;对照组患者仅给予TMD健康指导。观察6个月后,应用Fricton颞下颌关节紊乱指数评价TMD患者临床症状。将治疗组和对照组治疗前后差异进行统计学分析。结果:治疗组与对照组治疗前后Fricton指数减少有显著性差异。结论:使用Roth诊断垫治疗某些颞下颌关节紊乱病有明显效果。     

颞下颌关节病下颌运动计算机辅助诊断系统—关节内紊乱诊断指标…

以颞下颌关节侧位造影断层摄影检查为标准诊断，将７０侧关节的盘位置分为正常盘位、可复性盘移位、不可复性盘移位三种情形，以切牙区下颌运动描记为诊断性试验，对边缘运动及咀嚼运动指标进行判别分析，求出判别函数，并对其判别效果进行检验。结果表明，本文所建立起的颞下颌关节内紊乱判别函数，对盘位的判别符合率达９４．２９％，其中正常盘位１００％，可复性盘移位９５．７％，不可复性盘移位９２．５％，可望用于临床来诊断     

高分辨率超声诊断颞下颌关节盘前移位的初步临床研究

目的探讨高分辨率超声（HR-US）诊断颞下颌关节紊乱病（TMD）关节盘前移位（ADD）的可行性。方法对40例TMD患者的40侧关节作HR-US（静态图像和动态图像）与关节造影检查。结果HR-US在显示可复性盘前移位与关节造影显示中等一致性,在显示不可复性盘前移位与关节造影显示高度一致性。结论HR-US在诊断ADD方面显示较强的可行性,可以作为ADD诊断方法在临床上应用。     

稳定垫治疗颞下颌关节紊乱病的疗效分析

目的观察采用稳定垫治疗颞下颌关节紊乱病(TMD)的临床疗效分析。方法选取2016年5月—2017年5月大连市口腔医院颞下颌关节门诊接诊的156例颞下颌关节紊乱病患者,比较采用稳定垫治疗前后临床疗效、颞下颌关节功能指数和髁突影像学改变(CBCT)。结果经过3～6个月治疗后,94.87%患者原有的颞下颌关节症状均得到改善; Fricton颞下颌关节紊乱指数明显下降; 70.51%的患者髁突骨质增生硬化,出现适应性改建。结论稳定垫可以作为有效治疗颞下颌关节紊乱病的方法之一。     

稳定咬合板短期治疗颞下颌关节紊乱病的临床疗效观察

颞下颌关节紊乱病（temporomandibular disorders，TMD）足口颌系统的常见病和多发病，临床上主要表现为颢下颌关节区疼痛、异常关节音、下颌运动功能障碍等三大症状。由于其病因复杂，目前尚缺少有效的治疗方法。稳定咬合板作为一种保守、可逆、无创性的治疗方法被广泛的应用在TMD的治疗上，但是，对于稳定咬合板的疗效尚有争议。本试验采用随机、对照的试验方法，用客观、统一、定量的标准Fricton指数评估稳定咬合板短期治疗TMD的临床疗效，结果显示，稳定咬合板短期内可有效缓解TMD患者肌肉和关市的疼痛。     

Efficacy of low-level laser therapy in the treatment of temporomandibular disorder

AIMS: To evaluate the effectiveness of low-level laser therapy (LLLT) in patients presenting with temporomandibular disorder (TMD) in a random and placebo-controlled research design. METHODS: The sample consisted of 40 patients, divided into an experimental group (G1) and a placebo group (G2). The treatment was done with an infrared laser (830nm, 500mW, 20s, 4J/point) at the painful points, once a week for four consecutive weeks. The patients were evaluated before and after the treatment through a Visual Analogue Scale (VAS) and the Craniomandibular Index (CMI). RESULTS: The baseline and posttherapy values of VAS and CMI were compared by the paired T-test, separately for the placebo and laser groups. A significant difference was observed between initial and final values (p < 0.05) in both groups. Baseline and post-therapy values of pain and CMI were compared in the therapy groups by the two-sample T-test, yet no significant differences were observed regarding VAS and CMI (p > 0.05). CONCLUSION: After either placebo or laser therapy, pain and temporomandibular symptoms were significantly lower, although there was no significant difference between groups. The low-level laser therapy was not effective in the treatment of TMD, when compared to the placebo.     

