无牙颌总义齿咬合垂直距离修复前后颞下颌关节的对比研究

通过对１４例戴旧总义齿的无牙颌患者行新总义齿修复垂直距离升高前后颞颌关节间隙及髁状突相对于蝶窦中心的位置变化研究，发现咬合垂直距离的改变能引起髁状突位置的改变，垂直距离升高后，髁状突呈前移位，在总义齿修复中，防止及减缓垂直距离的降低，对维持ＴＭＪ的正常位置，预防无牙颌ＴＭＪＤＳ的发生有重要意义．     

髁突复位钢板在下颌升支矢状劈开术中的应用

为了防止正颌外科术后髁突位置变化引起颞下颌关节症状及畸形复发，作者对１７例颌骨畸形患者行下颌升支矢状劈开截骨术中，应用髁突复位钢板记录和恢复髁突术前位置。结果提示，１５例患者的３０侧髁突位置术后检查未发生移位，仅２例患者各有１侧髁突发生了内侧旋转移位。作者认为，髁突复位钢板对于记录和恢复髁突术前位置是行之有效的。     

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目的 研究成人骨性安氏Ⅲ类错(殆)正畸-正颌联合治疗前后颞下颌关节(TMJ)变化.方法 选择2002-2010年在中国医科大学口腔医院正畸科就诊的成人骨性安氏Ⅲ类错(殆)患者30例,采用正畸治疗加双侧下颌升支矢状劈开后退术(BSSRO)的正畸-正颌联合治疗方案,分别在BSSRO术前、术后1个月、矫治结束时拍摄标准薛氏位片,采用Cohlmia测量法对关节片进行关节间隙及关节窝形态测量,观察髁突位置及关节形态的变化.结果 (1)关节间隙变化:与术前比较,术后1个月双侧关节各间隙均明显变大(P＜0.05);矫治结束后关节间隙测量值与术前比较,差异无统计学意义(P＞0.05).(2)髁突位置和关节窝形态变化:术后1个月髁突位置与术前比较,矢状向髁突位置后移,垂直向髁突位置下移.矫治结束后与术前比较,髁突位置各项指标差异无统计学意义(P＞005).反映关节窝形态的指标在术前、术后1个月和矫治结束后三者间比较差异均无统计学意义(P＞0.05).(3)30例患者中治疗前9例有关节弹响,治疗后5例弹响消失,术前无关节弹响者术后均未出现弹响,所有患者治疗前后均未出现关节疼痛及开口受限.结论 (1)BSSRO术后1个月关节间隙增大,髁突位置稍偏后,矫治结束后恢复正常.正畸-正颌联合治疗未引起关节窝形态的改变.(2)所有患者均未引起颞下颌关节紊乱病(TMD),且部分患者治疗后关节弹响消失,提示正畸-正颌联合治疗可能对TMD有一定的治疗作用.     

间接性颞颌关节损伤后的扫描电镜观察

目的：观察颞颌关节间接性损伤后，局部超微结构改变。方法：以１０ｍ／ｓ的撞击速度、撞击能量为１０Ｊ、方向平行于下颌角—颞下凹撞击５只山羊右侧下颌角部，伤后１月处死动物，扫描电镜观察关节盘及髁突形态的改变。左侧关节为对照。结果：损伤侧髁突和关节盘表面的凝胶样物质被破坏，暴露出下面疏松的、排列紊乱的胶原原纤维组织。结论：间接性ＴＭＪ损伤使具有抗原性的髁突表面纤维暴露，激发了抗原—抗体反应，引起关节自身破坏，导致颞下颌关节骨关节病的发生。     

间接性TMJ损伤后髁突软骨增殖能力的改变

目的：探讨间接性颞下颌关节损伤在颞下颌关节骨关节病发生、发展过程中的作用。方法：用撞击装置撞击山羊右侧下颌角部，间接造成ＴＭＪ损伤，以对侧关节为对照，伤后２小时，１、３、６月处死动物，采用免疫组化方法观察髁突软骨细胞ＰＣＮＡ阳性细胞的分布及改变。结果：与对照侧相比，髁突软骨ＰＣＮＡ阳性细胞在伤后２小时无变化，伤后１月时增多而在伤后３月和６月时明显减少。结论：ＴＭＪ损伤导致ＴＭＪＯＡ的机理是由于损伤破坏了髁突面屏障，使胶原纤维裸露于关节腔内，引起关节局部内环境变化，使滑液中的异物在关节内压作用下进入软骨或骨髓，破坏和抑制了软骨的增殖能力，引起软骨组织进行性丧失，导致ＴＭＪＯＡ。     

