口腔疾病防治 ›› 2020, Vol. 28 ›› Issue (1): 11-15.DOI: 10.12016/j.issn.2096-1456.2020.01.002

• 专家论坛 • 上一篇    下一篇

颞下颌关节紊乱病的“梯度序列治疗”

张清彬(),管红兵   

  1. 广州医科大学附属口腔医院·广州口腔疾病研究所·口腔医学重点实验室,广东 广州(510140)
  • 收稿日期:2018-12-28 修回日期:2019-07-18 出版日期:2020-01-20 发布日期:2020-01-17
  • 通讯作者: 张清彬
  • 作者简介:张清彬,教授,主任医师,现任广州医科大学附属口腔医院副院长,颞下颌关节病科主任。博士毕业于武汉大学口腔医学院,先后在首尔国立大学牙科研究所、解放军总医院口腔医学研究所做博士后研究。主要研究方向为干细胞生物学、骨组织工程学和颞下颌关节疾病、三叉神经痛的临床与基础研究。2014年3月牵头成立了广州医科大学附属口腔医院颞下颌关节病科,2017年提出了颞下颌关节疾病和三叉神经痛的“序列、微创、数字化、舒适化”诊疗模式,近五年诊疗患者超过30 000人次。迄今发表学术论文60余篇,其中SCI 18篇,累计影响因子40余分。获6项国家实用新型专利。主编由人民卫生出版社出版的《微创拔牙图谱》和高职高专教材、国家卫生与计划生育委“十二五”规划教材《口腔颌面外科学》。2016年获“广州医师奖”和“羊城明星牙医”称号,2019年入选“最强实力中青年医生榜”,被遴选为广州市医学重点人才。
  • 基金资助:
    广东省科技计划项目(2017A020215141);广州市科技计划项目(201707010026)

Gradient sequential treatment of temporomandibular joint disorders

ZHANG Qingbin(),GUAN Hongbing   

  1. Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou 510140, China
  • Received:2018-12-28 Revised:2019-07-18 Online:2020-01-20 Published:2020-01-17
  • Contact: Qingbin ZHANG

摘要:

颞下颌关节紊乱病是口腔科临床常见的疾病,好发于青年群体,女性多见,发病率在30%左右;其临床表现多为下颌运动异常、疼痛、弹响与杂音,部分患者伴有耳鸣、头痛等症状。颞下颌关节紊乱病的治疗目前主张采用“梯度序列治疗”模式,每个“层级”均有其严格的适应证。一般首选保守治疗或无创治疗,适用于功能障碍性或轻度器质性病变患者;次选微创治疗,适用于保守治疗无效患者或轻度器质性病变患者;最后才考虑选择开放手术治疗,适用于前两种治疗无效并伴有严重器质性病变的患者。“梯度序列治疗”方案的制定应该是个性化的,由医生主导,患者配合的情况下完成的。本文对颞下颌关节紊乱病的“梯度序列治疗”进行阐述。

关键词: 颞下颌关节紊乱病, 下颌运动异常, 关节疼痛, 关节弹响, 梯度序列治疗, 物理治疗, 咬合板治疗, 注射治疗, 关节腔灌洗术, 关节镜微创手术, 开放手术, 个性化

Abstract:

Temporomandibular joint disorder (TMD) is a common clinical disease in stomatology that occurs frequently in young people, mostly in women, with an incidence of approximately 30%; its clinical manifestations include mandibular dysfunction, regional pain, and clicking noises around the temporomandibular joint (TMJ). Some patients have tinnitus, headache and other symptoms. With regard to the treatment procedures of TMD, a gradient sequential treatment model is currently preferred, each of which has strict indications. Generally, conservative treatment or noninvasive treatment is preferred and is suitable for patients with dysfunction or mild organic disease. The second-choice minimally invasive treatment is suitable for patients who have failed conservative treatment or patients with mild organic disease. Finally, open surgery, which is suitable for patients who are not responsive to the first two treatments and show severe organic lesions, can be considered. The formulation of an open surgery treatment diagnosis and treatment plan should be personalized, led by doctors, and completed with the cooperation of patients. This article describes the “gradient sequential treatment” of temporomandibular joint disorders.

Key words: temporomandibular joint disorders, abnormal mandibular movement, regional pain around the temporomandibular joint, clicking noises around the temporomandibular joint, gradient sequential treatment, physical therapy, occlusal plate treatment, injection therapy, articular lavage, arthroscopic minimally invasive surgery, open surgery, personalized

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