Kundi Nasir Akram, Mehmood Talat, Abid Omair
Department of ENT, Combined Military Hospital, Nowshera, Peshawar.
Department of Emergency, Combined Military Hospital, Nowshera, Peshawar.
J Coll Physicians Surg Pak. 2015 Apr;25(4):268-70.
To determine the effect of duration of application of mouth gag on Temporomandibular (TM) joint pain and trismus after tonsillectomy.
Descriptive study.
Department of ENT and Head and Neck Surgery, Combined Military Hospital, Nowshera, from February to July 2012.
A total of 40 patients undergoing tonsillectomy, in mouth opening prior to surgery was measured as inter incisor distance in cms. A stop watch was used to calculate the time of application of mouth gag. Mouth opening was again measured 06 hours after the surgery. Difference between the two readings was considered as trismus score and categorized as mild (1 cm), moderate (2 cm) and severe (3 cm). Patient was asked to score pain on a visual analogue scale (0 - 9). Score 0 was categorized as no pain; 1 - 3 as mild pain; 4 - 6 as moderate pain; 7 - 9 as severe pain. Spearman's rank correlation was used for finding correlation between time of mouth gag application and study outcome (pain and trismus).
Trismus as observed by difference in inter incisor distance was mild in 11 patients; moderate in 15 patients and severe in 14 patients 06 hours after the surgery. Eleven (27.5%) had mild pain over temporomandibular joint, 15 (37.5%) had moderate and 14 (35%) had severe pain 06 hours after the surgery. Direct relationship was observed between duration of application of mouth gag with postoperative pain and trismus. Significant strong correlation was observed between length of mouth opening to severity of pain and trismus (rs = 0.738; p < 0.001).
Duration of mouth gag application should be reduced to cause less TM joint pain and trismus in early postoperative period in tonsillectomy.
确定扁桃体切除术后张口器使用时间对颞下颌关节疼痛和牙关紧闭的影响。
描述性研究。
2012年2月至7月，瑙谢拉联合军事医院耳鼻喉科及头颈外科。
共有40例接受扁桃体切除术的患者，术前测量其开口度，以厘米为单位记录切牙间距离。使用秒表计算张口器的使用时间。术后6小时再次测量开口度。两次测量结果的差值被视为牙关紧闭评分，并分为轻度（1厘米）、中度（2厘米）和重度（3厘米）。要求患者使用视觉模拟评分法（0 - 9分）对疼痛进行评分。0分表示无疼痛；1 - 3分为轻度疼痛；4 - 6分为中度疼痛；7 - 9分为重度疼痛。采用Spearman等级相关分析来确定张口器使用时间与研究结果（疼痛和牙关紧闭）之间的相关性。
术后6小时，通过切牙间距离差异观察到牙关紧闭情况为：11例患者为轻度，15例患者为中度，14例患者为重度。术后6小时，11例（27.5%）患者颞下颌关节有轻度疼痛，15例（37.5%）患者有中度疼痛，14例（35%）患者有重度疼痛。观察到张口器使用时间与术后疼痛和牙关紧闭之间存在直接关系。观察到开口度与疼痛及牙关紧闭严重程度之间存在显著的强相关性（rs = 0.738；p < 0.001）。
在扁桃体切除术后早期，应减少张口器的使用时间，以减轻颞下颌关节疼痛和牙关紧闭。
