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颞下颌关节脱位的病因及治疗——260 例回顾性分析。

Causes and treatment of temporomandibular luxation-a retrospective analysis of 260 patients.

机构信息

Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

出版信息

Clin Oral Investig. 2023 Jul;27(7):3991-3997. doi: 10.1007/s00784-023-05024-z. Epub 2023 Apr 29.

Abstract

OBJECTIVES

We aimed to clarify the etiology, diagnostic process, and treatment of temporomandibular joint (TMJ) luxation, as the standard care is mainly based on case-reports and systematic studies are lacking. The hypotheses were that luxation occurs spontaneously, recurrence manifests particularly among geriatric patients, and surgery is needed infrequently.

PATIENTS AND MATERIALS

A retrospective study of TMJ luxation patients (n = 260) from 2007 to 2020 was designed and implemented. The primary outcome was type of TMJ luxation (i.e., recurrent or non-recurrent), and secondary outcomes were the need for and type of surgical intervention. Predictor variables comprised age, sex, presence of neurological condition, and mechanism of luxation. Administered treatment and clinical outcomes were recorded.

RESULTS

Of luxation, 61.9% was recurrent and 40.0% due to spontaneous cause. Only 1.9% of patients underwent surgical intervention. The presence of neurological condition caused a 1.34-fold risk for recurrence of luxation and general condition a 1.57-fold risk.

CONCLUSIONS

TMJ luxation is often recurrent, bilateral, and spontaneous. Recurrent luxation is associated with geriatric and neurological conditions, and in this group recurrent TMJ luxation predicted death.

CLINICAL RELEVANCE

Our findings contribute to more effective diagnostics and treatment of TMJ luxation patients. We show that there is a need to standardize diagnostic measures and treatment patterns. Moreover, collaboration with other specialities, especially neurology and geriatrics, is important.

摘要

目的

我们旨在阐明颞下颌关节(TMJ)脱位的病因、诊断过程和治疗方法,因为标准治疗主要基于病例报告,缺乏系统研究。假设是脱位是自发发生的,复发主要发生在老年患者中,且手术需求不高。

患者和材料

设计并实施了一项 2007 年至 2020 年 TMJ 脱位患者(n=260)的回顾性研究。主要结局是 TMJ 脱位的类型(即复发性或非复发性),次要结局是手术干预的必要性和类型。预测变量包括年龄、性别、是否存在神经状况以及脱位机制。记录了所实施的治疗和临床结果。

结果

脱位中,61.9%为复发性,40.0%为自发性。仅 1.9%的患者接受了手术干预。存在神经状况使脱位复发的风险增加 1.34 倍,一般状况使脱位复发的风险增加 1.57 倍。

结论

TMJ 脱位常常是复发性的、双侧的和自发性的。复发性脱位与老年和神经状况相关,在该组中,复发性 TMJ 脱位预示着死亡。

临床意义

我们的发现有助于更有效地诊断和治疗 TMJ 脱位患者。我们表明,有必要标准化诊断措施和治疗模式。此外,与其他专科(尤其是神经病学和老年医学)的合作很重要。

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本文引用的文献

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Imaging of the temporomandibular joint.颞下颌关节影像学。
Clin Radiol. 2021 Jan;76(1):76.e21-76.e35. doi: 10.1016/j.crad.2020.06.020. Epub 2020 Jul 21.
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Treatment of temporomandibular joint luxation: a systematic literature review.颞下颌关节脱位的治疗:系统文献回顾。
Clin Oral Investig. 2020 Jan;24(1):61-70. doi: 10.1007/s00784-019-03126-1. Epub 2019 Nov 15.
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Surgical management of recurrent TMJ dislocation-a systematic review.复发性颞下颌关节脱位的手术治疗——一项系统评价
Oral Maxillofac Surg. 2019 Mar;23(1):35-45. doi: 10.1007/s10006-019-00746-5. Epub 2019 Feb 7.
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Bilateral Dislocation of the Temporomandibular Joint in Children.儿童双侧颞下颌关节脱位
J Oral Maxillofac Surg. 2018 Nov;76(11):2307-2315. doi: 10.1016/j.joms.2018.04.004. Epub 2018 Apr 11.
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The Treatment of Temporomandibular Joint Dislocation.颞下颌关节脱位的治疗。
Dtsch Arztebl Int. 2018 Feb 2;115(5):59-64. doi: 10.3238/arztebl.2018.0059.
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Temporomandibular joint dislocation.颞下颌关节脱位
Natl J Maxillofac Surg. 2015 Jan-Jun;6(1):16-20. doi: 10.4103/0975-5950.168212.
8
Temporomandibular joint dislocation.颞下颌关节脱位
Oral Maxillofac Surg Clin North Am. 2015 Feb;27(1):125-36. doi: 10.1016/j.coms.2014.09.009.
9
Complications of TMJ surgery.颞下颌关节手术的并发症。
Oral Maxillofac Surg Clin North Am. 2015 Feb;27(1):109-24. doi: 10.1016/j.coms.2014.09.008.
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Temporomandibular joint dislocation: experiences from Zaria, Nigeria.颞下颌关节脱位:来自尼日利亚扎里亚的经验
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