Резюме
Ярославська Ю.Ю. Фактори розвитку синдрому м’язової дисфункції скронево-нижньощелепного суглоба в дитячому та юнацькому віці.
Метою роботи було удосконалення методів ранньої діагностики синдрому м’язової дисфункції СНЩС в дитячому та юнацькому віці шляхом вивчення факторів його розвитку. Було обстежено клінічно і рентгенологічно 33 пацієнта з синдромом м’язової дисфункції СНЩС у віці від 10 до 18 років. При клінічному обстеженні були виявлені фактори, що призводять до виникнення даного захворювання, що дозволило нам створити робочу схему розвитку синдрому м’язової дисфункції СНЩС в дитячому та юнацькому віці. Отже, етіологічними факторами синдрому м’язової дисфункції СНЩС можуть бути не тільки зубощелепні аномалії, але й наявність шкідливих звичок, диспропорції росту кісткового і м’язового скелета та гіпокінетичні стани, викликані психофізіологічними реакціями на хронічний стрес.
Ключові слова: скронево-нижньощелепний суглоб (СНЩС), синдром м’язової дисфункції.
Резюме
Ярославская Ю.Ю. Факторы развития синдрома мышечной дисфункции височно-нижнечелюстного сустава в детском и юношеском возрасте.
Целью работы являлось усовершенствование методов ранней диагностики синдрома мышечной дисфункции ВНЧС в детском и юношеском возрасте путем изучения факторов его развития. Было обследовано клинически и рентгенологически 33 пациента с синдромом мышечной дисфункции ВНЧС в возрасте от 10 до 18 лет. При клиническом обследовании были выявлены факторы, предрасполагающие к возникновению данного заболевания, что позволило нам создать рабочую схему развития синдрома мышечной дисфункции ВНЧС в детском и юношеском возрасте. Таким образом, этиологическими факторами синдрома мышечной дисфункции ВНЧС могут быть не только зубочелюстные аномалии, но и наличие вредных привычек, диспропорции роста костного и мышечного скелета и гипокинетические состояния, вызванные психофизиологическими ответными реакциями на хронический стресс.
Ключевые слова: височно-нижнечелюстной сустав (ВНЧС), синдром мышечной дисфункции.
Summary
Yaroslavska Yu.Yu. Development factors of the temporomandibular joint syndrome in childhood and adolescence.
The purpose was to improve the methods of early diagnosis of TMJ syndrome in childhood and adolescence by examining the factors of its development. Were examined clinical and radiological 33 patients with TMJ syndrome aged 10 to 18 years. Clinical examination revealed the factors predisposing to the disease, which allowed us to establish a working plan for development of TMJ syndrome in childhood and adolescence. And also conclude that the etiological factors of TMJ syndrome in childhood and adolescence can be not only dentoalveolar anomalies, but also the presence of harmful habits, disparities growth of bone and muscle and skeletal hypokinetic condition caused by psycho-physiological reactions to the chronic stress.
Key words: temporomandibular joint, TMJ syndrome.

Рецензент: д.мед.н., проф. Р.С. Назарян

УДК 616.31-053.67:616.724-008.6-02-092

Харківський національний медичний університет

Харьковский национальный медицинский университет

Kharkiv National Medical University

Alex7307.73@mail.ru

Etiologic and pathogenetic aspects cause the most contentious issue in the study of TMJ syndrome in childhood and adolescence. Some researchers have linked the emergence of this group of diseases with abnormal occlusion [4,6], others have more emphasis on the age characteristics of a growing organism, or rather on a number of morphological and psychomotor processes arising and ending at puberty and cause physiological abnormalities in the growing organism [3,10]. In addition, some authors attribute the presence of TMJ syndrome with endocrine disorders, occurring in adolescence, particularly with the increase of the free fraction of androgens and free index testosterone [5], as well as with vitamin deficiencies, especially B vitamins, which leads to the appearance of doldrums, pain in the muscles, general weakness.

The aim of the study was to improve the methods of early diagnosis of TMJ syndrome in childhood and adolescence by researching the factors of its development.

