基于生物力学分析的分侧口内外联合法 治疗颞下颌关节前脱位

目的 探讨分侧口内外联合法治疗颞下颌关节前脱位的临床效果。方法 利用口颌系统姿态肌链平衡理论对颞下颌关节复位过程进行生物力学分析,改进复位手法;运用分侧口内外联合法治疗87例颞下颌关节前脱位患者,对临床效果进行评价。结果 分侧口内外联合法可有效避免升颌肌群反射性收缩,提高复位效率;87例患者均成功复位,术程用力轻巧高效,髁突下降指征明确,患者并发症少。结论 分侧口内外联合法是一种高效、便捷、微创的颞下颌关节前脱位复位方法,在临床上有一定的推广应用价值。     

陈旧性颞下颌关节脱位口内外联合手法复位法(附4例报告)

陈旧性颞下颌关节脱位手法复位常比较困雅。近几年来,我们应用“口内外联合手法复位法”对4例陈旧性颞下颌关节前脱位患者实行手法复位,取得了满意效果。 临床资料 本组4例患者,均为双侧颞下颌关节前脱位,全部为老年,其中50—60岁3例,70岁1例;男性3     

正畸治疗对下颌髁突肥大术后颞下颌关节的影响

目的:评价正畸治疗对下颌髁突肥大术后颞下颌关节的影响,并探讨其术后关节的稳定性。方法:下颌髁突肥大高位切除术后转诊患者20例,男8例,女12例,年龄17~34岁,平均21.2岁,采用固定或隐形正畸治疗,种植钉压低患侧上颌后牙。术前、术后及正畸后进行颞下颌关节功能对比,常规拍摄锥形束CT(CBCT),头颅定位侧位片,Tc99m_MDP颌骨计算机体层扫描(SPECT)检查,着重测量关节间隙的改变。结果:术前患侧和健侧比较关节间隙(包括前间隙、上间隙及后间隙)无统计学差异,手术后及正畸后各关节间隙手术侧与非手术侧差异有统计学意义。结论:髁突高位切除术联合术后正确的正畸治疗可以有效改善患者由于髁突肥大导致的颜面及错牙合畸形以及由此引发的颞下颌关节障碍,正畸治疗后髁突回到关节窝正常位置,患侧髁突改建,稳定性较好。     

透明质酸钠关节腔注射联合牙合垫治疗不可复性关节盘前移位的疗效评价

目的:评价关节腔注射透明质酸钠联合稳定性牙合垫治疗颞下颌关节不可复性盘前移位的临床疗效。方法:将在郑州市口腔医院就诊的40例不可复性盘前移位的患者随机分为实验组和对照组,实验组采用关节上腔注射透明质酸钠联合稳定性牙合垫治疗,对照组采用单纯的关节上腔注射透明质酸钠治疗,对比分析两组患者在治疗前、治疗后、治疗后3个月、6个月时的Friction颞下颌关节紊乱指数、疼痛视觉模拟评分(VAS)和最大开口度。结果:两组患者治疗后开口度、疼痛程度及颞下颌关节紊乱症状及体征与术前比较均明显改善,差异均有统计学意义(P<0.05)。实验组与对照组患者治疗后同时点比较,张口度差异不明显(P>0.05)。实验组患者治疗后及治疗后3、6个月时VAS、颞下颌关节紊乱指数(craniomandibular index ,CMI)和颞下颌关节功能障碍指数(dysfunction index , DI)低于对照组,差异均有统计学意义(P<0.05)。结论:关节上腔注射透明质酸钠联合牙合垫治疗颞下颌关节不可复性盘前移位疗效优于单纯的关节上腔注射治疗透明质酸钠。     

“分侧复位法”在颞下颌关节脱位中的应用与评价

对50例各类颞下颌关节脱位的患者使用"分侧复位法"进行颞下颌关节复位,1次成功49例、失败1例,无任何并发症发生,与传统的颞下颌关节复位术对比有操作简单、复位迅速、效果可靠、患者痛苦小等优点。     

