Temporomandibular Eklem Bozuklukları
Özet
Temporomandibular eklem (TME) bozuklukları, çene eklemi ve çiğneme kaslarını etkileyen, ağrı, ses ve hareket kısıtlılığıyla karakterize multifaktöriyel bir klinik tablodur. Diş sıkma, duruş bozuklukları, travma ve stres gibi etkenlerin zemin hazırladığı bu rahatsızlıklar; çiğneme kası bozuklukları, eklem içi düzensizlikler, kronik hipomobilite ve gelişimsel anomali grupları altında sınıflandırılmaktadır. Kas patolojilerinde lokal ağrı, spazm ve tetik noktalar öne çıkarken; eklem içi problemlerde anterior disk deplasmanları, kilitlenmeler, adezyonlar ve dejeneratif artrit türleri (osteoartrit, romatoid artrit) kronik hasara yol açabilmektedir. Ayrıca ankiloz gibi eklem hareketini tamamen engelleyen ciddi hipomobiliteler ile kondiler hiperplazi, hipoplazi veya bifid kondil gibi gelişimsel sert/yumuşak doku anomalileri de fasiyal asimetri ve maloklüzyona neden olmaktadır. Konuşma ve çiğneme gibi temel fonksiyonları doğrudan etkileyen bu karmaşık bozuklukların tedavisinde, erken ve doğru teşhis klinik tablonun gerilemesi açısından kritik önem taşır.
Temporomandibular joint (TMJ) disorders are multifactorial clinical conditions affecting the jaw joint and masticatory muscles, characterized by pain, joint sounds, and restricted movement. Initiated by factors such as bruksizm, poor posture, trauma, and stress, these disorders are classified into masticatory muscle disorders, internal derangements, chronic hypomobility, and developmental anomalies. While local pain, spasms, and trigger points prominent in muscle pathologies; anterior disc displacements, locking, adhesions, and degenerative arthritis types (osteoarthritis, rheumatoid arthritis) cause chronic damage within internal derangements. Moreover, severe hypomobilities like ankylosis that completely obstruct jaw movement, alongside developmental hard or soft tissue anomalies such as condylar hyperplasia, hypoplazia, or bifid condyle, lead to facial asymmetry and malocclusion. Directly impacting essential functions like speech and mastication, early and accurate diagnosis of these complex disorders is critically important for the regression or slow progression of the clinical picture.
Referanslar
Bender ME, Lipin RB, Goudy SL. Development of the Pediatric Temporomandibular Joint. Oral Maxillofac Surg Clin North Am. 2018;30(1):1-9.
Bilge OM, Akgül HM, Dağıstan S, Harorlı A, Yılmaz AB, Çakur B, et al.. Diş hekimliğinde muayene ve oral diagnoz. Erzurum: ESER OFSET, 2017.
Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet, JP, List T, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research.
Okeson JP. Bell’s orofacial pains. Fifth Edition, Quintessence Publishing Co., Inc. USA. 295-345, 1995
Stegenga B. TMJ disc derangements. TMDs, an evidence based approach to diagnosis and treatment. Quintessence Pub Co; 2006.
Yaltırık M, Palancıoğlu A, Koray M, Turgut CT. Temporomandibular eklem bozuklukları ve teşhisi. 7tepe Klinik Dergisi, 2017:13(2), 43-50.
Peck, C.C.; Goulet, J.P.; Lobbezoo, F.; Schiffman, E.L.; Alstergren, P.; Anderson, G.C.; de Leeuw, R.; Jensen, R.; Michelotti, A.; Ohrbach, R.; et al. Expanding the taxonomy of the diagnostic criteria for temporomandibular disorders. J. Oral Rehabil. 2014, 41, 2–23.
Applications: Recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Groupdagger. J. Oral Facial Pain Headache 2014, 28, 6–27
Karan A, Aksoy C. Temporomandibular eklem rehabilitasyonu. Tıbbi Rehabilitasyon. İstanbul: Nobel Kitabevi. 2004.
Yengin E. Temporomandibular rahatsızlıklarda teşhis ve tedavi. İstanbul: İstanbul Üniversitesi Diş Hekimliği Fakültesi; 2000.
