颞下颌关节的超声成像特征及临床应用进展

颞下颌关节(temporomandibular joint, TMJ)是颌面部唯一的运动关节，其左右双侧对称且形态结构复杂。颞下颌关节紊乱病(temporomandibular joint disorder, TMD)好发于中青年，发病高峰为20～40岁，可累及10%～15%的成年人，是口腔颌面部的常见病和多发病。超声检查具有无创、无痛、经济、实时、便捷等优点，在颞下颌关节区疾病诊疗中的应用已受到国内外学者的广泛关注。因此，本文对颞下颌关节的超声成像特征及临床应用进展作一综述，以期探讨超声成像技术在实际临床工作中的应用方案。     

人工颞下颌关节的研究进展

颞下颌关节结构和功能的复杂性使得其重建成为外科医生所面临的最大挑战之一。人工颞下颌关节是颞下颌关节重建的重要方式之一，主要适用于颞下颌关节强直、无法复位固定的髁突粉碎性骨折、颞下颌关节肿瘤、晚期关节内紊乱及一些先天性颅面综合征等所致的颞下颌关节发育不良等。人工颞下颌关节旨在改善颞下颌关节的功能、减少疼痛并防止严重的并发症。在口腔颌面外科，人工颞下颌关节具有能模仿正常的解剖形态、与宿主贴合、不需另行取材、术后能立即进行功能训练等优点。假体材料在人工颞下颌关节的发展中起着至关重要的作用，优良的设计、牢靠的固定都是人工颞下颌关节能够行使其功能必不可少的条件，当然关节生物力学的研究也是必不可少的。随着材料学、关节生物力学及制作工艺等相关学科的飞速发展，人工颞下颌关节在关节假体的植入材料、假体的设计等方面取得了不少进展。随着人工颞下颌关节的发展，其应用也越来越广泛。本文对人工颞下颌关节的发展及其临床应用作一综述。     

颞下颌关节间接性损伤后转归及其机理

颌面部损伤常问接造成颞下颌关节损伤,如不及时治疗,可引起颞下颌关节内紊乱(TMJID)、颞下颌关节骨关节病(TMJOA)及颞下颌关节纤维性或骨性强直等后遗症的发生。本文就间接性TMJ损 伤后的转归,及导致并发症的机理,TMJ损伤与TMJID和TMJOA之间的关系做一系统综述。     

肋骨肋软骨移植在颞下颌关节重建中的应用进展

颞下颌关节疾病如骨折、强直、肿瘤等,常会造成髁突破坏或缺损,需进行颞下颌关节重建。目前,肋骨肋软骨移植已成为颞下颌关节重建的首选方法。20世纪20年代首次将肋骨肋软骨移植应用于颞下颌关节重建,之后诸多学者在肋骨肋软骨选择、术后肋软骨生长情况以及如何减少手术创伤等方面做了大量研究。本文主要从以上几个方面,对肋骨肋软骨移植重建颞下颌关节的现状作一综述。     

细胞凋亡在颞下颌关节中的研究进展

颞下颌关节是人体中最复杂的关节之一,是实现各种口腔功能的重要器官。近年来对颞下颌关节的发育和常见的颞下颌关节疾病等生理病理过程与细胞凋亡关系逐渐引起学者们的关注。本文对颞下颌关节的发育及其常见疾病中的细胞凋亡及凋亡因素作一综述。     

肋骨肋软骨移植重建颞下颌关节的临床研究

目的：探讨颞下颌关节真性强直的手术治疗和预防术后的复发。方法：采用自体肋骨肋软骨移植对32例颞下颌关节真性强直患者进行了关节重建术，术后通过测量张口度，计算手术前后张口度的差值、下颌前伸和侧向运动范围，以及颞下颌关节x线片检查等，综合评价手术治疗效果。结果：32例随访1～12年术前后张口度的差值均在2．0cm以上，效果优良，重建关节无骨质吸收，咬合关系良好，下颌具有前伸和侧向运动功能，无复发。结论：自体肋骨肋软骨移植的颞下颌关节重建术是治疗颞下颌关节真性强直的一种较理想方法。     

颞下颌关节损伤的实验动物模型

颞下颌关节损伤可以导致颞下颌关节内紊乱，颞下颌关节骨关节病及病关节强直等后遗症，动物模型是研究颞下颌关节损务后病理变化及发生的机理的重要手段，本文目前关于颞下颌关节损伤的实验动物选择及损伤方法和优，缺点作一系统综述。     

