temporomandibular contracture
Introduction
Introduction to temporomandibular contracture Temporomandibular contracture: mainly caused by trauma and infection. Trauma includes extensive avulsion of the cheeks, firearm injuries, open fractures, such as fractures or firearm injuries in the nodules or mandibular branches, causing scar contracture between the jaws. Infections include large areas of ulcers in the mouth, severe spores involving the face and jaw, psoriasis, bullous epidermis and other skin diseases associated with facial skin scar contracture. Intermaxillary contracture mainly manifests as difficulty in opening mouth or varying in mouth. There are cheek trauma, open fractures, infections, physical and chemical injuries, radiation therapy and surgical history. Extra-articular lesions are difficult to open or completely unable to open the mouth, and the scars can be touched between the jaws. The ear area is in contact with the pressure, and the condylar activity is weakened or disappeared. Surgery is the main treatment. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: synovitis
Cause
The cause of temporomandibular contracture
Mainly caused by trauma and infection. Trauma includes extensive avulsion of the cheeks, firearm injuries, open fractures, such as fractures or firearm injuries in the nodules or mandibular branches, causing scar contracture between the jaws. Infections include large areas of ulcers in the mouth, severe spores involving the face and jaw, psoriasis, bullous epidermis and other skin diseases associated with facial skin scar contracture. Progressive ossification of the upper and lower mandibular osteomyelitis, secondary to intermaxillary contracture, resulting in limited mandibular movement. Head and neck tumors are exposed to large doses of radiation, resulting in extensive fibrosis of the soft tissue between the upper and lower jaws, which can also cause scar contracture between the jaws. Burns, burns, and chemical burns cause large areas of scar formation on the cheek tissue. Inaccurate cheeks and intraoral surgery and improper skin grafting can also lead to scar formation between the jaws and affect jaw movement.
Prevention
Temporomandibular contracture prevention
1. The key to preventing this disease is to avoid trauma and treat recurrent dislocation. The disease is mainly caused by large openings, injuries, etc., which cause the condyles to escape from the joints and cannot be re-determined by themselves. When the muscles of the elderly are abnormal and the ligaments are loose, recurrent paralysis can occur.
2, temporomandibular contracture should be re-determined in time, and bandage for craniofacial fixation, limiting mouth opening for 2-3 weeks.
3. For patients with prolonged sputum and chewing muscles, patients may be treated with local hot compress or chewing nerves before they are re-established by hand.
4, when the various methods are re-invalidated, it can be considered to be re-established under general anesthesia, and even surgery is re-determined.
Complication
Temporomandibular contracture complications Complications Synovitis
(1) Extrapyramidal hyperfunction
The main symptoms are slapping and opening too large. When the snapping occurs on one side, the open type is biased to the healthy side at the end of the opening; when both sides are bounced, the open type is not skewed or biased toward the weaker side of the external muscle contraction force. Generally no pain.
(2) pterygoid tendon
The main manifestations are pain and limited opening, and the mechanism that causes pain and limited opening is the extra-pteryx tendon. During the examination, the opening is moderately limited, the opening degree is 2 to 2.5 cm, the passive opening degree is greater than the natural opening degree, and the mandible is biased toward the affected side when opening. The corresponding parts of the external muscles of the pterygoids (the lower part of the lower jaw and the upper part of the upper jaw nodules) have tenderness, but no redness and swelling, and there is no tenderness in the joint area.
(3) Myofascial pain
Mostly caused by factors, mental stress, excessive masticatory muscle load, trauma and cold stimulation. The nature of the pain is persistent dull pain, there is a tender point, and the trigger point is called when the tender point is sensitive. The opening is slightly restricted and the passive opening can be opened to the normal range with pain.
(4) Reversible disc displacement
There is a snap on the opening and closing. The mechanism is that when the disc is in the front shifting state, the condyle squats against the trailing edge of the posterior disc of the disc in the opening motion and moves forward and forward to move forward, and the disc retreats backwards, thereby returning to normal. The structural relationship of a discoidal disc. The open type is biased to the affected side before the sounding occurs, and returns to the center line after the sounding occurs. X-ray film (Xu Le position) can be seen that the posterior space of the joint is narrowed, and the articular view or MPI examination can confirm the displacement of the articular disc. If accompanied by pterygoid tendon or synovitis, it is associated with symptoms.
