单侧有多种症状的颞下颌关节紊乱患者双侧关节锥形束CT对比研究

目的:探讨单侧有多种症状的颞下颌关节紊乱(temporomandibular disorders,TMD)患者双侧颞下颌关节(temporomandibular joint,TMJ)在锥形束CT(cone-beam computed tomography,CBCT)成像上可能存在差异的参考层面,为TMD诊断和对比研究提供参考.方法:选取仅一侧TMJ有多种症状的TMD患者(不含仅有一种症状的病例)50例,通过CBCT三维成像和重建,观察比较同一患者两侧TMJ重建后横断面的水平角;平行于髁突长轴的斜位关节间隙、髁突长轴径值、髁突垂直角;垂直于髁突长轴的斜位与矢状位的关节结节斜度、关节窝深度和关节间隙,采用SPSS 13.0软件包对每例患者上述各测量指标进行两配对样本t检验.结果:两侧TMJ在矢状位60°关节间隙时的测量值差异显著(P＜0.05),平行位120°关节间隙、矢状位90°关节间隙时的测量值差异显著(P＜0.01),其余测量值均无显著差异.结论:对于单侧有多种症状的TMD患者,矢状位或垂直位是较易观察到两侧关节有差异的位置,在这一层面重建意义较大.     

颞下颌关节紊乱病患者的三维咬合接触观察

目的 :探讨颞下颌关节紊乱病 (TMD)患者的咬合异常特征。方法 :2 3名无症状全牙列大学生志愿者和 10 1名全牙列TMD患者 ,取研究模 ,从垂直向、颊舌向、近远中向三维方向观察、记录并以指数评价咬合特征 ;TMD患者摄许勒片及侧位体层片 ,弹响关节摄造影片 ,分析咬合指数与颞下颌关节 (TMJ)影像变化的关系。结果 :66.3 %的TMD患者有垂直向咬合异常 ,其垂直向咬合指数明显高于对照组 (P <0 .0 5 ) ;垂直向咬合异常与TMJ影像结果间未见明显相关性 (P >0 .0 5 )。结论 :垂直向咬合异常与TMD临床表现有密切关系。     

成人正畸治疗与颞下颌关节紊乱病的MRI研究

目的 探讨成人正畸治疗与颞下颌关节紊乱病(temporomandibular disorder TMD)的关系,为预防和治疗TMD提供参考.方法 选择60例20 ～ 29岁成年正畸患者,用Helkimo指数将患者分为TMJ无症状组(44例)、TMJ有症状组(16例),分别于治疗前(t1)、治疗中(t2)、治疗后(t3),用MRI检查TMJ关节盘的位置,并用电子测量尺测量TMJ前、后间隙,观察颞下颌关节在治疗前后的变化情况与TMD间的关系.结果 治疗中TMJ无症状组、TMJ有症状组分别有8、9例患者发生TMD,两组TMD发生比例差异有统计学意义(P＜0.05);治疗前后两组均发现关节盘移位;两组治疗前后TMJ各间隙线距发生改变,但两组差异无统计学意义(P＞0.05).结论 成人正畸治疗不会导致TMD,但治疗过程中可诱发TMD症状,并有出现TMD重度症状的风险.在成人正畸治疗前对TMJ进行评估有重要意义.     

颞下颔关节磁共振FIESTA动态成像的诊断价值

目的:探讨颞下颌关节(TMJ)磁共振FIESTA动态成像的诊断价值.方法:对40例患者80侧TMJ进行常规静态磁共振扫描和斜矢状位FIESTA动态磁共振扫描.由2名医师分别对每侧TMJ FIESTA动态扫描时关节盘的位置、髁突的骨质改变和关节腔积液情况进行诊断,并与常规静态磁共振扫描诊断结果进行比较.结果:80侧TMJ磁共振FIESTA动态图像中,对关节盘移位的诊断,72侧与静态磁共振扫描结果相符,准确率为90％;对髁突骨质改变和关节腔积液的诊断,所有病例与静态磁共振结果完全相符,准确率达100％.结论:TMJ磁共振FIESTA动态图像诊断颞下颌关节内紊乱(TMJID)具有一定价值,但单凭动态检查结果不够全面,必须与常规静态磁共振扫描相结合.     

