The temporomandibular joint is a synovial, condylar and hinge-type joint made up between the mandibular fossa, the articular tubercle and the head of the mandible.

顳下頜關節是一個滑膜、髁狀關節和鉸鏈型關節，由下頜窩、關節結節和下頜頭組成。

It is a fibrocartilage joint with no hyaline and it is a unique joint because there is a disc called the articular disc that separates the joint into two synovial cavities.

這是一個沒有透明質的纖維軟骨關節，也是一個獨特的關節，因為有一個叫做關節盤的椎間盤將關節分隔成兩個滑膜腔。

There are four muscles of mastication, innervated by the mandibular branch of the trigeminal nerve.

有四塊咀嚼肌，由三叉神經下頜支支配。

They include the temporalis, which is the most powerful muscle of the temporomandibular joint muscles and is involved in elevation and retrusion of the mandible, the masseter, which is responsible for elevating the jaw, and the medial pterygoid muscle, involved in elevation and protrusion of the mandible.

這些肌肉包括顳肌，它是顳下頜關節肌肉中最有力的肌肉，參與下頜的抬高和後縮；頜下肌，負責抬高下頜；翼內側肌，參與下頜的抬高和前突。

The lateral pterygoid muscle functions to protrude the mandible and is the only muscle of mastication involved in depressing the mandible.

翼外側肌具有突出下頜骨的功能，也是唯一參與壓迫下頜骨的咀嚼肌。

Pain is one of the main features of temporomandibular joint disorder, seen in 96% of patients.

疼痛是顳下頜關節紊亂症的主要特徵之一，在 96% 的患者中可見。

Especially, this happens on palpation or with movement like chewing or yawning.

尤其是在觸診時，或者在咀嚼或打哈欠等動作時。

It is usually one-sided and just anterior to the ear, with a tendency to be worse in the morning.

它通常是單側的，就在耳朵的前方，早上會加重。

The character is typically described as a poorly localized aching.

其特徵通常被描述為局部疼痛不明顯。

Ear discomfort and headaches are present in around 80% of cases.

約 80% 的病例會出現耳部不適和頭痛。

Another main feature is jaw discomfort or dysfunction, seen in around 75% of cases.

另一個主要特徵是下頜不適或功能障礙，約佔 75% 的病例。

This can include trismus, which is a limited range of movement in the mandible, which can make eating and talking difficult.

這可能包括下頜畸形，即下頜的活動範圍受到限制，從而使進食和說話變得困難。

Alongside this, patients often complain of the jaw locking.

與此同時，患者還經常抱怨下頜鎖定。

Clicking or popping noises are another feature of temporomandibular joint disorder, which can come from temporary dislocation of the articular disc and its subsequent return to normal position.

咔嗒聲或啪嗒聲是顳下頜關節紊亂的另一個特徵，可能是由於關節盤暫時脫位，隨後又恢復到正常位置。

The locking of the jaw may occur when the disc does not go back to its usual position.

當椎間盤無法回到正常位置時，可能會出現下頜鎖定。

The noise is often louder to the patient than to others due to the proximity to the ear.

由於靠近耳朵，患者聽到的噪音往往比其他人聽到的要大。

Other associated symptoms include pain in the neck or in the teeth, and in some cases hearing loss, tinnitus and dizziness.

其他相關症狀包括頸部或牙齒疼痛，在某些情況下還會出現聽力下降、耳鳴和頭暈。

Temporomandibular joint disorder is more common in younger adults, with the 20-40 age group being affected most commonly.

顳下頜關節紊亂症在年輕人中更為常見，20-40 歲年齡段的人最容易患病。

Some studies suggest that up to nearly 40% of the population have a sign or symptom associated with temporomandibular joint disorder, but only around 5% will have symptoms severe enough to seek medical advice.

一些研究表明，多達近 40% 的人有與顳下頜關節紊亂有關的體徵或症狀，但只有約 5% 的人症狀嚴重到需要就醫。

It is between 2 and 9 times as common in females than it is in males.

女性的發病率是男性的 2 到 9 倍。

Psychosocial factors also seem to play a role, particularly stress.

社會心理因素似乎也有影響，尤其是壓力。

If you've seen the fibromyalgia and irritable bowel syndrome videos, you'll know that temporomandibular joint disorder was mentioned in those, which are also often associated with stress.

如果你看過纖維肌痛和腸易激綜合徵的視頻，你就會知道其中提到了顳下頜關節紊亂，這通常也與壓力有關。

Between 50 and 70% of sufferers report having had stressful life events in the 6 months before the onset of symptoms.

