【晨读】颞下颌关节综合征（五）

 英语晨读 ·

山东省立医院疼痛科英语晨读已经坚持10余年的时间了，每天交班前15分钟都会精选一篇英文文献进行阅读和翻译。一是可以保持工作后的英语阅读习惯，二是可以学习前沿的疼痛相关知识。我们会将晨读内容与大家分享，助力疼痛学习。

本次文献选自Maini, K., & Dua, A. (2020). Temporomandibular Joint Syndrome. In StatPearls. StatPearls Publishing。本次学习由赵学军主任医师主讲。

Differential Diagnosis

Various other disorders can present as facial or ear pain or even headaches.  A thorough history and physical exam with basic labs like blood counts, kidney and liver function tests, and sedimentation rate help in localizing the lesion for most presentations of TMJ pain.

1. Common causes of facial pain include trigeminal, glossopharyngeal, or post-herpetic neuralgia, sinusitis, salivary gland disorders, and carotidynia.

2. Common causes of headaches include migraines, cluster headaches, strokes, and temporal arteritis.

3.   Common causes of ear pain or stuffiness are middle ear infections, injuries, barotrauma, and Eustachian tube dysfunction.

鉴别诊断

许多疾病可以表现为面部或耳朵疼痛，甚至头痛。全面的病史和体格检查，以及基本的实验室检查，如血细胞计数、肾功能和肝功能检查以及血沉，有助于确定大多数颞下颌关节疼痛的病因。

1. 面部疼痛的常见原因包括三叉神经痛、舌咽痛或疱疹后神经痛、鼻窦炎、唾液腺疾病和颈动脉瘤。

2. 头痛的常见原因包括偏头痛、丛集性头痛、中风和颞动脉炎。

3. 耳痛或耳塞的常见原因是中耳感染、损伤、气压伤和咽鼓管功能障碍

Prognosis

Most patients with TMJ pain have a favorable response to treatment, whereas a small number of patients develop refractory or persistent TMD. There are no known risk factors associated with chronic TMD. Recent data published did correlate heightened sympathetic tone with chronic TMJ pain

预后

多数颞下颌关节疼痛患者对治疗反应良好，只有少数患者出现难治性或持续性颞下颌关节功能紊乱。目前还没有已知的与慢性TMD相关的危险因素。最近公布的数据表明交感神经张力增高与颞下颌关节慢性疼痛有关。

Consultations

Referral to an oral maxillofacial surgeon (OMFS) is the usual recommendation for:

1. Refractory TMD with no response to noninvasive or minimally invasive techniques like intraarticular injections, trigger point injections or botulinum toxin injections

2.   Structural or articular abnormalities

Imaging is diagnostic for most structural abnormalities. Surgical techniques include arthroscopy, arthrocentesis, reconstructive jaw procedures, discectomy, and condylotomy.

会诊

以下情况通常建议转诊至口腔颌面外科医生（OMFS）：

1难治性TMD对关节内注射、触发点注射或肉毒毒素注射等无创或微创技术无反应

2结构或关节异常

影像学可以诊断大多数结构异常。外科技术包括关节镜检查、关节穿刺、重建颌骨手术、关节盘切除术和髁突切开术。