颞下颌关节不可复性盘前移位患者的口面肌功能训练

目的提高颞下颌关节不可复性盘前移位患者治疗效果。方法将64例颞下颌关节不可复性盘前移位患者随机分为对照组31例、训练组33例。两组均行透明质酸钠关节腔注射;对照组接受常规护理,训练组在此基础上增加口面肌功能训练,连续3个月后评价效果。结果干预后训练组疼痛评分及最大张口度显著优于对照组(均P<0.01);干预后两组负性情绪均达到正常范围,两组比较,差异无统计学意义(均P>0.05)。结论对颞下颌关节不可复性盘前移位行透明质酸钠关节腔注射患者,增加口面肌功能训练可有效缓解患者疼痛程度和增加张口度。     

透明质酸钠关节腔注射对无错群畸形关节盘前移位患者的疗效分析

目的：评价透明质酸钠关节腔注射治疗无错盼畸形颞下颌关节盘前移位的临床疗效。方法：选择46名非错豁畸形颞下颌关节盘前移位患者用透明质酸钠同时进行关节上下腔注射治疗,治疗完成（每周注射1次,每位患者注射3～4次）后1周,每月1次复诊,随访6个月,行关节常规检查并拍曲面断层片,并行颞下颌关节核磁检查,评价治疗效果。结果：经过治疗,随访6个月后,41例弹响患者中27例弹响完全消失6例弹响明显减轻（总有效率80．49％）,17例疼痛患者中11例疼痛消失3例患者疼痛减轻（总有效率82．35％）,6例张口受限患者中4例转为正常,1例张口度改善超过5mm（总有效率83．33％）。结论：关节腔注射对治疗无错骼畸形伴颞下颌关节盘前移位具有较好的疗效。     

透明质酸钠注射联合垫治疗颞下颌关节盘不可复性前移位的临床疗效分析

目的:探讨透明质酸钠联合垫治疗颞下颌关节盘不可复性前移位的临床疗效,进而探索效果明显且疗效持久的治疗方法。方法:选取60例颞下颌关节盘不可复性前移位患者,利用抽签取样法将其以1:1比例分成治疗组和对照组,治疗组30例患者应用透明质酸钠注射联合垫治疗;对照组30例患者应用单纯垫治疗。治疗后2、4、6周和6个月复诊,通过疼痛自评视觉模拟尺和FRICTON指数变化来评价临床疗效,从而比较2种治疗方法的疗效。结果:治疗组患者6个月后的总有效率均明显高于对照组;并且疼痛分值、Fricton指数均低于对照组,P0.05差异有统计学意义。结论:透明质酸钠注射联合咬合板治疗颞下颌关节盘不可复性前移位的疗效明显,能有效缓解各种临床症状。     

弹性枢轴(牙合)垫治疗颞下颌关节不可复性盘前移位的临床效果评价

目的探讨弹性枢轴[牙合]垫治疗颞下颌关节不可复性盘前移位的可行性及临床效果。方法总结分析2000年～2004年就诊、且有完整诊治过程记录的颞下颌关节不可复性盘前移位的病例，其中采用弹性枢轴[牙合]垫治疗颞下颌关节不可复性盘前移位28例。男11例，女17例，年龄15～58岁。结果所有患者均经治疗1个月和3～6个月随访，总有效率为85．71％。其中病程较短的患者效果较好，而病程较长者效果较差。结论弹性枢轴[牙合]毕是治疗颞下颌关节不可复性盘前移位的一种有效方法，对病程短者早期治疗效果较好。     

Ⅳ型胶原在颞下颌关节紊乱病中的表达

目的 探讨颞下颌关节紊乱病病变与Ⅳ型胶原之间的关系.方法 应用链菌素亲生物素-过氧化酶连结法检测19例颞下颌关节病变关节盘和盘后组织中Ⅳ型胶原的表达.结果 19例颞下颌关节紊乱病患者中,不可复性盘前移位3例,盘前移位伴关节盘穿孔5例,骨关节病伴关节盘穿孔11例.Ⅳ型胶原主要存在于病变关节盘和双板区的血管基底膜.其中骨关节病伴关节盘穿孔的阳性反应最为明显.6例在软骨细胞周围有弱阳性反应.结论 Ⅳ型胶原在病变颞下颌关节盘和盘后组织的血管基底膜以及软骨细胞周围可出现表达,Ⅳ型胶原免疫组织化学的染色强度与病变的严重程度有一定关系.     

