下颌升支矢状截骨术后肌功能康复训练的临床探讨

目的 探讨肌功能康复训练对下颌升支矢状截骨术后功能恢复的作用.方法 利用自行研制的张口训练器,借鉴国外的功能训练方法 ,对接受下颌升支矢状截骨术的27例患者进行被动张口训练和有阻力的肌肉耐力训练,在颌间牵引拆除后2～3 d,使用张口训练器插入牙列间锻炼张口度,5 min/次,3～4次/d.在张口度达到20～25 mm后进行肌肉耐力训练.患者用后牙咬合施加阻力后的张口器并维持5 s后,松弛5 s再咬合,反复进行,5 min/次,3～4次/d,持续3～4周.27例康复训练结果 与20例接受同类手术未行功能康复训练的患者对比.结果 接受肌功能训练的患者术后4周时张口度[(34.72±3.75)mm]已接近术前水平,8周时(牙合)力[(231.08±62.52)N]达到术前水平.未接受肌功能训练的患者在术后4、8周时张口度[(28.42±4.11)mm]和(牙合)力[(210.90±73.40)N]均值仍低于术前,差异有统计学意义(P＜0.05).结论 系统和规范的肌功能康复训练,并配合使用新型张口训练器,能加速下颌升支矢状截骨术患者口颌系统功能的恢复速度.     

下颌升支矢状劈开截骨术后退和前徙下颌骨对下颌运动范围的影响

作者对接受下颌升支矢状劈开截骨术患者（下颌骨后退１１例，下颌骨前徙１０例）手术前自下颌运动范围进行了测量，并对颞下颌关节进行了临床检查。发现在术后６个月时，后退组患者的张口度已恢复到术前水平，前徙组患者的张口度仍低于术前，且差异有高度显著性（Ｐ＜０．０１），术后两组患者下颌前伸和侧向运动（左右）均无明显变化。提示下颌升支矢状劈开截骨术后退下颌骨对患者张口度影响较小，且术后恢复较快。     

下颌骨矢状劈开后退术对颞下颌关节的影响

目的:评价下颌骨矢状劈开后退术对颞下颌关节(TMJ)的影响.方法:研究我院50 例术前有颞下颌关节病(TMD),且行下颌骨矢状劈开后退术的患者,从关节压痛、弹响、张口度、张口型等方面量化评估术前、术后颞下颌关节症状变化情况.结果:从关节压痛、弹响、张口度、张口型等各方面评估均显示术后颞下颌关节症状评分均显著低于术前(P<0.05).结论:对于术前有颞下颌关节病的患者,行下颌骨矢状劈开后退术可以有效改善颞下颌关节症状.     

下颌升支矢状劈开术后正畸快速建立咬合关系的研究

目的:探讨快速建立下颌升支矢状劈开术后患者咬合关系的方法。方法:37例术前未做正畸治疗的下颌前突患者,下颌升支矢状劈开术后第2日即开始用固定矫治器快速正畸,利用带钩方丝托槽行颌间牵引建立咬合。结果:3～7个月内患者基本上建立正常的咬合关系,恢复咬合功能。结论:!下颌前突患者行下颌升支矢状劈开术后立即开始正畸治疗可以快速建立咬合关系。     

下颌升支矢状劈开截骨术后下颌骨短期稳定性的三维分析

目的:本研究利用三维测量方法分析下颌骨在下颌升支矢状劈开截骨术后短期内的复发趋势.方法:收集在北京大学口腔医院接受正颌-正畸联合治疗并行下颌升支矢状截骨手术的患者共49例,分为下颌前徙患者22例,下颌后退患者27例,收集术前4 d(T0)、术后4 d(T1)、术后4～6周(T2)、3个月(T3)的CBCT数据,利用计算...     

下颌支矢状骨劈开术数字模型的建立及不同固定方式的稳定性分析

目的:建立下颌支矢状骨劈开术数字模型,探讨3种不同固定方式的应力及位移改变.方法:CT扫描数据导入三维重建软件Mimics以及Geomagic中,建立下颌骨三维实体模型,并进行矢状劈开、坚固内固定,ANSYS进行网格划分,建立三维有限元模型.边界约束后,进行双侧下颌第一磨牙咬合力(132 N)加载.结果:建立了双侧下颌支矢状骨劈开术3种不同固定方式三维有限元模型,获得术前下颌骨及矢状骨劈开后咬合力加载的应力及位移生物力学特点.结论:下颌支矢状骨劈开术倒L形固定应力分布最均匀,劈开处位移最小,与其他2种方式相比,其固定稳定性最佳.     

