temporomandibular joint stiffness
Introduction
Introduction to temporomandibular joint ankylosis The temporomandibular joint and the periarticular and intermaxillary parts, due to fibrous scar or ossification, cause mandibular dyskinesia or the mandible can not move, called the temporomandibular joint. basic knowledge The proportion of illness: 0.035% Susceptible people: no specific population Mode of infection: non-infectious Complications: malnutrition, sleep apnea syndrome
Cause
Temporomandibular joint ankylosis
The most common cause of temporomandibular joint stiffness is trauma, joint structure, muscle and adjacent tissue trauma can cause bleeding and inflammation. Fiber and bone formation can cause permanent movement limitation. At birth, trauma can be caused by The forceps directly acts on the joint area or the forceps acts on other parts of the mandible or the hip production. The subsequent trauma can also cause the joint toughness, often due to the impact of the ankle, which indirectly forms joint trauma. The extra-articular rigidity can be caused by the following factors. : condyle trauma, sacral muscle fracture, burn scar, oral cancer burning treatment.
Inflammation caused by infection is another important cause. The primary infection of the temporomandibular joint is rare, and the infection is mostly spread from the clinical area, such as the spread of odontogenic infection. In this case, the extra-articular tissue is more It is easy to be affected. In the past, otitis media often caused chronic infection of the temporomandibular joint. However, since the application of antibiotics, this kind of complication has been rare. Microorganisms that cause osteomyelitis can form new lesions when the blood reaches the temporomandibular joint. , causing joint stiffness and growth stagnation.
Joint stiffness can also be caused by radiation therapy, and rheumatoid arthritis can also cause joint stiffness.
Prevention
Temporomandibular joint ankylosis prevention
Regardless of the type of temporomandibular joint stiffness, postoperative recurrence has always been a concern for the public, but has not yet been fully resolved. According to domestic and international data, the recurrence rate is very large, about 10%~ Between 55%; the recurrence rate of true and pseudo joint ankylosis is similar; the long-term effect of mixed tonic is even worse. There are many factors leading to recurrence, and the current views are not completely consistent. It is generally considered to be related to the following factors.
Complication
Temporomandibular joint ankylosis Complications, malnutrition, sleep apnea syndrome
Difficulties in opening caused by this disease, such as long course of disease, can cause malnutrition; the occurrence of joint stiffness in young children will affect the development of the mandible, severe deformity may be associated with sleep apnea syndrome.
Symptom
Temporomandibular joint ankylosis symptoms Common symptoms Eating difficult to close the joints
(1) Clinical features
If there is no stagnation of the condylar growth or tissue loss, the joint stiffness will not be accompanied by facial asymmetry deformity. The diagnostic features include: when the unilateral incomplete rigidity, the midline of the ankle is biased toward the affected side when opening the mouth, because The contralateral condyle descends or slides forward, and the affected side condyle is relatively immobile; before putting the double-finger into the external auditory canal or tragus, the patient can open the mouth and check the movement of the condyle on the affected side is significantly reduced or Loss, X-ray usually has a positive finding, such as unclear joint structure, the position of the condyle and joint space is occupied by a large irregular X-ray opaque area.
If the joint stiffness is accompanied by growth stagnation or tissue loss, the clinical malformation is obvious. When the unilateral lesion is present, the midline of the closed fistula is biased toward the affected side; if the patient can open the mouth slightly, the phenomenon of the mandible biasing to the affected side is more obvious; Because the ascending branch is short, the chewing muscle appears to be fuller than the contralateral side. The anterior notch is deeper than the contralateral side. On both sides, the ankle is retracted obviously, and the lower 1/3 is short. The motion of the condylar can be detected obviously. Reduction or loss, X shows the mandibular deformity is also very obvious, the condylar neck is large, the condyle increases and grows, the ascending branch is short, and the increased mandibular angle is in sharp contrast with the deepened anterior notch.
A preliminary diagnosis can be made with obvious and typical clinical signs, but it must be confirmed by X-ray before surgery to develop a reasonable treatment plan.
Clinically divided into three categories:
1 true joint rigidity: the lesion involves the joint body, causing fibrosis or bony adhesion between the condyle and the joint recess, causing the joint to lose its active function.
2 pseudo-articular ankylosis: the structure of the cheeks or the upper and lower jaws, the jaws are contracted together due to scar adhesion, making the opening difficult, but the joint body structure is normal.
3 mixed joint rigidity: joint stiffness in the joint extra-articular lesions.
The common feature of temporomandibular joint ankylosis is that the joint is fixed, the opening is difficult, the progressive aggravation is not completely open, and the jaw is closed. The severity is related to the type of lesion and the course of the disease. The patient has complete loss of motor function due to mandibular function and difficulty eating. It can only squeeze the soft food after the molar gap and the interdental space, affecting the chewing function, oral cleaning and body development, causing the jaw to develop malformation, occlusion, and the movement of the condyle.
Examine
Examination of temporomandibular joint ankylosis
If there is no condylar growth stagnation or tissue loss, the joint stiffness will not be accompanied by facial asymmetry deformity. At this time, it is found that when the unilateral incomplete rigidity is reached, the midline of the ankle is biased toward the affected side when the mouth is opened. This is because the contralateral condyle Sliding or sliding forward, and the affected side of the condyle is relatively immobile; with two fingers placed in the external auditory canal or tragus, so that the patient can open the mouth, can check the movement of the affected side of the condyle is significantly reduced or lost, X-ray There are usually positive findings, such as unclear joint structure, and the position of the condyle and joint space is occupied by a large irregular X-ray opaque area.
If the joint stiffness is accompanied by growth stagnation or tissue loss, the clinical malformation is obvious. When the unilateral lesion is present, the midline of the closed fistula is biased toward the affected side; if the patient can open the mouth slightly, the phenomenon of the mandible biasing to the affected side is more obvious; Because the ascending branch is short, the chewing muscle appears to be fuller than the contralateral side. The anterior notch is deeper than the contralateral side. On both sides, the ankle is retracted obviously, and the lower 1/3 is short. The motion of the condylar can be detected obviously. Reduction or loss, X shows the mandibular deformity is also very obvious, the condylar neck is large, the condyle increases and grows, the ascending branch is short, and the increased mandibular angle is in sharp contrast with the deepened anterior notch.
Diagnosis
Diagnosis and differentiation of temporomandibular joint ankylosis
Because the intra-articular and external torsion surgery methods are different, it must be clearly identified as belonging to intra-articular rigidity, extra-articular rigidity or mixed type.
