Sidebottom A J, Carey E C, Madahar A K
Department of Oral and Maxillofacial Surgery, QMC Campus, Nottingham University Hospitals NHS Trust, United Kingdom.
Br J Oral Maxillofac Surg. 2011 Dec;49(8):653-6. doi: 10.1016/j.bjoms.2010.11.007. Epub 2010 Dec 21.
Cryoanalgesia is a controversial adjunct to the management of chronic pain, but we know of no studies that have investigated its effect in the management of temporomandibular joint (TMJ) pain. In this five-year retrospective study we treated 17 patients who had severe pain that had failed to respond to all forms of conventional conservative treatment and were not appropriate for simple open operation. None had a clear indication for open operation on the joint or had too severe disease to warrant a simple procedure. Preliminary diagnostic injections of bupivacaine to the TMJ relieved the pain. We applied the cryoprobe in the region of the auriculotemporal nerve and TMJ capsule. There was a small but insignificant improvement in mean mouth opening together with a significant (p=0.000) improvement in visual analogue pain scores (VAS) from 6.8 (range 4-10) to 2.0 (range 0-7). Two patients had no change in their pain scores, and 2 had complete resolution of their pain. The mean number of pain-free months after treatment was 7 (IQR 3-15). Three patients had long-term pain relief, and 12 temporary relief; 6 of these subsequently had successful relief after total replacement of the TMJ. One patient had further cryoanalgesia, one was referred for specialist pain management, and one controlled the pain with nortriptyline. Of the 17 cases studied, 2 had temporary complications after cryoanalgesia. Cryoanalgesia is a useful adjunct to the management of intractable pain in the TMJ. Short-term pain relief can be achieved, and long-term relief is possible in some, deferring more complex and costly treatments.
冷冻镇痛是慢性疼痛管理中一种颇具争议的辅助手段，但我们尚未发现有研究调查其在颞下颌关节（TMJ）疼痛管理中的效果。在这项为期五年的回顾性研究中，我们治疗了17例患者，这些患者的严重疼痛对所有形式的传统保守治疗均无反应，且不适合进行简单的开放性手术。没有患者有明确的关节开放性手术指征，也没有患者病情过于严重而无法进行简单手术。对TMJ进行布比卡因的初步诊断性注射可缓解疼痛。我们将冷冻探头应用于耳颞神经和TMJ囊区域。平均开口度有小幅但不显著的改善，视觉模拟疼痛评分（VAS）从6.8（范围4 - 10）显著改善（p = 0.000）至2.0（范围0 - 7）。2例患者的疼痛评分无变化，2例患者疼痛完全缓解。治疗后无痛月数的中位数为7（四分位间距3 - 15）。3例患者长期疼痛缓解，12例患者暂时缓解；其中6例患者在TMJ全置换术后成功缓解疼痛。1例患者接受了进一步的冷冻镇痛，1例患者被转诊至专科疼痛管理部门，1例患者用去甲替林控制疼痛。在研究的17例病例中，2例患者在冷冻镇痛后出现了暂时性并发症。冷冻镇痛是TMJ顽固性疼痛管理的一种有用辅助手段。可以实现短期疼痛缓解，部分患者也可能实现长期缓解，从而推迟更复杂、成本更高的治疗。
