颞下颌关节盘移位患者髁突运动轨迹分析

目的:记录颞下颌关节盘移位患者和正常人下颌运动时髁突运动轨迹,分析关节盘移位对髁突运动的影响.方法:选取双侧不可复性关节盘移位(DDwoR)和可复性关节盘移位(DDwR)患者各18例,健康对照(HC)10例.电子髁突运动轨迹描记仪记录受试者下颌开闭口、前伸后退时髁突铰链轴运动轨迹,计算髁突最大位移(Smax)、髁突位移...     

三维超声下颌定位技术在(牙合)垫治疗颞颌关节绞锁中的应用

目的应用三维超声下颌定位技术,观察颞颌关节绞锁应用于（牙合）垫治疗前后髁突运动轨迹的变化。方法对21例单侧颞颌关节绞锁患者使用下颌稳定性（牙合）垫治疗。运用三维超声下颌定位技术观察绞锁性颞颌关节在（牙合）垫治疗前后健患侧髁突运动轨迹在最大开口运动、最大前伸运动和侧方运动中运动范围的变化。结果通过三维超声下颌定位技术可观察到患者髁突运动轨迹表现为双侧的不对称性。患侧关节在（牙合）垫治疗前后运动范围的比较发现,在最大开口运动的矢状位、冠状位、轴位的髁突运动范围增大（P〈0．05）;前伸和侧方运动的矢状位、冠状位的髁突运动范围增大（P〈0．05）。结论（牙合）垫治疗后绞锁性颞颌关节健患侧髁突的运动轨迹更加对称,患侧关节运动轨迹的范围增大。三维超声下颌定位技术可作为（牙合）垫治疗颞颌关节绞锁髁突运动轨迹改变有效的观测与评价手段。     

安氏Ⅱ类1分类错(牙合)髁突运动轨迹与关节盘位置的相关性研究

目的 探讨安氏Ⅱ类1分类错(牙合)患者髁突运动轨迹变化与关节解剖结构的相关性,以期为颞下颌关节疾病的早期诊断提供参考.方法 选择20例安氏Ⅱ类1分类错(牙合)患者(男女各10例,年龄11～12岁),于治疗前进行髁突运动轨迹描记仪检查和MRI影像检查,依据关节盘位置分为关节盘位置正常组和可复性关节盘前移位组,比较两组髁突运动轨迹.结果 开闭口运动中可复性关节盘前移位组患者双侧髁突侧向运动量[左右侧分别为(0.32±0.10)和(-0.91±0.49)mm]、垂直向运动分量[左右侧分别为(4.20±0.70)和(3.44±0.21)mm]、髁突矢状向倾斜度[左右侧分别为(32.48±7.70)°和(33.47±12.60)°]与髁突水平向倾斜度[左右侧分别为(-2.60±2.02)°和(-9.23±5.58)°]与关节盘位置正常组患者的差异有统计学意义(P<0.05).结论 大开口运动中的髁突横向移动可能是引起关节盘前移位的诱因.髁突运动轨迹变化可为早期的功能治疗提供有用的信息.     

生长期兔颞下颌关节盘前移位对髁突软骨内Ihh和PTHrP表达的影响

目的：研究颞下颌关节盘前移位对生长期兔髁突软骨印度豪猪蛋白（Ihh）和甲状旁腺相关蛋白（PTHrP）表达的影响,探讨关节盘前移位与下颌骨髁突生长发育之间的关系。方法：取3个月龄日本大耳白兔21只．建立颞下颌关节盘前移位动物模型,分别于建模后4、8、12周处死取材,观察髁突软骨组织学变化,并通过免疫组织化学方法检测Ihh、PTHrP在髁突软骨中的表达与定位。结果：关节盘移位后4周,髁突软骨结构轻度紊乱;8周时,髁突前部软骨形态结构发生显著改变;12周时．软骨正常结构丧失进一步加剧。关节盘移位后4周,可见Ihh、PTHrP在增殖带深层细胞内明显表达,8周、12周时在髁突深层软骨细胞内表达。结论：颞下颌关节盘前移位导致髁突软骨结构进行性病理性损害．Ihh和PTHrP在盘移位后髁突软骨病理性改变的过程中发挥重要作用．提示关节盘前移位可能通过Ihh-PTHrP负反馈信号通路对生长期髁突软骨内成骨过程产生影响。     

