Özkan Nilüfer Cakir, Ozkan Fatih
Department of Oral and Maxillofacial Surgery, Gaziosmanpaşa University Faculty of Medicine, Tokat, Turkey.
Agri. 2011 Jan;23(1):13-7. doi: 10.5505/agri.2011.48615.
The objective of this study was to retrospectively analyze the incidence of the concurrent existence of temporomandibular disorders (TMD) and headaches.
Forty patients (36 female, 4 male, mean age: 29.9±9.6 years) clinically diagnosed with TMD were screened. Patient records were analyzed regarding: range of mouth opening, temporomandibular joint (TMJ) noises, pain on palpation of the TMJ and masticatory muscles and neck and upper back muscles, and magnetic resonance imaging of the TMJ.
According to patient records, a total of 40 (66.6%) patients were diagnosed with TMD among 60 patients with headache. Thirty-two (53%) patients had TMJ internal derangement (ID), 8 (13%) patients had only myofascial pain dysfunction (MPD) and 25 (41.6%) patients had concurrent TMJ ID/MPD. There were statistically significant relationships between the number of tender masseter muscles and MPD patients (p=0.04) and between the number of tender medial pterygoid muscles and patients with reducing disc displacement (RDD) (p=0.03).
The TMJ and associated orofacial structures should be considered as possible triggering or perpetuating factors for headaches, especially tension-type. There might be a significant connection between TMD and headache. However, most medical and dental practitioners are unaware of this relationship. Therefore, a careful evaluation of the TMJ and associated orofacial structures is required for a correct interpretation of the craniofacial pain in headache patients, and these patients should be managed with a multidisciplinary approach.
本研究的目的是回顾性分析颞下颌关节紊乱病（TMD）与头痛并存的发生率。
对40例临床诊断为TMD的患者（36例女性，4例男性，平均年龄：29.9±9.6岁）进行筛查。分析患者记录，内容包括：张口度、颞下颌关节（TMJ）弹响、颞下颌关节及咀嚼肌、颈部和上背部肌肉触诊疼痛，以及颞下颌关节的磁共振成像。
根据患者记录，60例头痛患者中共有40例（66.6%）被诊断为TMD。32例（53%）患者有颞下颌关节内紊乱（ID），8例（13%）患者仅有肌筋膜疼痛功能障碍（MPD），25例（41.6%）患者同时存在颞下颌关节ID/MPD。咬肌压痛数量与MPD患者之间（p=0.04）以及翼内肌压痛数量与盘移位减少（RDD）患者之间（p=0.03）存在统计学显著关系。
颞下颌关节及相关口面部结构应被视为头痛尤其是紧张型头痛可能的触发或持续因素。TMD与头痛之间可能存在显著关联。然而，大多数医学和牙科从业者并未意识到这种关系。因此，对于头痛患者颅面部疼痛的正确解读需要仔细评估颞下颌关节及相关口面部结构，并且这些患者应采用多学科方法进行管理。
