穴位注射治疗颞下颌关节周围炎94例

颞下颌关节周围炎系翼外肌亢进、痉挛，颞下颌关节后区损伤和咀嚼肌群痉挛四症之总称，原是颞下颌关节功能紊乱症的一部分。由于罹患关节咬合运动频繁，故而病期较长，常常反复发作，难以治愈。笔者对经治不愈的１３２例患者，随机对局部病损采用穴位水针疗法为治疗组，中...

Effectiveness of Mesotherapy on Temporomandibular Joint Disorders

TMJDs （Temporomandibular joint disorders） are a common pathology but best treatment remains unclear. The goal of this study was to evaluate the effectiveness of mesotherapy on TMJD. We conducted a case review of all TMJD patients treated since 2006 with mesotherapy procedures only and using a cocktail of drugs composing of lidocaine, piroxicam and pentoxifylline. Patients were treated every 15 days until symptomatic relief was achieved and thereafter every two months. Main outcome was complete symptomatic relief, and associated factors were analysed. 27 patients were included. Complete pain relief was achieved in 26. The necessary number of procedures to get pain relief ranged from 1 to 6 （median of 1） and the total number of treatments from 1 to 40 （median of 11）. 19 patients had other painful complains mainly related with anxiety disorders. A weak correlation （r = 0.357; p = 0.05） between anxiety disorders and the required months of treatments was found. Mesotherapy is a valuable option on pain relief in a temporomandibular pain syndrome with none of the systemic effects of oral medication. Anxiety may have a role on the aetiology and therapeutic success highlights the holistic approach of these patients. Future comparative studies are necessary.

Difficult Endotracheal Intubation -Scales and Causes

The aim of the study is to assess the possibility of intubation in each patient, the lyche to be difficult intubation, to fred all the causes of the difficult intubation, to fred and apply appropriate scales for difficult intubation, to estimate the frequency of difficult intubation. Endotmcheal intubation is the basic reanimation procedure performed both in hospital and out-of-hospital settings. It is carded out whenever chest movements and spontaneous respiration are compromised. Respiratory arrest may occur for a variety of reasons （such as cardac arrest, coma of any origin, poisining） or direct damage to the airways, e.g. in various traumas （damages to the face, oropharynx, larynx, trachea, chest）. The basic endotracheal intubation kit contains： laryngoscope, endotracheal tubes, connectors （tube and Ambu bag connectors）, complete Ambu kit （face mask and bag）, 20 mL syringe for cuff inflating, suction apparatus, stylete, and Magill forceps. In order to assess the successfulness of endotracheal intubation, it is necessary first to identify patients who need to be intubated. With the aim of identifying such patients, numerous screening tests and scales have been created to predict difficult intubation. The best known and most commonly used are the Mallampati and Wilson classifications as well as the LEMON airway assessment method. Nevertheless, difficult intubation accounts for 1% of cases. It usually occurs when manipulation of the laryngoscope blade is not possible in obese patients and patients with short neck, in congenital restricted mouth opening, limited neck movement as well as limited temporomandibular joint mobility; in cases of edema, fibrosis and lesions of the tongue, pharynx and larynx; when there are anatomical variations and congenital malformations of the oral cavity, pharynx, larynx, head, neck and chest.

Technical and Dosimetric Study of Four Facio-cervical Fields Conformal Radiotherapy for Nasopharyngeal Carcinoma

Objective： The aim of this study is to establish the methods of four facio-cervical fields＇ conformal radiotherapy （4F-CRT） for nasopharyngeal carcinoma （NPC）, and to optimize the methods for clinical practice. Methods and Materials： 40 patients with untreated NPC of T1-T4 （1997AJCC Staging System） were rolled into this study. Conventional and four ratio-cervical fields conform plans were designed for each patient using Pinnacle 8.0 three-dimension treatment planning system （3D-TPS）： 1） Improved plan, four ratio-cervical fields＇conform plans, anterior, posterior ratio-cervical and 2 lateral opposing facio-eervical fields; 2） Conventional plan, two lateral opposing facio-cervical fields only with the same dose delivered to the target in each plan, close volume histograms （DVHs） of the targets and normal organs, brain stem, spinal cord, parotid glands, and temporal mandibular joints （TMJs） were compared and the dose distribution were evaluated. Results： 1） The dose distribution of the improved plan could meet the requirements for the target volume. 2） There was not any significant difference in the dose of spinal cord between the two plans. The mean doses of Dmax for brain stem in conventional plan were much lower than those in the improved plan, though both were within safety limits. 3） Compared with the conventional plans, the improved plan significantly decreased the hotspot areas in the target volume and had better parotid glands and temporal mandibular joints sparing effect. Conclusion： Compared with the conventional plan, the improved plan provides satisfactory dose coverage to the tumor volume and better sparing of the parotid gland, TMJs and other normal tissues in external beam radiotherapy of NPC.

