Centre for TMD and Orofacial Pain, Peking University School and Hospital of Stomatology, Beijing, China; Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, Beijing, China; National Clinical Research Centre for Oral Diseases, Beijing, China; National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China; Beijing Key Laboratory of Digital Stomatology, Beijing, China.
Centre for TMD and Orofacial Pain, Peking University School and Hospital of Stomatology, Beijing, China; Department of Dentistry, Ng Teng Fong General Hospital, National University Health System, Singapore; Faculty of Dentistry, National University of Singapore, Singapore.
Int J Oral Maxillofac Surg. 2020 Mar;49(3):361-368. doi: 10.1016/j.ijom.2019.07.005. Epub 2019 Jul 26.
This study investigated the efficacy of a sequential combination of arthrocentesis, mandibular manipulation, and anterior repositioning splint (ARS) in the management of acute temporomandibular joint (TMJ) disc displacement without reduction (DDwoR). Twenty-one consecutive patients diagnosed with acute DDwoR by Diagnostic Criteria for Temporomandibular Disorders and magnetic resonance imaging (MRI) were recruited and managed with this method. Clinical and MRI data were obtained before and at 1 week after treatment. The disc-condyle relationship was determined by disc-condyle angle measurement. Condyle/disc positions were described as x-y coordinates with the summit of the articular fossa as the coordinate origin. Statistical analyses including independent/paired samples t-tests were conducted; significance was set at P<0.05. Clinical success was observed in 95.2% of patients (20/21) with 22 joints affected by acute DDwoR. After combined treatment and ARS insertion, TMJs with DDwoR showed (a) normal disc-condyle relationships with substantial forward and downward condyle movement and significant disc reduction in closed position, and (b) discs with an intermediate zone located between the condylar head and articular eminence in open position. The combined approach was highly effective in 'unlocking' acute TMJ DDwoR and achieving spatial full disc reduction and a normal disc-condyle relationship. The duration of acute DDwoR appears to be critical for success.
本研究旨在探讨关节腔穿刺、下颌手法复位及前导型牙合垫（ARS）序贯治疗伴不可复性盘前移位（DDwoR）的急性颞下颌关节（TMJ）紊乱的疗效。共纳入 21 例经 TMJ 紊乱诊断标准和磁共振成像（MRI）诊断为急性 DDwoR 的连续患者，采用该方法进行治疗。在治疗前和治疗后 1 周分别采集临床和 MRI 数据。通过测量髁突-关节盘角来确定关节盘-髁突关系。将髁突/关节盘位置描述为 x-y 坐标，以关节窝顶点为坐标原点。采用独立样本/配对样本 t 检验进行统计学分析，以 P<0.05 为差异有统计学意义。21 例（22 个关节）伴急性 DDwoR 的患者中，有 95.2%（20/21）的患者临床疗效显著。经过联合治疗和 ARS 插入后，伴 DDwoR 的 TMJ 表现为：（a）髁突-关节盘关系正常，髁突明显向前向下运动，闭口时关节盘明显复位；（b）开口时关节盘处于介于髁突头和关节结节之间的中间带。该联合方法在“解锁”急性 TMJ DDwoR 和实现空间全关节盘复位及正常关节盘-髁突关系方面非常有效。急性 DDwoR 的持续时间似乎对疗效至关重要。
