- 期刊
Temporomandibular Joint Dislocation Following Endotracheal Intubation - A Case Report -
氣管插管引起之下顎脫臼－病例報告－
摘要
顳頜關節脫臼之發生在一般民眾並不算少見，無論是在急診室或一般基層醫療之開業醫師，多少均會遇上病患因下巴脫臼而來求助，所以處理顳頜關節脫臼應成為一般醫師之普遍具有的醫療能力。顳頜關節之脫臼多常發生於飲食、談話、打哈欠等口腔過度張大的時候；在某些醫療處置如牙科之口腔治療，有時也會因病患之嘴巴張得太大太久而導致脫臼；耳鼻喉科之治療也可能發生；近代因鏡檢技術普遍，許多鏡檢如胃鏡、氣管鏡、喉鏡之檢查，因喉頭多半有局部麻醉，所以偶會使病患在不知不覺中因嘴巴張得太開太久，而產生了下巴脫臼。 所以臨床醫師們應對顳頜關節脫臼之成因及治療有基本之了解，從而能在替病患作檢查時小心施行以免發生不必要之脫臼。而且應能在一旦脫臼發生而又無法自動回復時，替病患施行整復。本文報告一位六十歲之慢性阻塞性肺疾病之病患，先前並無下巴脫臼之病史，因慢性阻塞性肺疾急性發作導致呼吸困難被家人先緊急送至附近之基層診所，該診所醫師先行給予氣管內管插管再轉送至醫院之急診。病患在醫院處理穩定後，醫師發現病患之顳頜關節因先前的插管時張口過大而有脫臼發生，隨及施行整復處理。國外也有報告病患在接受外科手術時，因麻醉之插管導致顳頜關節脫臼之病例，其發生恰與本病例因插氣管內管而發生脫臼類似。
並列摘要
Temporomandibular joint dislocation is not an infrequent emergency department presentation. It can occur while people are eating, yawning, talking, or receiving dental treatment. Dislocation happens when the capsule and the temporomandibular ligament relax permitting the condyle to move away from the eminentia articularis while the mouth is widely opened. It may also occur when jaw is forcibly displaced during general anesthesia. Reduction can occur spontaneously, but in many instances dislocation requires reduction. In most instances, reduction can be easily achieved by properly applying downward pressure on the mandible. We report the case of a 60-year-old male COPD patient sent to the emergency department endotracheal intubation at a local clinic. The TMJ dislocation was discovered after transfer and successfully reduced without complication.