Çocuklarda Temporomandibular Eklem
Özet
Çocuklarda temporomandibular eklem (TME) bozuklukları, maloklüzyonlar, parafonksiyonel alışkanlıklar, emosyonel stres ve travmalar nedeniyle gelişerek yetişkinlikte daha ciddi sorunlara yol açabilir. TME; kondil, glenoid fossa ve artiküler diskten oluşan, alt çenenin konuşma, yutkunma ve çiğneme fonksiyonlarını sağlayan bir yapıdır. Çocuklarda mandibular büyüme 0-5 ve 10-15 yaşlarında oldukça aktiftir. Temporomandibular bozuklukların (TMB) etiyolojisi yaş gruplarına göre; infant döneminde travmatik doğum ve emzik kullanımı, erken çocuklukta tırnak yeme ve diş gıcırdatma, ileri çocukluk ve ergenlikte ise stres kaynaklı bruksizm ve aşırı sakız çiğneme gibi parafonksiyonel eylemlerle değişkenlik gösterir. TME disfonksiyonlarının en büyük sebebi %79 oranla travmalardır. Ayrıca Juvenil İdiyopatik Artrit (JİA), TME ankilozu, septik artrit gibi sistemik hastalıklar da eklem tutulumuna ve gelişim geriliğine yol açabilir. Tanıda klinik muayenenin yanı sıra sert dokular için bilgisayarlı tomografi, yumuşak dokular için MRG kullanılır. Tedavi yaklaşımı olarak çocuklarda çene ve yüz yapısının dinamik değişimi nedeniyle çoğunlukla hasta eğitimi, fiziksel tedavi, oklüzal splint ve davranışsal terapi gibi geri döndürülebilir (konservatif) yöntemler tercih edilirken, cerrahi gibi geri döndürülemeyen tedavilerin kullanımı oldukça sınırlıdır.
Temporomandibular joint (TMJ) disorders in children can develop due to malocclusions, parafunctional habits, emotional stress, and trauma, leading to more serious problems in adulthood. The TMJ is a component consisting of the condil, glenoid fossa, and articular disc, enabling functions such as speaking, swallowing, and chewing. Mandibular growth in children is highly active between the ages of 0-5 and 10-15. The etiology of temporomandibular disorders (TMD) varies by age group, involving traumatic birth and prolonged pacifier use in infancy; nail-biting and teeth grinding in early childhood; and stress-induced bruxism or excessive gum chewing during late childhood and adolescence. Trauma is the primary etiological factor responsible for 79% of TMJ dysfunctions. Additionally, systemic diseases such as Juvenile Idiopathic Arthritis (JIA), TMJ ankylosis, and septic arthritis can cause joint involvement and growth retardation. Diagnosis utilizes clinical examination alongside computed tomography for hard tissues and MRI for soft tissues. Due to the ongoing dynamic changes in facial structures during childhood, reversible (conservative) treatments such as patient education, physical therapy, occlusal splints, and behavioral therapy are preferred, whereas irreversible methods like surgery remain highly limited.
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