Симптоми внутрішніх розладів скронево-нижньощелепних суглобів за даними обстеження хворих на скронево-нижньощелепні дисфункції

Abstract

Робота присвячена підвищенню якості діагностики внутрішніх розладів скронево-нижньощелепних суглобів (СНЩС) шляхом характеристики їхніх клінічних ознак. У дослідженні здійснено аналіз симптомів внутрішніх суглобових розладів (ВСР) та визначено частоту їх виявлення за результатами обстеження хворих. Установлено, що на самовільний біль скаржився кожний третій хворий на ВСР. Біль, як правило, був локалізований у ділянці СНЩС (82,4±9,5% серед хворих із болем). У кожного другого хворого відкривання рота супроводжувалося болем чи відчуттям дискомфорту у СНЩС. Зміщення диска СНЩС із редукцією у хворих характеризувалося хрускотом чи клацанням (у 88,6±4,7% випадків), девіацією нижньої щелепи, збереженою амплітудою відкривання рота. Зміщення диска без редукції характеризувалось обмеженим відкриванням рота (до 35-40 мм), дефлекцією нижньої щелепи, наявністю в анамнезі клацання при відкриванні рота (у 86,7±9,1%).This paper is dedicated to the improvement of diagnosis quality of internal disorders (ID) of temporomandibular joints (TMJs) by means of characteristic of their clinical symptoms. In research, the symptoms of TMJ internal disorders were analyzed and the frequency of their revealing was determined due to the results of patients’ examination. Among the patients with various diagnosed forms of temporomandibular disorders (TMD), a group of persons with ID was singled out. Besides the dental inspection, in order to make a proper clinical diagnosis, the individuals with suspicion as to TMD, were directed to undergo the additional examination: orthopantomography, zonography of TMJ, that was performed both with patient’s clenched teeth and widely open mouth as much as possible; computed tomography of TMJ with possibility of programmed three-dimensional reconstruction of TMJ; ultrasonography of TMJ and masseter muscles; magnetic resonance tomography. The number in group of ID patients of all the examined was equal to 61 person that makes up 51,70±4,60% in the structure of articular TMD. Among the individuals with ID the number of females was 83,61±4,74%, males -16,39±4,74%, the ratio between the number of women and men was 5,1:1,0. Internal disorders were more frequently characterized by different sounds in TMJ (crackling, clicking in 69,39±6,58% individuals with ID) and trajectory and amplitude disturbance of mouth opening (42,86±7,07%), than by arthralgia (34,69±6,80%). Even if a pain was present, it mostly had a local (82,35±9,53% in pain sufferers) than irradiating character (17,65±9,53%). From anamnesis, it was ascertain that the pain, generally, occurred after the arisen sounds in the joint. Disc displacement with reduction (72,13±5,74% out of all ID sufferers) was characterized by the normal amplitude of mouth opening, deviation of mandible (towards the affected area) and joint sound (crackling, clicking – at a moment of interrelation normalization of head of the mandible and disc) when the patient was openmouthed. The clicking when the patient was moving his/her mandible, served as the main symptom of disc displacement with reduction (in 88,64±4,78% patients). Disc displacement without reduction (27,87±5,74% cases) was characterized by amplitude disturbance of mouth opening (restriction), mandible deflection (towards the affected area). The most important aspect in diagnosing the disc displacement without reduction was to reveal, in anamnesis, the presence of clicking in TMJ during mouth opening (in 86,67±9,09% patients); during the examination the clicking sound is absent. The size of mouth opening in patients was up to 35-40mm. In both cases of disc displacement with reduction and disc displacement without reduction, the effort of patients with ID to open their mouth was accompanied by pain or discomfort in the area of affected TMJ (in 44,90±7,11% patients). Internal joint disorders were often accompanied by muscular disorders (in 53,06±7,13% patients with ID). It was also revealed: the combination of ID with TMJ dislocation in 9 individuals, the combination of ID with arthritis in 2 persons, and the combination of ID with arthrosis in 1 person.