髁突矢状骨折继发颞下颌关节强直31例临床分析

目的:探讨髁突矢状骨折继发创伤性颞下颌关节强直的临床特点。方法:回顾性分析2001～2010年武汉大学口腔医院口腔颌面外科收治的31例、48侧继发于髁突矢状骨折的颞下颌关节强直患者的相关临床资料。结果:31例颞下颌关节强直患者平均外伤年龄15.6岁,其中23例(74.2%)外伤年龄小于16岁。病程3月~20年,平均病程6.5年。42侧强直关节的关节盘发生移位,6侧强直关节的关节盘完全破坏。强直关节标本镜下观察:内侧髁突骨折块发生废用萎缩性改变,外侧骨球区见软骨细胞呈灶性增生成骨,关节盘纤维结构紊乱、玻璃样变性。结论:青少年髁突矢状骨折易发生颞下颌关节强直,关节盘的移位损伤是颞下颌关节强直发生的重要条件。创伤性颞下颌关节强直首先发生在关节外侧,融合骨赘的组织病理学表现为软骨化生、成骨。     

骨性II类下颌后缩伴前牙开正畸治疗一例

目的 探讨骨性II类患者伴颞下颌关节疾病导致的前牙开的临床治疗效果。材料与方法： 拔除上颌右侧第一前磨牙、上颌左侧第一前磨牙、下颌左侧第二前磨牙、下颌右侧第二前磨牙后,上颌后牙颊侧植入微种植体加强上颌支抗内收上前牙,下颌弱支抗内收下前牙,同时上颌后牙区腭侧置入微种植体辅助压低上颌后牙。结果 该病例在微种植体的辅助下,最终在颞下颌关节稳定的状态下建立正常的咬合关系,同时面型得到较好的改善。     

改良型治疗性义齿在颞下颌关节紊乱综合征患者咬合重建中的应用

目的 探讨改良型治疗性义齿在颞下颌关节紊乱综合征患者咬合重建中的应用。方法 使用改良型治疗性义齿对20例牙列缺损伴有颞下颌关节区器质性病变的患者进行咬合重建,分别在使用治疗性义齿期间及更换最终修复体后调查患者的主观感觉,检查临床症状,并采用Friction颞下颌关节紊乱指数（CMI）进行评估,采用SPSS 17.0软件进行统计分析。结果 患者佩戴治疗性义齿1个月后,关节区症状缓解有效率达到100%;佩戴最终修复体后,关节区舒适性以及修复体使用方面均能达到满意的疗效;CMI较治疗前明显下降（P<0.05）。结论 对于牙列缺损伴有颞下颌关节紊乱综合征（骨关节病）的患者,改良型治疗性义齿在咬合重建过程中可获得理想的疗效。     

颞下颌关节侧向脱位的复位

目的探讨颞下颌关节侧向脱位的诊治方法。方法根据颞下颌关节侧向脱位临床特点,对诊断为颞下颌关节侧向脱位的3例患者在局部麻醉下采取一手压、一手推的手法复位。结果3例患者均1次复位成功。复位后面部形态、面肌紧张度、咬合关系即刻恢复。结论根据颞下颌关节侧向脱位临床特点明确诊断。采用正确的手法可获得良好的复位效果。     

鸭嘴形开口器复位法治疗颞下颌关节脱位的临床应用

目的：介绍一种新的颞下颌关节脱位的复位方法。方法：185例（283侧）颞下颌关节前脱位，2例（3侧）颞下颌关节后脱位病例，应用鸭嘴形开口器置于脱位侧上下颌磨牙间，张大开口器，使磨牙间距达到1．5～2．0cm，然后旋转开口器，下颌关节前脱位者使下颌骨向后移位、下颌关节后脱位者使下颌骨向前移位，同时快速抽出开口器，使关节复位。结果：185例（283侧）颞下颌关节前脱位，2例（3侧）颢下颌关节后脱位病例的复位效果均满意。结论：该方法简便易行，可控性强，稳定性好，对不能用常规手法复位的病例同样安全有效。     