(5) irreversible disc displacement
There is a typical history of joints and bullets, followed by a history of intermittent joint locks, which in turn disappears and the opening is limited. The clinical examination opening is limited. When the opening is open, the mandible is biased toward the affected side, and the joint area is painful; when the passive opening is checked, the opening degree cannot be increased. X-ray film (Xu Le position) can be seen that the posterior space of the joint is narrowed, and the articular view or MPI examination can confirm the displacement of the articular disc.
(6) joint capsule dilatation with articular disc attachment relaxation
Similar to the symptoms of hyperkinesia, the degree of opening is too large, may be associated with chronic synovitis. Arthrography can confirm the expansion of the joint capsule with the loosening of the disc.
(7) Synovitis
Local joint pain occurs during joint movement, and the pain is aggravated by the increased joint load in the upward direction. If there is joint cavity effusion, there may be mild swelling in the joint area and the ipsilateral posterior teeth may not be tightly engaged. Joint capsule inflammation is difficult to distinguish from synovitis in clinical practice, but its tender point is mainly outside the joint capsule, which is helpful for diagnosis.
(8) Osteoarthrosis
The main symptom of rupture and perforation of the articular disc is that there are multiple sound breaks and open-ended distortions at any stage of the jaw movement. The main symptom of condylar degeneration is the continuous friction sound during the opening and closing movement. Arthrography can be seen in the upper and lower chambers; X-ray films can be seen in articular sclerosis, destruction, cystic changes, bone hyperplasia, and callus.
Symptom
Temporomandibular contracture symptoms common symptoms contracture scars difficult to open mouth
Intermaxillary contracture mainly manifests as difficulty in opening mouth or varying in mouth. The lateral movement of the mandible is limited, depending on the extent and severity of the fibrous scar between the jaws. In cases of cotton skin trauma and infection history, the face has obvious scars, defect deformities and facial deformities caused by scar contraction. Open fractures, especially those located in the alveolar process, can distort the teeth. There may be scars in the mouth. Because the joint structure itself is not involved, the condyle has a certain degree of mobility. When there is only a scar between the jaws, the degree of condylar movement is weakened. If there is intermaxillary bone adhesion, the condylar movement can disappear, but during lateral movement. Have a certain degree of activity. The intermaxillary contracture that occurs after the developmental stage is mainly characterized by difficulty in opening the mouth, and the cases before the development may be accompanied by facial deformity and occlusion.
Examine
Examination of temporomandibular contracture
There are cheek trauma, open fractures, infections, physical and chemical injuries, radiation therapy and surgical history. Extra-articular lesions are difficult to open or completely unable to open the mouth, and the scars can be touched between the jaws. The ear area is in contact with the pressure, and the condylar activity is weakened or disappeared.
According to different etiology and onset time, there may be no or no facial deformity and occlusion. Fibrous intermaxillary contracture, the scar tissue is located in the soft tissue or cheek skin of the oral mucosa and cheek. A small number of lesions are caused by scars on the edge of the hole around the mouth. These lesions are often associated with varying degrees of deformity between the cheeks, the mouth, and the upper and lower jaws. Bone intermaxillary contracture is the formation of bony adhesion between the upper and lower jaws or between the mandible and the zygomatic arch. Most of the bony adhesions are accompanied by scar contracture of soft tissues and defects and deformities of soft and hard tissues of the maxillofacial region. The joint X-ray film showed clear joint space and no obvious damage to the joint structure. In the case of orphan adhesion, X-ray films showed narrowing of the gap between the upper and lower jaws, increased density or bony fusion, bony fusion with the maxillary nodules and tibia, or bony of the maxillary nodules and mandibular branches. Fusion.
Diagnosis
Diagnosis and differentiation of temporomandibular contracture
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
It is differentiated from oral and maxillofacial injuries and temporomandibular joint ankylosis.
