改良切口关节盘锚固术治疗颞下颌关节盘不可复性前移位的临床评价

目的: 评价应用改良切口关节盘锚固术治疗颞下颌关节盘不可复性前移位的临床疗效。方法: 选取2014年9月—2016年9月我院颞下颌关节专科就诊的24例（30侧）颞下颌关节紊乱病患者,采用改良切口颞下颌关节盘锚固术进行治疗, 分析术前、术后6个月不同时期患者的疼痛值、开口度的变化及MRI影像学表现,采用SPSS17.0软件包中的t检验评价手术效果。结果: 治疗前平均开口度为（23.63±3.31）mm(17~29 mm),治疗后平均开口度为（38.00±2.30）mm(32~42 mm),治疗后开口度≥35 mm 的患者占 87.5%（21/24）;疼痛直观模拟标尺（visual analogue scale,VAS）值术前为29.76±23.35（0~80）,术后6个月为3.71±7.91（0~50）,术后6个月的开口度及VAS值均与治疗前有显著差异（P<0.05）。MRI影像学评价有效率达96.67%（29/30侧）,所有病例均无并发症发生。结论: 颞下颌关节盘锚固术能有效治疗颞下颌关节盘不可复性前移位,在复位关节盘的前提下,显著改善开口度和缓解疼痛。     

Clinical predictability of temporomandibular joint disc displacement

Single items from a typical clinical examination have proved disappointing in their predictive value for temporomandibular joint (TMJ) disc displacement. Only one criterion (the 12 o'clock) is used to diagnose normal disc position. According to this criterion, the posterior band of the disc should be located at the top of the condyle, at the 12 o'clock position. The purpose of this study was to determine which signs and symptoms provide a valid prediction of the condition of the joint based on 4 magnetic resonance imaging (MRI) criteria used to define normal disc position. Sagittal MRI and clinical findings of 137 temporomandibular disorder patients and 23 normal asymptomatic volunteers were used. Three calibrated and blinded observers interpreted the images. Disc position with the mouth closed was evaluated based on 4 MRI criteria: 12, 11, 10 o'clock, and the intermediate zone. Disc position with the mouth open was determined based on one criterion. It was considered normal if the intermediate zone of the disc was located between the condyle and the articular eminence. Joints were classified as normal or as having disc displacement with or without reduction. The sensitivity and specificity of multiple clinical parameters for predicting the condition of the joint established by each of these 4 gold-standard MRI criteria were then determined. Regarding disc displacement with reduction, significant differences were observed in the sensitivity and specificity of all of the clinical parameters used to predict the imaging diagnosis established by each of the criteria. Concerning disc displacement without reduction, no significant differences were observed. The intermediate zone criterion was the criterion that most accurately reflected the condition of the joint. The clinical predictability of the disorder diagnosed according to this criterion suggests that clinical findings alone are too often nonspecific as predictors of the imaging stage of disc displacement. However, we found that combining the most sensitive clinical items to predict the disorder and using an overall criterion for positivity to interpret the results led to an impressive increase in the specificity of the combination, enabling false-positive diagnoses to be excluded.     

The evaluation of lateral pterygoid signal intensity changes related to temporomandibular joint anterior disc displacement

Oral Radiology - The aim of this study was to evaluate lateral pterygoid muscle (LPM) signal intensity changes related to different degrees of disc status groups using magnetic resonance imaging...     

Mechanisms of disc displacement in the temporomandibular joint

The sign of 'clicking' in the temporomandibular joint is not a normal phenomenon. It is, in fact, often the first indication of potential myofascial pain or temporomandibular joint pain dysfunction syndrome and as such should be detected early and diagnosed correctly. Clicking is a cardinal sign of altered function within the joint, the aetiology for which can only be diagnosed from a sound knowledge of anatomy and physiology. With this background it is possible to ascertain whether the cause is essentially biochemical, neuromuscular, or occlusal in nature or multifactorial components of all three categories. An attempt has been made to provide background knowledge in order that a correct diagnosis can be made.     

