颞下颌关节强直动物模型中最大张口度与强直严重程度关系研究

 目的　研究主、被动最大张口度（AMMO、PMMO）与颞下颌关节强直严重程度的关系。方法　选取28只健康雄性绵羊随机分为实验组和对照组,每组各14只。实验组绵羊双侧颞下颌关节模拟髁突矢状骨折,其中左侧翼外肌被切断以阻断其功能;对照组绵羊未进行手术。于术前及术后12、24周对所有绵羊体重、AMMO、PMMO、颞下颌关节形态学特点进行测量评估。结果　实验组只有右侧保留翼外肌功能的颞下颌关节发生了骨强直。术后12、24周,实验组绵羊AMMO、PMMO、极限距离均显著低于对照组,差异均有统计学意义（均P < 0.05）。实验组绵羊AMMO和PMMO与骨融合区宽度、长度、面积及钙化程度均呈负相关（均P < 0.05）,其中骨融合区面积为主要影响因素（术后12、24周相关系数r分别为-0.94、-0.95）。结论　颞下颌关节强直动物模型中阻断翼外肌功能可阻止骨强直的发生;对于早期髁突矢状骨折,可通过牙合垫或牙合板进行张口训练,进而阻断翼外肌功能。当颞下颌关节发生骨强直时,骨融合区面积越大,张口受限越明显。     

颞下颌关节强直动物模型中最大张口度与强直严重程度关系研究

目的　研究主、被动最大张口度（AMMO、PMMO）与颞下颌关节强直严重程度的关系。方法　选取28只健康雄性绵羊随机分为实验组和对照组，每组各14只。实验组绵羊双侧颞下颌关节模拟髁突矢状骨折，其中左侧翼外肌被切断以阻断其功能；对照组绵羊未进行手术。于术前及术后12、24周对所有绵羊体重、AMMO、PMMO、颞下颌关节形态学特点进行测量评估。结果　实验组只有右侧保留翼外肌功能的颞下颌关节发生了骨强直。术后12、24周，实验组绵羊AMMO、PMMO、极限距离均显著低于对照组，差异均有统计学意义（均P < 0.05）。实验组绵羊AMMO和PMMO与骨融合区宽度、长度、面积及钙化程度均呈负相关（均P < 0.05），其中骨融合区面积为主要影响因素（术后12、24周相关系数r分别为-0.94、-0.95）。结论　颞下颌关节强直动物模型中阻断翼外肌功能可阻止骨强直的发生；对于早期髁突矢状骨折，可通过牙合垫或牙合板进行张口训练，进而阻断翼外肌功能。当颞下颌关节发生骨强直时，骨融合区面积越大，张口受限越明显。     

Temporomandibular joint bony ankylosis: comparison of treatment with transport distraction osteogenesis or the matthews device arthroplasty

Temporomandibular joint (TMJ) bony ankylosis with micrognathia is a rare congenital condition that is difficult to treat and may result in recurrence. In a series of affected patients, we compared two new methods of treatment: transport distraction osteogenesis and Matthews Device arthroplasty. All patients had computed tomography scan documented bilateral TMJ bony ankylosis. Group I (transport distraction osteogenesis) underwent distraction advancement of the mandible (for micrognathia) followed by resection of the condyles, recontouring of the glenoid fossas with interposition temporoparietal-fascial flaps, and transport distraction osteogenesis of mandibular rami segments. Group II (Matthews Device arthroplasty) underwent all of the above procedures except for transport distraction osteogenesis. Instead, the Matthews Devices were anchored to the temporal bone and mandibular rami. Hinged arms allowed for motion at the reconstructed TMJ. In both groups, patients underwent extensive postoperative therapy. Preoperative, postoperative, and follow-up lateral cephalograms were obtained, and incisor opening distances were recorded. All patients but one had severe micrognathia (n = 9). For group I (transport distraction osteogenesis), mean age was 6.8 years. and mean advancement was 28.5 mm. For group II (Matthews Device arthroplasty) mean age was 8.2 years, and mean advancement was 23.5 mm. In group I (transport distraction osteogenesis), mean incisor opening was 1 mm preoperatively and 27.5 mm postoperatively; however, it relapsed to 14.3 mm by 12.5 months follow-up (48% relapse). Mean incisor opening in group II (Matthews Device arthroplasty) was 3.9 mm preoperatively and 33.4 mm postoperatively and remained at 30.6 mm after 11.1 months follow-up (8% relapse). One patient in group I (transport distraction osteogenesis) underwent surgical revision because of relapse. Our data showed that for congenital TMJ bony ankylosis both transport distraction osteogenesis and Matthews Device arthroplasty techniques were successful initially; however, the Matthews Device arthroplasty avoided long-term relapse.     

