hrvatski

Poremećaj čeljusnog zgloba uzrokovanog traumom – prikaz bolesnice

Opisan je klinički slučaj 26-godišnje pacijentice s poremećajem čeljusnog zgloba, koja je kliničke simptome povezala s lakšom traumom u području orofacijalne regije. Udarac mandibulom u ovratnik doživjela je 2000. te joj se nakon dva mjeseca pojavilo škljocanje u desnom čeljusnom zglobu. Od 2002. počelo ju je i boljeti u istom zglobu, ali tek je 2006. godine upućena od svog stomatologa na Stomatološki fakultet u Zagrebu. Bol je u području čeljusnog zgloba izražena tijekom žvakanja i jačeg otvaranja usta, čiji je intenzitet izmjeren na analogno-vizualnoj skali (AVS=7, 5). Desni čeljusni zglob lagano je bio bolan na palpaciju sa sitnim krepitacijama tijekom aktivnog otvaranja usta, koje je iznosilo 34, 5 mm. Pasivno otvaranje praćeno bolovima iznosilo je 41 mm. Desna laterotruzijska kretnja iznosila 9 mm, a lijeva je bila limitirana na samo 3 mm i praćena bolovima u desnom zglobu. Pacijentica je imala sanirane zube, protetski nenadomješten zub 36 te bez znakova patološkog trošenja zubi. Negirala je bruksističku aktivnost. Laterotruzijske kretnje bile su vođene očnjacima i bez intereferntnih ili balansnih dodira. Dinamičkim te pasivnim kompresijama utvrđena je limitiranost otvaranja usta s induciranim bolovima u bilaminarnoj zoni desnog zgloba. Magnetskom rezonancijom potvrđen je anteriorni pomak zglobne pločice bez redukcije s lagano hipoplastičnom i deplaniranom glavicom kondila desnog zgloba, kompenzatornom progresivnom adaptacijom bilaminarne zone u smislu stvaranja pseudodiskusa te hipomobilnim položajem kondila u položaju otvorenih usta s vidljivo defromiranom i anteriorno smještenom zglobnom pločicom. Pacijentica je liječena okluzijskom udlagom, a zatim i fizijatrijski: ultrazvukom, TENS-om i oralnim vježbama kod kuće. Nakon oko 10 mjeseci terapije došlo je do poboljšanja kliničke slike (AVS=5, 4). Makrotrauma stomatognatskog sustava potencijalni je inicijacijski etiološki uzročnik funkcijskih poremećaja, a cilj inicijalnog liječenja je poboljšanje funkcijskog stanja te smanjivanje ili potpuno uklanjanje bolova. The case presented is of a 26-year-old female patient with temporomandibular joint disorder who attributed her clinical symptoms to a mild trauma in the orofacial region. In 2000, she hit a door jamb with her mandible and two months later clicking in her right temporomandibular joint started. In 2002, she started feeling pain in the same joint, but only in 2006 she was referred to the School of Dental Medicine in Zagreb. Pain in the temporomandibular joint region was pronounced during chewing and greater mouth opening and its intensity was measured on the analogue-visual scale (AVS=7.5). The right temporomandibular joint was slightly painful on palpation with minor crepitations during active mouth opening, which amounted to 34.5 mm. Passive opening accompanied by pain was 41 mm. Right laterotrusive movement was 9 mm and the left one was limited to only 3 mm with pain in the right joint. The patient had treated teeth and a prosthodontic replacement of tooth number 36 and did not show signs of pathological tooth wear. She denied any bruxist activity. Laterotrusive movements were canine guided and without interference and balanced contacts. Limited mouth opening with induced pain in the bilaminar zone of the right joint was determined by dynamic and passive compressions. MRI confirmed anterior disc displacement without reduction with a slightly hypoplastic and deplaned condylar head of the right joint, compensatory progressive adaptation of the bilaminar zone in the sense of creating a pseudodisc and a hypomobile position of the condyle in open mouth position with visibly deformed and anteriorly placed articular disc. The patient was treated with occlusal splint therapy and afterwards physiatrically: by ultrasound, TENS and oral exercises at home. After about 10 months of treatment, the clinical picture improved (AVS=5.4). Macrotrauma of the stomatognathic system is a potential initiating etiological cause of functional disorders and the purpose of initial treatment is to improve the functional condition as well as to reduce or completely remove pain.