正畸治疗和颞下颌关节紊乱综合征关系的研究进展

正畸治疗和颞正颌关节紊乱综合征之间的关系，长期以来争论不一。本文从正畸治疗与ＴＭＪＤＳ的治疗之间的关系和正畸治疗与ＴＭＪＤＳ的诱发之间的关系这两方面加以综述，重点讨论正畸治疗对髁突位置和关节杂音的影响。     

正颌术中髁突定位技术的研究进展

正颌手术后髁突移位可导致患者复发以及出现颞下颌关节症状.为减少术后髁突移位,众多髁突定位技术运用于临床中.旨探讨髁突定位技术预防术后出现关节症状及复发的有效性,本文回顾近20年内国内外正颌术中髁突定位技术的相关文献,经文献归纳发现,定位技术以稳定术前髁突位置为最终目的,可分为非计算机辅助和计算机辅助定位技术.目前计算机...     

功能板影响错伴特发性髁突吸收正颌术后稳定性的初步研究

目的:探讨特发性髁突吸收（idiopathic condylar resorption, ICR）患者在关节功能板治疗结合正颌-正畸联合治疗后下颌骨及髁突位置的改变,为后期研究提供依据。方法:回顾分析2008—2012年收治的13例特发性髁突吸收患者的临床数据,所有患者均在正颌手术前接受关节功能板治疗7.5±1.5个月。对患者正颌术前(T0)、正颌术后即刻(T1)、正颌术后至少12个月(T2)的咬合、头颅侧位片、MRI检查结果进行测量,采用SPSS 22.0软件包对数据进行统计学分析,评价正颌术后髁突和下颌骨的位置变化。结果:正颌手术(T1)纠正了所有患者的骨性Ⅱ类错畸形,建立了正常的咬合关系、前伸运动及侧方斜导运动。正颌手术平均下颌骨前移量(Y Axis-B, T1-T0)为（5.05±3.54）mm。与T1相比,T2时颞下颌关节间隙参数无显著改变。下颌骨位置参数中, 仅Y轴到B点的距离（Y轴-B）在T2与T1间存在统计学差异,其改变量平均值为（-1.64±2.48）mm,其余参数均无显著差异。13例患者中,11例患者Y轴-B 改变值<2 mm（84.6%）,仅 2例患者出现>2 mm的后退（15.4%）。结论:关节功能板治疗可增加ICR患者正颌手术的稳定性,可能是关节功能板保守治疗能够稳定ICR患者髁突在关节窝内的位置。     

下颌升支矢状截骨前徙术对颞下颌关节影响的近期观察

作者通过对１０例接受下颌升支矢状劈开截骨术前徙下颌骨患者手术前后颞下颌关节位置改变的分析，并结合临床检查，发现在术后６个月时，患者张口度小于术前，且差异有高度显著性，颞下颌关节前，上，后间隙也较术前有不同程序的改变，髁状突向后移位占１４／２０，向前移位占６／２０。术后多数患者颞下颌关节可通过调整，改建适应新的位置，而不出现临床症状，有的患者因术后髁状突位置改变使术前的关节症状消失。     

颞下颌关节病变的CT检查

随着影像技术的飞速发展 ,对颞下颌关节疾病诊断提到了一个新的高度。本文介绍了ＣＴ检查 ,尤其三维ＣＴ成像在颞下颌关节中的应用。一、ＴＭＪＣＴ检查及用途[1～ 6]80年代初ＣＴ开始用于ＴＭＪ病变的检查。常用位置有横断位、直接矢状位和冠状位扫描。主要观察 :①ＴＭＪ关节结节和关节窝形态、位置及骨质结构改变。②关节间隙周围的关系并进行关节间隙测量。③髁状突骨质形态、边缘、解剖结构和活动范围并进行髁状突水平角、垂直倾斜角及内外前后径测量。④ＴＭＪ关节盘改变 (闪烁法显示 )。另外 ,横断位扫描还易于进行矢状、冠状和任意…     

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.     