Body posture during sleep and disc displacement in the temporomandibular joint: a pilot study

Many possible factors associated with internal derangement of the temporomandibular joint (TMJ) have been discussed, but the causal factors remain unproven. The present study aimed to investigate habitual body posture during sleep (HBP) of patients with anterior disc displacement (ADD) in the TMJ. The sample comprised 87 patients (12 males, 75 females) aged 13-68 years (mean 25 years) and diagnosed by magnetic resonance imaging as having unilateral or bilateral ADD in the TMJ. The HBPs were classified into five categories: supine, prone, right lateral, left lateral, and no-dominant positions. Of the 50 patients with the unilateral ADD, 33 (66%) had the ipsilateral HBP to the affected joint while none (0%) had the contralateral HBP. This contrast showed that the HBP was a possible contributing factor to the ADD. It was suggested that HBP allows the ipsilateral condyle to displace posteriorly and this posterior position causes relative ADD.     

兔颞下颌关节盘移位与骨关节病关系的评价

目的评价颞下颌关节盘移位与骨关节病的关系。方法通过手术方法将２５只大耳白兔的颞下颌关节盘前移，术后１、２、４、８、１２周进行组织病理学检查。结果１１侧手术关节为部分关节盘前移位，８侧为完全性关节盘前移位，６侧为关节盘穿孔。部分关节盘前移位出现早期退行性改变和后期生理性改建，完全性关节盘前移位和关节盘穿孔出现退行性改变和严重的骨关节病。结论颞下颌关节盘前移位的程度与骨关节病有关，关节盘前移位越明显，越易出现骨关节病     

手术治疗颞下颌关节盘移位的近期疗效观察

目的:评价手术治疗颞下颌关节盘移位的方法和近期疗效.方法:2009年10月-2010年9月间手术治疗颞下颌关节盘移位患者9例(11侧),其中男1例、1侧,女8例、10侧,平均年龄28.4岁.术前平均开口度21.3mm.术前均行磁共振检查,明确诊断和分期,4例(5侧)行关节镜手术,5例(6侧)行关节盘锚固定术.术后进行至少3个月的临床随访和磁共振检查.结果:所有患者手术切口均一期愈合,未发生永久性面瘫等严重并发症,随访期末,平均开口度为32.8mm,磁共振复查显示关节盘髁关系保持稳定.结论:通过完善术前检查,严格掌握手术适应证,2种手术方法治疗颞下颌关节盘移位均有良好疗效.     

Magnetic resonance imaging of partial temporomandibular joint disc displacement

Unilateral magnetic resonance imaging (MRI) of the symptomatic temporomandibular joint (TMJ) was performed on 55 patients. The position of the articular disc in relation to the condyle was established on sagittal images. Particular attention was paid to partial or complete anterior positioning of the disc. MRI was correlated with clinical and, in 33 cases, surgical findings. The concept of partial anterior displacement may be useful in relation to treatment planning.     

Therapeutic outcome assessment in permanent temporomandibular joint disc displacement

In permanent temporomandibular disc displacement (TMJ-DD) outcome studies many authors claim positive effects of arthroscopic surgery, arthrocentesis and physical therapy. This literature review was undertaken to analyse whether the claimed effects are based on acceptable methodology. The recorded papers were analysed by two independent observers according to (1) method of investigation, (2) therapeutic intervention studied, (3) therapeutic outcome variables used, and (4) claimed effectiveness of the intervention. Agreement between observers was calculated. Twenty-four papers were found in which therapeutic outcome of interventions on temporomandibular disorders were studied. Six studies applied a true experimental design. Each of these six studies compared a different set of interventions. Twenty-two papers used maximal mouth opening (MMO) as an outcome variable, nine studied pain intensity on a visual analogue scale, one paper assessed the mandibular function impairment questionnaire. Kappa for overall agreement concerning the reviewing criteria was 0.82 (P < or = 0.001). No distinguishing effects on MMO, pain or function impairment were reported between arthroscopic surgery, arthrocentesis and physical therapy. Results of methodological sound outcome studies evaluating the effects of arthroscopic surgery, arthrocentesis and physical therapy are needed.     