成人骨性下颌偏斜患者与正常人下颌骨及颞下颌关节单光子发射型CT/CT同机融合骨显像的比较研究

目的 采用单光子发射型(single-photo Emission CT,SPECT)CT/CT同机融合骨显像技术对成人骨性下颌偏斜患者与正常人下颌骨及颞下颌关节的生长差异进行比较研究.方法 选取成人骨性下颌偏斜患者20例和正常成人志愿者15例,进行SPECT/CT同机融合骨扫描检查,以分析比较下颌偏斜患者与正常人两侧下颌骨及颞下颌关节骨血流和骨代谢的差异性.结果 成人骨性下颌偏斜患者下颌骨不同部位的骨血流和骨代谢存在特定性差异,正常人下颌骨不同部位的骨血流和骨代谢存在特定性差异;正常人下颌骨不同部位左右两侧放射性计数值比值均接近于1,对称性较好;与正常对照组相比,骨性下颌偏斜患者放射性强度均为对侧高于偏斜侧;髁状突差异最大(P＜0.01),其次为下颌角(P＜0.01),下颌升支中份差异最小(P＜0.05);不同部位两侧差异均有统计学意义.结论 SPECT/CT同机融合骨显像在精确解剖定位的基础上,能更加准确显示颞下颌关节的功能变化.

Abstract：

Objective To investigate mandible and temporomandibular joint (TMJ) in adults with and without mandible deviation using SPECT/CT fusion imaging. Methods SPECT/CT fusion imaging over bilateral mandible and TMJ was performed in 20 adult patients with mandibular deviation and 15 adult volunteers without mandibular deviation. Results Compared with the control group, the radioactive intensity of contralateral side was higher than that of the deviated side in patients with mandibular deviation. The biggest difference was found in the condyle process (P＜0. 01) and the mandibular angle (P＜0. 01). Conclusions Based on accurate anatomical localization, SPECT/CT fusion imaging was very sensitive in detecting functional alteration in TMJ.     

颞下颌关节紊乱病关节液中尿纤溶酶原激活物及其受体的表达

目的 检测颞下颌关节(TMJ)关节液中尿纤溶酶原激活物(urokinase-type plasminogen activator,uPA)及受体(urokinase-type plasminogen activator receptor,uPAR)的分泌量,探讨TMJ液中uPA及uPAR与颞下颌关节紊乱病(TMD)的关系.方法 采用酶联免疫吸附实验法检测56例TMD患者的64侧关节和10名健康志愿者的16侧关节的关节液标本中的uPA及uPAR的量.将符合纳入标准的48侧TMD患者的关节液标本根据临床诊断分为关节炎性组(A组)、结构紊乱组(B组)、骨关节病组(C组),每组16侧;10名健康志愿者的16侧关节液设为对照组(D组).结果 TMD中A组、B组、C组、D组uPA的检出量分别为(51.200±8.786)ng/L、(53.667±11.894)ng/L、(81.278±25.828)ng/L、(17.960±9.859)ng/L;uPAR检出量分别为(5.840±0.179)ng/L、(6.168±1.465)ng/L、(2.416±0.525)ng/L、(2.416±0.525)ng/L.uPA和uPAR表达量均高于健康对照组(P＜0.05),C组uPA和uPAR表达量高于A组及B组(P＜0.05),但A组与B组差异无统计学意义(P＞0.05).结论 TMJ内过度分泌的uPA和uPAR可能参与了TMD关节组织的病理破坏过程;关节液中uPA和uPAR的水平可部分反映TMD病变的程度,可作为反映TMD关节损害和代谢的客观生化分子标志.     

