- 期刊
齒顎矯正患者顳顎關節障礙之篩檢
Screening Examination of Temporomandibular Disorder in Orthodontic Patients
摘要
矯正治療並不會引發或避免顳顎關節障礙(Temporomandibular disouler, TMD)之發生，然而顳顎關節內紛亂(Temporomandibular joint internal derangement, TMJ ID)卻被發現與骨性二級顱顏面型態、下顎顏面不對稱、前牙開咬、及某些齒性二級異常咬合有關。因此對一個沒有明顳臨床症狀的顳顎關節內紛亂患者而言，經由臉型變化以及系統性危險因子之評估，再經由病史及詳細的開閉口檢查，觀察是否疼痛、是否有關節聲響、下顎是否偏向、髁頭滑動量、及最大開口量等，可約略依功能作出臨床診斷。所以矯正科醫師有可能是第一個發現患者顳顎關節結構異常的醫師，若有需要，再轉介顳顎關節障礙專科醫師做進一步檢查及治療。嚴重的顳顎關節內紛亂，對正在發育中的兒童及青少年，可能會影響矯正的治療計畫及預後。本篇將回顧與矯正相關的顳顎關節障礙問題，與矯正相關的臨床表徵，及顳顎關節內紛亂的臨床檢查方法。最後並提出三個具顳顎關節內紛亂的矯正病例，以闡明顳顎關節障礙對矯正病患族群之影響及其篩檢原則。
並列摘要
Orthodontic treatment neither results in nor prevents the development of temporomandibular disorder (TMD). However, temporomandibular joint internal derangement (TMJ ID) was reported to be associated with certain characteristic class II malocclusion pattern, including retrognathism, mandibular asymmetry, anterior open bite, etc. For an asymptomatic patient, TMJ ID might be disclosed by evaluating the craniofacial pattern, systemic risk factors, anamnesis, and detailed clinical functional examinations, especially pain, joint noises, mandibular deflection, and amount of condylar translation along the path to the maximal mouth opening. The orthodontists can be the first medical professional to diagnose young patient to have abnormal TMJ; and refer proper TMD patients to specialist for further examination and treatment. Due to still existing growth potential, the severity of TMJ ID should be taken into consideration while making orthodontic treatment planning for children and teenager. In this paper we have reviewed the association between TMD and orthodontics, clinical manifestations of TMD related to orthodontics, and clinical examinations assisting in diagnosis of TMJ ID. Three orthodontic patients having TMJ ID are presented in the end of this article to illustrate the appearing of TMJ ID in orthodontic patients and its screening principle.
延伸閱讀
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