di Paolo Carlo, Pompa Giorgio, Arangio Paolo, di Nunno Anna, Di Carlo Stefano, Rosella Daniele, Papi Piero, Cascone Piero
Gnathology Unit, Department of Oral and Maxillo Facial Science, "Sapienza" University of Rome, Rome, Italy.
Implant Prosthetic Unit, Department of Oral and Maxillo Facial Science, "Sapienza" University of Rome, Rome, Italy.
J Int Soc Prev Community Dent. 2017 Mar-Apr;7(2):125-129. doi: 10.4103/jispcd.JISPCD_443_16. Epub 2017 Mar 29.
Temporomandibular disorders may be associated with dental and facial malformations. The aim of this study is to record the prevalence of TMDs in patients scheduled for orthognathic surgery, reporting the development of TMDs and symptoms during the entire period of the treatment, and demonstrating the benefits of a team effort on this population.
Assessment of temporomandibular status was performed using the RDC/TMD criteria at T0 (prior to orthodontic therapy), T1 (3 months after the surgery), and T2 post-therapeutic cycle (6 to 12 months postoperatively). A total of 76 participants were included in the study; all the patients underwent surgical treatment: 12 had bilateral sagittal split osteotomy, 6 with condylar position devices; 64 had Le Fort I + bilateral sagittal split osteotomy, and 15 with condylar position devices. Results were evaluated with a paired-sample -test and segmentation analysis.
Forty-seven patients were affected by TMDs. At T0, 25 patients experienced TMJ pain, 27 had muscular pain, 31 suffered headaches, 42 had disc dislocation with reduction, and 5 were affected by disc dislocation without reduction. Thirty-five patients had occlusal signs of parafunctions, 8 reported tinnitus, and 7 dizziness. At T1, TMJ pain changed from 33.3% to 4.44%, muscular pain changed from 35.5% to 11.1%, headaches improved from 40% to 6.67%, and disc dislocation from 55.2% to 17.7%. Segmentation analysis highlighted improvement after therapy; 57 patients were considered recovered, 14 improved, none were considered stable, whereas 5 patients demonstrated some worsening, 3 of whom had not presented disc dislocation before surgery. At T2, 71 patients were considered completely recovered or improved.
Our data indicates beyond any doubt that both functional status and pain levels related to TMDs can be significantly improved with a multi-disciplinary approach. We concluded that surgeon's intervention need to be modified in the presence of presurgical TMDs.
颞下颌关节紊乱病可能与牙齿及面部畸形有关。本研究旨在记录正颌手术患者中颞下颌关节紊乱病的患病率，报告治疗全过程中颞下颌关节紊乱病的发展及症状，并证明团队协作对该人群的益处。
采用RDC/TMD标准在T0（正畸治疗前）、T1（手术后3个月）和T2治疗周期后（术后6至12个月）对颞下颌关节状况进行评估。共有76名参与者纳入本研究；所有患者均接受手术治疗：12例行双侧矢状劈开截骨术，6例使用髁突定位装置；64例行Le Fort I +双侧矢状劈开截骨术，15例使用髁突定位装置。结果采用配对样本t检验和分段分析进行评估。
47名患者患有颞下颌关节紊乱病。在T0时，25名患者出现颞下颌关节疼痛，27名有肌肉疼痛，31名有头痛，42名有可复性盘移位，5名有不可复性盘移位。35名患者有异常功能的咬合体征，8名报告有耳鸣，7名有头晕。在T1时，颞下颌关节疼痛从33.3%降至4.44%，肌肉疼痛从35.5%降至11.1%，头痛从40%改善至6.67%，盘移位从55.2%降至17.7%。分段分析突出了治疗后的改善情况；57名患者被认为已康复，14名有所改善，无人被认为病情稳定，而5名患者病情有所恶化，其中3名在手术前未出现盘移位。在T2时，71名患者被认为已完全康复或有所改善。
我们的数据毫无疑问地表明，采用多学科方法可显著改善与颞下颌关节紊乱病相关的功能状态和疼痛程度。我们得出结论，在术前存在颞下颌关节紊乱病的情况下，外科医生的干预需要进行调整。
