颞下颌关节紊乱病(英文)

TEMPOROMANDIBULARDISORDERS

AmericanDentalAssociation,1983definedTMDasagroupoforofacialdisorderscharacterizedby:Paininthepreauriculararea,TMJ,ormusclesofmasticationLimitations/deviationsinmandibularrangeofmotionTMJsoundsduringjawfunction1990YCraniomandibularDisorders(CMD)DefinitionEpidemiologyofTMDTMDpainhasbeenestimatedtoaffect10%(5-12%)ofthepopulationItisatleasttwiceascommoninwomenasinmenItoccursmorefrequentlyinpeople20-50yearsoldAnatomyofTMJMandibularcondyleJointsurfaceoftemporalboneArticulardiscTMJcapsuleTMJligamentMulti-axis&multi-direction

►MovementagilityAimportantpartinstomatognathicsystem►AremodelinginalllifetimejointAnatomyofTMJSagittalplaneview:Therelationshipamongdics&condyle&glenoidinCOPNormal:Oneplane:frontbevelofcondyle/middlepartofdisc/posteriorbevelofnodeOneline:crossridgeofcondyle/posteriorborderoflaterbeltofdisc/peakofglenoidAbnormal:1.Retrusionofcondyle2.HyperfunctionoflateralpterygoidmuscleAnatomyofTMJCoronalplaneview:therelationshipofdisc&condyle&nodeinCOPNormal:middlepositioncondyleanddiscinmiddlepositionAbnormal:Ingressionorout-shiftofcondyleanddiscAnatomyofTMJEtiologyofTMDPsychicfactorBadhabitsTraumaOthersOcclusalfactor:OcclusalinterfereProtrusiveocclusalinterfereLateralocclusalinterfereRetrusive

occlusalinterfereHighspot×occlusionEtiologyofTMDLateralocclusalinterfereOcclusalfactorPrematurecontact：interferehappenedinPPtoICPElongationofupper3rdmolarAnteriorsuperiordisplacementofcondyleElongationoflower3rdmolarPosteriordisplacementofcondyleEtiologyofTMDOcclusalfactorMalocclusion:MalocclusionofindividualtoothMalocclusionofdentitionEtiologyofTMDAnteriorteethlingualtippingdeepoverbiteOcclusalfactorMoreteethlosedLateralmolarsloss：unilateralmasticationBilateralmolarsloss：PosteriordisplacementofcondyleMaladjustmentofReversetensilereflectionEtiologyofTMDOcclusalfactorChangeofinterarchdistance:Morehigher:apertognathiaMorelower:excessivewearAnteriorinferiordisplacementofcondyleSustainedtensionofmasticationalmusclePosteriorsuperiordisplacementofcondyleMaladjustmentofreversetensilereflectionEtiologyofTMDMorehigherverticaldistance

withmoretensermusclesMorelowerininterarchdistance－－seriousteethwearOcclusalfactorsLatrogenicfactors:OralmadicineProsthodonticsOrthodonticsEtiologyofTMDPredisposingfactorsInitiationfactorsPerpetuatingfactorEtiologyofTMDPainTMJsoundsLimitationsinmandibularrangeOthersClinicalmanifestationofTMDMusclederivedpainArticularderivedpainprotectivemusclesplintinglocalmusclesorenessmyofascialpainmyospasmchronicmyosis

painhappenedindiscandligamentretrodiscitissynovitisorcapsulitisosteoarthritisClinicalmanifestationofTMDDisplacementofdiscRecoverablitydiscdislocationUnrecoverabilitydiscdislocationRecoverablitydiscdislocationUnrecoverabilitydiscdislocationClinicalmanifestationofTMDAntiorerdiplacementofdiscAntiorerdiplacementofdiscTMJsoundsTMJsoundsHyperosteogeny&discperforationSynoviumlesionsClinicalmanifestationofTMDOpeninglimitationAbnormalopeningClinicalmanifestationofTMDTensiontypeheadacheMigraineOthersClinicalmanifestationofTMDClinicalexaminationofTMDOpeningpatternsStraightDeviation(right&left)CorrecteddeviationOthersClinicalexaminationofTMDOpeningpattenStraightDeviation(right&left)CorrecteddeviationOthersClinicalexaminationofTMDClinicalexaminationofTMDClinicalexaminationofTMDClinicalexaminationofTMDClinicalexaminationofTMD患者自身条件评价（patientassessmentofcondition)：chiefcomplaints;treatmenthistory&expectation行为状态评价(behavioralstatus)：jawdisability;parafunctionalbehaviors;generalhealthbehaviors心理评价(psychologicalstatus)：depression;anxiety;somatization（精神状态的躯体表现）社会心理评价(psychosocialstatus)

：pain-relatedinterferencewithdailylife,painintensityandpersistence,socialsupportClinicalexaminationofTMDTreatmentofTMDRelaxationsplintTreatmentofTMDStabilizationsplintTreatmentofTMDRepositioningsplintTreatmentofTMDPivotsplintTreatmentofTMDTreatmentofTMDOcclusaladjustmentSurgeryOrthodonticsProsthodonticsThanks下颌运动轴心►