Med Hypotheses. 2010 Apr;74(4):710-8. doi: 10.1016/j.mehy.2009.10.028. Epub 2009 Nov 11.
Temporomandibular disorder is a generic and inadequate conception to be used as a diagnosis. It fails to express the etiology or the pathophysiology and it is mainly associated with the anatomical site. Moreover, the clinical condition presents a mandibular motor problem and not a joint problem. The hypothesis presents the new diagnosis stomatognathic motor adaptive syndrome, which comprehend a motor response and the adaptive processes it induces. Inadequate occlusal contacts cause the mandible to shift in order to reach an ideal intercuspal position. The condylar displacements are proportional to such movements. Temporomandibular joint (TMJ) receptors respond to the capsular mechanical stress and the information reaches the trigeminal sensory nuclei. The mandibular modified position seems to be relevant information and may interfere with catecholaminergic neurotransmission in basal ganglia. The main motor responses comprise increased jaw muscle tone, decreased velocity of movements and incoordination. The overload of muscle function will produce adaptive responses on many stomatognathic structures. The muscle adaptive responses are hypertonia, pain, fatigue and weakness. Temporomandibular joint presents tissue modification, disc alteration and cracking noise. Periodontium show increased periodontal membrane, bone height loss and gingival recession. Teeth manifest increased wear facets, abfraction and non-accidental fractures. The periodontal and teeth adaptive processes are usually identified as occlusal trauma. The altered stomatognathic functions will show loss of velocity during mastication and speech. Fatigue, weakness in jaw muscle and difficulties to chew hard food are related to hypertonia. Incoordination between stomatognathic muscles groups is found, causing involuntary tongue/cheek biting and lateral jaw movements on speech. Otologic complaints, as aural fullness and tinnitus, are related to the tensor tympani muscle, innervated by the trigeminal nerve.
颞下颌关节紊乱是一种通用且不充分的概念,不适合作为诊断。它未能表达病因或病理生理学,主要与解剖部位有关。此外,临床情况表现为下颌运动问题,而不是关节问题。该假说提出了新的诊断——咀嚼肌适应性综合征,它包含了运动反应及其诱导的适应过程。咬合不良会导致下颌移位,以达到理想的正中关系位。髁突的移位与这些运动成比例。颞下颌关节 (TMJ) 感受器对关节囊的机械应力做出反应,信息到达三叉神经感觉核。下颌的改变位置似乎是相关信息,并可能干扰基底节中的儿茶酚胺能神经传递。主要的运动反应包括增加咀嚼肌张力、运动速度降低和不协调。肌肉功能的超负荷会导致许多咀嚼结构产生适应性反应。肌肉适应性反应包括张力亢进、疼痛、疲劳和无力。TMJ 会出现组织改变、盘移位和爆裂声。牙周组织表现为牙周膜增加、牙槽骨高度丧失和牙龈退缩。牙齿表现出增加的磨损面、非外伤性骨折和牙裂。牙周和牙齿的适应性过程通常被识别为咬合创伤。改变的咀嚼功能在咀嚼和说话时会表现出速度下降。咀嚼肌的疲劳、无力和咀嚼硬食物的困难与张力亢进有关。咀嚼肌之间的不协调会导致不自觉的舌/颊咬伤和说话时的下颌侧向运动。耳科投诉,如耳闷和耳鸣,与由三叉神经支配的鼓膜张肌有关。