50%到 70% 的患者表示，在症狀出現前的 6 個月內曾經歷過緊張的生活事件。

Bruxism, which is a form of parafunctional activity, in this case grinding teeth and clenching the jaw, has been linked to temporomandibular joint disorder, but the relationship between the two isn't clear.

磨牙症是一種副功能活動，這裡指的是磨牙和咬緊下巴，它與顳下頜關節紊亂有關，但兩者之間的關係並不明確。

The exact cause is not known, but the temporomandibular joint disorders are divided grossly into articular disorders, meaning intra-articular, or masticatory muscle disorders, meaning extra-articular.

確切的病因尚不清楚，但顳下頜關節紊亂大致可分為關節紊亂（即關節內）和咀嚼肌紊亂（即關節外）。

Articular disorders could be disc derangement, which is the most common intra-articular cause.

關節紊亂可能是椎間盤脫位，這是最常見的關節內病因。

One theory suggests the lateral pterygoid muscle contracts instead of relaxing when the mouth closes, leading to disc displacement.

一種理論認為，當嘴巴閉合時，翼外側肌肉會收縮而不是放鬆，從而導致椎間盤移位。

Degeneration of the joint, like osteoarthritis, congenital disorders, trauma or even infections are other articular disorders, while masticatory muscle disorders could be myofacial pain disorder, inflammation such as myositis, or muscle spasms.

關節退化（如骨關節炎）、先天性疾病、外傷甚至感染是其他關節疾病，而咀嚼肌疾病則可能是肌面痛症、發炎（如肌炎）或肌肉痙攣。

The diagnosis is primarily made based on the history and physical exam, which can include painful palpation of the temporomandibular joint, abnormal movement of the jaw or poor range of motion, and associated clicking sounds, although these are not specific.

診斷主要依據病史和體格檢查，其中可能包括顳下頜關節觸痛、下頜運動異常或活動範圍小以及相關的咔嗒聲，但這些並不具有特異性。

The cranial nerve exam should also be unremarkable.

顱神經檢查也應無異常。

In terms of imaging, x-rays, including panoramic x-ray, are the first line imaging for evaluation of potential temporomandibular joint disorder if the history and physical are not enough, although CT, MRI or even ultrasound can also be used to visualise the joint.

在影像學檢查方面，如果病史和體格檢查不夠充分，X 光片（包括全景 X 光片）是評估潛在顳下頜關節紊亂的第一線影像學檢查手段，不過 CT、核磁共振甚至超音波也可用於觀察關節。

Differentials of facial pain include dental conditions, various forms of neuralgia such as trigeminal, glossopharyngeal or postherpetic neuralgia.

面部疼痛的鑑別包括牙科疾病、各種形式的神經痛，如三叉神經痛、舌咽神經痛或帶狀皰疹後遺神經痛。

Disorders of the salivary glands, temporal arteritis and migraines are also included, as well as ENT infections such as sinusitis and ear infections.

此外還包括唾液腺疾病、顳動脈炎和偏頭痛，以及耳鼻喉科感染，如鼻竇炎和中耳炎。

For the treatment, symptomatic care is the first line, which includes a soft diet, hot and cold packs and analgesia. 40% of patients will have spontaneous resolution of symptoms.

在治療方面，對症護理是第一位的，包括軟食、冷熱敷和鎮痛。40% 的患者會自發緩解症狀。

Patient education is important, including counselling on stress reduction, sleep hygiene and avoidance of parafunctional habits like grinding teeth or chewing objects.

患者教育非常重要，包括減壓、睡眠衛生以及避免磨牙或咀嚼物品等副功能性習慣方面的諮詢。

Cognitive behavioural therapy can also be effective and physical therapy has some evidence of benefit as well.

認知行為療法也很有效，物理療法也有一定的療效。

Medications that may be used include non-steroidal anti-inflammatory drugs, specifically naproxen as a first line, and tricyclic antidepressants like amitriptyline, muscle relaxants and anti-convulsants like diazepam or gabapentin are more advanced options.

可使用的藥物包括非甾體抗炎藥，特別是作為一線藥物的萘普生，而阿米替林等三環類抗抑鬱藥、肌肉鬆弛劑和地西泮或加巴噴丁等抗驚厥藥則是更高級的選擇。

In some patients occlusal therapy is useful, which focuses on the position of the mandible.

對一些患者來說，咬合治療是有用的，它主要針對下頜骨的位置。

This can be altered temporarily with a splint that the patient places in the mouth, somewhat like a retainer, or more permanent modifications can be made to the teeth.

患者可以將夾板放在口中，就像固定器一樣，暫時改變牙齒的位置，也可以對牙齒進行更永久性的修復。

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