State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, 145# Western Changle Road, Xi'an, 710032, P.R. China.
Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University (FMMU), Xi'an, 710032, China.
Head Face Med. 2021 Mar 27;17(1):11. doi: 10.1186/s13005-021-00261-7.
Temporomandibular joint (TMJ) 'closed lock' is a clinical condition causing TMJ pain and limited mouth opening (painful locking). Recent studies suggest an increasing prevalence of degenerative joint disease associated with the onset of TMJ closed lock in adolescents and young adults. Early interventions are recommended, but the curative effect of standard therapies remains controversial. In this retrospective study, an alternative method of non-surgical treatment of TMJ closed lock is presented, and its long-term efficacy has been observed.
Forty adolescents and young adults, aged 16 to 30 years old, with distinct combination of symptoms of TMJ closed lock, were enrolled. Patients received anesthetic blockages of the auriculotemporal nerve, then performed mandibular condylar movement exercise for 10 min, and subsequently received hypertonic dextrose prolotherapy in retro-discal area of TMJ. Clinical assessments at baseline and at follow-up (2 weeks, 2 months, 6 months, and 5 years) included intensity and frequency of TMJ pain, mandibular range of motion, TMJ sounds, and impairment of chewing.
Cone beam CT images of the TMJs revealed joint space changes in all patients and degenerative bone changes in 20% (8/40) of the patients. The patients were diagnosed as having disc displacement without reduction with limited opening. Successful reduction of displaced disc had been achieved in the treatment. And pain at rest and pain on mastication had substantially decreased in all patients and mandibular function and mouth opening had significantly improved since 2 weeks' follow-up. The overall success rate kept at a high level of 97.5% (39/40) at 6 months and 5 years' follow-up.
The technique combining mandibular condylar movement exercise with auriculotemporal nerve block and dextrose prolotherapy is straightforward to perform, inexpensive and satisfactory to young patients with TMJ closed lock.
颞下颌关节（TMJ）“闭锁”是一种导致 TMJ 疼痛和张口受限（疼痛性闭锁）的临床病症。最近的研究表明，青少年和年轻成年人中 TMJ 闭锁的发病与退行性关节病的发生率呈上升趋势。建议早期干预，但标准治疗的疗效仍存在争议。在这项回顾性研究中，提出了一种 TMJ 闭锁的非手术治疗的替代方法，并观察了其长期疗效。
纳入了 40 名年龄在 16 至 30 岁之间的青少年和年轻成年人，他们均有明确的 TMJ 闭锁症状组合。患者接受耳颞神经阻滞麻醉，然后进行下颌髁突运动锻炼 10 分钟，随后在 TMJ 关节盘后区进行高渗葡萄糖普鲁卡因治疗。基线和随访时（2 周、2 个月、6 个月和 5 年）的临床评估包括 TMJ 疼痛的强度和频率、下颌运动范围、TMJ 声音和咀嚼功能障碍。
TMJ 的锥形束 CT 图像显示所有患者的关节间隙均发生变化，20%（8/40）的患者发生退行性骨改变。患者被诊断为髁突不可复位的盘前移位。在治疗中成功地复位了移位的关节盘。所有患者的静息痛和咀嚼痛均明显减轻，下颌功能和张口度自 2 周随访以来显著改善。6 个月和 5 年随访时，总体成功率保持在较高水平，为 97.5%（39/40）。
将下颌髁突运动锻炼与耳颞神经阻滞和葡萄糖普鲁卡因治疗相结合的技术，对于 TMJ 闭锁的年轻患者来说，操作简单、经济实惠且效果满意。