血管化腓骨肌瓣下颌骨重建中髁突不同处理方法对颞下颌关节功能的影响评价

目的 对髁突采用不同处理方法的血管化腓骨肌瓣下颌骨缺损重建后评价患者的临床及颞下颌关节(TMJ)功能状态.方法 患者41例,其中男性21例,女性20例.41例均为累及下颌升支上部且未超过下颌中线的颌骨良性病损,其中应用腓骨替代髁突法重建24例、游离髁突法重建5例、保留髁突法重建12例.采用Fricton TMJ功能量表评价患者术后的TMJ功能,并进行统计学分析.结果 所有患者均未发生关节强直,术后最大开口度31～53 mm,平均值(42.8±5.7)mm.不同术式患者术后面部外形、进食及语音功能比较,差异无统计学意义(P＞0.05);但患者的TMJ功能指数,即功能障碍指数(dysfunction index,DI)及功能紊乱指数(cramiomandibular index,CMI)间比较,差异有统计学意义(P＜0.01).保留髁突组患者的TMJ功能优于腓骨替代髁突组.结论 保留髁突的血管化腓骨瓣下颌骨重建有助于恢复TMJ功能;以腓骨瓣末端替代髁突进行下颌骨重建时,重建髁突的位置和形态对于TMJ的功能有明显影响.     

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。     

单侧弹响的颞下颌关节紊乱病患者双侧关节锥形束CT对比研究

目的:探讨仅有单侧弹响的颞下颌关节紊乱病(temporomandibular disorders,TMD),患者双侧颞下颌关节(temporomandibular joint,TMJ)在锥形束计算机体层摄影(cone-beam computed tomography,CBCT)成像上存在差异的参考层面,为TMD诊断和对比研究提供参考.方法:选取一侧TMJ仅有弹响的TMD患者10例,通过CBCT三维成像和重建,观察同一患者两侧TMJ重建后横断面的水平角;平行于髁突长轴的斜位关节间隙、髁突长轴径值、髁突垂直角;垂直于髁突长轴的斜位与矢状位的关节结节斜度、关节窝深度和关节间隙,采用SPSS13.0软件包对每位患者上述各测量指标做两配对样本t检验.结果:上述横断面的水平角;平行于髁突长轴的斜位关节间隙、髁突长轴径值、髁突垂直角;垂直于髁突长轴的斜位与矢状位的关节结节斜度、关节窝深度和关节间隙等观察指标在同一患者中,左右两侧测量值均无统计学差异(P＞0.05).结论:对于单侧TMJ仅有弹响的TMD患者,锥形束CT不具有对比研究意义上的参考价值.     

应用磁共振评估无牙患者颞下颌关节关节盘位置

目的:探讨11例无牙患者双侧颞下颌关节(TMJ)关节盘-髁关系。方法:通过11例无牙患者的临床和磁共振(MRI)检查,记录其临床表现及双侧TMJ的MRI影像学表现,并比较两者之间的关系。结果:11例无TMJ症状的无牙患者的22侧关节中,10侧关节盘移位,占45%。其中,男性14侧关节中,4侧关节盘移位,占28.6%;女性8侧关节中,6侧关节盘移位,占75%。结论:无牙患者关节盘移位与临床表现无相关关系,无牙患者中,女性关节盘移位多于男性,缺牙可能造成无牙患者TMJ结构紊乱。     

成人与儿童颞下颌关节骨性形态比较研究

目的:比较成人与儿童颞下颌关节(temporomandibular joint,TMJ)骨性形态的差异。方法:用多排螺旋 CT(multislice CT,MSCT)对30例健康成年志愿者和20具咬合关系正常的儿童尸体 TMJ 扫描,结合影像中心保存的10例正常儿童 TMJ 的 MSCT 资料,在工作站上对上述60例120侧 TMJ 的 MSCT 图像进行多平面重建和参数测量,SPSS 软件对反映 TMJ 骨性形态特征的参数或其比值作统计学分析。结果:髁突纵轴倾斜角、髁突颈最小/髁突头最大横断面积、髁突前后径/关节窝前后径、髁突内外径/关节窝内外径、髁突在关节窝中后间隙/前间隙、关节窝前斜面倾角、关节窝深度、关节结节倾角,成人和儿童差异有显著性(P<0.05)。结论:成人与儿童 TMJ 骨性形态存在部分差异,它对 TMJ 疾病的防治有指导意义。     