猴下颌升支矢状骨劈开前徙术后骨愈合区的X线和光镜研究

通过对猴下颌升支矢状骨劈开前徙术后3、6、12和24周时骨段连接区的X线和光镜组织学研究发现，术后的骨愈合过程以次级愈合为主。术后第6周可获得相对稳定的骨连接。在达到充分减张的前提下，尽可能保留升支内外侧肌附丽，有利于提供充足血供和促进骨愈合。下颌升支矢状劈开前徙术有充足的骨创界面，是矫治颌骨畸形的一种理想手术。     

下颌偏突颌畸形患者手术前后（牙＋合）力、咀嚼效能的变化

目的：研究下颌偏突颌畸形患者手术前后胎力,咀嚼效能的变化,并探讨其影响因素．方法：从2008年2月～2008年10月对24例在武汉大学口腔医学院接受正颌手术的下颌偏突颌畸形患者。根据畸形的具体情况,将其分为两组,仅接受双侧下颌升支矢状劈开截骨术16例（单颌治疗组）,接受LeFort Ⅰ型截骨术合并双侧下颌升支矢状劈开截骨术8例（双颌治疗组）。利用咬合力计和分光光度计分别对两组患者术前、术后l、3、6个月的胎力和咀嚼效能进行测定。结果：术后1个月时,两组患者胎力及咀嚼效能显着低于术前。术后3个月时,两组患者胎力和咀嚼效能已有明显改善。术后6个月时,单颌治疗组患者的胎力均值超过术前,而双颌组患者的咀嚼效能均值也高于术前。结论：正颌手术短时间内对下颌偏突颌畸形患者的胎力、咀嚼效能影响较大。随着手术后患者对新的胎关系逐渐适应,其胎力和咀嚼效能均有明显变化。单颌治疗组胎力改善较快,双颌治疗组咀嚼效能提高更明显。     

双侧升支矢状劈开截骨后退下颌术后骨的稳定性的研究

目的：探讨双侧升支矢状劈开截骨术（BSSRO）后退下颌骨以钢丝结扎固定两骨段加颌间固定术后骨的稳定性，了解导致复发的有关因素。方法：双侧下颌升支矢状劈开截骨手术后退下颌的患者14例，于手术前1周，手术后1周，术后6个月分别拍摄定位头颅侧位片及许勒位X线片，用于测量下颌移动的距离及确定下颌骨髁状突的位置。结果：双侧下颌升支矢状劈开截骨后退术后，6个月的复发率为27.2%，多元逐步回归分析示下颌后退的距离与复发相关。结论：BSSRO后退下颌骨的距离越大，术后下颌骨向前移位的可能越大。     

双侧下颌支矢状劈开截骨术后咽腔气道的变化

目的：通过头影测量分析骨性下颌前突患者双侧下颌支矢状劈开截骨术后咽腔气道的变化,为术后保持与防止复发提供依据。方法骨性下颌前突患者20例,均接受口内入路的下颌支矢状劈开截骨术。术前1周、术后1周、术后6个月拍摄标准颅颌侧位片进行头影测量,通过治疗前、后对照,比较下颌支矢状劈开截骨术后咽腔气道的改变。采用SPSS 17.0 软件包对数据进行统计学分析。结果术后1周与术前1周相比,软腭长度显著增加,咽腔气道显著减小;术后6个月咽腔气道有所恢复,与术后1周相比软腭长度显著减小,咽腔气道显著增加;术后6个月与术前1周相比,软腭长度及咽腔气道变化无显著差异。结论骨性下颌前突患者行双侧下颌支矢状劈开截骨术后短期内咽腔气道较术前显著减小,可能加大发生睡眠呼吸暂停综合征的几率。但经过一段时间的组织适应和改建后,咽腔气道有恢复至术前宽度的趋势。     

The effect of physical rehabilitation on mandibular function after ramus osteotomies