Özcan B. Bruksizme eşlik eden miyofasial ağrı sendromlu ve temporomandibular rahatsızlığı olan hastalarda oklüzal splint ve tens tedavilerinin klinik ve ağrı eşiği üzerine olan etkinliklerinin karşılaştırılması. 2005, Doktora Tezi.
Molinari F, Manicone PF, Raffaelli L, Raffaelli R, Pirronti T. Temporomandibular joint soft-tissue pathology, I: Disc abnormalities. Science direct. 2007;28(3): 192-204.
Johansson A-S, Isberg A. The anterosuperior insertion of the temporomandibular joint capsule and condylar mobility in joints with and without internal derangement: a double-contrast arthrotomographic investigation. Journal of oral and maxillofacial surgery. 1991;49(11):1142-8.
Pereira FJ, Lundh H, Eriksson L, Westesson P-L. Microscopic changes in the retrodiscal tissues of painful temporomandibular joints. Journal of oral and maxillofacial surgery. 1996;54(4):461-8.
Foucart, JM, Carpentıer P, Pajonı D, Marguelles-Bonnet R, Pharaboz C. (1998). MR of 732 TMJs: anterior, rotational, partial and sideway disc displacements. European Journal of Radiology. 28; 86-94.
Tasaki MM, Westesson PL, Isberg AM, Ren YF, Tallents RH. Classification and prevalence of temporomandibular joint disk displacement in patients and symptom-free volunteers. Am J Orthod Dentofacial Orthop. 1996 Mar;109(3):249-62. doi: 10.1016/s0889-5406(96)70148-8. PMID: 8607470.
Marguelles-Bonnet RE, Carpentier P, Yung JP, Defrennes D, Pharaboz C. Clinical diagnosis compared with findings of magnetic resonance imaging in 242 patients with internal derangement of the TMJ. J Orofac Pain. 1995 Summer;9(3):244-53.
Heffez L, Jordan S. (1989). A classification of Temporomandibular Joint Disk Morphology. Oral Surgery Oral Medicine Oral Pathology Oral Radiology Oral Endodontics. 67; 11-19.
Orhan K, Delılbası C, Paksoy C. MRI evaulation of mandibular condyle bone marrow and TMJ disc signal intensity in anemia patients. Dentomaxillofacial Radiology.2009.
Widmalm SE, Westesson PL, Brooks SL, Hatala MP, Paesani D. Temporomandibular joint sounds: correlation to joint structure in fresh autopsy specimens. Am J Orthod Dentofacial Orthop. 1992 Jan;101(1):60-9.
Eriksson L, Westesson PL, Rohlin M. Temporomandibular joint sounds in patients with disc displacement. Int J Oral Surg. 1985 Oct;14(5):428-36.
Honda K, Natsumi Y, Urade M. Correlation between MRI evidence of degenerative condylar surface changes, induction of articular disc displacement and pathological joint sounds in the temporomandibular joint. Gerodontology. 2008 Dec;25(4):251-7.
Stegenga B, de Bont LG, Boering G, Nickerson Jr JW. Classification of temporomandibular joint osteoarthrosis and internal derangement. Part II: specific diagnostic criteria. CRANIO®. 1992;10(2):107-17.
Kaminishi, R. M. (1989). Temporomandibular joint arthroscopic observation of superior space adhesion. Oral Maxillofac Surg Clin North Am, 1, 103-109.
Israel, H. A., Langevin, C. J., Singer, M. D., & Behrman, D. A. (2006). The relationship between temporomandibular joint synovitis and adhesions: pathogenic mechanisms and clinical implications for surgical management. Journal of oral and maxillofacial surgery, 64(7), 1066-1074.
Millon-Cruz A, Martín-Granizo R, Encinas A, Berguer A. Relationship between intra-articular adhesions and disc position in temporomandibular joints: Magnetic resonance and arthroscopic findings and clinical results. J Craniomaxillofac Surg. 2015 May;43(4):497-502.
Aksoy C. Temporomandibular Ağrı ve Disfonksiyon. In: Beyazova M, Gökçe-Kutsal Y, ed. Fiziksel Tıp ve Rehabilitasyon. Ankara: Güneş Kitabevi, 2000: p. 1391-1425
White SC, Pharoah MJ. Oral Radiology – Principles and Interpretation. Mosby, 2004.