Physiological effects of anterior repositioning splint on temporomandibular joint disc displacement: a quantitative analysis

Anterior repositioning splints (ARS) are used primarily for the management of temporomandibular joint (TMJ) anterior disc displacement with reduction (ADDwR). However, the exact physiological effects of ARS are still unclear. This study investigated the short and long‐term effects of ARS on disc and condyle angles/positions by metric analysis. Twenty‐two subjects diagnosed with ADDwR were recruited. Maxillary full‐coverage ARS were fabricated, and MRI of TMJs was obtained before splint treatment, immediate post‐insertion and 6 months after splint treatment. Disc–condyle relationship was determined by disc–condyle angle measurement. Disc and condyle positions were described as X‐Y coordinates with the summit of glenoid fossa as the origin of the coordinates. Thirty‐two TMJs were classified as ADDwR and 12 were normal. Upon ARS insertion, all TMJs with ADDwR got normal disc–condyle relationships. The condyles moved significantly forward and downward, while the discs moved significantly backward and upward. MRI at 6 months after treatment (without ARS insertion) indicated that only 40·6% (13/32) of the joints were maintained in the normal disc–condyle relationship. The majority of condyles returned to their pre‐treatment positions, while the discs generally moved anteriorly again. The use of ARS resulted in forward and downward condyle movement, and a concurrent backward movement of the disc resulting in ideal spatial disc–condyle relationship. The stability of this relationship, however, could not be maintained in the majority of TMJs upon ARS removal. Findings explain the good short‐term clinical outcomes with ARS and their relatively lower efficacy in the long term.     

前牙开(牙合)患者颞下颌关节间隙及髁突形态的锥形束CT评价

目的应用锥形束CT(cone-beam CT,CBCT)对前牙开(牙合)患者的颞下颌关节间隙及髁突形态进行测量分析,探讨前牙开(牙合)患者与正常覆(牙合)患者的颞下颌关节的差异。方法选取2014年6月至2020年8月于南京大学医学院附属口腔医院正畸科就诊的前牙开(牙合)患者54例(前牙(牙合)开组)和正常覆(牙合)患者54例(正常覆(牙合)组),对其拍摄的颌面部CBCT图像使用多平面重建技术重建颞下颌关节矢状位及冠状位图像。使用Ka-melchuk法测量颞下颌关节上、后、前间隙,根据髁突骨质情况将髁突形态分为正常型与异常型2类,对前牙开(牙合)组和正常覆(牙合)组进行关节间隙及髁突形态的统计学分析。将前牙开(牙合)组根据开(牙合)的程度分为3个亚组:(1)Ⅰ°开(牙合)组(开(牙合)距离<3 mm);(2)Ⅱ°开(牙合)组(3 mm≤开(牙合)距离≤5 mm);(3)Ⅲ°开(牙合)组(开(牙合)距离>5 mm),比较3个亚组间关节间隙的差异。结果前牙(牙合)开组与正常覆(牙合)组相比,颞下颌关节前、上间隙差异无统计学意义(P>0.05),颞下颌关节后间隙显著增宽(P<0.01);前牙开(牙合)组髁突骨质异常占52.8%,正常覆(牙合)组骨质异常占21.3%,两组间具有显著性差异(P<0.01)。与Ⅰ°和Ⅱ°前牙开(牙合)患者相比,Ⅲ°前牙开(牙合)患者髁突在关节窝内更靠前(P<0.05)。结论前牙开(牙合)患者的髁突在关节窝内位置更加靠前、髁突骨质异常比例较高。     

Cone-beam computed tomography findings of temporomandibular joints with osseous abnormalities

Objective

To evaluate the cone-beam computed tomography (CBCT) findings of temporomandibular joints (TMJs) with osseous abnormalities.