颞颌关节前脱位口外整复的最佳着力点

颞颌关节前脱位为颞颌关节各个方位脱位中最常见者.1 颞颌关节前脱位的病理分析在生理状态下,当双侧翼外肌收缩时,可牵引下颌骨的下颌头与关节盘脱离下颌窝,沿关节结节的后斜面向前移动,至关节结节凸出的嵴上,而呈开口位;翼外肌松弛时,下颌头与关节盘又沿关节结节的后斜面向后滑动,返回下颌窝,而呈闭口位.     

稳定性牙合垫治疗非深覆牙合颞颌关节盘前移位患者的疗效分析

目的:评价稳定性颌垫治疗颞下颌关节紊乱中关节盘前移位的临床疗效。方法:对26例(每册关节为一例)非深覆牙合颞下颌关节紊乱关节盘前移位患者给予稳定颌板治疗,治疗中每15天复诊1次,治疗期限为6个月,治疗后每月复诊1次,随访6个月,并行关节常规检查并拍X线片,并行颞下颌关节核磁检查,评价治疗效果。结果:经过治疗,21例弹响患者中15例(71.42%)弹响完全消失,4例明显减轻(19.05%),总有效率90.46%,11例疼痛患者中7例(63.64%)疼痛消失,2例疼痛减轻(18.73%),总有效率(82.36)。6例张口受限患者中3例(50.00%)转为正常1例张口度改善大于0.5cm(16.67%)总有效率(66.67%)。结论:稳定颌板对治疗非深覆牙合颞下颌关节盘前移位有较好的的疗效。     

再定位垫对于治疗深覆伴颞下颌关节盘前移位患者的疗效分析

目的:评价再定位咬合板治疗深覆伴颞下颌关节盘可复性前移位的临床疗效。方法:选择25例深覆伴颞下颌关节盘可复性前移位患者戴用再定位咬合板治疗,治疗期限为6个月,治疗完成后随访6个月,行关节常规检查并拍X线片,并行颞下颌关节核磁检查,评价治疗效果。结果:经过治疗,23例弹响患者中16例(69.56%)弹响完全消失,2例(8.70%)弹响减轻,总有效率78.24%,11例疼痛患者中6例(54.55%)疼痛消失,3例(28.18%)疼痛明显减轻,总体有效率为82.72%,4例张口受限患者中2例(有效率50.00%)转为正常,1例(有效率25%)即张口度改善大于0.5cm,总体有效率75.00%。结论:再定位咬合板对治疗深覆伴颞下颌关节盘前移位患者具有较好的疗效。     

下颌骨截骨整形手术三维有限元模型的建立

目的：为研究下颌骨截骨整形手术的生物力学原理,建立了生物力学相似性较高的无牙下颌骨和颞下颌关节三维有限元模型。方法：以颅颌面系统正常的女性青年志愿者为标本,经过薄层CT断层扫描得到DICOM格式文件,经Mimics和Ansys软件建模,采用只受拉的Link10单元模拟下颌韧带和咀嚼肌约束,采用接触单元对关节窝进行约束。结果：建立了包括颞下颌关节、肌肉和韧带的正常下颌骨三维有限元模型。可根据实验设计建立实验分模型。结论：提高了模型的相似性,为进一步研究下颌角截骨整形生物力学奠定了基础。     

颞下颌关节盘前移位的动物模型

目的 建立一个类似人类颞下颌关节盘前移位的动物模型。方法 用手术方法将兔关节盘前移，并观察其病理变化。结果 33只实验动物中，13例为部分关节盘前移位，关节出现早期退行性变和生理性改建。11侧为完全性关节盘前移位，5侧为关节盘穿孔，关节出现退行性变和严重的骨关节病。结论 本实验建立的关节盘前移位动物模型为系统性研究其发病机理奠定了良好的基础。     