用MRI研究颞颌关节盘的前方移位与形态变化

颞颌关节的关节盘由较厚的前带,薄的中间带和最厚的后带组成,各部分之间无明显的界限。闭口时,后方肥厚部位于髁状突顶上方,中间部则位于髁状突前上方与关节前结节后下方之间,而前方肥厚部位于髁状突的前方。关节内障碍可由关节盘前方移位引起;     

单侧后牙锁患者前伸及后退髁突运动轨迹的研究

目的探讨单侧后牙锁者在下颌前伸、后退运动过程中髁突运动轨迹的特征及其与正常者之间的差异。方法选择单侧后牙锁患者24例和个别正常25例,应用髁突运动轴图描记仪(computer aided diagnosis axiograph,CADIAX)记录下颌前伸、后退运动时髁突的运动轨迹。结果实验组在下颌前伸、后退运动过程中髁突轨迹曲折、不流畅、重合性差,两侧髁突运动不对称、侧方位移增大;其锁侧在矢状方向和空间位移上以及髁突矢状面倾斜度小于非锁侧(P<0.05),锁侧髁突矢状面倾斜度较对照组小(P<0.05),在髁突位移5mm处水平面髁突倾斜度大于对照组(P<0.05)。结论单侧后牙锁者下颌前伸、后退运动时两侧髁突运动不对称,侧方位移增加。     

联合动态MRI和下颌运动轨迹描记仪分析健康人开闭口时下颌运动轨迹特征

目的：结合动态MRl分析健康人开闭口时下颌运动轨迹特征。方法：18例健康人最大开闭口过程进行动态MRI和下颌运动轨迹描记仪检查，分析髁状突及下颌前牙切点的运动特点及范围。结果：动态MRI显示闭口位关节盘本体部呈双凹形，本体部位于髁状突横嵴的前方（盘分界角〈10。）。健康人下颁前牙切点运动轨迹平滑，双侧运动中心运动轨迹左右对称；运动轴始终保持平行，呈现开闭口初、末时密度比开闭口中时大；运动中心运动距离（13．2±3．1）mm，切点运动距离（41．1±3．8）mm。结论：下颌运动轨迹描记能记录髁状突运动轨迹并且间接反映颞下颌关节的关节盘在开闭口运动中的位置变化情况，为初步建立下颌运动轨迹描记对辅助诊断关节病的参考标准奠定了基础。     

偏侧咀嚼对颞下颌关节的影响

目的：进一步探讨骀与颞下颌关节的关系。方法：通过建立动物模型,观察偏侧咀嚼时不同的垂直距离对双侧髁状突、关节盘形态的影响。结果：偏侧咀嚼时双侧髁状突各细胞层及关节盘的形态均有不同变化。非咀嚼侧重于咀嚼侧。加高垂直距离后,双侧髁状突、关节盘在形态学上的改变比保持原垂直距离组变化更明显。结论：偏侧咀嚼是颞下颌关节紊乱综合症的病因之一。     

再定位牙合垫戴入前后颞下颌关节盘和髁突的位置改变

目的测量再定位牙合垫（ARS）戴入前后关节盘和髁突的位置改变,探讨ARS的治疗机制。方法选择22例单侧或双侧可复性颞下颌关节盘前移位患者进行研究,其中关节盘前移位的关节31侧,设为前移位组;关节盘位置正常的关节13侧,设为正常组。分别在闭口位（ARS戴入前）、对刃位和下颌最少前伸位（ARS戴入后）行磁共振成像扫描,测量不同下颌位置时的2组关节的盘突角度、关节盘和髁突位置的变化。结果1）盘突角度：闭口位时前移位组为54.23°,正常组为9.80°;对刃位和下颌最少前伸位时,前移位组的盘突角度多可回复至正常范围。2）关节盘位置：从闭口位至对刃位或下颌最少前伸位,正常组关节盘位置无明显改变,前移位组关节盘明显向后移动。3）髁突位置：从闭口位至对刃位或下颌最少前伸位,髁突在关节窝中向前下方移动,正常组与前移位组比较的差异无统计学意义（P＞0.05）。结论ARS使髁突向前下方移动,关节盘向后回复。ARS的作用可能是阻止已经向后上方移动而复位的关节盘在闭口过程中再次发生前移位,起到固定作用。     

