颞下颌关节紊乱综合征患者的髁突位置及对称性

目的:探讨伴有颞下颌关节紊乱综合征(temporomandibular disorders,TMD)的错(牙合)畸形患者的髁突位置及对称性.方法:在就诊的错(牙合)畸形患者中,选取有TMD症状的15例患者纳入实验组,并选取15例无症状患者作为对照组.分别对实验组和对照组行双侧颞下颌关节CT扫描,选取适当的断层并测量其关节间隙及对称性.采用SPSS17.0软件包对数据进行统计学处理.结果:实验组患者的髁突位置明显偏后位,而对照组患者的髁突位置稍前位.实验组患者患侧髁突水平倾斜角较健侧大(P＜0.05),而垂直倾斜角较健侧小(P＜0.05),两侧髁突内外径、前后径、髁突长轴、髁突中心至正中矢状面距离、两侧髁突前后距均无显著差异.结论:颞下颌关节紊乱综合征患者的髁突位置明显偏后位,且两侧髁突存在垂直向不对称.     

成人下颌偏斜患者下颌髁突三维CT形态对称性研究

目的:建立成人下颌偏斜患者CT三维重建模型,测量、分析髁突形态、三维特征,并比较双侧髁突对称性,为下颌偏斜患者临床诊断、治疗提供参考.方法:对20例下颌偏斜患者(18～30岁)的头颅进行螺旋CT扫描,在Mimics 8.13软件工作站上进行三维图像重建和参数测量,对结果进行统计学分析.结果:偏斜对侧髁突高度较偏斜侧增大(P＜0.05);髁突内外径较偏斜侧增大(P＜0.01);髁突后斜面长度、髁突后斜面倾斜角较偏斜侧减小(P＜0.01).结论:下颌偏斜可引起髁突的非对称性改建,故下颌偏斜患者双侧髁突形态不对称.     

髁突形态与覆(牙合)深度关系的研究

目的探讨髁突形态与不同覆(牙合)深度的关系.方法选择正常(牙合)者、开(牙合)畸形患者、覆(牙合)正常的错(牙合)畸形患者和深覆(牙合)畸形患者各50人,均为18至26岁成人.应用曲面断层片研究左右两侧的髁突形态,分别测量并计算上部髁突高度/升支高度比(UCH/RH)和髁突高度/宽度比(TCH/CW).将髁突形态分为四种类型:直立型(类A),前倾型(类B),后倾型(类C)和尖型(类D).结果开(牙合)组的上部髁突高度相对升支高度明显小于其他各组(P＜0.001).正常(牙合)组的髁突形态比较粗壮,高度宽度比明显小于其他各组(P＜0.001).类A和类B属于正常髁突形态,占正常(牙合)组的99%.类C和类D属于异常髁突形态,且在开(牙合)组中的比例明显高于正常覆(牙合)组或深覆(牙合)组.另外,只有开(牙合)组中显示上部髁突高度两侧不对称(P＜0.05).结论开(牙合)组髁突形态与其他各组相比明显不同.     

成人安氏Ⅰ类错(牙合)正畸前、后髁突形态的变化

目的:运用锥形束CT(CBCT)分析成人安氏Ⅰ类错(牙合)正畸治疗前、后髁突形态在三维方向上的变化.方法:选取25例临床无口腔颞下颌关节紊乱症状的成人安氏Ⅰ类错(牙合)患者(男5例,女20例)正畸治疗前、后双侧颞下颌关节的CBCT影像,应用Mimics10.01软件对CBCT影像进行三维重建,测量正畸治疗前、后髁突的高度、最大轴位平面和最大矢状位平面的面积及骨密度,三维髁突及上部三维髁突的体积及骨密度,采用SPSS 19.0软件包对数据进行统计学分析.结果:最大轴位平面和最大矢状位平面的面积和骨密度值较治疗前显著降低(P＜0.05);三维髁突体积及骨密度和上部三维髁突骨密度较治疗前显著降低(P＜0.05).结论:成人安氏Ⅰ类错(牙合)正畸治疗前、后髁突发生适应性的改建.     