Methods

CBCT images of 88 TMJs in 44 patients with arthrogenic TMJ disorder and 40 normal TMJs of 20 asymptomatic patients were selected for the study. All images were used for evaluation of the condyles (position and width), glenoid fossae (width and depth), and joint spaces (anterior, posterior, and maximum superior). The frequencies of the condylar positions were compared between the two groups using the Chi-square test. The mean values of the remaining CBCT findings were compared between the two groups using the Mann?CWhitney U test.

Results

In the 88 TMJs with osseous abnormalities, a dorsal position of the condyle was most frequently seen (62/88), whereas central and ventral positions of the condyle were seen in two and 24 joints, respectively. The TMJs with osseous abnormalities exhibited a significantly lower mean value for the condyle width and a significantly higher mean value for the anterior joint space than the TMJs without such abnormalities.

Conclusions

Small and dorsally positioned condyles are characteristic CBCT findings of TMJs with osseous abnormalities.     

Location of the hinge axis and the kinematic centre in asymptomatic and clicking temporomandibular joints

The study aimed to compare the locations of the hinge axis and the kinematic centre in both clicking and non-clicking TMJs. The six degrees of freedom optoelectronic jaw movement recording system OKAS-3D was used to record open/close movements in 10 asymptomatic subjects and 30 subjects with a clicking joint. Movement paths of the hinge axis and the kinematic axis were calculated. A t-test was used in the analysis of the locations of the two condylar movement reference points. Variances between the values of the hinge and the kinematic axes were compared with the F-test. Locations of the hinge axis and the kinematic centre on the average did not differ significantly for the asymptomatic subjects at the group level (P>0. 05), while individually the locations differed 4.96 mm on the average. The difference between the hinge axis and the kinematic axis was significant for the group of subjects with clicking joints (P<0.01), with the average individual level difference of 9 mm. Variances differed significantly between the coordinates of the hinge and the kinematic axes between the two groups of subjects (P<0. 01). The study shows the importance of the choice of a condylar movement reference point for the study of condylar movements and suggests the use of the kinematic centre in such studies.     

Apoptosis in displaced temporomandibular joint disc with and without reduction: an immunohistochemical study

J Oral Pathol Med (2011) 40 : 103–110 Internal derangement (ID) of the temporomandibular joint (TMJ) is due to an abnormal relationship of the articular disc to the mandibular condyle, glenoid fossa and articular eminence. The two most common types of internal derangement are anterior disc displacement with (ADDwR) and without reduction (ADDwoR). Disc displacement is associated with degenerative tissue changes. The histological features of discs from patients with TMJ ID reflect a general remodelling caused by abnormal loading. A correlation has been demonstrated between TMJ ID and apoptosis. Few investigations have addressed the role of apoptosis or caspase activity in TMJ ID. The apoptosis activation process was studied in different areas of discs from 18 patients with ID (both ADDwR and ADDwoR) and four cadavers (controls), with emphasis on the expression of caspase 3, whose activation makes the death process irreversible. The results showed a greater proportion of caspase 3‐positive cells in ADDwR and ADDwoR than in control discs. Immunopositivity also varied between disc areas; in particular, in ADDwoR sections labelled cells were significantly more numerous (P < 0.01) in the posterior disc attachment than in the anterior and intermediate bands. In addition, a significantly greater proportion of labelled cells was seen in the anterior (+) and intermediate (++) band of ADDwR compared with ADDwoR discs both bands (P < 0.05). These data suggest the importance of programmed cell death in the progression of TMJ ID.     

