颞下颌关节曲面体层的投照技术及临床应用

30例TMD患者同时拍摄颞下颌关节曲面体层片及髁状突经咽侧位片.结果显示:TMJ曲面体层摄影术显示髁状突骨质改变优于经咽侧位且投照技术容易掌握,作者建议使用TMJ曲面体层摄影术观察TMD患者的髁状突骨质改变.     

颅骨颞下颔关节侧位间隙X线检查的实验研究

本研究选用１０个颅骨，使髁状突在关节窝中处于后移位状态，用红蜡固定。全部颅骨均拍摄标准关节侧位体层片、水平位矫正关节侧位体层片，完全矫正关节侧位体层片及矫正许勒泣片。用定量方法分别确定各片位髁状突在关节窝中的位置，并对诸片位显示结果进行比较。结果表明，水平位矫正关节侧泣体层片不能完全取代完全矫正关节侧泣体层片。矫正许勒位片髁状突形态及位置与完全矫正关节侧位体层片外侧影像基本一致，因而认为矫正许勒位片可较准确地反映关节外侧的关节间隙及形态。     

54例正常人双侧颞下颌关节CBCT测量值分析

目的：探讨应用CBCT（cone-beamcomputedtomography）对成年人两侧颞下颌关节进行多项指标数据测量分析。方法：在TMJ成像与测量技术的基础上，筛选出正常成人54例，通过严格的TMJ临床检查确定为健康关节，利用Newtom9000CBCT对其ICP位颞下颌关节进行成像后测量分析。结果：在轴位测得髁状突水平角以及单侧髁状突距矢状中线的距离；平行于髁状突长轴的斜位，测髁状突长轴径，垂直角度，沿髁状突长轴顶内外极间任意角间隙宽度；垂直于髁状突长轴的斜位测量关节髁状突前中后任意角间隙宽度，关节凹深度和前斜面角度关节颈厚度；矢状位测关节髁状突前中后任意角间隙宽度，关节凹深度和前斜面角度关节颈厚度。结论：正常成人双侧髁状突位置及关节窝形态性别差异不明显，双髁状突位置及关节窝形态基本对称。     

颞颌关节侧位校正断层摄影技术

一般颞颌关节侧位断层不是髁状突真正的侧位影像,因为髁状突的横轴一髁状突内外径联线与冠状面有一定的角度。经我院放射科测量,最大为36°,最小为0°,并且两侧髁状突的角度大部不一致。因此一般颞颌关节侧位断层不是髁状突及关节凹的侧位影像。     

牙颌专用CT对颞下颌关节骨性结构的测量技术

目的：探讨牙颌专用CT对颞下颌关节（temporomandibular joint，TMJ）骨性结构的测量技术。方法：在牙颌专用CT对TMJ成像技术的基础上，对TMJ成像的轴位、矢状位、平行于髁状突长轴的斜位、垂直于髁状突长轴的斜位重建影像，建立座标点并进行测量。结果：轴位测得髁状突水平角和单侧髁状突与矢状中线的半径距离。平行于髁状突长轴的斜位测得髁状突长轴径值、髁状突垂直角、关节间隙和髁状突受力角。垂直于髁状突长轴的斜位与矢状位均可测得髁状突内外极间各层切面径值、关节间隙、关节凹深度、关节结节斜度和髁颈厚度。结论：牙颌专用CT成像系统可以对TMJ骨性结构行多种体位、角度的影像重建及定点测量。     

