Medical University of South Carolina, Charleston, South Carolina.
Medical University of South Carolina College of Pharmacy, Charleston, South Carolina.
Am Fam Physician. 2023 Jan;107(1):52-58.
Temporomandibular disorders affect between 5% and 12% of the population and present with symptoms such as headache, bruxism, pain at the temporomandibular joint, jaw popping or clicking, neck pain, tinnitus, dizziness, decreased hearing, and hyperacuity to sound. Common signs on physical examination include tenderness of the pterygoid muscles, temporomandibular joints, and temporalis muscles, and malocclusion of the jaw and crepitus. The diagnosis is based on history and physical examination; however, use of computed tomography or magnetic resonance imaging is recommended if the diagnosis is in doubt. Nonpharmacologic therapy includes patient education (e.g., good sleep hygiene, soft food diet), cognitive behavior therapy, and physical therapy. Pharmacologic therapy includes nonsteroidal anti-inflammatory drugs, cyclobenzaprine, tricyclic antidepressants, and gabapentin. Injections of the temporomandibular joints with sodium hyaluronate, platelet-rich plasma, and dextrose prolotherapy may be considered, but the evidence of benefit is weak. A referral to oral and maxillofacial surgery is indicated for refractory cases.
颞下颌关节紊乱影响 5%至 12%的人群，其症状包括头痛、磨牙症、颞下颌关节疼痛、下颌弹响或咔哒声、颈部疼痛、耳鸣、头晕、听力下降和对声音的超敏反应。体格检查的常见体征包括翼内肌、颞下颌关节和颞肌压痛，以及下颌咬合不正和弹响。诊断基于病史和体格检查；但是，如果诊断有疑问，建议使用计算机断层扫描或磁共振成像。非药物治疗包括患者教育（例如，良好的睡眠卫生，软食饮食），认知行为疗法和物理疗法。药物治疗包括非甾体抗炎药、环苯扎林、三环类抗抑郁药和加巴喷丁。可考虑向颞下颌关节注射透明质酸钠、富含血小板的血浆和葡萄糖 prolotherapy，但获益证据较弱。对于难治性病例，建议转诊至口腔颌面外科。