手法整复颈椎配合铍针松解治疗颞颌关节功能紊乱60例

目的:评价手法整复颈椎配合铍针松解治疗颞颌关节功能紊乱的临床疗效。方法:自2012年3月至2017年5月,应用手法整复颈椎配合铍针松解治疗颞颌关节功能紊乱60例,男26例,女34例;年龄18~60岁,平均32.5岁;病程1周~5年,平均3个月。对患者颞颌关节最大主动张口度、弹响程度、VAS疼痛评分,进行治疗前和治疗后随访评估。结果:60例均获随访,时间6~24个月,平均12个月。末次随访时,颞颌关节最大主动张口度从治疗前的(1.99±0.47)cm提高至治疗后的(3.17±0.19)cm,关节弹响度从治疗前100%降至治疗后的(27.33±13.51)%,VAS评分从治疗前的4.73±0.67降至治疗后的1.80±0.53。结论:采用手法整复颈椎配合铍针松解治疗颞颌关节功能紊乱,具有操作简便、疗效确切、疗程短等优点,是治疗颞颌关节功能紊乱的有效方法。     

The utilization of Dacron as interposition material in the treatment of the temporomandibular ankylosis--retrospective study: 1993-2005

The treatment of temporomandibular ankylosis, indifferently by anatomoclinical type or etiologic factor (trauma, infection, rheumatism), is exclusively surgical. The frequent indication in the temporomandibular ankylosis of types I and II Topazian remains the neo-articular modeling osteotomy with or without interposition. A clinical and retrospective study of 25 patients diagnosed with temporomandibular ankylosis (unilateral or bilateral) was performed. The patients were operated between 1993- 2005 by interpositional arthroplasty after resection of the joint osseous block. From 32 surgical procedures in temporomandibular ankylosis, the Dacron was used for 29 interventions. The qualities of this material were confirmed by good results obtained after 1-12 years of following. The mobility of the mandible and postoperative mouth opening were in normal limits with lack of complications or recurrences. The technique is simple and the interposition material is well tolerated by the body. The Dacron texture is soft, elastic, resistant with physically and chemically stable. It is easy to be modeled, perfectly adaptable on resting osseous mass, and it is integrates intra new joint by penetration of the connective fibrous in itself. Given these facts, the interposition material of Dacron plays the role of the fibrocartilage in the temporomandibular joint.     

Treatment of fractures of the mandible: a new type of external fixator

The use of external fixators in the treatment of complex mandibular fractures is described, as are the advantages offered by the technique which permits accurate, controlled reduction of the bone fragment without immobilising the temporomandibular joint.     

Effectiveness of manual physical therapy, therapeutic exercise, and patient education on bilateral disc displacement without reduction- of the temporomandibular joint: a single-case design

STUDY DESIGN: Single-case A1-B-A2 design. OBJECTIVE: To determine if manual physical therapy, therapeutic exercise, and patient education would be an effective management strategy for a patient with a disc displacement without reduction of both temporomandibular joints. BACKGROUND: A number of conservative management strategies have been proposed for the treatment of temporomandibular disorders. However, little evidence exists to indicate the effectiveness of physical therapy interventions in patients with bilateral disc displacement without reduction. METHODS AND MEASURES: Phase A1 of the study consisted of a baseline condition in which no intervention was initiated. Phase B included manual physical therapy, therapeutic exercise, and patient education focusing on the temporomandibular joint and cervical spine. Phase A2 consisted of withdrawal of the intervention. The Steigerwald/Maher disability questionnaire was used to collect data relative to function. A visual analog scale was used to collect pain data and maximal mouth opening measurements were obtained as an indicator of range of motion. Visual analysis and the 2 standard deviation band method of statistical analysis were used to compare data. RESULTS: Following the implementation of the intervention phase, the patient demonstrated significant reductions in pain and improvements in maximal mouth opening and function as measured by the Steigerwald/Maher disability questionnaire. These observed improvements were maintained at the time of a 3-month follow-up. CONCLUSIONS: The results of our study suggest that manual physical therapy, therapeutic exercise, and patient education may have been an effective management strategy for a patient with bilateral disc displacement without reduction of the temporomandibular joints. Further outcome studies in the form of randomized controlled trials are needed to determine the clinical utility of this treatment approach in a larger population.     

