ЛУЧЕВАЯ ДИАГНОСТИКА ПРИ ЛЕЧЕНИИ СМЕЩЕНИЯ СУСТАВНОГО ДИСКА ВИСОЧНО-НИЖНЕЧЕЛЮСТНОГО СУСТАВА И МИОФАСЦИАЛЬНЫХ РАССТРОЙСТВ

Abstract

Purpose: Determination of the volume and sequence of radiation studies in the treatment of patients with displacement of the articular disc of the temporomandibular joint (TMJ)and myofascial pain disorders.
 Material and methods: The study included 48 patients with displacement of the articular disc of the TMJ and myofascial pain disorders. Clinical criteria for articular displacement were confirmed by MRI and CBCT. Studies of the function of the masticatory muscles were carried out at the Synapsis electromyograph. All patients underwent complex treatment, including relaxation of the masticatory muscles and relief of pain using injections of botulinum toxin in the actual masticatory, temporal and lateral pterygoid muscles (LPM), followed by repositioning split therapy. For the introduction of muscle relaxant in LPM, we have developed and applied external periarticular injection access to LPM. The method is based on reaching the zone of joint attachment of the upper and lower heads of the LPM with MRI navigation. Surveillance continued for up to 12 months with MRI monitoring of the position of the articular disc.
 Results: The stages of treatment of SJS of the TMJ with control use of MRI and CT, as well as a method for the administration of botulinum toxin under MRI navigation, have been developed. The first stage included CT and MRI of the temporomandibular joint, the second stage – injections of botulinum toxin into the masticatory muscles using the developed periarticular access to the LPM with MRI navigation, as well as CBCT with a splint to control the new (established) position of the lower jaw; the third and fourth stages included continuation of the reduction splint therapy, correction of the splint, observation for 3-6 months with control CBCT after 6 months to assess the position of the mandible without splint. Achieved an increase in the posterior and upper temporomandibular joint distances and the correct position of the lower jaw.
 Conclusion: Performing radiation studies on time at certain stages of treatment, differing in their content and volume, provided a complete diagnosis, planning treatment measures and monitoring the results.