A hypothesis on the desired postoperative position of the condyle in orthognathic surgery: a review

It is very important to clarify the relationship between a dentofacial structure and a temporomandibular joint (TMJ) structure in orthognathic surgery. Recently, it was reported that the skeletal and occlusal patterns were associated with the TMJ morphology, including the disk position. In orthognathic surgery, some surgeons state that alterations in the condylar position from surgery can lead to malocclusion associated with the risk of early relapse, and also favor the development of temporomandibular disorders. For these reasons, several positioning devices have been proposed and applied, but now there is no scientific evidence to support the use of condylar positioning devices. There are some reasons why scientific evidence cannot be obtained; however, it also includes the question of whether the preoperative position of the condyle is the desired postoperative position. The purpose of this study was to verify the desired condylar position in orthognathic surgery, based on literature on the postoperative condylar position in orthognathic surgery. From the studies reviewed, it was suggested that the preoperative position of the condyle was not the desired postoperative position in orthognathic surgery.     

正颌手术前、后颞下颌关节间隙三维重建及对比分析

目的: 采用新的方法重建正颌患者手术前、后的颞下颌关节间隙,比较术前、术后关节间隙的变化,为正颌术后颞下颌关节功能评价提供参考。方法: 收集20例骨性Ⅲ类正颌患者手术前及术后半年的CT影像资料,利用Mimics软件三维重建手术前、后颞下颌关节间隙,进行容积计算。采用SPSS 22.0软件包对数据进行统计学分析。结果: 术后双侧关节间隙有不同程度增大,右侧关节及双侧关节间隙的增大有统计学意义（P<0.05）。通过线性回归分析,正颌手术前、后双侧关节间隙容积呈明显正相关（手术前r=0.54,P=0.014;手术后r=0.59,P=0.006）。手术前、后性别间无统计学差异。结论: 利用Mimics软件重建正颌手术前、后颞下颌关节三维结构,可更直观地显示关节间隙容积与三维结构的变化,为关节间隙的研究提供了一种新的方法。通过比较正颌手术前、后颞下颌关节间隙容积,发现术后6个月髁突未恢复到术前位置。     

Analysis of temporomandibular joint function after orthognathic surgery using condylar path tracings

Condylar path tracings provide quantitative and qualitative data regarding the functional status of the temporomandibular joint. This study was designed to identify the functional status of the TMJ by means of condylar path tracings before treatment and to monitor the response of the TMJ to orthognathic surgery. Baseline data for condylar tracings using a sagittal recording device were established in relation to normal limits for opening, protrusive, and medial excursions of the mandible. In 54 patients 108 joints were studied before and up to 1 year after orthognathic surgery. Internal derangements were identified with condylar tracings before treatment in 72% of all joints studied. Also, condylar tracings identified internal derangements that were not found on clinical examination in 11 of 39 patients. Functional adaptation of the TMJ was found to be more favorable for mandibular reduction and maxillary impaction than for mandibular advancement or combined upper and lower jaw procedures. Condylar path tracings were shown to represent a noninvasive technique to identify and monitor the functional status of the TMJ in response to surgical orthodontics.     

Clinical and magnetic resonance findings in the temporomandibular joints of patients before and after orthognathic surgery

It is difficult to achieve the correct position of the condyle in the temporal fossa during orthognathic surgery in angle class II patients with disorders of the temporomandibular joint. This led us to examine the TMJ of 25 of our own patients before and shortly after orthognathic operations. We recorded the clinical and magnetic resonance imaging findings of the temporomandibular joint preoperatively and three months postoperatively. The patients had skeletal class II dysgnathia and had been treated with fixed orthodontic appliances for a mean of two years and three months before operation. Operation resulted in a mean reduction of maximal incisor distance of 12 mm. In five of the 25 patients, the pattern of mouth-opening changed. Nine patients had less pain than before surgery, and nine had fewer abnormal joint sounds. The magnetic resonance imaging showed displacement of the articular disc in 38 of the 50 joints preoperatively and in 28 postoperatively. Degenerative joint changes were not improved by operation. Improvement of the disc position was achieved by repositioning of the condylar-disc complex during orthognathic surgery in angle class II patients. Clinical and magnetic resonance imaging findings regarding the temporomandibular joint in class II patients correlated significantly both preoperatively and postoperatively.     