Bjørnland T, Gjaerum AA, Møystad A. Osteoarthritis of the temporomandibular joint: an evaluation of the effects and complications of corticosteroid injection compared with injection with sodium hyaluronate. J Oral Rehabil. 2007 Aug;34(8):583-9.
Tanaka E, Detamore MS, Mercuri LG. Degenerative disorders of the temporomandibular joint: etiology, diagnosis, and treatment. J Dent Res. 2008 Apr;87(4):296-307.
Massilla Mani F, Sivasubramanian SS. A study of temporomandibular joint osteoarthritis using computed tomographic imaging. Biomed J. 2016 Jun;39(3):201-6.
Field A, Longman L, Tyldesley WR. Tyldesley's Oral Medicine. 5th ed. England: Oxford Medical Publications; 2003.p256, ISBN: 978-0192631473.
Savtekin G, Sehirli AO. Rheumatoid arthritis in temporo-mandibular joint: A review. Niger J Clin Pract. 2018 Oct;21(10):1243-1246. doi: 10.4103/njcp.njcp_117_18. PMID: 30297553.
Rivanor RLC, Chaves HV, Val DR, Freitas AR, Lemos JC, Rodrigues JAG, et al. A Lectin from the Green Seaweed Caulerpa Cupressoides Reduces Mechanical Hyper-Nociception and Inflammation in the Rat Temporomandibular Joint During Zymosan-Induced Arthritis. Int Immunopharmacol 2014;21:34-43
Whıte SJ, Pharaoh MJ. Oral Radiology 4th Edition. St.Louis: Mosby Inc, 2000.
Bortoluzzi Marcelo Carlos, Sheffer MAR. Treatment of temporomandibular joint ankylosis with gap arthroplasty and temporal muscle/fascia graft: a case report with five-year follow-up. Rev Odonto Cienc. 2009;24(3):315–318.
Shivakotee S, Menon CS, Sham ME, Kumar V, Archana S. TMJ Ankylosis Management: Our Experience. J Maxillofac Oral Surg. 2020 Dec;19(4):579-584. doi: 10.1007/s12663-019-01293-y. Epub 2019 Sep 30. PMID: 33071506; PMCID: PMC7524989.
Sales MA, Amaral JI, Amorim RF, Almeida Freitas R. Bifid mandibular condyle: case report and etiological considerations. J Can Dent Assoc. 2004; 70(3):158-62.
Alpaslan S, Ozbek M, Hersek N, Kanli A, Avcu N, Firat M. Bilateral bifid mandibular condyle. Dentomaxillofac Radiol. 2004; 33(4):274-7.
Artvinli LB, Kansu O. Trifid mandibular condyle: A case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003; 95(2):251-4
Dolwick MF. Temporomandibular Disorders. In: Koopman WJ, ed. Arthritis and Allied Conditions. 13th edition. Baltimore: Williams&Wilkins Co; 1997: 1813-1820.
Huisinga-Fischer CE, Zonneveld FW, Vaandrager JM, Prahl-Andersen B. Relationship in hypoplasia between the masticatory muscles and the craniofacial skeleton in hemifacial microsomia, as determined by 3-D CT imaging. J Craniofac Surg. 2001 Jan;12(1):31-40. doi: 10.1097/00001665-200101000-00006. PMID: 11314185.
Kebede B, Megersa S. Idiopathic masseter muscle hypertrophy. Ethiop J Health Sci. 2011 Nov;21(3):209-12. PMID: 22435002; PMCID: PMC3275871.
Ben Slama L, Zaghbani A, Hidaya S. Tumeurs musculaires des mâchoires [Jaw muscle tumors]. Rev Stomatol Chir Maxillofac. 2009 Dec;110(6):335-7. French. doi: 10.1016/j.stomax.2009.07.005. Epub 2009 Oct 15. Erratum in: Rev Stomatol Chir Maxillofac. 2010 Apr;111(2):119. Zoghbani, A [corrected to Zaghbani, A]. PMID: 19836039.
