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颞下颌关节内紊乱:与头痛、关节积液、磨牙症及关节疼痛的关联

Temporomandibular joint internal derangement: association with headache, joint effusion, bruxism, and joint pain.

作者信息

Costa André L F, D'Abreu Anelyssa, Cendes Fernando

机构信息

Department of Neurology, State University of Campinas, Campinas, SP, Brazil.

出版信息

J Contemp Dent Pract. 2008 Sep 1;9(6):9-16.

Abstract

AIM

The aim of the present study was to assess the correlation of temporomandibular joint internal derangement (TMJ ID) in patients with the presence of headache, bruxism, and joint pain using magnetic resonance imaging (MRI).

METHODS AND MATERIALS

This study evaluated 42 joints in 42 patients; 21 patients diagnosed with unilateral TMJ ID and a history of headaches and 21 patients diagnosed with unilateral TMD ID without a history of headaches. Signs of headache, bruxism, and joint pain were diagnosed clinically and were also obtained from the patient's history. Sixteen joints in 16 patients without signs or symptoms of TMD or headache were included as a control group. All patients underwent bilateral MRI of the TMJ to evaluate the disc position and the presence of joint effusion. Data were analyzed using Chi-square and Fischer's exact tests.

RESULTS

Bruxing behavior was most frequently reported by patients with headaches (p<0.0125). Eighty-five percent of subjects with headaches also reported joint pain. A significant association was found between headache and TMJ effusion (p<0.0125). Patients with more severe disc displacement also had a higher frequency of effusion (p=0.001).

CONCLUSION

The results suggest joint effusion may have a role in the pathogenesis of headache in TMJ ID.

CLINICAL SIGNIFICANCE

Temporomandibular joint effusion on MRI may serve as a biological marker of headache associated with TMD and could be helpful for diagnostic classification and treatment follow up.

摘要

目的

本研究旨在利用磁共振成像(MRI)评估颞下颌关节内紊乱(TMJ ID)患者中头痛、磨牙症和关节疼痛之间的相关性。

方法和材料

本研究评估了42例患者的42个关节;21例被诊断为单侧TMJ ID且有头痛病史的患者,以及21例被诊断为单侧TMJ ID但无头痛病史的患者。头痛、磨牙症和关节疼痛的体征通过临床诊断,并从患者病史中获取。16例无TMD或头痛体征或症状的患者的16个关节作为对照组。所有患者均接受双侧TMJ的MRI检查,以评估盘状位置和关节积液情况。数据采用卡方检验和费舍尔精确检验进行分析。

结果

头痛患者最常报告有磨牙行为(p<0.0125)。85%有头痛的受试者也报告有关节疼痛。头痛与TMJ积液之间存在显著关联(p<0.0125)。盘状移位更严重的患者积液频率也更高(p=0.001)。

结论

结果表明关节积液可能在TMJ ID头痛的发病机制中起作用。

临床意义

MRI上的颞下颌关节积液可能作为与TMD相关头痛的生物学标志物,有助于诊断分类和治疗随访。

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