Unsuspected temporomandibular joint pathology leading to a difficult endotracheal intubation

A 40-yr-old woman with an unremarkable medical history and no prior surgeries presented for ambulatory surgery. Physical examination revealed normal jaw opening. On induction of general anesthesia, her jaw was found to be locked in a nearly closed position. We discuss anesthetic considerations and the pathology of temporomandibular joint anterior disk dislocation without reduction. A simple maneuver to reduce the dislocation is described.     

Functional results of unilateral mandibular condylar process fractures after open and closed treatment

BACKGROUND: This retrospective study compared the functional results of unilateral mandibular condylar process fractures treated either by open reduction or by closed treatment. METHODS: Sixty-six patients with unilateral mandibular condylar process fractures were reviewed. Thirty-six patients received open reduction, and the other 30 underwent closed treatment (intermaxillary fixation only). Each group was further divided into condylar and subcondylar subgroups according to fracture level. The functional outcome was evaluated by posttreatment occlusion status, maximal mouth opening, facial symmetry, chin deviation, and temporomandibular joint symptoms. RESULTS: Patients undergoing closed treatment exhibited more condylar motility than those treated by open reduction. Patients in the condylar subgroup with open reduction presented less chin deviation (21.43%) compared with those with closed treatment (56.25%; p = 0.072). Although a greater severity of subcondylar fractures existed in patients treated with open reduction, patients treated with open reduction or closed treatment did not reveal a significantly functional difference. CONCLUSION: The present study revealed that patients with condylar neck or head fractures gained more benefits from open reduction in terms of chin deviation and temporomandibular joint pain. For subcondylar fractures, open reduction provides satisfactory functional results in patients with severely displaced fractures.     

Application of MRI in indirect temporomandibular joint injury without condylar fracture

Objective： To discuss the application of MRI in indirect temporomandibular joint injury without condylar fracture. Methods： MRI examination on temporomandibular joint was conducted in 28 patients with indirect injury to temporomandibular joint without condylar fracture. The scanning sequence included TIWI, PDWI on oblique sagittal section at both open and closed mouth positions, and T1WI, T2WI on oblique coronal section. The MRI appearance was analyzed by 2 senior radiologists. Results： Among the 56 temporomandibular joints of28 patients, 35 joints exhibited pathological changes on MRI, in which there were 9 bone injuries, 21 articular disc dislocation, 24 intracapsular hematocele and hydrops. Conclusions： MRI can clearly reveal bone injury, articular disc dislocation as well as articular capsule abnormality in the indirect injury of temporomandibular joint without condylar fracture. It is highly advocated in clinical use.     

综合性护理在颞下颌关节紊乱病患者中的应用效果

目的 探讨综合性护理在颞下颌关节紊乱病患者中的应用效果。方法 选取2020年12月-2022年 12月本院收治的50例颞下颌关节紊乱病患者为研究对象，按照随机数字表法分为研究组与参照组，各 25例。参照组采用常规护理，研究组采用综合性护理，比较两组心理韧性、疼痛程度、颞下颌关节功能障 碍指数评分以及治疗依从性。结果 研究组护理后CD-RISC各项评分及总分均高于参照组，差异有统计学 意义（P＜0.05）；研究组护理后VAS评分低于参照组，差异有统计学意义（P＜0.05）；研究组依从率高于 参照组，差异有统计学意义（P＜0.05）；研究组护理后DI各项评分及总分低于参照组，差异有统计学意 义（P＜0.05）。结论 综合性护理干预应用于颞下颌关节紊乱病患者，可改善其心理韧性，缓解疼痛，提 高患者治疗依从性，可帮助患者尽快恢复颞下颌关节功能。