中醫與口腔顎面外科合併治療之顳顎關節疾患病例報告

Temporomandibular Disorder under combined treatments of Traditional Chinese Medicine and Oral and Maxillofacial Surgery: A Case Report

曾怡嘉(Yi-Chia Tseng)；黃婷愉(Ting-Yu Huang)

顳顎關節疾患 ； Temporomandibular disorder（TMD） ； 頭頸部顏面疼痛 ； Orofacial pain ； 針灸治療 ； Temporomandibular disorder(TMD) ； Orofacial pain ； acupuncture

北台灣中醫醫學雜誌

14卷2期（2022 / 09 / 01）

57 - 72

繁體中文

患者為20歲女性，張口聲響數月後突發右側面部疼痛，於晨起張口、咀嚼更甚，伴右側肩頸緊繃不適、長期眠差且易於緊張。患者於109年8月5日至口腔顎面外科就診，診斷為咀嚼肌群疼痛、雙側顳顎關節可復位之關節盤位移及右側顳顎關節滑膜炎，經藥物及復健治療後，患者張口度改善，但咀嚼肌群疼痛反覆。8月20日起合併中醫治療，中醫診斷為上盛下虛、三焦經氣滯的氣血偏移失衡，治療中以脈診與症狀變化做為觀測方式，使用針刺使患者氣血達到「以平為期」的治療目標，協同處理疼痛及下顎活動度問題。在中西醫合併治療下，患者的顳顎關節功能於一個月內恢復，追蹤亦未復發。本文以中西合作診治的患者為例，探討中醫在顳顎關節疾患治療中的角色。為呈現全貌，文中詳述患者在中西醫兩方的檢查與治療，希望能提供一些不同的參考方向。

We present a case received combination treatments for Temporomandibular disorders (TMD) from Chinese medicine and Oral and maxillofacial surgery. The 20-year-old female suffered from pain over right face during opening mouth and chewing, discomforts over right shoulder and neck, and poor sleep quality. The patient also mentioned getting stressed easily. The patient visited Oral and maxillofacial surgery department on 5^(th) August 2020. The diagnosis were tonic contraction myalgia of masticatory muscles, disc displacement with reduction of bilateral temporomandibular joints and synovitis of right temporomandibular joint. The patient's opening mouth distance gained but the myofascial pain of masticatory muscles still on and off after 2 weeks of conservative treatment in Oral and maxillofacial surgery department. Therefore, the patient was suggested to receive combination treatment with Chinese medicine. The patient was diagnosed with syndrome of upper excess and lower deficiency with qi stagnation in Chinese medicine, and mainly received acupuncture and health education. Within one-month treatment, the patient recovered with normal function of temporomandibular joints and free of pain.

1. 劉耕豪,陳玉昇,葉柏巖,游均晶,游智勝(2013)。脈之根柢探源—由中醫典籍及現代生理切入探討。中醫藥雜誌，24(1)，49-63。
   連結：
2. Ay, S,Evcik, D,Tur, B.S.(2010).Comparison of injection methods in myofascial pain syndrome: a randomized controlled trial.Clin. Rheumatol.,29(1),19-23.
3. Carlson, CR,Bertrand, PM,Ehrlich, AD,Maxwell, AW,Burton, RG(2001).Physical self-regulation training for the management of temporomandibular disorders.J. Orofac. Pain,15(1),47-55.
4. Edwards, RR,Grace, E,Peterson, S,Klick, B,Haythornthwaite, J,Smith, MT(2009).Sleep continuity and architecture: Associations with pain-inhibitory processes in patients with temporo-mandibular joint disorder.Eur. J. Pain,13,1043-1047.
5. Fernandez-de-las-Penas, C,Svensson, P(2016).Myofascial Temporomandibular.Curr. Rheumatol. Rev.,12(1),40-54.
6. Gauer, Robert L.,Semidey, Michael J.(2015).Diagnosis and treatment of temporomandibular disorders.Am. Fam. Physician,91(6),378-386.
7. Lai, Hsiang-Chun,Lin, Yi-Wen,Hsieh, Ching-Liang(2019).Acupuncture-Analgesia- Mediated Alleviation of Central Sensitization.Evid. Based. Complement. Alternat. Med.,2019,6173412.
8. List, Thomas,Jensen, Rigmor Højland(2017).Temporomandibular disorders: Old ideas and new concepts.Cephalalgia,37(7),692-704.
9. Manfredini, D,Guarda-Nardini, L,Winocur, E,Piccotti, F,Ahlberg, J,Lobbezoo, F(2011).Research diagnostic criteria for temporomandibular disorders: a systematic review of axis I epidemiologic findings.Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod.,112,453-462.
10. Ozdinc, SP,Ata, HM,Selcuk, HM,Can, HBM,Sermenli, NM,Turan, FNP(2020).Temporomandibular joint disorder determined by Fonseca anamnestic index and associated factors in 18- to 27-year-old university students.Cranio.,38(5),327-332.
11. Ritenbaugh, Chery,Hammerschlag, Richard,Dworkin, Samuel F.,Aickin, Mikel G.,Mist, Scott D.,Elder, Charles R.,Harris, Richard E.(2012).Comparative Effectiveness of Traditional Chinese Medicine(TCM) and Psychosocial Care in the Treatment of TMD associated Chronic Facial Pain.J. Pain,13(11),1075-1089.
12. Schmitter, Marc(2015).Sleep-associated aspects of myofascial pain in the orofacial area among Temporomandibular Disorder patients and controls.Sleep medicine,16(9),1056-1061.
13. Smith, MT,Wickwire, EM,Grace, EG(2009).Sleep disorders and their association with laboratory pain sensitivity in temporomandibular joint disorder.Sleep,32,779-790.
14. Vazquez-Delgado, E,Cascos-Romero, J,Gay Escoda, C(2010).Myofascial pain associated to trigger points: a literature review. Part 2: differential diagnosis and treatment.Med. Oral Patol. Oral Cir. Bucal.,15(4),e639-e643.
15. Wilk, Bruce R.,Stenback, Jeffrey T.,McCain, Joseph P.(1993).Postarthroscopy Physical Therapy Management of a Patient with Temporomandibular Joint Dysfunction.J. Orthop. Sports Phys. Ther.,18(3),473-478.
16. Zotelli, Vera L. Rasera,Grillo, Cássia M.,Gil, Maria L. Bressiani,Wada, Ronaldo S.,Sato, Jorge E,de Sousa, Maria da Luz R(2018).Patterns of Energy Imbalance of the Meridians in Patients with Temporomandibular Dysfunction.J. Acupunct. Meridian Stud.,11(1),1-6.
17. 吳建華,衡墩前(1994)。顳頜關節紊亂綜合癥中醫藥治療概況。中醫藥信息，10，1590-1595。