Twenty cases of temporomandibular disorders with warming-needle moxibustion on ginger at Xiàguān(下关ST 7)

Objective: To observe the clinical efficacy of treatment for temporomandibular disorders with warmingneedle moxibustion on ginger at Xiàguan(下关ST 7).Methods: Twenty patients with temporomandibular disorders were given acupuncture at ST 7 of the affected side, and then the self-prepared round cake-shaped ginger with moxa was set on the needle closing to skin surface, Ignited moxa, burn out as one cone, three cones were given for once. The treatment was performed once a day, 7 times was 1 course, and the curative effect was evaluated after 1 course of treatment.Results: Among 20 patients, 12 were cured, improvement was observed in 7 patients, and 1 case had no response to treatment. The effective rate was up to 95.0%;improvement was observed in 14 patients after treatment for 3 times. According to follow-up visit 1 month after treatment, 1 patient relapsed due to excessive mouth opening, but the symptom was mild and relieved after rubbing.Conclusion: The clinical efficacy of treatment for temporomandibular disorders with warming-needle moxibustion on ginger at ST 7 was ideal.

Application of MRI in indirect temporomandibular joint injury without condylar fracture

Objective： To discuss the application of MRI in indirect temporomandibular joint injury without condylar fracture. Methods： MRI examination on temporomandibular joint was conducted in 28 patients with indirect injury to temporomandibular joint without condylar fracture. The scanning sequence included TIWI, PDWI on oblique sagittal section at both open and closed mouth positions, and T1WI, T2WI on oblique coronal section. The MRI appearance was analyzed by 2 senior radiologists. Results： Among the 56 temporomandibular joints of28 patients, 35 joints exhibited pathological changes on MRI, in which there were 9 bone injuries, 21 articular disc dislocation, 24 intracapsular hematocele and hydrops. Conclusions： MRI can clearly reveal bone injury, articular disc dislocation as well as articular capsule abnormality in the indirect injury of temporomandibular joint without condylar fracture. It is highly advocated in clinical use.

Clinical observation of tuina plus heat-sensitive moxibustion for temporomandibular disorders

Objective： To observe the clinical efficacy of tuina plus heat-sensitive moxibustion in treating temporomandibular disorders （TMD）. Methods： Fifty patients with TMD were randomized into a treatment group and a control group, 25 cases in each group. The treatment group was intervened by tuina plus heat-sensitive moxibustion, while the control group was by medication. The Fricton-Shiffman craniomandibular index （CMI） was observed before and after intervention, and the clinical efficacies of the two groups were also evaluated. Results： There was no significant difference in comparing the CMI score between the two groups before intervention （P^0.05）. After a treatment course, there were significant improvements in evaluating the CMI score in both groups （P^0.01）, and the improvement was more significant in the treatment group than that in the control group （P〈0.01）. The total effective rate of the treatment group was significantly higher than that of the control group （P〈0.01）. Conclusion： Tuina plus heat-sensitive moxibustion is effective in treating TMD, and it＇s safe, without adverse reactions, thus worth promoting in clinic.

Treatment of Temporomandibular Joint Dysfunction Syndrome by Acupuncture,Taiyi Moxa-cigar Plus Tuina

Summary： Fouty-five cases of temporomandibular joint dysfunction syndrome were diagnosed by Xray, excluding the organic diseases. The acupoints Xiaguan （ST 7）, Jiache （ST 6）, Yifeng （TE 17） and Hegu （LI 4） on the affected side were punctured first, after removal of needles, 5-7 layers of cotton cloth was placed on the above acupoints, then moxibustion with moxa-roll made of Chinese medicine was performed. Finally Dian-finger pressing, An-pressing and Rou stationary circular pressing with finger belly of the thumb were applied to the local region around the mandible joint for 3-5 min. After 1-2 courses of treatments, 45 cases all got effect.

Research Progress on Acupuncture and Tuina Therapy for Temporomandibular Joint Dysfunction Syndrome in Recent 5 Years

Temporomandibular joint dysfunction syndrome （TMD） is a commonly encountered disease in the oral and maxillofacial region and often occurs in the young and middle-aged adults. The epidemiological study on this disease by domestic scholars showed its incidence rate was 32.0%-57.3% [1-3].