下颌偏斜畸形术后髁突位置改变的研究

目的:观察下颌双侧升枝矢状劈开术Bilateral Sagittal Split Ramous Osteotomy(以下简称BSSRO)矫治下颌偏斜畸形术后髁突位置的变化.方法:通过定位薛氏位片研究BSSRO矫治20例下颌偏斜畸形病例术前、术后1周及术后1年关节间隙的改变.结果:BSSRO术后1周髁突位置发生变化,1年后髁突位置恢复到术前状态,关节弹响症状多数缓解.结论:BSSRO矫治下颌偏斜畸形术后髁状突位置远期无明显改变.     

Plate fixation after mandibular osteotomy

Skeletal asymmetry in patients who undergo orthognathic surgery is frequently associated with postoperative temporomandibular joint (TMJ) disorders caused by condylar rotation. This study was designed to elucidate the relation between changes in the condylar long axis and TMJ function after bisagittal split osteotomy (BSSO). A total of 42 patients with mandibular prognathism underwent BSSO. Split osseous fragments were secured by standard titanium plates in 22 patients; bent titanium plates were used to secure fragments in 20 patients. The angle of the bent plates was adjusted to avoid displacement of the condyle after osteotomy, as compared with condylar position on preoperative submental-vertical (S-V) cephalograms. The postoperative position of the condyle was assessed on X-ray film, and changes in TMJ function were evaluated. The condylar long axis differed significantly on X-ray film between patients using a standard titanium plate and those using a bent plate (P<0.05), and no sign of TMJ functional impairment was noted in the bent-plate group. Although the use of bent plates requires further study, maintenance of a suitable position of the condyle relative to the condylar axis is one of the conditions for a successful outcome of BSSO.     

Amount and direction of temporomandibular joint growth changes in Herbst treatment: a cephalometric long-term investigation

The amount and direction of condylar growth, glenoid fossa displacement, and "effective" temporomandibular joint (TMJ) changes (a summation of condylar growth, glenoid fossa displacement, and condylar position changes within the fossa) were analyzed in 35 Class II, Division 1 malocclusions (23 boys and 12 girls) treated with the Herbst appliance. Lateral head films in habitual occlusion and with the mouth wide open from before (T1) and after 7.5 months of Herbst treatment (T2) as well as 7.5 months (T3) and three years (T4) after treatment were evaluated. As a control group, a sample of 12 untreated male Class II Division I malocclusions was used during a 7.5-month time period corresponding to the treatment period (T2-T1) of the Herbst cases. The results revealed that during the treatment period (T2-T1) condylar growth was directed posteriorly about twice the amount as in the control subjects, and the fossa was displaced in an anterior inferior direction. The effective TMJ changes showed a pattern similar to condylar growth but were more pronounced. During the first posttreatment period (T3-T2), all TMJ changes reverted. The glenoid fossa was displaced backward; the amount of condylar growth and effective TMJ changes was reduced, and the changes were more superiorly directed. During the second posttreatment period (T4-T3), all TMJ changes were considered physiological. Conclusion: During Herbst treatment, the amount and direction of TMJ changes (condylar growth, fossa displacement, and effective TMJ changes) were only temporarily affected favorably by Herbst treatment.     

Worsening of pre-existing TMJ dysfunction following sagittal split osteotomy: a study of three cases

When patients seeking treatment for malocclusion also suffer from temporomandibular joint (TMJ) disorders, it is hard to predict the result of simultaneous treatment of both conditions, or to plan for its different goals, because of unpredictable changes in the relationship between the disk, the fossa and the condylar head. Prediction is harder in cases of presurgical TMJ hypomobility, especially those with adhesion in the upper TMJ compartment. Authors differ widely on the likely effect of orthognathic surgery on TMJ disorders. This paper reports three cases in which TMJ disorders worsened after treatment of malocclusion by sagittal split osteotomy. It examines how presurgical diagnosis of TMJ disorders could assist treatment planning in such cases. The results suggest that microbleeding in the upper TMJ compartment during orthognathic surgery, as well as long-term postoperative intermaxillary fixation, carries a risk of creating worse adhesion that adversely affects the outcome for patients. Therefore, preoperative diagnosis of disk position and pathological conditions in the upper TMJ compartment, as well as careful choice of method and term of postoperative fixation, are essential in planning the treatment of malocclusion with sagittal split osteotomy.