颞下颌关节开闭口曲面断层影像与开闭口薛氏位影像的对照观察

颞颌关节紊乱综合征(TMJDS)是常见的疾病,发病因素较复杂,诊断多借助X线拍片,常规以两侧开闭口薛氏位,曲面断层及经咽侧位为主,但是受颞颌关节解剖位置的影响,开闭口薛氏位的影像骨质重叠的部分较多,关键部位的观察如关节间隙的改变情况及髁突运动度的变化,还有骨质的改变,会因体位的摆放不良及投照角度的原因造成变形和模糊不清.临床投照效果不理想,往往加拍其它片子,增加了患者的投照次数和经济负担.另外暗室洗片设备及片子的储存方式对片子影像质量都会产生影响.我院自1998年引进德国西门子SIRONA数字口腔全景断层照相装置.其中的6号程序可拍摄颞下颌关节开闭口曲面断层影像.本文比较颞下颌关节开闭口曲断影像与开闭口薛氏位影像,为临床更好地选择片位提供依据. 材料和方法 1 病人情况:随机抽取98年9月-99年9月颞颌关节紊乱综合征(TMJDS)病人50例共100侧,年龄10-80岁平均45岁. 2 拍片情况:每位病人同时拍摄颞下颌关节开闭口曲面断层位和两侧开闭口薛氏位,并将两种影像进行比较分析. 3 设备情况:用东芝DFW-10B500MA设备,投照两侧开闭口薛氏位.用西门子SIRONA数字口腔全景断层照相装置.其中的6号程序投照颞下颌关节开闭口曲面断层位. 4 比较分析观察内容:观察内容包括髁突骨质,关节凹骨质,关节间隙及开口活动度.根据观察清晰情况分为清晰,不清晰,无法观察. 结果 1 影像显示结构的对比:见表1,曲断片显示髁突骨质,关节凹骨质,关节间隙的清晰状态均优于薛氏位片.开闭口薛氏位因受投照体位的影响,髁突部位骨质重叠较多受投照角度及投照距离的影响使影像的失真变形较曲面断层大,使髁突骨质,关节凹骨质,等影像的观察均比开闭口曲面断层要模糊,而开闭口曲面断层在观察骨质的细微结构方面相对较好,例如病人外伤时观察髁突脱位和半脱位以及高位骨折时关节间隙中有无碎骨片及关节面骨质的破坏情况关节增生,强直纤维化及肿瘤等方面均比薛氏位要清楚,而且开闭口影像在同一张图象片中体现,便于对比观察双侧髁突情况.     

2例垂直距离升高1.2 mm患者的髁状突位置的研究

目的 探讨2例垂直距离升高1.2mm前后颞颌关节的形态学改变，以便指导临床修复工作。方法 2例患者分别在升高垂直距离前后拍左右两侧牙尖交错位的颞颌关节侧位X线片，用Luzex-F显微图像分析处理系统对关节腔面积进行计算。结果 升高垂直距离前：牙尖交错位时，1例髁状突位于关节凹的正中位，前后间隙相等；1例髁状突位于关节凹的后位，前间隙大于后间隙。升高垂直距离1.2mm后：牙尖交错位时，2例髁状突均位于关节凹的正中位。在此情况下，为患者进行修复治疗经长期观察观察，未见颞颌关节出现异常改变。结论 牙尖交错位时，髁状突位于关节凹的正中位和后位的条件下，升高垂直距离1.2mm是安全可行的，不会引起颞颌关节的功能改变。     

髁突经咽侧位片干扰髁突显示因素的分析

髁突经咽侧位片可以清晰显示髁突骨质的变化，但其投照难度较大。在诸多影响髁突显示的因素中区分出主次将对临床工作有较大指导意义。本文对３９０侧（１６９例）颗突经咽侧位片和薛氏位片进行了详细的测量统计。结果表明关节形态对于照片效果的影响较小，而投照技术是主要影响因素，其一最主要的是ｘ线角度。特别应注意使病人的头部矢状面与胶片平行，而不能仅为矢状线与胶片平行。同时注意ｘ线入射点准确无误，再用手指触摸被照髁突，以确保其稳定于关节前结节下方。最后，使ｘ线球管尽量贴近对侧皮肤。     

髁状突骨折治疗效果的临床分析

本文对我院 1995～ 2 0 0 0年间收治髁状突骨折 2 4例 (32侧 )的治疗效果进行临床分析 ,报告如下 :1　临床资料1.1　一般情况　 2 4例中男性 2 2例 ,女性 2例 ,男女之比为11∶1,年龄范围 18～ 5 2岁 ,平均年龄 36 .5岁 ,单侧 18例 ,双侧 6例。骨折按骨折线部位分 3类 ,高位 (囊内 )骨折 8例 ,中位骨折 (髁颈 ) 16例 ,低位 (基部 )骨折 6例。1.2　髁状突骨折的诊断　根据临床表现为局部肿疼 ,牙合关系紊乱和下颌运动障碍外 ,主要依靠Ｘ线诊断分析 ,放射学包括曲面体层和下颌后前位片 (Ｔｏｗｎ投照法 ) ,另外 ,髁状突进行矢状与冠状的ＣＴ检…     

