DISEASE OF THE JAWS : ARTHRITIS OF THE JAW (ARTHRITIS MANDIBULAE) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Etiology. Arises from various causes: trauma, traumatic articulation, gonorrea, the spread of infection from adjacent areas or metastatic if it is a General infection of the organism.
The pathogenesis. In inflammatory lesions of the joints in the disease are involved in varying degrees, bone, cartilage and meniscus. The loss of cartilage and meniscus usually leads to ankylosis. Chronic inflammation of the jaw joint occurs in the form of deforming arthritis; reverse the development of articular cartilage in parallel with growing reactive proliferation of the articular region. In this process, the thinner the joint the meniscus, the articular head is flattened and glenoid cavity.
Symptoms. Redness and swelling of the soft tissues in the joint, difficulty opening the mouth, the displacement of the jaw to the affected side when opening the mouth, General malaise and fever. The symptoms of chronic arthritis: a little joint stiffness upon opening of the dentition after a long rest (night sleep), a feeling of uneasiness in the joint. Then there balatoni feeling, flipping the joint during movements of the mandible. At times of exacerbation of pain; at last, there is a characteristic shift to the healthy side, the habitual dislocation.
Course and complications. The course is determined by the nature of the lesion of the articular cartilage and meniscus. Only mild forms of inflammation have consequences for the joint. Often, however, superficial lesion of the cartilage sooner or later leads to a deforming arthritis. Laid bare bony surfaces of the joint are almost always formed ankylosis.
The differential-diagnostic value of acute arthritis are the following two of the most distinctive characteristics:
When deforming arthritis x-ray facilitates the recognition.
Expressed form over function give little favourable prediction, as is often sooner or later there is a more or less significant violation of the movements of the lower jaw.
Only in the case of growth of pyogenic arthritis shows arthrotomy. In other cases, apply heat, vaccinotherapy, intra - and periarticular injection of penicillin, possible immobilization of the joint (with the patient side lay a piece of rubber, chin pull up with elastic bandages). Only after the attenuation of the acute effects can be activated movement of the lower jaw. Treatment of temporomandibular arthritis in the initial phases, when there is the clicking of the joint, a small temporary stiffness can restrict usage to hyperemesis tools (heat), monoterapia, salicylates. When the intermittent appearance of lockjaw, subluxation, habitual dislocation is recommended that more active treatment: injection of 70% alcohol, 2 ml of masseter and temporal muscle, 1 ml of the internal pterygoid muscle. Thus there is a risk of facial paralysis. Mechanical strengthening of the jaw with the sliding plane with simultaneous carrying out physiotherapy treatments (galvanization, diathermy, mud) is not always effective, but is not dangerous unlike alcohol injections into the muscles.