Department of Oral and Maxillofacial Surgery, University Hospital Marburg UKGM GmbH, Marburg, Germany; Department of Dentistry, Oral Medicine and Maxillofacial Surgery, University of Rostock, Rostock, Germany; CMD-Centrum Hamburg-Eppendorf, Hamburg, Germany.
Dtsch Arztebl Int. 2018 Feb 2;115(5):59-64. doi: 10.3238/arztebl.2018.0059.
The estimated incidence of temporomandibular joint dislocation in Germany is at least 25/100 000 per year. A correct diagnosis and the initiation of appropriate treatment without delay are essential if permanent damage to the joint is to be avoided.
This review is based on pertinent publications retrieved by a systematic search in the PubMed, Cochrane, Embase, and ZB Med databases.
The initial search yielded 24 650 hits; duplicates were removed and 136 studies were chosen for further analysis. The diagnosis of temporomandibular joint dislocation is generally made clinically from the finding of a lower jaw that is fixed in the open position. Acute dislocations are manually repositioned at once. The most common method is Hippocratic repositioning, in which the physician's thumb is placed laterally next to the teeth and the other fingers are placed on the lower surface of the lower jaw. The physician then exerts pressure, first caudally, then dorsally. Repositioning is carried out in two steps. For dislocations that have been present for a longer time, manual repositioning may be ineffective and surgery may be needed. Recurrent dislocation can be treated in a minimally invasive way with botulinum toxin injections or autologous blood therapy. Surgery may be needed if these methods are ineffective.
There have been no more than a few randomized, controlled trials of treatments for temporomandibular joint dislocation, in particular concerning minimally invasive and open surgical treatments, and therefore only limited evidence-based conclusions can be drawn. Nonetheless, the diagnostic and therapeutic standards that have been established in recent years have gained wide international acceptance.
德国每年至少有 25/100000 人患有颞下颌关节脱位。如果要避免关节永久性损伤，正确诊断和及时开始适当治疗至关重要。
本综述基于通过在 PubMed、Cochrane、Embase 和 ZB Med 数据库中进行系统搜索获得的相关出版物。
最初的搜索产生了 24650 个结果；去除重复项后，选择了 136 项研究进行进一步分析。颞下颌关节脱位的诊断通常通过发现下颚固定在张开位置来进行临床诊断。急性脱位应立即手动复位。最常见的方法是 Hippocratic 复位法，医生的拇指放在牙齿旁边的外侧，其他手指放在下颚的下表面。然后医生施加压力，先向尾侧，再向背侧。复位分两步进行。对于已经存在较长时间的脱位，手动复位可能无效，可能需要手术。对于复发性脱位，可以采用肉毒毒素注射或自体血液疗法进行微创治疗。如果这些方法无效，可能需要手术。
对于颞下颌关节脱位的治疗，特别是微创和开放性手术治疗，只有为数不多的随机对照试验，因此只能得出有限的基于证据的结论。尽管如此，近年来确立的诊断和治疗标准已得到广泛的国际认可。
