Hodges J M
Department of Otolaryngology--Head and Neck Surgery, University of Tennessee Center for the Health Sciences, Memphis.
Laryngoscope. 1990 Jan;100(1):60-6. doi: 10.1288/00005537-199001000-00013.
Pain in the temporomandibular joint is primarily responsible for the morbidity often associated with this syndrome. Of the 448 cases in this study, 48% presented as ear pain and 46% complained of either headache, sinus pain, or neck pain. Temporomandibular joint pain and mastication muscle tenderness elicited with palpation were frequent physical findings. In this review, temporomandibular joint syndrome was successfully managed in 75% of 448 cases with conservative treatment consisting of patient education, heat, massage, non-narcotic analgesics, and occlusal splints. Seventeen percent were referred to dentists for restorations or orthodontics. The success rate for the 6% who underwent diagnostic arthroscopy and/or open joint surgery with disc replacement was 67%. Therefore, patients with ear pain or head and neck pain require an objective evaluation of medical history and physical examination to obtain the correct diagnosis and subsequent correct treatment and pain relief. Early diagnosis helps to prevent changes in the joint that can become irreversible with intractable pain. Surgery is reserved for those patients who fail to respond to conservative management.
颞下颌关节疼痛是该综合征常伴发病症的主要原因。在本研究的448例病例中，48%表现为耳痛，46%主诉头痛、鼻窦痛或颈部疼痛。触诊时出现的颞下颌关节疼痛和咀嚼肌压痛是常见的体格检查发现。在本综述中，448例病例中有75%通过包括患者教育、热敷、按摩、非麻醉性镇痛药和咬合夹板在内的保守治疗成功治愈。17%的患者被转诊至牙医处进行修复或正畸治疗。接受诊断性关节镜检查和/或开放性关节手术及椎间盘置换的6%患者的成功率为67%。因此，有耳痛或头颈部疼痛的患者需要对病史进行客观评估并进行体格检查，以获得正确诊断并随后进行正确治疗和缓解疼痛。早期诊断有助于预防关节发生不可逆的变化，而这种变化可能会导致顽固性疼痛。手术仅适用于那些对保守治疗无反应的患者。