脱位性髁突矢状骨折手术治疗的近期疗效观察

目的总结脱位性髁突矢状骨折（DSFMC）的手术治疗经验。方法将22例28侧DSFMC分型,总结各类型DSFMC的手术治疗方法,并对术前及术后6个月患者的咬合关系、最大张口度、张口偏斜、髁突术后形态等进行观察比较。结果①DSFMC以Ⅱ型骨折最多,占57%;其次为Ⅲ型骨折和Ⅰ型骨折,分别占25%和18%。②5侧Ⅰ型骨折均行骨折片摘除术;16侧Ⅱ型骨折中,9侧行骨折片游离再植加微型接骨板坚固内固定术,5侧行骨折片摘除,2侧切除髁突;Ⅲ型骨折中有5侧行骨折片游离再植加微型接骨板坚固内固定术,2侧行摘除骨碎片,修整髁突残端。③22例患者术后6个月平均张口度为33.9 mm,平均张口偏斜1.5 mm,均比术前明显改善（P<0.05）。术后6个月咬合关系完全恢复正常17例,5例术后仍有1~2 mm的前牙开!,经调!后,咬合关系恢复良好。④术后再植髁突未见明显吸收,微型接骨板无明显变形。结论DSFMC手术治疗可以取得较好的效果,张口度、张口型均较术前明显改善,咬合关系恢复良好,再植髁突无明显吸收。     

Bilateral temporomandibular joint ankylosis as sequel of bilateral fracture of the mandibular condyle and symphysis

Background

Temporomandibular joint (TMJ) ankylosis is an extremely disabling affliction that causes problems in mastication, digestion, speech, appearance, and hygiene. The disease also has an impact on the psychological development of the patients.

Case report

A 49-year-old male patient came to our unit with complaint of restriction in his alimentation and of mouth opening. In the anamnesis, the patient reported that this limitation began 11 years ago, soon after a serious car accident that caused trauma on the face. In the clinical examination, the patient’s mouth opening was 1 mm, and there was satisfactory occlusion. He was diagnosed with bilateral temporomandibular joint (TMJ) ankylosis after an imaging examination.

Discussion

In order to confirm the post-traumatic etiology of the anquilose, we got the medical records from the hospital where the patient received the first treatment. The records, at that time, reported facial trauma with bilateral condylar fracture and comminuted symphyseal fracture which was reduced and fixed followed by maxillomandibular fixation that remained for 45 days. After collecting all the information needed for diagnosis, surgical treatment was proposed through arthroplasty. The patient was placed on immediate post-operative jaw physiotherapy, and 12 months after surgery, his mouth opening improved to 35 mm. Thus, in our case, ankylosis may have been developed as a sequel of the mandibular fractures.     

Clinical investigation of early post-traumatic temporomandibular joint ankylosis and the role of repositioning discs in treatment

This study investigated the development of temporomandibular joint (TMJ) ankylosis after condylar fracture and the functional results of surgery that included repositioning of the articular discs. In a total of 18 patients, there were 13 cases of fibrous ankylosis (type I) and 11 of partial bony ankylosis (type II). CT scans for both groups and MRI scans for type I patients were analysed. Intraoperative inspection of the damaged disc, the sites of adhesion or bony fusion, and remaining intra-articular movement was recorded. After release arthroplasty and repositioning of discs, follow-up was for 1 to 3.5 years (mean 2.2 years). Post-traumatic TMJ ankylosis was highly associated with sagittal and comminuted condylar fractures. Type I ankylosis usually formed in the 4th to 5th month post-trauma with mean interincisal opening distance of 18.3+/-5.5mm. Progression from type I to II ankylosis occurred 1 year post-trauma and caused a reduction of 5mm in the range of mouth opening. The disc was displaced for each of the involved joints, and intra-articular adhesions or ossification initiated at the site where there was no intervening disc present. After surgical repositioning of the disc, stable joint function and mouth opening from 30 to 45 mm were obtained in all patients but one (recurrence due to dislocation). Sagittal and comminuted condylar fractures predispose the TMJ to ankylosis, and the displacement of the articular disc plays a critical role. Early surgical intervention to reposition the disc was successful for early trauma-induced TMJ ankylosis.     