Forsus矫治器对骨性Ⅱ类错(牙合)下颌矢状运动时髁突轨迹影响的初步分析

目的 探讨Forsus矫治器对骨性Ⅱ类错(牙合)下颌矢状运动时髁突轨迹的影响方法选取骨性Ⅱ类错(牙合)患者10例作为实验组,10例安氏Ⅰ类患者为对照组.应用髁突运动轨迹轴图描记仪,对实验组戴用Forsus矫治器前后及对照组下颌矢状运动时的髁突运动轨迹进行检查和记录,对结果进行定性定量分析.结果 实验组戴用Forsus矫治器前后,髁突的垂直向位移和旋转度比对照组均偏大(P＜0.01),而实验组矫治前后髁突的垂直向位移和旋转度均无显著性差异(P＞0.05).结论 短期使用Forsus矫治器对Ⅱ类错(牙合)患者的髁突轨迹无明显影响.     

单侧后牙正锁(牙合)患者下颌侧方运动时的髁突轨迹特征

目的:探讨单侧后牙正锁(牙合)患者在下颌侧方运动过程中髁突的运动轨迹特征及其与正常(牙合)者之间的差异.方法:选取单侧后牙正锁(牙合)患者26例为实验组,个别正常(牙合)26例为对照组,应用髁突运动轴图描记仪(computer aided diagnosis axiograph,CADIAX)记录下颌侧方运动时髁突的运动轨迹.实验数据采用SPSS10.0软件包分析,选用成组t检验、配对t检验或秩和检验比较组间差异有无统计学意义.结果:实验组下颌侧方运动过程中髁突轨迹不流畅变异大,两侧运动轨迹不对称.非锁(牙合)侧髁突的矢状位移、垂直位移以及空间最大位移大于锁(牙合)侧和对照组,水平位移小于后者,差异有统计学意义(P<0.05);非锁(牙合)侧髁突的矢状倾斜度大于锁(牙合)侧和对照组,水平倾斜度小于后者,差异有统计学意义(P<0.05).结论:单侧后牙正锁(牙合)患者下颌侧方运动过程中两侧髁突运动轨迹不对称.     

骨性Ⅲ类偏颌患者髁突与(牙合)平面特征的CBCT研究

目的 利用锥形束CT(CBCT)测量分析骨性Ⅲ类偏颌患者髁突及(牙合)平面特征。方法 选取符合纳入标准的骨性Ⅲ类成年患者40例,所有个体按照颏下点偏离正中矢状面距离进行分组,分别测量各组左右两侧(牙合)平面角、髁突位置及形态,并对数据进行统计学分析。结果 骨性Ⅲ类偏颌患者的偏侧与对侧相比,(牙合)平面角、关节前间隙、关节上间隙、关节外间隙及髁突内外径差异有统计学意义(P<0.05),偏侧关节后位所占比例较大,下颌骨偏移量与偏侧髁突前间隙及对侧(牙合)平面角均呈正相关(P<0.01)。骨性Ⅲ类非偏颌患者的左右两侧(牙合)平面角、髁突位置及形态指标之间差异均无统计学意义(P>0.05),关节以前位、中位为主。结论 骨性Ⅲ类偏颌患者左右两侧(牙合)平面角、髁突位置及形态不对称,偏侧(牙合)平面角及髁突内外径较小,髁突向后下内方移位,且偏颌程度与(牙合)平面角及髁突位置之间存在相关性。     

成人单侧后牙反患者髁突的对称性及矫治后髁突位置的变化

目的:探讨成人单侧后牙反患者髁突的对称性及矫治后髁突位置(R)的变化。方法:21例成功矫治的单侧后牙反成年患者作为实验组,男10例,女11例,年龄18～23岁,平均21.8岁。21例安氏Ⅰ类错患者作为对照组,男10例,女11例,年龄19～23岁,平均22.1岁。实验组矫治前后与对照组均拍摄全颌曲面断层片和双侧矫正薛氏位片,测量髁突的不对称指数和髁突在关节窝中的相对位置。结果:实验组两侧髁突高度(CH)不对称,与对照组相比,CH的不对称指数明显增大(P<0.05)。实验组矫治前后两侧髁突在关节窝中的位置均无显著性差异,但与矫治前相比,矫治后非反侧髁突相对位置由前位趋于正中位(R由13.52减小为9.48)。结论:成人单侧后牙反患者的髁突形态存在不对称性,而髁突位置相对对称,颞下颌关节可随咬合关系和下颌骨位置的变化发生改建;正畸治疗后髁突位置更加协调。     

