Schellhas K P, Wilkes C H, Baker C C
Headache. 1989 Apr;29(4):229-32. doi: 10.1111/j.1526-4610.1989.hed22904229.x.
We studied one hundred patients with suspected temporomandibular joint (TMJ) arthropathy in whom 64 also complained of headache and/or facial pain, using high field surface coil magnetic resonance (MR) imaging, and found that headache and facial pain are commonly observed in association with inflammatory arthropathy of the TMJ. Each patient complained of pain and/or tenderness localized to the immediate vicinity of at least one TMJ. Pathologic joint effusion was demonstrated by MR in 88 of the painful joints studied. Significant meniscus displacement, with or without meniscus deformity and alteration of intrinsic signal intensity was present in 94 of the 100 painful joints examined. Fascial inflammation and atrophy of the ipsilateral muscles of mastication were observed occasionally with painful joints. There were no mechanical TMJ symptoms, such as joint clicking, crepitus or locking in 14 internally deranged and painful joints, 12 of which exhibited joint effusion and local inflammation. At least 80 patients described occlusal changes within 12 months of imaging. 28 of the pathologic joints in the series underwent subsequent meniscectomy, including routine histologic evaluation of surgical material. We conclude that internal derangement and inflammation of the TMJ should be considered in patients with unexplained headache and/or facial pain, even if mechanical TMJ symptoms are absent.
我们使用高场表面线圈磁共振成像，对100例疑似颞下颌关节（TMJ）关节病的患者进行了研究，其中64例还伴有头痛和/或面部疼痛，结果发现头痛和面部疼痛常与TMJ的炎性关节病相关。每位患者均主诉至少一个TMJ紧邻区域有疼痛和/或压痛。在所研究的疼痛关节中，88例通过磁共振成像显示有病理关节积液。在检查的100个疼痛关节中，94个存在明显的半月板移位，伴有或不伴有半月板畸形及内部信号强度改变。偶尔在疼痛关节处观察到同侧咀嚼肌的筋膜炎症和萎缩。14个关节内紊乱且疼痛的关节没有出现机械性TMJ症状，如关节弹响、摩擦音或绞锁，其中12个关节有积液和局部炎症。至少80例患者在成像后12个月内出现咬合变化。该系列中的28个病理关节随后接受了半月板切除术，包括对手术材料进行常规组织学评估。我们得出结论，即使没有机械性TMJ症状，对于原因不明的头痛和/或面部疼痛患者，也应考虑TMJ的关节内紊乱和炎症。