颞下颌关节盘移位自然转归的MRI评价

目的:借助磁共振技术,对未经治疗的颞下颌关节盘前移位患者的盘-髁距离、关节盘长度及髁突高度的变化进行定量测量分析,从而为制订治疗计划提供参考。方法:收集62例(83侧关节)在随访期间未经有创或不可逆治疗的颞下颌关节盘移位患者,在初诊及随访结束时拍摄MRI,分别对盘-髁距离、关节盘长度及髁突高度进行测量,采用SPSS13.0软件包对源数据进行t检验。结果:患者初次就诊时,平均年龄为30.4岁,平均随访时间10.9个月。初诊时,39侧关节为可复性关节盘前移位,其中27侧随访期结束时变为不可复性关节盘前移位。随访结束时,盘-髁平均距离从初诊时的5.28mm增加至6.73mm,而关节盘的平均长度从8.31mm缩短至6.91mm,髁突高度从5.21mm降为4.65mm,以上变化均存在统计学差异(P<0.01)。结论:在颞下颌关节盘前移位的自然转归过程中,关节盘前移距离逐渐增大,关节盘长度逐渐缩短,髁突高度逐渐下降,但需更长期的随访及分层研究。     

Osteoarthritis of the temporomandibular joint organ and its relationship to disc displacement

To overcome disagreements with regard to the relationship between disc displacement and osteoarthritis of the temporomandibular joint (TMJ), the evidence for suggested disease mechanisms and clinical course of these disorders is reviewed. The TMJ behaves as a complex organ in which biochemical and biomechanical processes regulate the physiology of cartilage, bone, synovium, ligaments, and synovial fluid. In this concept, TMJ osteoarthritis is an organ failure involving all its structures. The development of as well as recovery from disease appears to be intimately related to exceeding and supporting the adaptive capacity of the tissues that make up the joint organ. Loss of fibrocartilage and inflammation appear to be major pathobiologic processes, while serious doubts exist about the significance of disc position in joint pathology.     

青少年单侧颞下颌关节盘移位患者颌骨三维变化的测量分析

目的分析伴有颞下颌关节盘移位青少年患者颌骨生长发育的变化及特点。方法 32例经MRI诊断为单侧颞下颌关节盘移位的青少年患者,采集头颅CT扫描数据并应用Surgicase 5.0软件进行三维头影测量。设定上/下颌骨标志点及参考平面,对水平向、垂直向及矢状向的生长进行测量,比较两侧颌骨发育的差异,并对测量数据进行统计学分析。结果所有患者均表现出不同程度的面部不对称。下颌骨颏顶点(Gn)向关节盘移位侧偏斜,Gn与正中矢状面(SAG平面)的距离(GnSAG)为0.72~12.37 mm,平均为(4.72±3.41)mm;患侧下颌骨体部长度较健侧缩短(P<0.05);下颌角点(Go)、髁突点(Co)距SAG平面的离散(Go-SAG、Co-SAG)均小于健侧(P<0.001);下颌中切牙中点(Li)向关节盘移位侧偏斜((3.44±2.72)mm)较上颌中切牙点(Ui)的偏斜(1.19±0.63)mm增大(P<0.001);关节盘移位侧髁突内外径小于健侧,两者差异具有统计学意义(P<0.001)。结论青少年期颞下颌关节盘移位与颌骨不对称畸形的发生有密切联系,且具有较为一致的特征。     

Ruptured disc after arthroscopic repositioning in the temporomandibular joint: a retrospective magnetic resonance imaging study

Our aim was to explore the incidence of rupture after arthroscopic repositioning of the disc of the temporomandibular joint (TMJ) by reviewing magnetic resonance images (MRI) of the TMJ taken before and after operation, and to investigate correlations retrospectively. We studied 247 patients with anterior disc displacement of the TMJ, and categorised them into 3 groups based on the postoperative MRI. The first group comprised those whose disc ruptured after repositioning, the second those who had a possible rupture of the disc after repositioning, and the third had no rupture of the disc after repositioning. Age, sex, duration of symptoms, maximum incisal mouth opening, whether the anterior disc displacement was unilateral or bilateral, and the Wilkes stage, were included in the analysis. The incidence of rupture (5/247) was 2%. Weak points at the intermediate zone of the disc were found in 4 of the 5 joints. The patients whose discs ruptured were significantly younger than the other 2 groups (p = 0.001). There was no statistically significant difference in preoperative duration of symptoms and mouth opening among the groups. The proportions of unilateral and bilateral disc displacement (p = 0.047) and Wilkes stage (p = 0.027) differed among the 3 groups. The Wilkes stages was significantly more advanced in the ruptured group than in the other 2 groups (p = 0.027) with 4/5 being bilateral. The weak point in the intermediate zone of the disc on MRI could be a sign of rupture. Teenagers and young adults with anterior disc displacement without reduction, particularly those in whom it is bilateral, are at a higher risk of a rupture after repositioning of the disc by arthroscopy.     