特发f生髁突吸收的颞下颌关节锥形束CT分析

目的利用特发性髁突吸收（ICR）患者的锥形束CT（CBCT）资料,探讨其颞下颌关节的变化。方法对39例ICR患者及28例正常人行颞下颌关节的CBCT扫描,测量颞下颌关节结构的各相关指标,并进行统计学分析。结果 ICR组与正常组间髁突内外径、前后径、水平角、关节结节斜度、关节上间隙等测量指标之间的差异均有统计学意义（P＝0.000）,表现为ICR组的髁突内外径、前后径、结节斜度、关节上间隙等减小,水平角则增大。结论 ICR的影像学主要表现是髁突的变小、前斜面的吸收、结节斜度的降低,同时髁突有往前内旋转和往上移动的趋势,这些指标可用来评估ICR的进展、疗效及预后。     

髁突摘除术治疗粉碎性髁突骨折疗效分析

目的:探讨髁突颈部以上粉碎性骨折行髁突摘除术的可行性及适应证.方法:回顾我院2007年9月-2011年9月间因外伤导致髁突骨折患者61例,其中完全行手术内固定治疗30例,保守治疗15例,髁突颈部以上粉碎性骨折患者16例(18侧)予以髁突摘除术,术后随访5～48个月,观察疗效.结果:16例(18侧)患者中,止血纱布排异反应导致创口愈合不良1例,咬合偏斜1例,开口轻度受限1例,前牙开(牙合)1例,其余患者无明显咬合不适,牙尖窝关系良好,面容基本对称.结论:对于颌面部发育基本完成的患者,其髁突颈部以上粉碎性骨折采取髁突摘除术是可行的治疗方法,术后可能出现咬合偏斜、前牙开(牙合)及开口受限,进一步治疗后可恢复正常.     

Osseous changes of the mandibular condyle affect backward-rotation of the mandibular ramus in Angle Class II orthodontic patients with idiopathic condylar resorption of the temporomandibular joint

Objective: To evaluate whether osseous changes of the temporomandibular joint (TMJ) condyle affect backward rotation of the mandibular ramus in Angle Class II orthodontic patients with idiopathic condylar resorption (ICR).

Methods: Twenty Japanese women with Class II malocclusion with ICR (ICR group) and 24 women with Class II malocclusion without ICR (non-ICR group) were examined. Pre-treatment panoramic radiographs were used to measure condylar ratios. Pre-treatment lateral cephalograms were used to evaluate maxillofacial morphology.

Results: The ICR group had a significantly smaller condylar ratio, greater backward rotation of the ramus, less labially inclined upper incisors, and a steeper occlusal plane. The increased backward rotation of the ramus in the ICR group was significantly associated with a smaller condylar ratio.

Conclusion: Angle Class II patients with ICR had shorter condylar height attributable to osseous changes of the TMJ condyle, and the shorter condylar height may affect subsequent backward rotation of the ramus.     

A retrospective study of temporomandibular joint ankylosis secondary to surgical treatment of mandibular condylar fractures

We investigated the incidence of ankylosis of the temporomandibular joint (TMJ) after open operations for fractures of the mandibular condyle, and analysed possible risk factors in a total of 385 patients with 492 condylar fractures who had been operated on in our department from 2001 to 2010. Sixteen patients developed postoperative ankylosis of the TMJ with 26 joints (5%) affected during a follow-up of 6 months–10 years. Of the 492 condylar fractures, the most common ones that were associated with postoperative ankylosis were those of the condylar head (20/248), followed by the condylar neck (6/193). Subcondylar fractures did not cause postoperative ankylosis (0/51). Among the 16 patients with postoperative ankylosis, 13 had associated anterior mandibular fractures. Long-screw (bicortical screw) fixation of fractures of the condylar head seemed to be associated with a lower incidence of postoperative ankylosis than fixation by miniplate and wire or removal of the fractured fragment. The articular discs were damaged in all ankylosed joints, and the remaining fractured fragment was found in 10 ankylosed joints after fractures of the condylar head. The results suggest that fractures of the condylar head are more prone to lead to postoperative ankylosis of the TMJ, and that the possible risk factors seem to include the technique used for fixation and damage to the disc, together with an anterior mandibular fracture with the fractured fragment remaining.     