Materials and methods. We have examined by clinical and radiological methods 33 patients with TMJ syndrome disorder between the ages of 10 to 18 years, 20 of them (60.6%) girls and 13 (39.4%) boys. All examined patients complained of the presence of clicks in the joint when they open mouth widely, irregular movement of the lower jaw when opening the mouth, the periodic occurrence of unilateral pain in the joint and the ear, increasing when taking rigid and solid food, which allowed us to establish the diagnosis of the TMJ syndrome.

A clinical study has focused on the survey of patients, and in some cases their parents, in order to study carefully the history of life and disease, and the patient's complaints. We have found out the factors predisposing to the disease: the presence of various bad habits, family history, trauma of the lower jaw and TMJ, errors in orthodontic treatment.

The data obtained showed that 16 (48.5%) patients had a history revealed various factors that contribute to the TMJ syndrome. The presence of various bad habits was about 38%. In addition, 13 (39.4%) patients reported the presence of emotional stress.

The presence of orthodontic pathology was determined in 26 (78.8%) patients, 7 (21.2%) patients had no dentofacial disorders was not determined.

During the study of TMJ it was noted volume of movement of the mandible, the nature of the tour heads of the mandible, the presence of the clicking, pain in the joints crunching, asynchronous of movement of the mandible, and the nature of head movement. Palpation of the masticatory muscles was performed to identify the trigger points.

The most common symptom, occurring in 27 (81.8%) patients was clicking in the joint with one or two sides, as well as excessive excursion of articular heads, occurring in 17 (51.5%) patients. A distinctive feature of TMJ syndrome manifestations in children and adolescents is relatively rare, in contrast to adults, the appearance of symptoms. For example, pain when opening the mouth wide celebrated only 7 (21.2%) patients; pain in the joints - 8 (24.2%) patients; pain in the masticatory muscles - 6 (18.2%) patients.

The data obtained in this study suggest that there are several major etiological factors that may equally contribute to TMJ syndrome in childhood and adolescence. According to our observations, these factors are the pathological changes in the dentition, growth imbalances of the musculoskeletal system in puberty, bad habits (chewing on one side, the constant chewing gum, wide mouth opening with biting food, yawning, etc..) frequent psycho-emotional and physical stress. Accordingly, treatment of patients with this pathology should be comprehensive and include not only the treatment of dental system, but also it must be directed to the balanced development of the musculoskeletal system in children and to eliminate bad habits and factors of chronic stress.

Further research is promising diagnostic methods TMJ syndrome in childhood and adolescence in order to develop specific treatments for this syndrome, as well as its prevention.

Литература

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2. Долецкий С.Я. Вопросы структуры и функции в педиатрической хирургии / С.Я. Долецкий. – М.: Медицина, 1973. – 38 с.
3. Егоров П.М. Болевая дисфункция височно-нижнечелюстного сустава / П.М. Егоров, И.С. Карапетян. - М.: Медицина, 1986. - 126 с.
4. Петросов Ю.А. Заболевания височно-нижнечелюстного сустава / Ю.А. Петросов, О.Ю. Калпакъянц, Н.Ю. Сеферян. - Краснодар, 1996. - 352 с.
5. Пузин М.Н. Болевая дисфункция височно-нижнечелюстного сустава / М.Н. Пузин, А.Я. Вязьмин. - М.: Медицина, 2002.- 160 с.
6. Силин А.В. Проблемы диагностики, профилактики и лечения морфо-функциональных нарушений в височно-иижнечелюстных суставах при зубо-челюстных аномалиях: автореф. дисс. . д-ра мед.наук: спец. 14.00.21 «Стоматология» / А.В. Силин - СПб., 2007. - 43 с.
7. Тревел Дж.Г. Миофасциальные боли / Дж.Г. Тревел, Д.Г. Симонс. - М.: Медицина, 1989. - Т.2. - С. 7-203.
8. Хватова В.А. Заболевания височно-нижнечелюстного сустава / В.А. Хватова. - М.: Медицина, 1982. - 160 с.
9. Oral habits and their association with signs and symptoms of temporomandibular disorders in adolescent girls / A. Gavish, M. Halachmi, E. Winokur, E. Gazit // J. Oral Rehabil. - 2000. - Vol.27, № 1. - P. 22-32.
10. Korszun A. Facial pain, depression and stress: connections and directions / A. Korszun // J. Oral Pathol. Med. - 2002. - № 31. - P. 615-619.

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