自体喙突移植重建髁突对儿童颞下颌关节强直患者下颌骨生长的远期影响

目的 儿童期下颌骨髁突受损通常导致错颌畸形和面部生长不协调。本研究目的是评价自体喙突移植重建下颌骨髁突对儿童颞下颌关节强直患者面部生长发育的远期影响。方法 追踪评估2008年1月1日至2016年12月31日期间收治于四川大学华西口腔医院正颌及关节外科的10名单侧颞下颌关节强直的儿童患者,其中包括3名男性和7名女性,于5~12岁期间接受了关节间隙成形术、同侧喙突移植髁突重建术和带蒂颞筋膜瓣置入术。术后追踪3~8年,平均4.9年。术后拍摄曲面断层X线片,测定患侧下颌体长度和下颌支高度的生长量并与健侧相比较。结果 所有患者术后恢复良好,追踪结束时10名患者的最大开口度为32~41 mm,平均35.6 mm。自体喙突移植重建髁突解除强直后下颌支高度和下颌体长度均继续生长,但是依然存在生长不足的现象。与初始数据（术后）相比,患侧下颌支高度（随访结束）增加了25.3%（P<0.05）,患侧下颌体长度增加了26.1%（P<0.05）。对比患侧与健侧的下颌骨生长率,患侧下颌支高度增长量与健侧相比少47.1%（P<0.05）,患侧下颌体长度的增长量与健侧相比少27.2% （P<0.05）。结论 自体喙突移植重建下颌骨髁突治疗儿童颞下颌关节强直后,患侧下颌骨可继续生长,但依然会存在生长不足的现象。在颞下颌关节强直治疗完成后,相比于健侧,患侧的生长率是减小的。     

Preservation of disc for treatment of traumatic temporomandibular joint ankylosis.

PURPOSE: A new operating method was used to treat traumatic temporomandibular joint (TMJ) ankylosis, to restore the structure of the TMJ, to improve the secondary maxillofacial deformity, and prevent recurrence of TMJ ankylosis. PATIENTS AND METHODS: Thirty-six patients (20 females, 16 males; aged 5 to 54 years old) with TMJ ankylosis type II or III of 1 to 16 years' duration, with a maximal mouth opening from 0 to 15 mm preoperatively participated. The new method was to separate bony fusion between condyle and glenoid fossa, remove the condylar fragment that displaced medially or anteroinferiorly, mobilize the remains of the disc over the condylar stump and suture it with articular capsule, and shave the surface of the condylar stump and glenoid fossa smooth. RESULTS: Follow-up was performed from 1 to 7 years postoperatively in 21 cases. No recurrences occurred in patients whose TMJ disc was retained during operation. Patients had an average maximal mouth opening of 33.7 mm postoperatively. An 11-year-old patient showed an improved facial symmetry after surgery. CONCLUSION: By restoring the normal structure of the TMJ and preservation of the disc, recurrence of traumatic TMJ ankylosis and facial deformity in younger patients can be prevented.     

创伤性颞下颌关节强直的病程特点与分类治疗

目的调查创伤性颞下颌关节强直（TMJA）的髁突骨折类型及病程特点；探讨各分类治疗方法及疗效。方法31例42侧创伤性TMJA，按Sawhney分类分成4型。Ⅰ型和Ⅱ型强直分别行关节松解和融合骨切除术＋关节盘复位术；Ⅲ型和Ⅳ型强直分别行全关节切除和全关节扩大切除术＋颞肌筋膜瓣衬垫术、选择性下颌支后缘垂直骨牵引及颏成形术。术后复查9～54个月（平均30个月），评价治疗效果。回顾调查引起强直的髁突骨折类型和强直发生的过程。手术与CT及MRI对照观察早期骨化部位、关节盘移位和关节残余运动方式。结果创伤性TMJA均继发于髁突矢状和粉碎性骨折，且关节盘发生移位者。I型（纤维性）强直通常出现在伤后4～5个月，平均张口度18．3mm。术中探及的关节盘全部发生移位，早期强直骨化发生在无关节盘区域。随诊期内，2例（6．45％）复发，其他患者张口度均稳定维持在30mm以上。结论髁突矢状和粉碎性骨折是最容易导致关节强直的骨折类型。关节盘移位是强直形成的重要因素。早期手术可以复位关节盘，避免后期强直时必须切除全关节。     

