Temporomandibular joint disease (TMJ) is one of the most pressing problems of modern dentistry, on the one hand, the frequency of pathology of the temporomandibular joint, and on the other hand - the complexity of diagnosis. In the medical specialty "dentistry" there is no section where there would be as many debatable and unresolved issues as in the diagnosis and treatment of diseases of the temporomandibular joints. Aim of the research. Based on the analysis of sources of scientific and medical information to determine the role and place of "Costen's syndrome" in the pathology of the temporomandibular joints. Results and discussion The term TMJ dysfunction has up to 20 synonyms: dysfunction, muscle imbalance, myofascial pain syndrome, musculoskeletal dysfunction, occlusal-articulation syndrome, cranio-mandibular TMJ dysfunction, neuromuscular and articular dysfunction. Finally, in the International Classification of Diseases (ICD-10), pain dysfunction of the temporomandibular joint has taken its place under the code K0760 with the additional name "Costen's syndrome", which is given in parentheses under the same code. Thus, such a diagnosis as "Costen's syndrome" is not excluded in the International Classification of Diseases. The first clinical symptoms and signs of TMJ were systematized in 1934 by the American otorhinolaryngologist J. Costen and included in the special literature called "Costen's syndrome". This syndrome includes: pain in the joint, which often radiates to the neck, ear, temple, nape; clicking, crunching, squeaking sound during movements of the lower jaw; trismus; hearing loss; dull pain inside and outside the ears, noise, congestion in the ears; pain and burning of the tongue; dizziness, headache on the side of the affected joint, facial pain on the type of trigeminal neuralgia. The author emphasized the great importance of pain and even singled out "mandibular neuralgia." The criteria proposed by McNeill (McNeill C.) in 1997 are somewhat different from those described in ICD-10: pain in the masticatory muscles, TMJ, or in the ear area, which is aggravated by chewing; asymmetric movements of the lower jaw; pain that does not subside for at least 3 months. The definition of the International Headache Society is similar in content. Anatomical and topographic study of the corpse material suggested the presence of a structural connection between the TMJ and the middle ear. According to some data, in 68% of cases the wedge-shaped mandibular ligament reaches the scaly-tympanic fissure and the middle ear, and in 8% of cases it is attached to the hammer. In addition, several ways of spreading inflammatory mediators from the affected TMJ to the middle and inner ear, which causes otological symptoms, have been described. It should be noted that there are certain prerequisites for the mutual influence of the structures of the cervical apparatus, middle and inner ear and upper cervical region at different levels: embryological, anatomical and physiological. At the embryological level. It is confirmed that from the first gill arch develops the upper jaw, hammer and anvil, Meckel's cartilage of the lower jaw, masticatory muscles, the muscle that tenses the eardrum, the muscle that tenses the soft palate, the anterior abdomen of the digastric muscle, glands, as well as the maxillary artery and trigeminal nerve, the branches of which innervate most of these structures. At the anatomical level. Nerve, muscle, joint and soft tissue structures of this region are located close enough and have a direct impact on each other. The location of the stony-tympanic cleft in the medial parts of the temporomandibular fossa is important for the development of pain dysfunction. At the physiological level. A child who begins to hold the head, the functional activity of the extensors and flexors of the neck gradually increases synchronously with the muscles of the floor of the mouth and masticatory muscles, combining their activity around the virtual axis of the paired temporomandibular joint. In addition, the location of the caudal spinal nucleus of the trigeminal nerve, which is involved in the innervation of the structures of the ear, temporomandibular joint and masticatory muscles at the level of the cervical segments C1-C3 creates the possibility of switching afferent impulses from the trigeminal nerve to the upper cervical system. Innervate the outer ear, neck muscles and skin of the neck and head. Also important are the internuclear connections in the brainstem, which switch signals between the vestibular and trigeminal nuclei. That is why the approach to the treatment of this pathology should be only comprehensive, including clinical assessment of the disease not only by a dentist or maxillofacial surgeon, but also a neurologist, otorhinolaryngologist, chiropractor, psychotherapist with appropriate diagnostic methods and joint management of the patient.
