拔牙及非拔牙引起trismus.docxVIP

关于咀嚼肌的解剖功能Ambulatory anesthesia门诊麻醉并发症1）病人位置、手术时间长短、防止关节过伸Complications related to patient positioningThe provision of anesthesia causes relaxation of the musculoskeletal system that can lead to Hyperextension of the joints2）血肿Venous stasis peripheral blood pooling creation of pressure points3）有骨骼肌损伤关节疾病Patients with a history of musculoskeletal injury or arthritis old/obese4）遗传疾病Marfansyndrome Ehlers-Danlos disorders of motion of joint hypermobility5）Injury to TMJKey preventive measures: neutral body positions, minimizing length of surgery in susceptible individuals, dental chairs cushioned and sized appropriatelyThird molar extractionInfectionSurgical wound infection rates rage 0.8-4.2% , exclusively involve mandibular 3rd molar sites50% infections are localized subperiosteal abscess-type infections occurring about 2-4 weeks after surgeryImpaction, removal bone, sectioning teeth, periodontal disease, increase risk/degreeComplication from antibiotic higher than SSISign of SSI: localized swelling and erythema, fluctuance, trismus, fever, dehydrationPenicillin, amoxicillinMandibular fracture下颌骨骨折(deeply impacted tooth, over 40 years old, 0.00490-0.00003%)TMJ injury虽然未有文献报道，但本来有TMJ疾病的人需要慎重拔牙Not supported in literatureAnterior disk displacement, more likely not have third molar extractionLimited opening: trauma from injections, inflammation of the muscles of mastication, body’s ownprotective mechanism to limit function and further traumatransient injury resolve by: soft diet, moist heat, jaw rest, NSAIDevaluatepreoperative joint disease, myofacial painOsteomyelitis颌骨骨髓炎Complication of infection, fracture, extraction in medically compromised patientsDull and deep pain, swelling, erythema, paresthesia of the inferior alveolar nerve, trismus, adenopathy, fistula（慢性常见）, fever, malaiseMichael Miloro and Antonia Kolokythas《Management of complications in oral and maxillofacial surgery》Ⅴmandibular motor contractions of muscles of masticationⅦ motor posterior belly of digastri