颞下颌关节侧向咬合位与对刃位薄层塑化断面对照研究

目的:对比分析下颌对刃位、侧向咬合位颞下颌关节的运动解剖形态,为颞下颌关节病变提供解剖依据。方法:将8例新鲜尸头摆置成对刃位5例、下颌侧向咬合位3例,以颞下颌关节为中心,切割成8cm×8cm×10cm的标本块,利用生物塑化技术,制成斜矢状位、斜冠状位、轴位塑化断层标本共16套。下颌侧向咬合位工作侧、非工作侧关节形态改变与对刃位相对照。结果:下颌侧向咬合位工作侧,髁突在关节窝内向后、向上、向外移位,关节盘位置无变化,关节盘双板及后带受压;非工作侧,髁突向下、向前、向内侧移位,关节盘后带位置向下移位,无前移位,关节盘中带外侧位居上下关节面之间,明显受压变薄。结论:关节盘并非随髁突作同步同向运动。关节盘在髁突作滑动运动时发生移位;当转动运动、滑动运动复合出现时,关节盘发生移位;而在关节窝内发生的转动运动,关节盘不发生移位。     

Is condylar position a predictor for functional signs of TMJ hypermobility?

Temporomandibular joint (TMJ) hypermobility is noted only when it interferes with smooth mandibular movements. These interferences (viz. clicking sounds and jerky mandibular movements) result from condylar dislocation in front of the eminence at wide mouth opening, or alternatively in front of the articular disc (posterior disc displacement). The aim of this study was to test the hypothesis that condyles of hypermobile persons are positioned more anterosuperiorly to the crest of the eminence during maximum mouth opening than those of persons without TMJ hypermobility. Possible posterior disc displacement was also evaluated. Nine persons with symptomatic hypermobility and nine control persons free of internal derangements were included, their diagnoses being based upon opto-electronic movement recordings. Condylar positions during maximum mouth opening were analysed on magnetic resonance images with two slightly different methods, showing the degree to which the condyles are displaced around the eminence. No posterior disc displacements were found in any of the magnetic resonance images. After excluding an outlier and using both measurement methods, a small difference in condylar position was found between the two groups of subjects. The condyles of all hypermobile persons travelled beyond the eminence; however, so were the condyles of nearly half of the non-hypermobiles. The large overlap between both groups suggests that condylar position alone is not a good predictor for symptomatic TMJ hypermobility. It is probably the combination of condylar location in front of the eminence with a particular line of action of the masticatory muscles, which gives rise to functional signs of hypermobility.     

Kinematic study of the temporomandibular joint in normal subjects and patients following unilateral temporomandibular joint arthrotomy with metal fossa-eminence partial joint replacement.

PURPOSE: The primary purpose of this study is to quantify the kinematics of the temporomandibular joint (TMJ) in patients following unilateral TMJ arthrotomy with metal fossa-eminence partial joint replacement and compare them with TMJ kinematics of healthy individuals. MATERIALS AND METHODS: Fourteen healthy volunteers and 13 female surgical patients (minimum 4 years postoperative) participated in this study. An electromagnetic tracking device was used to record the kinematics of the mandible relative to temporal bone during opening-closing, protrusive, and lateral movements. The mean linear distance (LD) traveled by condyles was compared between operated and normal subjects. RESULTS: Patients responded with statistically significant improvement in pain and jaw function questions. Mean satisfaction with the surgical result was 25.7 on a scale of 1 to 30. The LD measured for condyles during all 4 movements showed similar measurements. However, operated and unoperated condyles showed statistically significant motion values during opening and protrusive motion from each other and from normal subjects. In addition, contralateral condyles during lateral motion showed statistically significant values in operated, unoperated, and normal condyles. CONCLUSION: The results of this study suggest that the surgical reconstruction of the TMJ with partial joint replacement provided highly significant clinical improvement. Moreover, condyle and incisor kinematics were preserved to a significant amount as compared with the normal group. The difference in kinematic measurements between the operated and unoperated condyle was significant and secondary to previous joint disease and previous surgical intervention. These results should be evaluated by prospective studies in pre- and postsurgical patients.     