Anxiety and depression in adolescents and their relationship with signs and symptoms of temporomandibular disorders

PURPOSE: Several clinical studies suggest that psychologic factors may play an important role in the etiology and maintenance of temporomandibular disorder (TMD) signs and symptoms. The goal of this study was to verify the prevalence of anxiety and depression in adolescents, and their relationship with signs and symptoms of TMD. MATERIALS AND METHODS: The sample comprised 217 nonpatient adolescents between 12 and 18 years of age. The subjective symptoms and clinical signs of TMD were evaluated, respectively, using a self-report questionnaire and the Craniomandibular Index (CMI, which has 2 subscales), the Dysfunction Index, and the Palpation Index. The Hospital Anxiety and Depression Scale (HADS), a 14-item self-administered rating scale that was developed specifically to identify anxiety and depression in nonpsychiatric medical outpatients, assessed levels of anxiety and depression. RESULTS: In the total sample, anxiety and depression were present in 16.58% and 26.71% of subjects, respectively, including all levels of HADS. The results showed that there were positive correlations between CMI and Palpation Index and anxiety (HADSa) (P < .01) but not with depression (HADSd). An association between the number of TMD subjective symptoms and HADSa/HADSd was found (P < .01). CONCLUSION: Anxiety and depression, although of mild intensity, are common in adolescents. In this study both HADSa and HADSd were associated with an increasing number of TMD subjective symptoms. However, only anxiety was correlated with clinical signs of TMD (CMI), primarily muscle tenderness (Palpation Index).     

Reliability of a craniomandibular index

The Craniomandibular Index (CMI) was developed to provide a standardized measure of severity of problems in mandibular movement, TMJ noise, and muscle and joint tenderness for use in epidemiological and clinical outcome studies. The instrument was designed to have clearly defined objective criteria, simple clinical methods, and ease in scoring; it is divided into the Dysfunction Index and the Palpation Index. Inter-rater reliability (three raters) and intra-rater reliability (19 patients examined twice by one rater) were tested to determine whether the instrument has operational definitions sufficiently precise to allow for consistency in use between different raters and with one rater over time. Intraclass Correlation Coefficient for inter-rater reliability was 0.84 for the Dysfunction Index, 0.87 for the Palpation Index, and 0.95 for the CMI. Correlation for intra-rater reliability was 0.92 for the Dysfunction Index, 0.86 for the Palpation Index, and 0.96 for the CMI. These results support the reliability of the CMI for use in epidemiological and clinical studies. Users are cautioned about the subjectivity of numerous items within the CMI and the strict methodological guidelines that must be followed in order to assure accuracy and reproducibility of results.     

髁突运动中心大张口轨迹与关节窝形态的关系及临床应用探讨

目的　探讨髁突运动中心大张口轨迹与关节窝形态的关系 ,对TMD患者髁突运动中心轨迹特征进行初步研究。方法　利用自行开发的髁突运动中心轨迹显示分析系统 ,分别以运动中心、终末绞链轴点作为参考点 ,观察 10名健康人和 7例临床检查怀疑盘前移位的TMD患者大张口轨迹 ,与磁共振成像得到的相应关节窝形态及关节盘位置诊断结果进行比较。结果　健康人左右侧运动中心轨迹与关节窝形态曲线重合率分别为 80 % (8/ 10 )和 90 % (9/ 10 ) ;终末绞链轴点轨迹与关节窝形态重合率均为 0 (0 / 10 )。TMD患者中 ,11侧盘前移位关节 ,除 1侧可复性盘前移位关节外 ,髁突运动中心轨迹均与正常的轨迹明显不同 ,出现各种改变 ;3侧正常盘位关节 ,髁突运动中心轨迹均与健康人的轨迹相似。结论　运动中心轨迹较终末绞链轴点个体稳定 ,可认为是较理想的研究髁突运动轨迹的参考点     

下颌稳定型(牙合)垫治疗可复性盘前移位的临床评价

目的 探讨下颌稳定型(牙合)垫治疗颞下颌关节可复性盘前移位的疗效.方法 对32例(34侧)关节盘可复性前移位患者,采用下颌稳定型(牙合)垫治疗,疗程为3个月,采用Fricton指数及疼痛量化表来评价治疗效果.结果 统计学分析表明治疗前后的差异有统计学意义(P＜0.05),Fricton颞下颌关节指数(CMI)从治疗前的...     

Disk and joint morphology variations on coronal and sagittal MRI in temporomandibular joint disorders

Objectives

This study aims to assess the disk morphology and the condyle position in subjects with temporomandibular (TMJ) disk displacements on sagittal and coronal magnetic resonance imaging (MRI).

Materials and methods

Seventy-four TMJs (from 37 patients) with positive clinical TMD symptoms according to the RDC/TMD axis I protocol were evaluated by 1.5 T MRI. Disk position, disk morphology, sagittal and coronal condyle position, joint effusion, joint space, and coronal condyle angulation were evaluated. Multivariate logistic regression was used to explore the relationship between disk displacement and MRI variables.