润滑功能与颞下颌关节紊乱病

颞下颌关节是具有复杂运动的联动关节，其长期的健康状态与润滑功能密不可分。其有关的润滑机理包括滑液、关节盘和关节软骨等方面。关节内自由基过多可以导致润滑功能障碍，颞下颌关节紊乱病与润滑功能障碍密切相关。     

润滑功能与颞下颌关节紊乱病

颞下颌关节是具有复杂运动的联动关节,其长期的健康状态与润滑功能密不可分。其有关的润滑机理包括滑液、关节盘和关节软骨等方面。关节内自由基过多可以导致润滑功能障碍,颞下颌关节紊乱病与润滑功能障碍密切相关。     

创伤性颞下颌关节强直的分类和治疗进展

颞下颌关节强直是一类严重影响口颌系统功能的疾病,会导致开口受限,严重者引起面部畸形和睡眠呼吸暂停综合征等。由于创伤是引起颞下颌关节强直的主要原因,本文就创伤性颞下颌关节强直的诊断、分类和治疗进展等进行综述。     

功能性颞下颌关节成形术的初步报告

目的　功能性颞下颌关节成形术是本文设计的新颖术式,缘于以往的手术有可能发生严重并发症和术后关节功能欠佳,而作的改进术式。方法　手术是作下颌骨患侧的升枝部截断,再将病变的髁状突摇摆松动折断,摘下离体进行修整成形后,再予以复位重建关节。此术式可保存部分的残留关节组织结构,便可保留关节特有滑动功能。结果　本组施行了5例6侧功能性颞下颌关节成形术,在术后半年以上作随访复查,张口咀嚼等功能都很良好。结论　在讨论中对颞下颌关节成形术的手术演变与手术安全进行了分析。对功能性颞下颌关节成形术的手术术式与手术命名作了评价。     

深覆与颞颌关节形态结构的关系

对40例前牙重度深覆患者的薛氏位X线片进行了测量分析并与正常值进行比较。结果:关节弹响率为72.5％,牙尖交错时髁突不在关节凹中央者为81.2％,关节骨质改变率为51.2％。深覆患者的关节结节高度和斜度与正常人无显著性差异,前牙的覆、覆盖与关节凹宽度和关节结节高度无相关性。提示前牙的覆、覆盖与颞颌关节的骨性解剖形态之间无直接的相关性,深覆是不良型容易出现颅颌功能紊乱。     

关节源性颞下颌关节痛患者关节内窥镜检查结果

目的　探讨颞下颌关节紊乱病伴关节源性关节痛患者的关节腔内状况。方法　对20例颞下颌关节紊乱 病伴关节源性关节痛患者(按Truelove等关于颞下颌关节紊乱病的诊断分类标准确定)的23侧颞下颌关节先后进 行X线片检查和关节内窥镜检查。结果　关节镜下23侧关节内至少存在1种不同程度的腔内病变,最多有6种病 变共存。结论　局限于颞下颌关节的关节痛可能与关节腔内病理改变有关,可能是炎症(滑膜炎)引起疼痛。     

Effect of turban use on temporomandibular joint problems

The aim of this study was to evaluate the effects of daily turban wear on temporomandibular joint (TMJ) problems. This cross-sectional study was carried out on 249 female patients. Of these, 119 patients were using turban daily, while 130 patients did not use. Patients were asked questions to ascertain the signs of TMJ problems. Thereafter, the TMJ region was examined clinically. Cross-tabulations and Chi-square statistics were computed in accordance with Bonferroni correction for multiple comparisons. To investigate the association between continuous turban wear and temporomandibular disorder symptoms, logistic regression analysis was performed. Limited mouth opening, deviation, pain on TMJ palpation and mouth opening were not affected with turban usage. However, turban users more frequently demonstrated pain during palpation of the masticatory muscles than non-users (P = 0.001). Duration of the turban usage did not affect clinical examination findings except pain on masticatory muscles during palpation (P = 0.001). Complaint of pain on masticatory muscles are more frequently seen among the turban users.     

Signs of temporomandibular disorders in tinnitus patients and in a population-based group of volunteers: results of the Study of Health in Pomerania