Characteristics of condylar movements during mastication in stomatognathic dysfunction

In this investigation of the relationship between mastication and TMJ abnormalities, the movements of the incisal point and condyles during mastication were analyzed in two normal subjects and six patients with unilateral TMJ abnormalities. The path of the nonworking condyle was shorter than that of the working condyle when patients chewed on the side of the normal TMJ, causing the mandible to deviate to the abnormal side at the point of transition from opening to closing. Also, the mobility of the abnormal condyle influenced the convexity of the opening path, and posterior dislocation of the condyle resulted in a crossover chewing pattern.     

Changes in signs and symptoms following temporomandibular joint disc repositioning surgery.

Fifty-one subjects with documented intra-articular pathology refractory to non-surgical therapy underwent temporomandibular joint (TMJ) disc repositioning surgery. Following surgery, subjects were evaluated for 6 months to 6 years by clinical examinations and questionnaires at designated times, and by postsurgical joint imaging. Significant decreases were noted in pain (headache, TMJ pain, ear pain, and neck/shoulder pain), the incidence of joint sounds and locking, and the presence of dietary restrictions. However, 35% of the subjects continued to have residual TMJ pain, and a similar percentage continued to need periodic nonsteroidal anti-inflammatory drugs for analgesia. Some degree of dietary restriction remained in approximately 50% of the subjects, and joint sounds persisted in a similar percentage following surgery. Mean mouth opening was improved by 8 mm, although lateral movements were increased by less than 0.5 mm. Surgery did not decrease the occurrence of jaw deviation, and disc position was unchanged in 86% of the joints imaged at an average of 2 years following surgery. Although TMJ disc repositioning surgery significantly improved pain and dysfunction in TMJ surgery patients, the improvement in disc position was not maintained in most subjects following surgery.     

Synovial fluid dynamics with small disc perforation in temporomandibular joint

Summary The articular disc plays an important role as a stress absorber in joint movement, resulting in stress reduction and redistribution in the temporomandibular joint (TMJ). The flow of synovial fluid in the TMJ may follow a regular pattern during movement of the jaw. We hypothesised that the regular pattern is disrupted when the TMJ disc is perforated. By computed tomography arthrography, we studied the upper TMJ compartment in patients with small disc perforation during jaw opening–closing at positions from 0 to 3 cm. Finite element fluid dynamic modelling was accomplished to analyse the pattern of fluid flow and pressure distribution during the movements. The results showed that the fluid flow in the upper compartment generally formed an anticlockwise circulation but with local vortexes with the jaw opening up to 2 cm. However, when the jaw opening–closing reached 3 cm, an abnormal flow field and the fluid pressure change associated with the perforation may increase the risk of perforation expansion or rupture and is unfavourable for self‐repair of the perforated disc.     

Efficacy of temporomandibular joint arthrocentesis with and without injection of sodium hyaluronate in treatment of internal derangements.

PURPOSE: This study was designed to investigate the efficacy of arthrocentesis with and without injection of sodium hyaluronate (SH) into the upper joint space in the treatment of temporomandibular joint (TMJ) internal derangements. PATIENTS AND METHODS: Forty-one TMJs in 5 males and 26 females aged 14 to 53 years comprised the study material. The patients' complaints were limited mouth opening, TMJ pain and tenderness, and joint noises during function. Patients were randomly divided into 2 groups in which only arthrocentesis was performed in 1 group and arthrocentesis plus intra-articular injection of sodium hyaluronate was performed in the other group. Both groups contained patients with disc displacement with reduction and with closed lock. Clinical evaluation of the patients was done before the procedure, immediately after the procedure, on postoperative day 1, and at 1, 2, 3, 4, 5, 6, 9, 12, 18, and 24 months postoperatively. Intensity of TMJ pain, jaw function, and clicking sounds in the TMJ were assessed using visual analog scales. Maximal mouth opening and lateral jaw movements also were recorded at each follow-up visit. RESULTS: Both techniques increased maximal mouth opening, lateral movements, and function, while reducing TMJ pain and noise. CONCLUSIONS: Although patients benefitted from both techniques, arthrocentesis with injection of SH seemed to be superior to arthrocentesis alone.     

