The guiding principles of patient management include the establishment of an accurate diagnosis,and providing treatment based on the diagnosis and an understanding of the pathogenesis of the disease process.Furthermor...The guiding principles of patient management include the establishment of an accurate diagnosis,and providing treatment based on the diagnosis and an understanding of the pathogenesis of the disease process.Furthermore,therapeutic interventions should begin with the least invasive therapies with the highest benefit:risk ratio.When a patient responds to a minimal level of treatment,this usually is an indication that the pathology present is minor in nature and is reversible.Patients who do not respond to appropriate non-surgical therapies often have more complex pathology that may require invasive therapies.Management of the most common temporomandibular joint disorders requires a thorough understanding of the pathogenesis of synovitis,osteoarthritis and adhesions.These conditions represent tissue responses to external factors that exceed the adaptive capacity of the joint tissues.When the functional capacity of the joint tissues is exceeded,this leads to joint pain,limited range of motion and an inability of the joint to tolerate normal physiologic loads,leading to mandibular dysfunction.The principles of management of these conditions involve reduction of joint loading,restoring mandibular mobility and reduction of inflammation and pain.Non-surgical management of temporomandibular joint disorders is guided by these principles and will often result in decreased pain and improved mandibular function.When patients respond to non-surgical therapies,this is a reflection of the ability of the tissues to recover and heal.However,a failure of the patient to respond to a full course of non-surgical therapy is often a reflection of the magnitude of the pathology and represents an inability of the tissues to recover the structure and function necessary for normal mandibular loads.Arthroscopic temporomandibular joint surgery is a minimally invasive operative technique that enables the surgeon to directly visualize and treat intra-articular pathology.Operative arthroscopy permits maximum preservation of the structure and function of intra-articular tissues consistent with the removal and treatment of pathologic tissues such as synovitis,osteoarthritis and adhesions.Following surgical treatment,the postoperative rehabilitation regimen is required to continue to reduce joint loading,maximize mandibular mobility and reduce inflammation and pain while the joint tissues heal and regain function.Therefore,comprehensive treatment of patients with temporomandibular joint pathology involves a thorough understanding of the principles of non-surgical and surgical therapies,which are not mutually exclusive.To the contrary,both non-surgical and surgical therapies represent a continuum in the management of the patient suffering from temporomandibular joint pathology.Fortunately,most patients respond to treatment when the clinician has a thorough knowledge of the principles of non-surgical and surgical therapy.展开更多
文摘The guiding principles of patient management include the establishment of an accurate diagnosis,and providing treatment based on the diagnosis and an understanding of the pathogenesis of the disease process.Furthermore,therapeutic interventions should begin with the least invasive therapies with the highest benefit:risk ratio.When a patient responds to a minimal level of treatment,this usually is an indication that the pathology present is minor in nature and is reversible.Patients who do not respond to appropriate non-surgical therapies often have more complex pathology that may require invasive therapies.Management of the most common temporomandibular joint disorders requires a thorough understanding of the pathogenesis of synovitis,osteoarthritis and adhesions.These conditions represent tissue responses to external factors that exceed the adaptive capacity of the joint tissues.When the functional capacity of the joint tissues is exceeded,this leads to joint pain,limited range of motion and an inability of the joint to tolerate normal physiologic loads,leading to mandibular dysfunction.The principles of management of these conditions involve reduction of joint loading,restoring mandibular mobility and reduction of inflammation and pain.Non-surgical management of temporomandibular joint disorders is guided by these principles and will often result in decreased pain and improved mandibular function.When patients respond to non-surgical therapies,this is a reflection of the ability of the tissues to recover and heal.However,a failure of the patient to respond to a full course of non-surgical therapy is often a reflection of the magnitude of the pathology and represents an inability of the tissues to recover the structure and function necessary for normal mandibular loads.Arthroscopic temporomandibular joint surgery is a minimally invasive operative technique that enables the surgeon to directly visualize and treat intra-articular pathology.Operative arthroscopy permits maximum preservation of the structure and function of intra-articular tissues consistent with the removal and treatment of pathologic tissues such as synovitis,osteoarthritis and adhesions.Following surgical treatment,the postoperative rehabilitation regimen is required to continue to reduce joint loading,maximize mandibular mobility and reduce inflammation and pain while the joint tissues heal and regain function.Therefore,comprehensive treatment of patients with temporomandibular joint pathology involves a thorough understanding of the principles of non-surgical and surgical therapies,which are not mutually exclusive.To the contrary,both non-surgical and surgical therapies represent a continuum in the management of the patient suffering from temporomandibular joint pathology.Fortunately,most patients respond to treatment when the clinician has a thorough knowledge of the principles of non-surgical and surgical therapy.
