偏侧咀嚼对颞下颌关节结构的影响及其与颞下颌关节紊乱的关系

Research progress in effect of chewing-side preference on temporomandibular joint and its relationship with temporo-mandibular disorders

偏侧咀嚼是颞下颌关节紊乱(TMD)的重要危险因素,TMD患者中存在偏侧咀嚼的比例较高,偏侧咀嚼人群更易出现髁突短小、髁突移位、关节结节斜度和关节窝深度增大的改变,临床研究表明偏侧咀嚼与TMD症状和体征亦存在较强相关性。动物研究表明偏侧咀嚼会影响下颌骨的生长发育和损伤修复活动。长期偏侧咀嚼后关节内受力环境的改变造成颞下颌关节(TMJ)结构重建失衡、咀嚼肌纤维结构发生转化甚至破坏,导致双侧肌肉运动不协调。TMJ局部释放的神经肽P物质和降钙素基因相关肽增加所导致关节神经源性疾病可能是导致TMD发生的机制。本文就偏侧咀嚼对TMJ结构的影响、偏侧咀嚼与TMD的关系及其可能引起TMD的相关机制的研究进展做一综述。

Chewing-side preference is one of the risk factors for temporomandibular disorders(TMD),and people with chewing-side preference is more prone to have short and displaced condyles,increased articular eminence inclination and glenoid fossa depth.The proportion of TMD patients with chewing-side preference is often higher than that of the normal subjects.Clinical studies have shown a strong correlation between chewing-side preference and TMD symptoms and signs;and animal studies have shown that chewing-side preference can affect the growth,development,damage and repair of the mandible.After long-term unilateral mastication,changes in the stress within the joint cause the imbalance of temporomandibular joint(TMJ)structural reconstruction,the transformation and even destruction of the fiber structure of masticatory muscle,resulting in uncoordinated movement of bilateral muscles.The joint neurogenic diseases caused by the increase of neuropeptide substance P and calcitonin-gene-related-peptide(CGRP)released locally by TMJ may be the mechanism of TMD.This article reviews the research progress of the influence of chewing-side preference on the structure of TMJ,the relationship between chewing-side preference and TMD,and the related mechanisms.