成人下颌偏斜患者颞下颌关节形态及位置的变化

目的：研究下颌偏斜患者颞下颌关节形态及其位置的变化.方法：对21例下颌偏斜患者和20例个别理想[牙合]志愿者拍摄颞下颌关节中位断层片,选择描述髁突位置及髁突和关节窝形态的15个指标进行测量及统计分析.结果：下颌偏斜患者双侧关节结节高度、关节窝指数增大,髁突后斜面与水平基准线的夹角减小;偏斜侧的关节前间隙、关节前后间隙面积比,髁突高度、髁突上部高度减小;对侧的关节上间隙、髁突高度、髁突上部高度、髁突前斜面与水平基准线的夹角、关节窝后斜面与水平基准线的夹角增大.结论：下颌偏斜患者的双侧髁突和关节窝形态及髁突在关节窝中的位置都发生了改变,尤其以非偏斜侧髁突变化较为明显.     

髁突经咽侧位摄片技术标准化研究

为了设计和验证标准化髁突经咽侧位摄片方法,使显示的髁突影像甲级片率提高,并明显改善该片的重复性,研制了定位摄片架和开口度测量板,使摄片水平角和垂直角保持在5度,摄片距离和髁突位置保持基本固定.与非定位片比较,甲级片率提高3倍,丙级片率降低90%,髁突影像重复率达75%,髁突影像稍有差异者25%.结论是标准化髁突经咽侧位摄影方法可以明显提高髁突显示的甲级片率,降低丙级片率,并有良好的可重复性.     

Transcranial radiography and linear tomography: a comparative study.

There is continual controversy concerning the use of radiographs to determine the position of the mandibular condyle within the glenoid fossa for the diagnosis and treatment of temporomandibular disorders. This study compared joint space measurements from transcranial radiographs and linear tomographs with the anatomic joint space to determine whether condylar position could be accurately recorded radiographically. Anterior, superior, and posterior joint space dimensions were measured from projected radiographs with a sonic digitizer, whereas anatomic joint space dimensions were recorded from the thickness of polyether impressions of the joint space. Posterior/anterior joint space ratios were used to classify relative condylar position as anterior, concentric, or posterior. The Pearson correlations (alpha = 0.05) were calculated to determine the consistency between radiographic and anatomic joint space ratios. The corrected and standard transcranial projections did not accurately reproduce the anatomic joint spaces or the relative condylar positions. Only the corrected tomographic projection accurately reflected the condyle-fossa relationships.     

Conventional radiographic and computed tomographic findings in cases of fracture of the mandibular condylar process

A total of 40 patients with 46 fractures of the mandibular condylar process were examined an average of 47 months after the injury. The conventional radiologic examination consisted of panoramic radiography and lateral transcranial view of the fracture in the mouth-open and mouth-closed positions. Sixteen patients with 21 fractures of the condylar process were examined additionally by computed tomography (CT) because of temporomandibular joint problems in the sagittal and coronal projection. Computed tomography revealed bony changes in the fractured mandibular condyle and its position in the mandibular fossa more exactly than conventional radiographic examinations. Furthermore, the results showed that disturbances in the position and function of the articular disc may be more common than was earlier anticipated, suggesting the more frequent use of CT examinations to evaluate temporomandibular joint changes after condylar process fractures.     

The position of the mandibular condyle at maximal mouth opening in normal subjects

: To investigate the position of the mandibular condyle at maximal mouth opening in individuals 19 to 30 years of age with no functional disorders of the masticatory system. : Measurements were made in 153 subjects (99 men, 54 women), and 41 men and 44 women had transcranial radiographs taken of their right and left temporomandibular joints in the closed and maximal opening positions. : In all subjects the condyle moved forward beyond the summit of the articular eminence, and in more than half the subjects the condyle was located inferior to the eminence at maximal opening. : The correlation between maximal opening and anterion shift of the condyle from the summit of the eminence was significant, but the correlation with vertical shift of the condyle was not significant. The correlation between the form of the glenoid fossa (length and depth) and anterior or vertical shift of the condyle from the summit of the eminence also was not significant.     

