Місце синдрому больової дисфункції скроневонижньощелепного суглоба серед больових синдромів обличчя

Abstract

Висвітлюються важливі питання діагностики, диференційованої діагностики пацієнтів із СБД СНЩС із больовими синдромами обличчя та захворюваннями СНЩС. Правильність діагностичного пошуку дає практичному лікарю можливість проведення диференційованої діагностики, мінімізації діагностичних помилок і призначення адекватного лікування з урахуванням комплексного міждисциплінарного підходу; Освещаются важные вопросы диагностики, дифференциальной диагностики пациентов с СБД ВНЧС с болевыми синдромами лица и заболеваниями ВНЧС. Правильность диагностического поиска дает практическому врачу возможность проведения дифференциальной диагностики, минимизации диагностических ошибок и назначения адекватного лечения с учетом комплексного междисциплинарного похода; At the present time, the actual problem of dentistry is the study of the issues of the syndrome of pain dysfunction (SPD) of the temporomandibular joint (TMJ), which is found in 14-20% of teenagers and significantly increases with age (Siemkin V.A, Rabukhina N.A., 2000 ; Khavatova VA, 2005). The pathology of TMJ dysfunction was detected in 80% of the examined patients (Bezrukov V.M, 2002). Separately allocated dysfunction of TMJ in dysplastic-dependent form of joint pathology, thereby emphasizing that dysfunction is a characteristic manifestation of dysplasia of connective tissue in the maxillofacial area (Statovskaia Ye.Ye, 2005; Kozlov D.L., Viazmin A.Y., 2007). According to observations of A.I Mirza, I.V. Mikheieva, V.M. Novikov and according to our data, in more than 90% of people, pathological phenomena in the area of the temporomandibular joint have nothing to do with the inflammatory processes of this combination. At the same time, various dysfunctions and pain spasm of separate areas of chewing muscles occupy the main place. The aim of the work was to analyze the causes and clinical symptoms of patients with SPD. In this regard, as it turned out from the anamnesis, many patients had been undergoing inappropriate treatment for a long time. The cavity of the temporomandibular joint was repeatedly injected emulsion hydrocortisone acetate, antibiotics and other medications, which do not work in case of SPD of the temporomandibular joint. In some cases, after such therapy, dysfunction of the mandible occurred, leading to an even greater disruption of the joint function and increased pain. A number of patients with SPD of the temporomandibular joint due to a false diagnosis for a long time received treatment for neuralgia of the trigeminal nerve by drugs, Novocain blockade or alcoholization of sensitive branches of the trigeminal nerve. These patients often had neuritis, which greatly worsened the patient’s condition and the prognosis of the disease. The clinical picture of the SPD of the temporomandibular joint and a number of such diseases (syndromes of Slider, Sikara, etc.) is often so obscure and confusing that a large clinical experience is needed to evaluate individual symptoms. In addition, it should be noted that dysfunction of the mandible occurs with lesions of any part of the temporomandibular complex. Thus, limitation of the mobility of the mandible usually develops with arthritis of the temporomandibular joint, abscesses and phlegmons of the parotideomasseterica, temporal regions, pterygomandibulare, parapharingenal space, jaw-tongue groove and osteomyelitis of the branches of the mandible. Diagnostic difficulties often increase due to the fact that it is not always possible to find out the atypical etiological origin of the SPD of the temporomandibular joint. Against the background of the listed objective adverse factors, the presence of diagnostic errors largely contributes to insufficient knowledge of dentists who have clinical questions and questions on treatment of the SPD TMJ due to the difficulty in differential diagnosis, which is not fully covered in textbooks on dentistry. Control of correctness of the established diagnosis is the blockade of the motor branches of the trigeminal nerve subcutaneously using the Yehorov's method, which results in the removal of muscle spasm, stops pain and improves the mobility of the mandible. Conducting additional paraclinical examination methods such as dynamic MRT, 3-D MRT, CT and electromyography should be done.