The literature has documented a controversial discussion on the possible relationship of otogenous symptoms and craniomandibular dysfunction since the 1920s. Therefore, an investigation was conducted which consisted of two parts: a case study with population-based controls and a cross-sectional study. The aim of the first study was to screen a group of patients suffering from acute or chronic tinnitus for temporomandibular disorders (TMD) in comparison with a population-based group of volunteers without tinnitus. To this end, 30 patients (13 females and 17 males, age 18-71 years) suffering from acute hearing loss associated with tinnitus, isolated acute tinnitus, and chronically transient tinnitus were examined for symptoms of craniomandibular dysfunction. The results were compared with those of clinical functional analysis from 1907 subjects selected representatively and according to age distribution from the epidemiological 'Study of Health in Pomerania' (SHIP); the occurrence of tinnitus was ruled out in these control subjects. Statistical analysis was performed with Chi-square and Mann-Whitney U-tests. Sixty per cent of the tinnitus patients and 36.5% of the control subjects exhibited more than two symptoms of TMD (P = 0.004). Tinnitus patients had significantly more muscle palpation pain (P < 0.001), temporomandibular joint (TMJ) palpation pain (P < 0.001), and pain upon mouth opening (P < 0.001) than the general population group. No statistical differences were found in TMJ sounds, limitation of mandibular movement, or hypermobility of the TMJ. Furthermore, 4228 subjects of the population group examined in the epidemiological study were screened for co-factors of tinnitus with the help of a multivariate logistic regression model which was adjusted for gender, age, and a variety of anamnestic and examined data. Increased odds ratios (OR) were found for tenderness of the masticatory muscles (OR = 1.6 for one to three painful muscles and OR = 2.53 for four or more painful muscles), TMJ tenderness to dorsal cranial compression (OR = 2.99), listlessness (OR = 2.0) and frequent headache (OR = 1.84) A relationship between tinnitus and TMD was established in both examinations. Tinnitus patients seem to suffer especially from myofascial and TMJ pain. A screening for TMD should be included in the diagnostic survey for tinnitus patients.     

Validity of functional diagnostic examination for temporomandibular joint disc displacement with reduction

The choice of approach for diagnosing temporomandibular joint (TMJ) anterior disc displacement with reduction (ADDR), viz. functional examination or TMJ imaging, is debatable and complicated by findings of low agreement between these approaches. Our aim was to investigate the validity of functional ADDR diagnostics using clinical examination and opto‐electronic mandibular movement recordings versus magnetic resonance imaging (MRI). 53 participants (32 women and 21 men, mean age ± s.d. of 28·7 ± 10·1 years) underwent a clinical examination, mandibular movement recording and MRI of their TMJs within 1 month. All were performed and analysed in a single‐blind design by different experienced examiners for each technique. The sensitivity and specificity of each functional diagnostic method was calculated, with MRI as the gold standard. Anterior disc displacement with reduction was diagnosed in 27·6% of the TMJs clinically, in 15·2% using the movement recordings and in 44·8% on MRI. The specificity of the clinical examination for diagnosing ADDR was 81·0%, and of the movement recordings, 96·6%. The sensitivity was 38·3% and 29·8%, respectively. The chance of having a false‐positive functional diagnosis of ADDR compared with MRI is low, and disagreement between the functional methods and MRI is mainly due to the high number of MRI diagnoses in asymptomatic subjects. In view of the fact that ADDR becomes clinically relevant only when it interferes with TMJ function, the functional diagnostic approach can be considered benchmark in ADDR recognition.     

A technique to verify adequacy of eminectomy for recurrent temporomandibular joint dislocation

Recurrent dislocation of the temporomandibular joint (TMJ) can be highly debilitating, especially if the dislocation cannot be reduced by the patient. Despite being regarded as a ‘gold standard’ or ‘salvage’ procedure for refractory TMJ dislocations, complete mediolateral removal of the articular eminence can still lead to recurrences. A technique aimed at intraoperatively verifying the adequacy of osseous reduction in order to minimize the risk of re-dislocation of the TMJ is described.     

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颞下颌关节强直是口腔颌面部一类严重的疾病,其临床分型主要依据颞下颌关节骨性融合情况及其周围附属结构受累情况而定。临床针对颞下颌关节强直的治疗主要以手术为主,术后加以功能训练。外科手术治疗颞下颌关节强直的主要途径可以概括为以下三方面：解除关节强直的解剖因素;恢复或重建关节基本结构;对继发畸形的治疗。目前针对以上三方面的多种治疗手段各有利弊,本文将对近年来常用的手术治疗方法予以分类介绍。     

颞下颌关节盘的结构表征与组织工程研究

以关节盘变薄、透明样变和穿孔等不可逆性病变为特征的严重的颞下颌关节功能紊乱约占整个颞下颌关节疾病的5%～10%,常因疼痛和功能障碍严重影响患者的生活质量,是目前口腔医学界面临的疑难问题之一。近年来,组织工程技术的迅速发展提示,工程化颞下颌关节盘可能为治疗严重的颞下颌关节疾病提供一个新的途径。下面就颞下颌关节盘的结构与生物力学表征、关节盘组织工程细胞源、支架与接种技术以及生物和生物力学环境与前景等问题作一综述。