Gap arthroplasty of temporomandibular joint ankylosis by transoral access: a case series

This article describes a technique of gap arthroplasty in temporomandibular joint (TMJ) ankylosis performed by transoral access. The treatment of TMJ ankylosis by creating an adequate gap is of paramount importance in preventing any future recurrence and this can be achieved only when good access is gained to this complex anatomical joint. Five patients with TMJ ankylosis (eight TMJ) were treated by gap arthroplasty using an intraoral approach. The average mouth opening before surgery was 8.6 mm and the average mouth opening achieved postsurgery was 37.9 mm. The average follow-up time was 13 months and none of the patients had any recurrence or significant complications during or after surgery. Our technique relies on the use of a stable landmark to trace the superior-most extent of the ankylotic mass thereby facilitating the removal of the entire mass including the medial extent. We found that even though transoral access is technically challenging and took an average time of 84 min, it has many advantages over conventional extraoral approaches in terms of facial scars and facial nerve injury. The authors also emphasize the importance of good postoperative physiotherapy and presurgical patient counselling to prevent future recurrences.     

Management of temporomandibular joint ankylosis type III: lateral arthroplasty as a treatment of choice

Many surgical techniques for the management of temporomandibular joint (TMJ) ankylosis have been described in the literature. The purpose of this study was to report our experience using a lateral arthroplasty technique in the management of type III ankylosis. The records of 15 patients treated for TMJ ankylosis at our institution between 2007 and 2011 were reviewed. Pre- and postoperative information collected included age, gender, aetiology, ankylosis type/classification, existing facial asymmetry, maximum pre- and postoperative mouth opening, complications, and recurrence of ankylosis. The mean maximum inter-incisal opening in the preoperative period was 12.9 mm and in the postoperative period was 36.2 mm. No major complication was observed in any patient. No recurrence was noted in any patient. Our working hypothesis was that for patients with ankylosis type III, the medially displaced condyle and disc can fulfil their role in mandibular function and growth after extirpation of the ankylozed mass. Although they are located in an awkward medial position, they should function exactly as they would after a properly treated, displaced condylar fracture.     

保留颞下颌关节盘治疗外伤性颞下颌关节强直

目的：应用保留颞下颌关节盘的手术方法治疗外伤性颞下颌关节强直,达到恢复颞下颌关节结构、改善面部外形和防止术后复发的目的。方法：对36例外伤所致Ⅱ型和Ⅲ型颞下颌关节强直病例进行手术,男16例,女20例,年龄5～54岁,病程1～16a,最大开口度0～1.5cm。新的手术方法是凿开关节窝与髁突之间的骨性融合,凿除前内侧移位的髁突骨折碎片,将残余的关节盘向外牵拉、复位,与外侧关节囊缝合,同时将髁突与关节窝磨改光滑。结果：36例病例中,21例术后随访1～7a,保留关节盘手术的病例均无复发,术后平均开口度为3.37cm。1例11岁患儿术后面部畸形得到改善。结论：保留颞下颌关节盘正常结构在防止外伤性颞下颌关节强直手术后复发以及生长发育期患者面部畸形中具有重要作用。     

Development of temporomandibular joint ankylosis in rats: a preliminary experimental study

The objective of this study was to evaluate a model for the development of temporomandibular joint ankylosis in rats using disc removal and articular damage. In 30 adult male Wistar rats, articular damage was induced and disc removal performed in the right joint to induce ankylosis. The rats were divided into groups according to the time of killing (7, 15, 30, 60 and 90 days). Maximal mouth opening, mandibular deviation, initial and final weights, and duration of surgery were recorded and evaluated. After death, the joints were submitted to histological study in order to score the ankylosis. The mean duration of surgery was 14.23 min. Mean difference between initial and final maximal mouth opening was 3.38 mm, being greatest at the 15-day evaluation and lowest at 90 days, and was statistically significant at 15 days (p=0.043), 30 days (p=0.027) and 60 days (p=0.027). No mandibular deviation was observed at any of the evaluation times. Histological scores increased with time of evaluation from 7 to 30 days, when they started to fall. This study model permitted the development of fibrous ankylosis in the majority of the animals, and no bony bridge was observed between the mandibular condyle and the temporal bone.     