透明质酸钠注射治疗不可复性关节盘前移位的CBCT影像学评价

目的:对比治疗前后CBCT影像,观察透明质酸钠治疗颞下颌关节不可复性盘前移位后髁突位置及形态变化.方法:对40例患者进行3次透明质酸钠关节上腔注射治疗.通过治疗前、治疗后3、9、12个月CBCT影像学检查及临床检查,从髁突位置形态变化、疼痛度(VAS)、最大开口度(MMO)、Fricton指数观察透明质酸钠对颞下颌关节不可复性关节盘前移位的治疗效果.结果:CBCT显示不可复性关节盘前移位伴骨关节病患者治疗前与治疗后9、12个月比较,髁突骨质有明显改建,骨面变得平整光滑,骨赘减小(P =0.026,P=0.001),部分单纯不可复性关节盘前移位患者治疗后9个月髁突可以向前移动(P=0.038);治疗后患者MMO增大,VAS减小(P＜0.05),Fricton指数降低.治疗后3～12个月Fricton指数无显著变化(P＞0.05).结论:CBCT显示透明质酸钠可促进已破坏髁突表面骨质改建,但不能使后移位的髁突回到关节窝中央.     

双(牙合)垫矫治器治疗青少年安氏Ⅱ1错(牙合)患者颞下颌关节变化的初步研究

目的 运用锥形束CT(cone-beam computed tomography,CBCT)及Invivo5软件研究青少年安氏Ⅱ1错(牙合)患者在双(牙合)垫矫治器(Twin-block)矫治前后的颞下颌关节(Temporomandibular Joint,TMJ)骨性结构及其髁状突相对关节窝位置的变化,了解Twin-block矫治器对颞下颌关节结构形态的影响.方法 选取27例处于生长发育高峰期或高峰前期的下颌后缩型安氏Ⅱ1错(牙合)患者为研究对象.于Twin-block矫治前后拍摄CBCT,利用Invivo5软件进行三维重建后,进行各线距和角度的测量.对测量结果进行配对t检验.结果 双侧髁突前后径及髁突高度均增加,且治疗前后差异具有统计学意义(P＜0.01).其余各关于髁突和关节窝形态的测量项目的差异无统计学意义(P＞0.05).治疗前后各关节间隙的差异均无统计学意义(P＞0.05).结论 Twin-block能刺激青少年安氏Ⅱ1错(牙合)患者髁突的改建,使其髁突前后径及高度增加,但对其关节窝的改建及髁突相对于关节窝的位置关系的影响尚不明确.     

Associations between the articular eminence inclination and condylar bone changes, condylar movements, and condyle and fossa shapes

Objectives

The purpose of the present study was to determine the inclination and height of the articular eminence with respect to the condylar bone changes, condyle shape, fossa shape and condylar movements in patients with and without temporomandibular joint (TMJ) dysfunction using cone-beam computed tomography (CBCT).

Methods

The associations between the eminence inclination and the condylar bone changes, condylar movements, condylar shape and fossa shape were evaluated in patients with TMJ disorders and control patients without TMJ disorders. The measurements of the articular eminence inclination were established on central sagittal slices of the TMJ. The central coronal slices were used to determine the condyle and fossa shapes. The types of movements of the condyles were determined on open-mouth images, and mandibular hypermobility or hypomobility was noted for each joint.

Results

There were no significant differences in the eminence inclination and height with respect to the condylar bone changes and condylar movements in the TMJ disorder group. However, there was a significant association between the eminence inclination and the fossa shape in the TMJ disorder group and significant associations between the eminence inclination and both the condyle and fossa shapes in the control group. The articular eminence inclination was steeper in the control group than in the TMJ disorder group.