In modern dentistry, temporomandibular disorders (TMD) are the third most common dental disease after caries, its complications and periodontal pathology. Despite the fact that a significant amount of research has been devoted to this problem, the etiology and pathogenesis have still not fully derermined. The aim is to carry out an integrated assessment of anamnestic data in the differential diagnosis of temporomandibular disorders and diseases that affect them and to determine their clinical significance in the diagnosis. Material and methods. 178 patients with suspected temporomandibular disorders were examined who were referred by other medical institutions in Lviv, Lviv region and other regions of Ukraine to the Department of Orthopedic Dentistry of Danylo Halytsky Lviv National Medical University aged 9 to 76 years. 142 female patients and 36 male ones were involved in this examination. During clinical examination and processing of the obtained material, it was identified a number of factors that could affect the occurrence of myogenic, arthrogenic, combined and affected disorders. Results. During clinical examination and processing of the obtained material, a number of factors that could affect the appearance of arthrogenic disorders have been identified. During the method of logistic regression, 13 factors were singled out from among them, which, when combined, have a probable influence on the development of this disorder. Only two of them have a preventive effect (their presence reduces the patient’s risk of arthrogenic TMD): hypermobility of all joints and pain on palpation of the muscles. All other 11 factors have a provocative effect - if they are present, the patient has an increased risk of arthrogenic TMD. Similarly, 11 factors have been identified that, when combined, have a probable effect on the development of myogenic disorder. The values of their regression coefficients are given in table 3. From 11 ones, only three have a preventive effect (their presence reduces the patient’s risk of myogenic TMD): exercise, intubation anesthesia over the past year and a history of rheumatism. All other eight factors have a provocative effect - if they are present, the patient increases the risk of myogenic TMD. Similarly, 17 factors have been identified that, when combined, have a likely impact on the development of a combined disorder. From these 17 factors, only two have a preventive effect (their presence reduces the patient’s risk of combined TMD): exercise and a past history of rheumatism. Other 15 factors have a provocative effect - if they are present, the patient increases the risk of combined TMD. Similarly, 13 factors were identified that, when combined, have a likely impact on the development of this affected disorder. The values of their regression coefficients are given in table 5. From these 13 factors have been analyzed, five ones have a preventive effect (their presence reduces the patient’s risk of affected TMD): limited mouth opening; crunch, click or crepitation on auscultation of the joints; and pain on palpation of the muscles. All other eight factors have a provocative effect - during their presence, the patient increases the risk of affected TMD. Using the method of logistic regression, it has been identified a number of factors that, when they were combined, affect the development of these disorders. It will increase the efficiency of diagnosis of temporomandibular disorders by substantiating clinical and diagnostic criteria and the development of diagnostic complexes in the diagnosis of TMD.
На сучасному етапі розвитку стоматології актуальним є вивчення структури стоматологічних і супутніх соматичних захворювань, установлення взаємозв'язку патогенетичних факторів при даних патологіях, що визначають вибір адекватної лікувально-профілактичної дії [2, 4, 9]. Досить часто виникає необхідність ортодонтичного лікування зубощелепних аномалій у пацієнтів, які мають захворювання пародонта. Значну частину пародонта складає сполучна тканина, яка виконує в організмі численні функції: трофічну, захисну, опорну, механічну, гомеостатичну, структуроутворюючу. Системність ураження при патології сполучної тканини багато в чому пов'язана з її всеосяжним поширенням в організмі людини [1, 3, 5, 6, 7]. Характерною рисою сполучної тканини є наявність у ній, окрім клітин (фібробласти, гладкі клітини, макрофаги), сполучнотканинного матриксу (СТМ), що займає значно більший обсяг, ніж клітини. Основними компонентами СТМ є фібрилярні білки (колагени та еластини) та полісахариди (протеоглікани та глікопротеїни). Процеси запалення супроводжуються деструктивними змінами у сполучній тканині. Запальні захворювання пародонта призводять до деградації СТ ясен і руйнування альвеолярної кістки. Перехід від гінгівіта до пародонтита також супроводжується лізисом сполучнотканинного прикріплення ясен.
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