口内、口外手法复位在颞下颌关节急性前脱位中的临床疗效观察

目的：：观察口内、口外手法复位在颞下颌关节急性前脱位中的临床疗效。方法：随机数字表法将98例颞下颌关节急性前脱位患者分为口外和口内手法复位组,每组49例,评价组间复位成功率、复位成功时间、疼痛程度、收缩压( SBP)、舒张压(DBP)、心率(HR)变化和患者满意度。结果：口外手法组复位成功率(95.92%)及患者总满意度(76%)均高于口内手法组(81.63%)、(66%)；口外手法组复位成功时间(3.91±0.55) s、疼痛程度(3.51±0.25)均低于口内手法组(5.57±0.51) s、(6.6±0.21),且口外手法组SBP、DBP、HR,变化程度小于口内手法组SBP、DBP、HR,差异均有统计学意义(P<0.05)。结论：颞下颌关节急性前脱位时采用口外手法复位比口内手法效果更好。     

Endoscope-assisted conservative condylectomy in the treatment of condylar osteochondroma through an intraoral approach

Mandibular condylar osteochondroma (OC) can result in morphological and functional disturbances, including facial asymmetry and temporomandibular joint (TMJ) dysfunction. The aim of this study was to explore the feasibility of endoscope-assisted tumour resection and conservative condylectomy via an intraoral approach. Seven patients with condylar OC were enrolled in this study. Endoscope-assisted tumour resection and conservative condylectomy were achieved intraorally, and no conventional extraoral incision was needed. Direct vision of the magnified and illuminated operative field was realized with the assistance of an endoscope. No facial nerve injury or salivary fistula occurred in any patient. Stable occlusion was realized through postoperative orthodontic treatment. The patients showed no signs of tumour recurrence or TMJ ankylosis during follow-up (range 18–43 months). Endoscope-assisted condylar OC resection and conservative condylectomy via intraoral approach offers great advantages with no significant complications compared with conventional extraoral incisions. The endoscope provides us with a valuable treatment option for this potentially complicated procedure     

Post-surgical unilateral temporomandibular joint dislocation treated by open reduction followed by orthodontic treatment

A case of prolonged unilateral temporomandibular joint (TMJ) dislocation, which was treated by open surgical reduction and post-surgical orthodontic therapy, is presented. A 58-year-old woman presented complaining of facial asymmetry and malocclusion. She had received surgery for a malignant tumour in the right retromolar region 7 years previously. It was considered that contraction of the pterygoid muscle by surgical injury caused anterior meniscal displacement and TMJ dislocation. Since manual manipulation failed, direct open reduction was performed after separation of the lateral pterygoid muscle from the condylar head and removal of the intra-articular scar tissues. Although the condylar head was returned to the glenoid fossa, optimal occlusion was not obtained because of compensatory tooth movement and inclination. Satisfactory occlusion and symmetric facial appearance were brought about by post-surgical orthodontic therapy.     

颧蝶缝在颧骨骨折复位中的作用评价

目的：评价颧蝶缝在颧骨骨折复位中的意义,寻找颧蝶缝的暴露方法。方法：以尸头为研究对象,人为造成颧骨骨折后,先后采用常规复位方法及以颧蝶缝为复位标准方法进行复位固定,比较复位效果。分别采用口内及口外2种方法暴露颧蝶缝。结果：暴露颧蝶缝并直视下复位颧蝶缝再复位其他可见骨折线,能使颧骨骨折达到解剖复位,口内法仅能触摸到不能直视该缝,口外法可直视该缝全部。结论：颧蝶缝可作为颧骨复位的可靠标准,口外法为暴露颧蝶缝的可靠方法。     