关节镜下盘复位术对青少年髁突生长影响的回顾性队列研究

目的:探讨关节镜下盘复位术对青少年颞下颌关节（temporomandibular joint,TMJ）不可复性盘移位患者的髁突高度、关节盘长度以及盘移位距离变化的影响。方法:纳入2015年9月至2018年11月就诊于上海交通大学医学院附属第九人民医院口腔外科关节专科并且MRI诊断为不可复性关节盘移位（disc disp...     

青少年颞下颌关节盘前移位患者就诊情况分析

目的: 总结颞下颌关节 (temporomandibular joint,TMJ) 盘前移位 (anterior disc displacement,ADD) 就诊患者特征。方法: 纳入2015年4月至2018年11月初次就诊于上海交通大学医学院附属第九人民医院口腔外科并诊断为TMJ ADD的连续病例。收集患者人口统计学信息、首诊科室、主诉、现病史、既往史、临床检查、辅助检查结果和诊断等资料,采用SPSS 21.0软件包对数据进行统计学分析。结果: 研究期间共纳入743例ADD患者,男女比例为1∶5.52。其中20岁以下的患者比率最高 (58.0%),就诊高峰年龄为15~16岁。年龄 ≤ 20岁的青少年患者与成年患者相比,因牙颌面畸形主诉而首诊于正畸 (或正颌) 科的患者占比更高 (P<0.001),有更高的夜磨牙患者占比 (P<0.001),而有耳前区疼痛、下颌偏斜症状或被诊断为特发性髁突吸收的患者占比较低 (P<0.01)。在年龄≤20岁的青少年患者中,因牙颌面畸形主诉而首诊于正畸 (或正颌) 科的患者与因关节相关问题首诊于关节专科的患者相比,有耳前区疼痛和开口受限症状的患者占比更低 (P<0.01),但下颌后缩患者占比更高 (P<0.001)。结论: 青少年TMJ ADD患者对该疾病有很高的治疗需求,其中相当一部分患者以牙颌面畸形为主诉、有更轻的关节症状,但不了解颞下颌关节问题和牙颌面畸形的密切关系,可能会贻误最佳治疗时机。     

颞下颌关节盘前移位病因研究进展

颞下颌关节盘前移位(temporomandibular joint anterior disc displacement, TMJ ADD)是临床上常见的一种颞下颌关节紊乱病(temporomandibular disorder, TMD),主要表现为疼痛、关节弹响和下颌运动受限,严重者影响日常生活。但其病因复杂,至今尚无统一结论,对其发病机制也缺乏明确而全面的认识。本文将对ADD的病因以及发病机制作一综述。     

Inclination of the temporomandibular joint eminence and anterior disc displacement

The articular eminence angle of 179 temporomandibular joints (TMJ) with anterior disc displacement (ADD) in 179 patients was measured and compared with 200 left and 200 right joints of 400 young adults without TMJ dysfunction. A steeper inclination of the posterior slope of the articular eminence, with a mean difference compared to the control group of 14.5 degrees, was seen in joints with ADD. In the group of 179 joints with ADD of the TMJ, no difference was seen in the mean articular eminence angle between joints with an ADD with reduction, and an ADD without reduction, between conservatively or surgically treated joints, or between joints with different presumed causes of ADD.     

Posterior disc displacement of the temporomandibular joint: A rare case report

ABSTRACT

Background

Posterior disc displacement (PDD) of the temporomandibular joint (TMJ) is quite rare. The normal position of a disc is slightly anterior to the condyle, so the chances of disc displacement to the posterior direction are low.     

Clinical and radiological study of patients with anterior disc displacement of the temporomandibular joint

Patients displaying temporomandibular joint clicking or with a history of clicking followed by limitation of opening were subjected to clinical and radiological examinations including arthrography. Arthrotomographically the patients were found to have anterior displacement of the disc. In patients with clicking the disc was repositioned in association with clicking during opening. In patients with limitation of opening the disc was constantly displaced anterior to the condyle, blocking anterior condylar translation. The patients with limitation of opening had more pain, more signs of mandibular dysfunction, more hard tissue changes and more frequent perforation and deformation of the disc, compared to patients with clicking only. These findings may justify two different diagnoses, displacement with and without repositioning of the disc on opening. Displacement without repositioning seems to be the more advanced condition and may in some cases be a precursor of osteoarthrosis.