颅底结构螺旋CT影像的三维定量测量

目的　分析健康成人当下颌骨处在正常牙尖交错位时 ,髁突与颅底颈内动脉管外口、颈静脉窝、卵圆孔、棘孔、破裂孔等之间的空间位置关系 ,为术中对其他重要结构的位置评估提供依据。方法　选择健康成人 10 0名 ,在正常牙尖交错位时 ,用螺旋CT扫描、颅底三维影像重建 ,测量各结构间的最短距离和空间角度。 12个定点 ,测量 2 8项距离和空间角度以极坐标表示 ,髁突内缘点为中心点 ,髁突长轴为 0°轴作为参照系。结果　颌下入路能顺利显露髁突内缘点和髁突长轴的方向 ,以此为参照系 ,确定颈内动脉管外口外缘点为 12 0 1± 2 71mm ,5 14± 1 2 2° ,颈静脉窝外缘点为 15 11±2 72mm ,- 5 6 2 7± 14 0 5°。结论　以髁突内缘点为中心点 ,髁突长轴为 0°轴参照系有助于为颌下入路颅底手术的术中定位及颅底解剖教学提供参考。     

Associations between the location of the glenoid fossa and its remodeling. An experimental study in the rabbit.

The growth of the glenoid fossa is assumed to follow that of the cranial base. It has been observed recently that distal displacement in association with an obtuse cranial base angle is reduced on remodeling of the fossa anteriorly as a consequence of a more anterior position of the condyle in the fossa. The aim of this investigation was to simulate the increased distal displacement experimentally by causing a premature artificial cranial synostosis. Ten 10-day-old rabbits underwent gluing of the interparietal and temporoparietal sutures. These and ten controls were killed at 50 days for examination, and the articular surface of the right glenoid fossa was marked with a soft metal wire. The skulls were roentgenographed in standardized lateral projection. The articular surface was significantly shallower in relation to the skull base in the experimental group, and the glenoid fossa was located more superiorly and posteriorly. The most likely reason for the more horizontal direction of the articular surface is the more anterior location of the condyle, exerting increased pressure on the eminence. This becomes important, as it has recently been shown that in rabbits this shallowing of the fossa is associated with increased forward growth of the mandible.     

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。     

Pseudocysts of the mandibular condyle.

The panoramic radiographs of 507 consecutive patients receiving comprehensive dental treatment were evaluated for the presence of radiolucencies in the mandibular condyles. Nine patients met the study criteria. Five patients had bilateral and four patients had unilateral circumscribed radiolucencies in the anterior aspect of the condyle. Computerized tomography confirmed that these radiolucencies were age-related anatomic variants that were accentuated and distorted during panoramic radiography.     

The effects of positioning variations in transcranial radiographs of the temporomandibular joint: a laboratory study

The relationship of the mandibular condyle to the articular fossa and eminence as seen on transcranial oblique lateral (TOL) radiographs of the temporomandibular joint is used by some clinicians as an important diagnostic sign and indicator of treatment. The literature is divided on the validity of this. The aim of this study was to consider the effects of variations in both the position of the joint and the X-ray beam orientation on the image seen on TOL radiographs. TOL radiography of a mounted block specimen of a human temporomandibular joint and associated tissues was carried out using a range of specimen rotations (+20 degrees to -20 degrees with respect to the sagittal plane) and X-ray beam angulations (20 degrees, 25 degrees, 30 degrees). Analysis of tracings of the joint images showed that most of the parameters measured varied by statistically significant amounts with changes in either specimen rotation or beam angulation. It is concluded that any convention which purports to evaluate the position of the mandibular condyle in relation to the articular fossa from TOL radiographs is invalid when the orientation of the condyle to coronal and horizontal planes is unknown.     

An analytic method for evaluating condylar position in the TMJ and its application to orthodontic patients with painful clicking.

The purpose of this study was to develop a new method for evaluating the three-dimensional position of the mandibular condyle relative to the glenoid fossa and further to investigate its clinical application to orthodontic patients with temporomandibular disorders (TMD). A three-dimensional configuration of the temporomandibular joint was constructed by 108 triangles for the condyle and 180 triangles for the glenoid fossa. The shortest distance between the condyle and glenoid fossa (CGFD) was calculated in the model along a line perpendicular to the center of gravity of a triangle on the condyle. The CGFD was determined in the anterior, posterior, middle, lateral, and medial areas on the condyle. Preliminary investigation revealed that the present technique is accurate, regardless of condylar rotation and/or inclination to the tomographic table. The technique was applied to the diagnosis of orthodontic patients with painful clicking and TMD. It is shown that the present approach provides a method for evaluating the positional relationship between the mandibular condyle and glenoid fossa in patients with TMD.