第7章 颞下颌关节紊乱病（英文）

nullTEMPOROMANDIBULAR DISORDERSTEMPOROMANDIBULAR DISORDERSDefinitionDefinition American Dental Association, 1983 defined TMD as a group of orofacial disorders characterized by: Pain in the preauricular area, TMJ, or muscles of mastication Limitations/deviations in mandibular range of motion TMJ sounds during jaw function 1990Y Craniomandibular Disorders(CMD)Epidemiology of TMDEpidemiology of TMDTMD pain has been estimated to affect 10% (5-12%) of the population It is at least twice as common in women as in men It occurs more frequently in people 20-50 years oldAnatomy of TMJMandibular condyle Joint surface of temporal bone Articular disc TMJ capsule TMJ ligamentAnatomy of TMJAnatomy of TMJMulti-axis & multi-direction ►Movement agilityA important part in stomatognathic system ►A remodeling in all lifetime jointAnatomy of TMJAnatomy of TMJSagittal plane view: The relationship among dics & condyle & glenoid in COPNormal: One plane: front bevel of condyle / middle part of disc / posterior bevel of node One line: cross ridge of condyle /posterior border of later belt of disc /peak of glenoidAbnormal: 1.Retrusion of condyle 2.Hyperfunction of lateral pterygoid muscleAnatomy of TMJAnatomy of TMJCoronal plane view: the relationship of disc & condyle & node in COPNormal: middle position condyle and disc in middle position Abnormal : Ingression or out-shift of condyle and discAnatomy of TMJEtiology of TMDEtiology of TMDPsychic factorBad habitsTraumaOthersEtiology of TMDOcclusal factor:Occlusal interfereProtrusive occlusal interfere Lateral occlusal interfere Retrusive occlusal interfereHigh spot×occlusionEtiology of TMDLateral occlusal interfereLateral occlusal interferenullEtiology of TMDOcclusal factorPremature contact：interfere happened in PP to ICPElongation of upper 3rd molarAnterior superior displacement of condyleElongation of lower 3rd molarPosterior displacement of condyleEtiology of TMDEtiology of TMDOcclusal factorMalocclusion:Malocclusion of individual tooth Malocclusion of dentition Etiology of TMDAnterior teeth lingual tipping deep overbiteAnterior teeth lingual tipping deep overbiteEtiology of TMDOcclusal factor More teeth losed Lateral molars loss：unilateral mastication Bilateral molars loss：Posterior displacement of condyleMaladjustment of Reverse tensile reflectionEtiology of TMDEtiology of TMDOcclusal factorChange of interarch distance: More higher: apertognathia More lower: excessive wearAnterior inferior displacement of condyleSustained tension of masticational musclePosterior superior displacement of condyleMaladjustment of reverse tensile reflectionEtiology of TMDMore higher vertical distance with more tenser musclesMore higher vertical distance with more tenser musclesMore lower in interarch distance－－serious teeth wearMore lower in interarch distance－－serious teeth wearEtiology of TMDOcclusal factorsLatrogenic factors: Oral madicine Prosthodontics OrthodonticsEtiology of TMDEtiology of TMDPredisposing factors Initiation factors Perpetuating factorEtiology of TMDClinical manifestation of TMDPain TMJ sounds Limitations in mandibular range OthersClinical manifestation of TMDClinical manifestation of TMD Muscle derived pain Articular derived painprotective muscle splinting local muscle soreness myofascial pain myospasm chronic myosis pain happened in disc and ligament retrodiscitis synovitis or capsulitis osteoarthritisClinical manifestation of TMDRecoverablity disc dislocationDisplacement of disc Recoverablity disc dislocation Unrecoverability disc dislocationRecoverablity disc dislocationUnrecoverability disc dislocationClinical manifestation of TMDAntiorer diplacement of discAntiorer diplacement of discAntiorer diplacement of discAntiorer diplacement of discTMJ soundsTMJ soundsTMJ soundsTMJ soundsClinical manifestation of TMDHyperosteogeny & disc perforation Synovium lesionsClinical manifestation of TMDClinical manifestation of TMDOpening limitation Abnormal openingClinical manifestation of TMDClinical manifestation of TMDTension type headache Migraine OthersClinical manifestation of TMDClinical examination of TMDClinical examination of TMDClinical examination of TMDOpening patterns Straight Deviation (right & left) Corrected deviation OthersClinical examination of TMDClinical examination of TMDOpening patten Straight Deviation (right & left) Corrected deviation OthersClinical examination of TMDClinical examination of TMDClinical examination of TMDClinical examination of TMDClinical examination of TMDClinical examination of TMDClinical examination of TMDClinical examination of TMDClinical examination of TMDClinical examination of TMD患者自身条件评价（patient assessment of condition)：chief complaints; treatment history & expectation 行为状态评价(behavioral status)：jaw disability; parafunctional behaviors; general health behaviors 心理评价(psychological status)：depression; anxiety; somatization（精神状态的躯体表现） 社会心理评价(psychosocial status) ：pain-related interference with daily life, pain intensity and persistence, social supportClinical examination of TMDTreatment of TMDTreatment of TMDTreatment of TMDRelaxation splintTreatment of TMDTreatment of TMD Stabilization splintTreatment of TMDTreatment of TMDRepositioning splint Treatment of TMDTreatment of TMD Pivot splintTreatment of TMDTreatment of TMDTreatment of TMDOcclusal adjustment Surgery Orthodontics Prosthodontics nullThanks 下颌运动轴心 ►下颌运动轴心 ►null ┌─→ CNS ←─┐ │ │ │ muscle │ │ │ occlusion ←─→ TMJStomatognathic system 咀嚼运动中肌肉和关节的协调运动咀嚼运动中肌肉和关节的协调运动咀嚼运动中肌肉的左右协调运动咀嚼运动中肌肉的左右协调运动 ►