Treatment modalities of TMJ ankylosis: experience in Delta Nile,Egypt

The study reports the authors’ experience in managing TMJ ankylosis in Delta Nile, Egypt (1995–2006) and compares the surgical modalities used. 101 patients (109 joints) were reviewed in this retrospective study. Pre- and postoperative assessment included history, radiological and physical examination, and mouth opening. Age, sex, aetiology, joint(s) affected, surgical modality, complications and follow up periods were evaluated. Various types (fibrous, fibro-osseous and bony) of TMJ ankylosis were diagnosed; trauma was the commonest aetiology. The patients’ age range was 2–41 years, 62% were female, and the follow up period ranged from 14 to 96 months. Average mouth opening was significantly increased from 5.3 mm pre-operatively to 32.9 mm 12 months postoperatively (P = 0.0001). Marked improvement in mouth opening was documented when the ramus-joint complex was reconstructed using distraction osteogenesis (34.7 mm), costochondral graft (34.4 mm) and Surgibone (34.6 mm). Gap arthroplasty showed least satisfactory mouth opening compared with other techniques (P = 0.001). Minor and major complications were encountered in 33% of cases, including 5% recurrence rate. Early release of TMJ ankylosis; reconstruction of the ramus height with distraction osteogenesis or bone grafting combined with interpositional arthroplasty, followed by vigorous physiotherapy is successful for managing TMJ ankylosis.     

A clinical study on ankylosis of the temporomandibular joint.

INTRODUCTION: Restoration of normal function and jaw movement in patients with temporomandibular joint (TMJ) ankylosis is difficult. Various techniques have been defined for the treatment of the condition. PATIENTS: This study is based on the pre-, intra- and post-operative evaluation of 78 TMJ operations in 59 patients who were treated for TMJ ankylosis between 1985 and 2002. METHODS: The patients in this study were evaluated with regard to age, gender, aetiology of ankylosis, ankylosis type/classification, existing facial asymmetry, maximal pre- and post-operative mouth opening, the arthroplasty methods (gap and interpositional arthroplasty) including complications and recurrence of ankylosis. RESULTS: Falls represented the most widespread aetiological factor (85%), and women constituted the group with the highest incidence of ankylosis (61%). Forty cases were unilateral (68%) and 19 bilateral (32%); 82% (64 joints) were of the bony type. Gap arthroplasty was applied in 34 of the 59 cases (58%) and interpositional arthroplasty in the remaining 25 (42%). Pre- and post-operative mean mouth opening were 3.5+/-1.7 and 30.7+/-3.0mm, respectively. Re-ankylosis was noted in 5%. CONCLUSION: In addition to radical and sufficient resection of the ankylosed bone, early post-operative exercises, appropriate physiotherapy and close follow-up of the patient play an important role in the prevention of post-operative adhesions and re-ankylosis.     

Preservation of condyle and disc in the surgical treatment of type III temporomandibular joint ankylosis: a long-term follow-up clinical study of 111 joints

The purpose of this study was to establish the role of retaining the condyle and disc in the treatment of type III ankylosis, by clinical and computed tomography (CT) evaluation. A total of 90 patients with type III ankylosis met the inclusion criteria; 42 patients had left temporomandibular joint (TMJ) ankylosis, 27 patients had right TMJ ankylosis, and 21 had bilateral TMJ ankylosis, thus a total 111 joints were treated. Considerable improvements in mandibular movement and maximum mouth opening were noted in all patients. At the end of a minimum follow-up of 2 years, the mean inter-incisal mouth opening was 30.7 mm. Postoperative occlusion was normal in all patients, and open bite did not occur in any case because the ramus height was maintained through preservation of the pseudo-joint. Only three patients had recurrence of ankylosis, which was due to a lack of postoperative physiotherapy. The advantages of condyle and disc preservation in type III ankylosis are: (1) surgery is relatively safe; (2) the disc helps to prevent recurrence of ankylosis; (3) the existing ramus height is maintained; (4) the growth site is preserved; and (5) there is no need to reconstruct the joint with autogenous or alloplastic material. It is recommended that the disc and condyle are preserved in type III TMJ ankylosis.     