颞下颌关节盘穿孔早期上腔滑液的流体动力学研究

目的 通过建立颞下颌关节流体动力学模型,分析下颌运动中关节盘穿孔区域关节上腔滑液的流动模式和压力分布规律.方法 选择5例单侧颞下颌关节盘穿孔早期患者,利用关节上腔造影与计算机断层扫描相结合的方法获得颞下颌关节在不同下颌骨下降距离时的三维影像学图像,利用Mimics软件及Gambit软件提取患侧关节上腔立体轮廓并进行三维网格划分,应用Fluent软件进行滑液流体动力学分析.利用关节内压测量仪记录开颌运动中滑液压力进行模型验证.结果 颞下颌关节上腔滑液的流体动力学模型结果显示：在开颌运动中右侧关节腔内滑液沿逆时针循环.在闭口和小张口位,关节内力小于阈值,上腔滑液形成规律的循环流动;当下颌骨下降距离到达3 cm以上,上腔滑液压力增至（11.78 ±5.14） mmHg达阈值水平,细小穿孔部位张开形成异常流场和上下腔滑液交通,不利于关节盘的自我修复.结论 颞下颌关节盘穿孔的关节滑液循环仿真模型有助于对颞下颌关节紊乱综合征发病机制的研究,可为指导疾病的诊疗和预防提供依据.     

The Mitek mini anchor for TMJ disc repositioning: surgical technique and results

This study evaluated our treatment outcomes in 105 patients (188 discs) using the Mitek mini anchor for temporomandibular joint (TMJ) articular disc repositioning surgery, with 88 patients having simultaneous orthognathic surgery. Criteria for inclusion into the study were: (1) Presurgical TMJ disc displacement with salvageable disc; (2) No prior TMJ surgery; (3) TMJ disc repositioning with the Mitek mini anchor; (4) Absence of connective tissue/autoimmune disease; (5) Absence of postsurgical trauma; and (6) Minimum of 12 months postsurgery follow up. Presurgery (T1), immediately postsurgery (T2), and longest follow up (LFU) clinical and radiographic evaluations were performed. The mean age of the patients was 32.6 years (range 14-57 years), and mean follow-up time was 46.2 months (range 14-84 months). Radiographic evaluation at LFU demonstrated no significant condylar resorption or positional changes of the anchors. At LFU, there was a statistically significant reduction in: TMJ pain, facial pain, headaches, TMJ noises and disability, and improvement in jaw function and diet. Maximum incisal opening improved slightly and lateral excursive movements decreased slightly. The Mitek mini anchor provides a predictable method for stabilizing the TMJ articular disc to the condyle and a high success rate in decreasing TMJ dysfunction and pain in patients with no previous TMJ surgery.     

颞下颌关节灌洗术治疗不可复性关节盘前移位的临床研究

目的 评价颞下颌关节上腔灌洗术治疗不可复性关节盘前移位的临床疗效。方法 ３８例因不可复性关节盘多位引起张口受限的患者行关节上腔灌洗治疗,分析治疗不同时期患者的疼痛值、下颌运动度变化,通过关节造影判定治疗前后关节盘位置的变化。结果 治疗后不同时期的下颌运动均较治疗前的显著增加（Ｐ〈０．００１）,特别在治疗后１个月内增加明显,疼痛亦有显著缓解（Ｐ〈０．０１）。关节造影显示仅有２患者的关节盘部分复位。结     

The influence of pre- and intraoperative positioning of the condyle in the centre of the articular fossa on the position of the disc in orthognathic surgery. A magnetic resonance study

OBJECTIVE: We investigated the changes in the temporomandibular joint (TMJ) after bilateral sagittal split osteotomy of the mandible for orthognathic surgery and the influence of positioning of the condylar process in the centre of the articular fossa before and during the operation for preventing changes in the TMJ postoperatively. STUDY DESIGN: A total of 28 patients with mandibular retrognathism had bilateral sagittal split osteotomies for mandibular advancement. In one group of 14 patients (28 TMJ), the condyles were placed in the centre of the articular fossa before and during the operation, and in the other group they were not. Differences on magnetic resonance imaging (MRI) were calculated and the results were evaluated. RESULTS: The main differences were found at maximal mouth opening. 15/28 TMJs (54%) that had not been positioned changed the position of the disc from physiological to anterior disc derangement with and without reduction postoperatively. In the 28 that had been positioned, changes were found in only 3 TMJs (11%) postoperatively. CONCLUSIONS: Fixing the condylar process in the centre of the articular fossa intraoperatively before bilateral sagittal split osteotomy is a factor in preventing postoperative structural changes in the temporomandibular joint.