Results

Disk displacement with reduction (DDR) was found in 36.48 % and without reduction (DDwR), in 21.62 % of the joints. Disk displacement was anterior in 35.1 %, anterior-medial in 13.5 %, and anterior-lateral in 9.45 % of cases. The thickened posterior band (94.48 OR, p?=?0.001) and the posterior condyle position (4.57 OR, p?=?0.03) were more likely found on sagittal MRI in disk displacements. On coronal slices, the disk displacement was significantly associated with the distance from the most medial condyle point to the midplane (p?<?0.05).

Conclusions

Disk displacement is associated with changes of disk shape, disk dimension, and condyle position on sagittal MRI. A significant variation of the distance from the most medial condyle point to the midplane in disk displacement was found on coronal MRI.

Clinical relevance

Our study highlights the existence of changes on coronal MRI in TMD patients which should be assessed for better understanding of the clinical evolution of temporomandibular disorders.     

透明质酸钠注射治疗不可复性关节盘前移位的CBCT影像学评价

目的:对比治疗前后CBCT影像,观察透明质酸钠治疗颞下颌关节不可复性盘前移位后髁突位置及形态变化.方法:对40例患者进行3次透明质酸钠关节上腔注射治疗.通过治疗前、治疗后3、9、12个月CBCT影像学检查及临床检查,从髁突位置形态变化、疼痛度(VAS)、最大开口度(MMO)、Fricton指数观察透明质酸钠对颞下颌关节不可复性关节盘前移位的治疗效果.结果:CBCT显示不可复性关节盘前移位伴骨关节病患者治疗前与治疗后9、12个月比较,髁突骨质有明显改建,骨面变得平整光滑,骨赘减小(P =0.026,P=0.001),部分单纯不可复性关节盘前移位患者治疗后9个月髁突可以向前移动(P=0.038);治疗后患者MMO增大,VAS减小(P＜0.05),Fricton指数降低.治疗后3～12个月Fricton指数无显著变化(P＞0.05).结论:CBCT显示透明质酸钠可促进已破坏髁突表面骨质改建,但不能使后移位的髁突回到关节窝中央.     

Single portal arthroscopic temporomandibular joint discopexy: Technique and results

The aim of the present study is to assess the outcomes of monoportal arthroscopic disc repositioning (discopexy) for disc displacement of the temporomandibular joint.A retrospective, single-institutional clinical study included patients with temporomandibular joint internal derangements diagnosed and treated by monoportal discopexy. Each patient was diagnosed as having anterior disk displacement with or without reduction. The arthroscopy treatment consists of one portal approach fixing the disc with a 3/0 nylon to the tragus cartilage without anterior liberation. Arthroscopy surgery was carried out with a 1.9-mm 0° arthroscope and only one simple cannula. We use a needle to pierce of the disc through the skin and retrieve the suture inside the joint using a blind method through the arthroscopic cannula. The evaluated variables included the maximum interincisal opening, the presence of clicking and pain score.A total of 19 patients, 21 joints, were included in the present study. Of the 21 joints, 16 were classified as disc displacement with reduction and 5 without. Visual analogue scale (VAS) values (0–10) decreased from 5.5 to 1.26 (p < 0.0001) 1 year after surgery. At the first review, all patients had a VAS of at least 4 points less than before the surgery, four patients showed a VAS of 0, and nine patients near to 1. Mouth opening increased from 36.6 (±8.09) mm to 39.37 (±4.35) mm, and no significant limitations in the mouth opening range were seen (p < 0.12) 1 year after surgery. Clicking disappeared in all patients and remained stable after 12 months of follow-up. Postoperative magnetic resonance imaging demonstrated a correct or improved position of the disc in all but one patient.A minimally invasive single portal arthroscopic discopexy is an effective technique to improve function and pain reduction in patients with anterior disk displacement with or without reduction.     

Immunohistochemical expression of TLR-4 in temporomandibular joint dysfunction

Objective Toll-like receptor 4 (TLR-4) is a transmembrane protein involved in the innate immune system and has been implicated in the pathogenesis of temporomandibular joint dysfunction (TMD). The purpose of this study was to histologically examine the level of expression of TLR-4 relative to severity of TMD.

Methods Thirty-one human TMJ disc samples were immunostained for TLR-4 and evaluated for intensity of stain. Among the samples, 8 were control samples, 16 were from patients with anterior disc displacement with reduction (ADDwR), and 7 were from patients with anterior disc displacement without reduction (ADDwoR).

Results There was no statistically significant difference in intensity of stain between groupings (p = 0.673).

Conclusions The results indicate a negative correlation between TMD and the expression of TLR-4.