Association between maximum mouth opening and area of bony fusion in simulated temporomandibular joint bony ankylosis

The aim of this study was to investigate the quantitative association between active/passive maximum mouth opening (AMMO/PMMO) and the severity of simulated temporomandibular joint (TMJ) bony ankylosis. Twenty-eight male sheep were divided randomly and equally into surgical and control groups. Surgical group animals underwent bilateral TMJ osteotomy during which left lateral pterygoid muscle function was blocked. Control animals did not undergo surgery. Body weight, AMMO/PMMO, and TMJ morphological features were evaluated preoperatively and at 12 and 24 weeks post-surgery. In the surgical group, only the right TMJ complexes with maintained lateral pterygoid muscle function developed TMJ bony ankylosis. The AMMO/PMMO and end-feel distance in the surgical group were significantly lower than those in the control group (P < 0.001, both) at 12 and 24 weeks post-surgery. Moreover, AMMO (r = −0.940 and −0.952, P < 0.001, both) and PMMO (r = −0.944 and −0.953, P < 0.001, both) were negatively correlated with the area (mm²) of bony fusion post-surgery. These findings may be useful for the clinical treatment of early mandibular condyle fracture, with the use of occlusal pads/open-mouth plates to relax the lateral pterygoid muscle and block its function. When bony ankylosis developed in the TMJ, the greater the area of bony fusion, the more limited were AMMO/PMMO.     

髁突矢状骨折动物模型的实验研究

目的：建立髁突囊内矢状骨折动物模型,观察髁突骨折后不同时间的病理形态改变。方法：对10只绵羊进行实验,右侧关节为手术侧,从耳前区切开皮肤,到达颞下颌关节,切断关节盘前后附着,从髁突外侧嵴到内侧髁颈锯开髁突,建立斜形矢状骨折。髁突碎片和关节盘推向前下内侧,左侧关节为对照侧。分别于术后1周、4周和12周处死2只、4只和4只动物。记录术前和术后每组动物的体质量、最大开口度、侧方活动度,进行X线、CT和组织病理学观察。采用SPSS12.0软件包对数据进行统计分析。结果：各手术组体质量、左侧向活动度未发现显著差异,但是在4周和12周组中,最大开口度和右侧向活动度明显减小。在这2组中,X线检查发现髁突残端外侧有新骨生成,并向外侧生长,同时关节间隙变狭窄和模糊。三维CT检查发现,髁突残端、髁突碎片和关节结节均发生改建。组织病理学观察发现,在4周和12周组动物,关节腔充满纤维组织、软骨和骨组织。结论：该研究表明,此类骨折可以导致髁突骨关节病理改变,颞下颌关节有发展为关节强直的可能。     

正颌外科治疗颞下颌关节强直伴阻塞性睡眠呼吸暂停综合征

目的 评价正颌外科手术治疗颞下颌关节强直伴阻塞性睡眠呼吸暂停综合征(OSAS)的效果。方法 12例颞下颌关节强直伴OSAS患者(男4例，女8例，年龄10～25岁，平均18．4岁；双侧颞下颌关节强直8例，单侧颞下颌关节强直4例)，采用颞下颌关节成形术、下颌矢状劈开前徙术、颏前徙成形术、舌骨悬吊术以及牵张成骨术移动下颌骨和舌骨。术后随访3～36个月。结果 12例患者张口度由术前的0～2mm增大到术后25～40mm；术后患者颜面形态明显改善；其连续血氧饱和度最低值由术前的42％提高至术后的90％以上，睡眠呼吸障碍解除和睡眠质量获得提高。结论 在颞下颌关节强直伴OSAS患者的治疗中，行颞下颌关节成形术的同时，辅助正颌外科手术，不仅可以增大患者的张口度，而且还能解决患者下颌后缩的畸形，同时解除上气道狭窄，从而缓解或纠正患者的低氧血症。     

术中CT在颞下颌关节强直疗效评价中的应用

目的 探讨术中CT在颞下颌关节（temporomandibular joint,TMJ）强直手术治疗效果评价中的应用价值。方法 回顾分析2016年7月—2018年12月完成的4例颞下颌关节强直患者的临床资料,分析一般资料特点、强直类型、扫描时间、CT引导的术中修正及术后效果。结果 在术中CT的引导下,4例（5侧）颞下颌关节强直手术均顺利完成。术中CT平均耗时（10.2±3.3）min,3例进行了术中修正,修正率75%。所有患者术后创口愈合良好,开口度平均38.8 mm,患者满意度100%。结论 术中CT提高了TMJ强直手术的精确性,保证了手术的安全性和可靠性。