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目的 根据临床特征提出咀嚼肌痉挛的临床分型.方法 收集2000-2010年咀嚼肌痉挛病例36例,对患者的基本情况、临床表现、痉挛发作程度、发作频率、肌电图、治疗效果统计分析,并提出临床分型.结果 ①根据临床表现和肌电图将36例病例分为闭口型痉挛和开口型痉挛两型.闭口型痉挛18例,受累肌肉为咬肌和(或)颞肌,主要表现为痉挛发作时开口受限；开口型痉挛18例,受累肌肉为翼外肌,主要表现为闭口或紧咬牙困难.②闭口型痉挛18例,14例为20 ～ 50岁,间断性发作,单侧发病；开口型痉挛18例,50岁以上13例,多持续性发作,双侧受累13例.③闭口型肌电图可分为持续型、节律型和不规则型,开口型肌电图可分为自发型和运动诱发型.④接受肉毒毒素局部注射治疗12例,症状明显改善或痉挛消失.结论 咀嚼肌痉挛可分为闭口型和开口型,有各自的临床特征.

Objective To determine the classification of masticatory myospasm by analyzing characteristics of clinical appearances.Methods Thirty-six cases of masticatory myospasm from 2000 to 2010 were included.The clinical data of these patients were analyzed,including patient information,patient history,clinical characteristics,severity and the frequency of myospasmodic movement,electromyogram (EMG),and the efficacy of botulinum toxin injection treatment. Results There were 11 males and 25 females,aged from 15 to 71.According to the clinical manifestation and EMG findings,patients could be divided into two groups:18 cases were classified as jaw closing type which involved masseter and/or temporalis muscles presenting as trismus and acute pain,the other 18 cases were jaw opening type which involved lateral pterygoid muscles complaining difficulty in jaw closing and teeth clenching.The jaw closing type was often seen in patients of 20 to 50 years old,the jaw opening was frequently seen in patients over 50 years old. Jaw closing type was attacked intermittently and unilaterally,but jaw opening was often attacked continually and bilaterally.The rating scale of the severity of spasmodic movement was not different between the two types,but the frequency of spasmodic attack was much higher for jaw opening type ( P ＜0.05).The EMG of jaw closing type was classified into persistent,rhythmic and irregular type.The EMG of jaw opening type was classified into spontaneous and exercise-induced type.Twelve cases were treated by botulinum toxin injection that could significantly relieve symptoms.Conclusions Masticatory myospasm can be classified into jaw closing and jaw opening types.Jaw closing type involves masseter and/or temporalismuscles and jaw opening type involves lateral pterygoid muscles. Botulinum toxin injection was the most effective therapy for the masticatory myospasm.