Orofacial Pain and TMJ Disorders, Eastman Institute for Oral Health, University of Rochester, 625 Elmwood Ave, NY, 14620, USA.
Orofacial Pain Clinic, University of the Pacific Arthur A. Dugoni School of Dentistry, San Francisco, CA, 94103, USA.
J Bodyw Mov Ther. 2021 Oct;28:104-113. doi: 10.1016/j.jbmt.2021.07.015. Epub 2021 Aug 8.
Temporomandibular disorders (TMDs) are an umbrella term encompassing disorders of both the temporomandibular joint (TMJD) and masticatory musculature (MMD). The objective of this review is to provide an overview of the etiopathogenesis, clinical features and diagnosis of MMD, and to summarize the current trends in the therapeutic management.
A review of the literature was performed from 1985 to 2020. The keywords included were "temporomandibular disorders OR temporomandibular joint disorders" AND "myofascial pain OR masticatory myofascial pain OR trigger point". A total of 983 articles were screened with abstracts and approximately 500 full text articles were included in the review based on their relevance to the topic.
MMD's present significant challenges in diagnosis and treatment. Effective treatment requires a clear diagnosis based on an understanding of pathophysiologic mechanisms, a detailed history with assessment of predisposing local and systemic factors, perpetuating factors, a comprehensive clinical evaluation and a diagnostic workup.
A thorough history and clinical examination are the gold standards for diagnosis of MMD. Serological testing may help identify underlying co-morbidities. Recent diagnostic modalities including ultrasound sonoelastography and magnetic resonance elastography (MRE) have shown promising results. The treatment goals for MMD are to control pain, restore mandibular function and facilitate the return to normal daily activity and improve the overall quality of life of a patient. Conservative modalities including home care regimens, pharmacotherapy, intraoral appliance therapy, local anesthetic trigger point injections, physiotherapy and complementary modalities may be beneficial in patients with MMD's.
颞下颌关节紊乱病（TMDs）是一个涵盖颞下颌关节（TMJD）和咀嚼肌（MMD）疾病的总称。本综述的目的是概述 MMD 的病因发病机制、临床特征和诊断，并总结目前治疗管理的趋势。
对 1985 年至 2020 年的文献进行了回顾。使用的关键词包括“颞下颌关节紊乱病或颞下颌关节疾病”和“肌筋膜疼痛或咀嚼肌筋膜疼痛或触发点”。通过摘要筛选了 983 篇文章，根据与主题的相关性，大约有 500 篇全文文章纳入了综述。
MMD 的诊断和治疗目前存在重大挑战。有效的治疗需要基于对病理生理机制的理解，详细的病史评估，包括诱发局部和全身因素、持续因素、全面的临床评估和诊断检查，明确诊断。
详细的病史和临床检查是 MMD 诊断的金标准。血清学检测可能有助于确定潜在的合并症。最近的诊断方法，包括超声弹性成像和磁共振弹性成像（MRE），已经显示出了有前途的结果。MMD 的治疗目标是控制疼痛、恢复下颌功能、促进患者恢复正常日常活动并改善其整体生活质量。对于 MMD 患者，保守治疗方法，包括家庭护理方案、药物治疗、口腔内矫治器治疗、局部麻醉触发点注射、物理治疗和补充治疗可能是有益的。