Conclusions

The eminence inclination was steeper in the control patients than in the patients with TMJ disorders, and was not correlated with the condylar bone changes or condylar movements.     

髁突特发性吸收的临床观察

目的 通过对髁突特发性吸收（idiopathic condylar resorption,ICR）患者临床资料的回顾性分析,总结ICR的临床特点和影像学特点,探讨ICR可能的发病因素,提高诊断水平。方法 收集2007年6月—2012年7月中山大学附属口腔医院颞下颌关节病诊治中心收治的ICR患者46例,对其进行随访观察。记录患者面型、颞下颌关节症状及咬合状况;借助全景片、头颅定位正侧位片、许勒位片检查,以了解患者下颌支高度、髁突骨质破坏情况、颅面结构特征等影像学变化,借助颞下颌关节锥形束CT（CBCT）检查及造影检查,了解髁突吸收与关节盘-突结构改变之间的关系。结果 46例患者中,男4例,女42例（91.30%）,以青少年为主。患者均呈安氏Ⅱ类面型,侧貌突,侧貌不美观,下颌骨后缩,下颌支高度降低,前牙开、后牙早接触、安氏Ⅱ类错。多伴关节区弹响、杂音。X线平片显示,髁突形态变小甚至消失;下颌支垂直距离变短;头影测量呈安氏Ⅱ类高角型特征;TMJ CBCT造影示关节盘-突关系改变,尤其以关节盘穿孔较为常见,穿孔位置多在关节盘后区。结论 ICR具有独特的发病机制和临床特征。TMJ关节盘移位与ICR可能存在相关性。     

特发性髁突吸收患者下颌骨CBCT影像特点的研究

目的:研究特发性髁突吸收(ICR)患者下颌骨锥体束CT(CBCT)的影像学特点。方法:选取ICR患者和正常志愿者各41例,应用Invivo5软件测量所有受试者下颌骨CBCT数据资料,并进行统计学分析。结果:ICR组与正常组间SNB、NP-FH、S-Go、S-Go/N-Me、Co-Go、H、ACo-PCo、PCo-Co、前斜角、S-Ar-Go、Co-Go-Me的差异有统计学意义(P<0.05),而N-Me、Go-Me、S-Co、ACo-Co、后斜角无统计学意义(P>0.05)。结论:ICR仅发生在髁突的顶端和前斜面,以髁突高度降低为主。ICR患者的下颌后缩由下颌骨后下旋转引起,而非髁突后移所致。     

A comparative assessment of mandibular condylar position in patients with anterior disc displacement of the temporomandibular joint.

PURPOSE: The purpose of this study was to determine whether the position of the mandibular condyle in patients with anterior disc displacement (ADD) is different from that of a control group with normal joints using a novel method to quantify the irregular shape of the temporomandibular joint (TMJ). MATERIALS AND METHODS: Twenty-six magnetic resonance images of TMJs with ADD were evaluated and compared with 14 normal joints. The position of the condyle was determined by using 2 different methods: 1) measuring the horizontal and vertical normalized distances in millimeters between the geometric centers of the glenoid fossa and the condyle and 2) calculating the anteroposterior joint space ratio. RESULTS: Using the first method, the horizontal distance between the centers of the condyle and the glenoid fossa was 14.0 +/- 11.1 in the ADD group and 5.3 +/- 10.9 in the control group (P <.001). The vertical distance was 64.7 +/- 22.7 in the ADD group and 68.3 +/- 32.9 in the control group (P =.015). The ratio of the horizontal and the vertical condylar displacement in the ADD group was 2.4. Using the second method, the anteroposterior joint space ratios in the ADD group and in the control group were 1.7 +/- 0.5 and 1.2 +/- 0.4, respectively (P =.001). CONCLUSION: This study found that condyles of patients with ADD were situated more posterior and superior in the fossa than those in the control group. Moreover, in the ADD group, the posterior condylar displacement was noted to be 2.4 times greater than the superior condylar displacement.     

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.