The efficacy of a systematic regimen of rehabilitation of mandibular function after ramus osteotomy was investigated. Forty-eight patients who had had either sagittal split ramus osteotomy to advance the mandible or intraoral vertical ramus osteotomy to retract the mandible were studied; 24 patients received rehabilitation and 24 did not. Pre- and postsurgical maximal mandibular opening, lateral and protrusive mandibular movements, maximum bite force, muscle fatigability, and clinical evaluation of the temporomandibular joints were compared between the two groups. Patients who underwent an intraoral vertical ramus osteotomy did not show a significant decrease in any of the parameters measured whether or not rehabilitation was used. However, patients who underwent sagittal split ramus osteotomies without subsequent rehabilitation had significant decreases (P less than 0.05) in mean mandibular opening and bite force as well as increases (P less than 0.05) in muscular fatigability compared with patients who underwent rehabilitation. These findings indicate the need for routine preoperative evaluation of mandibular and temporomandibular joint function and postsurgical physical rehabilitation after ramus osteotomies.     

Hypomobility after maxillary and mandibular osteotomies

A retrospective recall study of forty patients was made to examine mandibular function after orthognathic surgery. Maximum maxillomandibular opening, protrusion, and lateral excursions were measured and compared with similar mandibular movements in a control group of patients of comparable age. Six months to 42 months after maxillary and mandibular osteotomies, the majority of patients demonstrated decreased maxillomandibular opening compared to the control group 54.8 mm (SD 4.7). The decrease was most dramatic in patients previously treated with sagittal split ramus osteotomies. The mean maxillomandibular opening after Le Fort I osteotomy to reposition the maxilla superiorly was 48.7 mm (SD 5.7); after bilateral intraoral vertical ramus osteotomies to retract the mandible it was 48.6 mm (SD 5.7); and after bilateral sagittal split ramus osteotomies to advance the mandible it was 35.1 mm (SD 6.7). The presence of mandibular hypomobility after orthognathic surgery and maxillomandibular immobilization may be due to pre-existing or surgically induced muscle or temporomandibular joint dysfunction. Our findings indicate the need for routine clinical assessment of mandibular function preoperatively and for a systematic regimen of muscular and occlusal rehabilitation postsurgically to normalize muscle function, condylar movement, and range of mandibular motion.     

Management of superolateral dislocation of the mandibular condyle: A retrospective study of 10 cases

IntroductionSuperolateral dislocation of the mandibular condyle (SDMC) is rarely described. The best treatment for superolateral dislocation of the fractured mandibular condyle (SDMC) is debated. This study investigated selection of the timing and techniques used in treating these fractures.Patients and methodsA retrospective clinical study was conducted on clinical data from 10 SDMC patients. Maximum mouth opening and occlusal relationships were compared following treatment using different techniques.ResultsThe 10 patients were followed for 6–25 months. Patients who had dislocation for less than 1 week had condylar reduction and rigid internal fixation of the fractures.Mandibular sagittal split ramus osteotomy and articular reduction and fixation were performed in seven cases. Postoperative mouth opening and occlusal relationships were satisfactory in all patients with the exception of one case with mouth opening of only 27 mm.ConclusionsFor all patients with superolateral dislocation, our first approach was to reduce the bone stump through surgery. When the dislocated joint had become adherent to the surrounding tissues and ankylosis developed, mandibular sagittal split ramus osteotomy was performed with good results.     

Removal of a deeply impacted mandibular third molar through a sagittal split ramus osteotomy approach

We describe the case of a 48-year-old man who, after a 5-year history of recurrent infection and intermittent trismus associated with a deeply impacted lower right third molar tooth, presented to the accident and emergency department with severely limited mouth opening, extensive facial swelling and pyrexia. The lower right third molar was later removed successfully through a sagittal split ramus osteotomy approach. This case shows that the sagittal split osteotomy continues to have a valuable role in the removal of deeply impacted lower third molars, particularly when they are in close proximity to the inferior alveolar nerve.     