MR abnormalities of the lateral pterygoid muscle in patients with nonreducing disk displacement of the TMJ

The aim of this study was to investigate the pathological changes of the lateral pterygoid muscle (LPM) using magnetic resonance imaging (MRI) in patients with anterior disk displacement with nonreduction (ADDnr) of the temporomandibular joint (TMJ) and to compare the abnormal findings of the LPM with the clinical symptoms and other pathological MRI alterations of the TMJ. Bilateral or unilateral ADDnr was demonstrated in 142 patents by MRI (176 TMJs; 106 females; 36 males; range 19 to 72 years; mean 43.9 years). In 123 TMJs, the LPMs were clearly observed in MRIs and analyzed in this study. Pathological changes of the LPM were found in 92 TMJs (74.8%) in MRI. Hypertrophy, atrophy and/or contracture were detected in the superior belly of the LPM (SBLPM) (35.8%, 44/123) or in the inferior belly of the LPM (IBLPM) (9.8%, 12/123) or in both bellies (29.3%, 36/123). The pathological changes of the LPM in MRI presented a significant association with the main clinical symptoms of TMJs with ADDnr, i.e. pain on jaw movement (P<0.01), pain in the LPM (P<0.01), pain in TMJ (P<0.05) and restricted jaw opening (P<0.05). The proportion of the abnormalities in LPM was significantly lower in TMJs with condylar limitation (63.6%) than in TMJs with condylar hypermobility (83.3%) and normal motion (88.9%)(P=0.008). Osteoarthritis was found to be correlated with condylar limitation (P<0.01). The results of this study indicate that the pathological changes of the LPM in TMJs with ADDnr could be detected by MRI and have a significant association with the main clinical symptoms of the patients. When condylar limitation happened, on the contrary, the pathological changes of the LPM in MRI were reduced. The alteration of the clinical symptoms in the patents with ADDnr might be associated with the pathological situations and symptoms of the LPM.     

Morphological differences in the temporomandibular joints in asymmetrical prognathism patients

OBJECTIVE: To investigate the morphology of the temporomandibular joints (TMJ) in skeletal asymmetry with prognathism. DESIGN: Three-group observational clinical study. SETTING AND SAMPLE POPULATION: University setting. Thirty-five patients undergoing orthognathic surgery without signs and symptoms of TMJ disorder were assigned to three groups (right deviation, n = 11; left deviation, n = 14; and non-deviation; n = 10) based on anteroposterior cephalometric analysis. OUTCOME MEASURE: Positional and morphological differences of the TMJs were evaluated using a total of 70 bilateral sagittal TMJ magnetic resonance images. RESULTS: In both the right and left deviation groups, the TMJ on the deviated side showed a significantly steeper eminence than that on the non-deviated side (p < 0.05). The anterior joint space was narrower on the deviated side than on the non-deviated side whereas the posterior joint space did not differ markedly, indicating an anterior position of the condyle in the glenoid fossa of the TMJ on the deviated side. Disk displacement comparisons revealed no significant differences between left and right sides in the symmetry or asymmetry group. CONCLUSION: Asymmetrical prognathism patients exhibit significant morphological differences between the right and left TMJs concerning the slope of the articular eminence, which correspond to facial asymmetry.     

A Tomographic Study of the Condyle/Fossa Relationship in Patients with TMJ Dysfunction

The authors undertook a tomographic study to evaluate the positional relationship of the bony components of the temporomandibular articulation. The sample group consisted of 35 patients with symptoms involving the temporomandibular joint. These were compared to a control group of 19 asymptomatic subjects who had “normal” occlusions. The condylar positions of the symptomatic and the asymptomatic TMJs of the sample group were compared with each other and with those of the control group.

Each of the subjects gave a complete dental history and underwent thorough intra- and extraoral examination. The authors used a submental vertex radiograph to determine the center of each condyle and the horizontal condylar angulation for each subject. The two values obtained from this were used to take a selective tomogram, in centric relation, of the condyles of all the subjects. An anterior prosthesis was used to obtain centric relation in each case.

The tomograms obtained from these subjects were enlarged ten times. Tracings and measurements were made of the enlarged images, and the measurements obtained were reduced by a factor of ten for recording. The authors then evaluated the position of the condyle within the glenoid fossa by comparing joint space measurements and by using a proportional analysis.