čeljusni zglob; trauma; etiologija

nije evidentirano

engleski

Tempromandibular joint disorder caused by trauma - report on a female patient

Opisan je klinički slučaj 26-godišnje pacijentice s poremećajem čeljusnog zgloba, koja je kliničke simptome povezala s lakšom traumom u području orofacijalne regije. Udarac mandibulom u ovratnik doživjela je 2000. te joj se nakon dva mjeseca pojavilo škljocanje u desnom čeljusnom zglobu. Od 2002. počelo ju je i boljeti u istom zglobu, ali tek je 2006. godine upućena od svog stomatologa na Stomatološki fakultet u Zagrebu. Bol je u području čeljusnog zgloba izražena tijekom žvakanja i jačeg otvaranja usta, čiji je intenzitet izmjeren na analogno-vizualnoj skali (AVS=7, 5). Desni čeljusni zglob lagano je bio bolan na palpaciju sa sitnim krepitacijama tijekom aktivnog otvaranja usta, koje je iznosilo 34, 5 mm. Pasivno otvaranje praćeno bolovima iznosilo je 41 mm. Desna laterotruzijska kretnja iznosila 9 mm, a lijeva je bila limitirana na samo 3 mm i praćena bolovima u desnom zglobu. Pacijentica je imala sanirane zube, protetski nenadomješten zub 36 te bez znakova patološkog trošenja zubi. Negirala je bruksističku aktivnost. Laterotruzijske kretnje bile su vođene očnjacima i bez intereferntnih ili balansnih dodira. Dinamičkim te pasivnim kompresijama utvrđena je limitiranost otvaranja usta s induciranim bolovima u bilaminarnoj zoni desnog zgloba. Magnetskom rezonancijom potvrđen je anteriorni pomak zglobne pločice bez redukcije s lagano hipoplastičnom i deplaniranom glavicom kondila desnog zgloba, kompenzatornom progresivnom adaptacijom bilaminarne zone u smislu stvaranja pseudodiskusa te hipomobilnim položajem kondila u položaju otvorenih usta s vidljivo defromiranom i anteriorno smještenom zglobnom pločicom. Pacijentica je liječena okluzijskom udlagom, a zatim i fizijatrijski: ultrazvukom, TENS-om i oralnim vježbama kod kuće. Nakon oko 10 mjeseci terapije došlo je do poboljšanja kliničke slike (AVS=5, 4). Makrotrauma stomatognatskog sustava potencijalni je inicijacijski etiološki uzročnik funkcijskih poremećaja, a cilj inicijalnog liječenja je poboljšanje funkcijskog stanja te smanjivanje ili potpuno uklanjanje bolova. The case presented is of a 26-year-old female patient with temporomandibular joint disorder who attributed her clinical symptoms to a mild trauma in the orofacial region. In 2000, she hit a door jamb with her mandible and two months later clicking in her right temporomandibular joint started. In 2002, she started feeling pain in the same joint, but only in 2006 she was referred to the School of Dental Medicine in Zagreb. Pain in the temporomandibular joint region was pronounced during chewing and greater mouth opening and its intensity was measured on the analogue-visual scale (AVS=7.5). The right temporomandibular joint was slightly painful on palpation with minor crepitations during active mouth opening, which amounted to 34.5 mm. Passive opening accompanied by pain was 41 mm. Right laterotrusive movement was 9 mm and the left one was limited to only 3 mm with pain in the right joint. The patient had treated teeth and a prosthodontic replacement of tooth number 36 and did not show signs of pathological tooth wear. She denied any bruxist activity. Laterotrusive movements were canine guided and without interference and balanced contacts. Limited mouth opening with induced pain in the bilaminar zone of the right joint was determined by dynamic and passive compressions. MRI confirmed anterior disc displacement without reduction with a slightly hypoplastic and deplaned condylar head of the right joint, compensatory progressive adaptation of the bilaminar zone in the sense of creating a pseudodisc and a hypomobile position of the condyle in open mouth position with visibly deformed and anteriorly placed articular disc. The patient was treated with occlusal splint therapy and afterwards physiatrically: by ultrasound, TENS and oral exercises at home. After about 10 months of treatment, the clinical picture improved (AVS=5.4). Macrotrauma of the stomatognathic system is a potential initiating etiological cause of functional disorders and the purpose of initial treatment is to improve the functional condition as well as to reduce or completely remove pain.

temporomandibular joint; trauma; etiology

nije evidentirano