正颌外科技术治疗颞颌关节强直后睡眠呼吸暂停综合征(附9例报告)

目的：评估用正颌外科技术矫治９例颞颌关节强直所致睡眠呼吸暂停综合征的效果。方法：采用患侧关节成形,下颌升支、体部的“Ｌ”型半层截骨及健侧矢状截骨术,将患侧下颌升支加高固定,下颌前部整体前移。结果：９例颞颌关节强直后睡眠呼吸暂停综合征患者术后张口度达２．５～３．５ｃｍ,连续血氧饱和度最低值由术前的５８％提高至术后的９５％以上,唾眠呼吸暂停综合征得以治愈。结论：颞颌关节强直后睡眠呼吸暂停综合征患者通过正颌外科手术可以在关节成形的同时,解决患者下颌后缩的缺陷,解除上气道狭窄,从而缓解或纠正患者的低氧血症。     

Original sagittal split osteotomy revisited for mandibular distraction

Introduction: A malformed mandible and an abnormally positioned mandibular foramen make it difficult to plan an ideal osteotomy line for mandibular distraction. In addition, there have been reports of such complications as nonunion, damage and stretch injury of the inferior alveolar nerve and tooth germ damage when conventional osteotomy or corticotomy are used for mandibular distraction. The authors utilized the original sagittal split ramus osteotomy for mandibular distraction. Patients and Methods: Five patients (three unilateral hemifacial microsomia, one bilateral hemifacial microsomia, and one mandibular retrusion) were included in this study of distraction osteogenesis using the sagittal split ramus osteotomy. Extraoral distraction devices were applied to the first four patients. An intraoral device with mono-cortical screw fixation was used for the fifth patient. Result: In all five cases, the results of the distraction were satisfactory. Complications (as listed) of conventional osteotomy when used for distraction were avoided. Satisfactory results were achieved and these were also well maintained postoperatively (mean follow up: 36 months). Conclusion: The authors believe that sagittal osteotomy for mandibular distraction osteogenesis makes it possible, to avoid injury to the inferior alveolar nerve during operation and stretching injury during distraction and to prevent tooth germ injury. It is also possible to diversify the osteotomy line for various force vectors to enlarge the bony contact surface area. Therefore, we suggest that sagittal split ramus osteotomy should be used as a preferred modification of osteotomy for mandibular distraction. Copyright 2001 European Association for Cranio-Maxillofacial Surgery.     

Original sagittal split osteotomy revisited for mandibular distraction.

INTRODUCTION: A malformed mandible and an abnormally positioned mandibular foramen make it difficult to plan an ideal osteotomy line for mandibular distraction. In addition, there have been reports of such complications as nonunion, damage and stretch injury of the inferior alveolar nerve and tooth germ damage when conventional osteotomy or corticotomy are used for mandibular distraction. The authors utilized the original sagittal split ramus osteotomy for mandibular distraction. PATIENTS AND METHODS: Five patients (three unilateral hemifacial microsomia, one bilateral hemifacial microsomia, and one mandibular retrusion) were included in this study of distraction osteogenesis using the sagittal split ramus osteotomy. Extraoral distraction devices were applied to the first four patients. An intraoral device with mono-cortical screw fixation was used for the fifth patient. RESULT: In all five cases, the results of the distraction were satisfactory. Complications (as listed) of conventional osteotomy when used for distraction were avoided. Satisfactory results were achieved and these were also well maintained postoperatively (mean follow up: 36 months). CONCLUSION: The authors believe that sagittal osteotomy for mandibular distraction osteogenesis makes it possible, to avoid injury to the inferior alveolar nerve during operation and stretching injury during distraction and to prevent tooth germ injury. It is also possible to diversify the osteotomy line for various force vectors to enlarge the bony contact surface area. Therefore, we suggest that sagittal split ramus osteotomy should be used as a preferred modification of osteotomy for mandibular distraction.     

Treatment of painful temporomandibular joint dysfunction with the sagittal split ramus osteotomy.

PURPOSE: We describe a new indication for the sagittal split ramus osteotomy with rigid fixation to treat patients with painful dysfunction of the temporomandibular joint. PATIENTS AND METHODS: Ten patients for whom nonsurgical management failed were found to have a mandibular condyle positioned postero-superior within the glenoid fossa with reduced joint space on corrected-axis tomograms. The sagittal split ramus osteotomy was used to reposition the proximal segment and to increase joint space. Preoperative and long-term postoperative (average, 44.7 months) symptoms and tomographic findings were retrospectively compared. RESULTS: Significant pain relief occurred postoperatively in all patients. One patient had a relapse after initial improvement. No patient developed a malocclusion. The long-term radiographic condyle-fossa relationship tended to return to its preoperative position with no relapse of clinical symptoms, except in the 1 patient. CONCLUSION: The sagittal split ramus osteotomy with rigid fixation is another procedure that can be used to treat painful temporomandibular joint dysfunction by changing the position of the mandibular condyle in the glenoid fossa.