Temporomandibular disorders: a review of current concepts in aetiology, diagnosis and management.
Temporomandibular disorders: a review of current concepts in aetiology, diagnosis and management.
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作者：
Kapos FP;Exposto FG;Oyarzo JF;Durham J
颞下颌疾病 (TMD) 是一组肌肉骨骼疾病的统称，涉及咀嚼肌、颞下颌关节 (TMJ) 和相关结构的疼痛和/或功能障碍。它是最常见的非牙源性口面部疼痛，患者可能会出现影响面部/头部、颞下颌关节和/或牙齿的疼痛、下颌运动受限以及下颌运动期间颞下颌关节发出声音。合并疼痛和非疼痛的病症在 TMD 患者中也很常见。随着时间的推移，TMD 的诊断有了显着改善，最近的 TMD 诊断标准 (DC/TMD) 对于大多数常见诊断来说是可靠且有效的，并且是多学科环境中有效的沟通方式。该分类涵盖 12 种最常见的 TMD，包括疼痛性（TMD 引起的肌痛、关节痛和头痛）以及非疼痛性（椎间盘移位、退行性关节病和半脱位）TMD 诊断。最近的研究表明，常见疼痛性 TMD 的病理生理学是生物心理社会和多因素影响的，没有任何一个因素导致其发生。重要的是，研究表明存在不同的诱发因素、起始因素和持续因素，包括外周和中枢机制。这是一个活跃的研究领域，未来的研究不仅会寻求阐明具体的因果途径，还将这些知识转化为机制导向的诊断和治疗。根据这种复杂的病因，目前的证据主要支持保守的多学科治疗，包括自我管理策略、行为治疗、物理治疗和药物治疗。本综述的目的是概述 TMD 的病因学、病理生理学、诊断和治疗方面的最新进展。
Temporomandibular disorders (TMD) is a collective term for a group of musculoskeletal conditions involving pain and/or dysfunction in the masticatory muscles, temporomandibular joints (TMJ) and associated structures. It is the most common type of non-odontogenic orofacial pain and patients can present with pain affecting the face/head, TMJ and or teeth, limitations in jaw movement, and sounds in the TMJ during jaw movements. Comorbid painful and non-painful conditions are also common among individuals with TMD. The diagnosis of TMD have significantly improved over time with the recent Diagnostic Criteria for TMD (DC/TMD) being reliable and valid for most common diagnoses, and an efficient way to communicate in multidisciplinary settings. This classification covers 12 most common TMD, including painful (myalgia, arthralgia and headache attributed to TMD) as well as the non-painful (disc displacements, degenerative joint disease and subluxation) TMD diagnoses. Recent studies have demonstrated that the pathophysiology of common painful TMD is biopsychosocial and multifactorial, where no one factor is responsible for its development. Importantly, research has suggested different predisposing, initiating and perpetuating factors, including both peripheral and central mechanisms. This is an active field of investigation and future studies will not only seek to clarify specific causal pathways but translate this knowledge into mechanism-directed diagnosis and treatment. In accordance with this complex aetiology, current evidence supports primarily conservative multidisciplinary treatment including self-management strategies, behavioural therapy, physical therapy and pharmacotherapy. The aim of this review is to present an overview of most recent developments in aetiology, pathophysiology, diagnosis and management of TMD.