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one
anatomical dissect
The temporomandibular joint consists of the articular fossa, the condyle, the articular disc in between, and the articular capsule that surrounds it. Temporomandibular disorders (TMD) is a general term for a group of diseases caused by multiple factors, which can be divided into masticatory muscle disorders, structural disorders (displacement of joint discs), inflammatory diseases (synovitis, capsulitis), Osteoarthropathy.
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Clinical features
1. Development stage: functional disorder, structural disorder, joint organic destruction;
2. Clinical features: temporomandibular pain, difficulty in chewing , limited mouth opening, and joint snapping;
3. The pain in the joint area is mainly manifested in the pain in the joint area and the soft tissue around the joint during joint movement, accompanied by different degrees of tenderness. Generally, there is no spontaneous pain;
4. Joint snapping and murmur are mainly manifested as snapping sound, breaking sound and fricative sound during opening movement, and the sound occurs in different stages of mandibular movement . Some patients may be accompanied by headache, eye disease, language difficulties and so on.
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three
medication Drug therapy
Drug therapy is a common treatment method for temporomandibular joint disorder syndrome, which can effectively relieve symptoms. The drugs include analgesics, anti-inflammatory drugs, corticosteroids, anti-anxiety drugs, muscle relaxants, tricyclic antidepressants, traditional Chinese medicine, etc.
Analgesics can reduce pain in patients and can also reduce secondary inflammatory diseases caused by pain, such as radiating pain caused by muscle contractions. Non-opioid analgesics are effective for mild to moderate pain caused by acute temporomandibular disorder syndrome, and opioids can only be used for short-term severe acute pain. Nonsteroidal anti-inflammatory drugs have analgesic and anti-inflammatory effects and are used for TMJ pain caused by inflammatory processes, but caution should be exercised in patients with gastrointestinal irritation and anxiety.
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Four
physiotherapy
Physiotherapy is an important method for the treatment of temporomandibular disorders, including Physiotherapy, manual therapy, rehabilitation training, etc. The commonly used physiotherapy methods include ultrashort wave therapy, ultrasonic therapy, infrared therapy, magnetic therapy, DC iontophoresis, etc.
1. Physiotherapy
(1) Infrared rays: irradiate the affected part vertically, at a distance of 20-30cm, 20
(2) Magnetic therapy: Magnetic therapy has a good antispasmodic effect, which can relax patients’ masticatory muscles, relieve pain and functional limitation, and can also improve local Blood circulation plays an anti-inflammatory and analgesic role, which is conducive to the recovery of patients. Fix the magnetic head on the temporomandibular joint of the affected side for 20 minutes;
(3) Laser: local irradiation of low-intensity helium-neon laser, 5-10mm, 10 minutes;< /span>
(4) Microwave therapy: Microwave therapy can promote local blood circulation, enhance metabolism, improve immune function, improve local nutrition and promote wound healing, relieve pain, promote edema absorption, relieve pain Muscle spasms. The microwave therapeutic apparatus irradiates the temporomandibular joint on the affected side, with a distance of 2.5cm between the electrodes and the treatment site, with micro-heating for 5-10 minutes each time;
(5) Ultrasound treatment: Place the vocal head at the temporomandibular joint of the affected side, fixation method, 0.4-0.5W/cm2, 8-10 minutes per treatment;
(6) Intermediate frequency electric: Electricity can speed up tissue blood circulation and metabolism, increase the excitability of sensory and motor nerves, improve local pain threshold, have analgesic effect, can also dissipate edema, promote the discharge of pain-causing substances and inflammatory products, and also loosen adhesions and soften tissues. It can relieve pain, reduce inflammation, relieve muscle spasm and improve myofascial tension, which is beneficial to the recovery of muscle function. Two small round electrodes were placed side by side at the temporomandibular joint on the affected side or on the opposite side of the temporomandibular joint using a modulated intermediate frequency electric or audio frequency electrotherapy apparatus, the tolerance, 20 minutes;
(7) Ultrashort wave or short wave: use a low-power therapeutic apparatus, the opposite or oblique method at the temporomandibular joint on the affected side, and micro heat.
2. Exercise therapy
Temporomandibular disorders Rehabilitation training for the syndrome includes massage of painful muscles, muscle stretching, etc.
(1) Massage: Use the kneading method to softly rub the acupoints such as Xiaguan and Tinggong on the affected side and the surrounding soft tissues, and press the Hegu point, paying attention to the gentle movements , subject to the patient’s tolerance;
(2) Mouth opening and closing training: make fists with both hands against the cheeks, the patient slowly opens the mouth, hold for 1-2 seconds, then Close your mouth, place a disposable tongue depressor or chopsticks under the affected side during training, open your mouth passively until you feel pain, pay attention to the maximum opening of 3cm, and train for 15-20 minutes each time; p>
(3) Occlusal plate treatment.
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Five
Prevention of prophylaxis
1. Let the patient eat a healthy diet, mix meat and vegetables, start with scientific prevention to improve the body’s disease resistance, and avoid unilateral chewing and eating Bad habits such as hard food and excessive chewing gum.
2. Create an optimistic attitude. With the help of “disease can only temporarily affect people’s movement trajectory, but can not stop the goal of excellence in life” to motivate patients, patients with TMD should be treated with a peaceful attitude and avoid loud, laughing, and excessive and fast talking.
3. Maintain adequate sleep, play a huge role through the reticular activation system, limbic system, and cortical functional areas to please the body and mind, regulate the balance of yin and yang in the human body, and make The masseter muscles that work all day can be fully relaxed and perfectly repaired.
4. Scientific physical exercise, based on aerobic exercise, from a holistic perspective, enhances the blood circulation of the whole body, and welcomes every day with strong energy and strong immunity. One day, local treatment, step by step, perform muscle strength training such as digastric muscles, lateral pterygoid muscles and masseter muscles, and strengthen core strength exercises for occlusal stability.
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