内置式下颌骨牵引成骨术的早期并发症及防治

目的 总结内置式下颌骨牵引成骨术(DO)术中和术后早期并发症，探讨其有效防治方法。方法 对1997年11月～2002年12月间应用DO治疗的48例(83侧)下颌骨畸形或缺损患者进行分析。其中颞下颌关节强直伴小颌畸形双侧13例、单侧9例，下颌骨发育不足或小颌畸形14例，第一、二鳃弓综合征单侧5例、双侧1例，爆炸伤或肿瘤术后缺损畸形5例，Treacher Colins综合征1例，伴睡眠呼吸暂停综合征(OSAHS)者19例。所有病例均采用口内或(联合)口外切口并应用内置式牵引器。总结自施行手术开始至牵引完成期间的并发症及处理措施。结果 6例患者出现术中或术后早期并发症，发生率为12．5％，其中牵引机械装置故障2例，骨皮质切开术不彻底1例，早期感染1例，前牙严重开He1例，牵引早期疼痛剧烈1例，积极处理后均达到预期治疗目的。结论 减少DO术中及术后早期并发症的关键在于充分理解下颌骨牵引成骨术的机理，熟悉掌握下颌骨及邻近解剖结构，熟练操作规范，充分的术前准备和术后护理尤为重要。     

手法复位在单侧颞下颌关节前脱位复位中的应用

目的:探讨单侧颞下颌关节前脱位手法复位法。方法:对32例单侧颞下颌关节前脱位患者,采用单手法复位。结果:全部病例均复位成功,复位时间短,复位过程中患者配合好,无明显痛苦。结论:单手复位法是单侧颞下颌关节前脱位的有效复位方法。     

Extraoral or intraoral approach in the oblique sliding osteotomy of the mandibular rami? Clinical experience and results

The clinical results of oblique sliding (subcondylar) osteotomy of the mandibular rami performed by the extraoral or intraoral approach were compared. The patient material comprised 40 patients with mandibular prognathism. Twenty patients were operated upon using the extraoral approach and 20 patients were operated on using the intraoral approach. All patients had intermaxillary fixation for 7 weeks. The patients in both groups were followed up for 18 months. The experience of the operations was that the intraoral approach gave a shorter operation time than the extraoral approach. The extraoral approach, however, gave better visibility in the operation field and greater possibilities of manipulating the proximal fragment into an optimal position. In the follow-up evaluation, there were no significant differences between the two surgical techniques with regard to dental relapse, post-operative occlusion and mandibular function.     

Comprehensive digital approach with the Digital Smile System: A clinical report

This clinical report describes a comprehensive digital approach with the Digital Smile System (DSS) and its clinical use in the prosthetic treatment of a patient for whom 6 anterior maxillary porcelain veneers were fabricated. Following this digital protocol, extraoral facial images and a diagnostic intraoral digital scan were obtained. Digital smile analysis, virtual diagnostic waxing, and milled trial restorations were made in the diagnostic phase. After tooth preparation, data from digital scans were used in the computer-aided design and computer-aided manufacturing (CAD-CAM) of the definitive restorations.     

声电图在可复性颞下颌关节盘前移位诊断中的临床价值

目的研究可复性颞下颌关节（TMJ）盘前移位关节杂音的波形和声电图特点，探讨其临床应用价值。方法利用计算机系统记录，用K6-I软件分析健康人群、可复性关节盘前移位、不可复性关节盘前移位、骨关节病的TMJ杂音声电图特点，并观察利用声电图辅助诊断可复性TMJ盘前移位的灵敏度和特异度。结果在可复性关节盘前移位关节杂音的声电图中反复出现一种波形，在健康TMJ、不可复性关节盘前移位、骨关节病TMJ杂音中未出现或很少出现该波形。利用声电图辅助诊断TMJ盘前移位的灵敏度为77．2％，特异度为93．3％。结论这种波形可能是可复性关节盘前移位关节杂音的特征波形，声电图检查可能是一种临床辅助诊断TMJ盘前移位的新方法。