【晨读】颞下颌关节综合征（三）

 英语晨读 ·

山东省立医院疼痛科英语晨读已经坚持10余年的时间了，每天交班前15分钟都会精选一篇英文文献进行阅读和翻译。一是可以保持工作后的英语阅读习惯，二是可以学习前沿的疼痛相关知识。我们会将晨读内容与大家分享，助力疼痛学习。

本次文献选自Maini, K., & Dua, A. (2020). Temporomandibular Joint Syndrome. In StatPearls. StatPearls Publishing。本次学习由赵学军主任医师主讲。

Evaluation

Signs and symptoms of TMD:

1) Pain:

Pain from the TMJ and muscles of mastication is a common symptom. It can be constant or periodic dull ache over the joint, the ear, and temporal fossa. It is more observed during the mandibular movement or by palpation of the affected regions. The pain can be myogenic caused due to mechanical trauma and muscle fatigue. Articular pain arising due to inflammation of articular and periarticular tissues either by overloading, trauma, or degenerative changes.

2). Joint Sounds:

The two common joint sounds observed are clicking and crepitations.

Clicking is a sound of the short event observed during the mandibular movement caused by the uncoordinated movement of the condylar head and the articular disc. Crepitations are compound sounds that are caused by the roughened, irregular articular surfaces of the joint  and observed during mandibular movement.

评估

TMD的症状和体征：

1） 疼痛：

颞下颌关节和咀嚼肌的疼痛是一种常见的症状，该疼痛是一种发生在关节、耳朵和颞窝的持续性或周期性的隐痛。在下颌骨运动时或触诊受累区域时该症状更常见。疼痛可能是由于机械创伤和肌肉疲劳引起的肌源性疼痛。由于关节和关节周围组织的炎症而引起的关节疼痛多因劳损、创伤或退行性改变引起。

2). 关节音：

两种常见的关节音是咔嗒声和咯吱声。

咔哒声是在下颌骨运动过程中由髁突和关节盘不协调运动引起的持续时间比较短的一种声音。咯吱声是一种复合的声音，是由粗糙的、不规则的关节面引起的，在下颌运动时可以观察到。

3). Limitation of Mandibular Movement:

The restrictions in movement of the mandible are observable either in all or in part of opening, closure, protrusion, and lateral movement. It can be due to muscular restriction, disc displacement, ligaments restriction.

4). Dislocation:

It is the displacement of the condyle from fossa, and the patient may be unable to close the mouth. The patient can reduce the dislocation himself or report to the clinician for reduction.

3). 下颌运动受限：

下颌骨运动受限可以在下颌骨全部或部分张开、闭合、突出和侧向运动中观察到。它可能是由于肌肉、韧带的功能障碍或关节盘移位所致。

4). 脱位：

这是髁突从颞骨的下颌窝中移位所致，患者可能无法闭上嘴。患者可自行复位或找临床医生复位。

5). Dental Symptoms:

Tooth mobility, pulpitis, tooth wear are the commonest dental symptoms elicited in TMD patients.

6). Otologic Symptoms:

TMJ pain in the auricular regions is more noticeable posteriorly. Tinnitus, itching in the ear, and vertigo are other symptoms associated with auricular pain.

7). Recurrent Headaches:

Patients perceive the pain and tenderness of masticatory muscles along the temporal region as headaches. Additionally, it can correlate with other headaches, such as migraine pain.

5). 牙齿症状：

牙齿活动、牙髓炎、牙齿磨损是TMD患者最常见的牙齿症状。

6). 耳科症状：

耳区颞下颌关节的疼痛更明显。耳鸣、耳痒和眩晕是与耳痛相关的其他症状。

7). 反复头痛：

患者认为颞区的咀嚼肌的疼痛和压痛是头痛。此外，它还可能与其他头痛相关，如偏头痛。