自体骨移植颞颌关节重建术的护理

总结了对15例实施自体骨移植颞颌关节重建术患的护理体会，认为围手术期的心理护理对于使患保持良好的心理状态，促进其病情的顺利恢复具有重要意义；术前的口腔护理和皮肤准备是预防伤口感染、保证移植骨成活和伤口愈合的前提；术后局部伤口的观察与护理是关系到移植骨能否成活的关键；早期和长期有效的功能锻炼对于颞颌关节功能的改善具有积极意义。     

胚胎骨植入颞颌关节结节重建术的护理

颞下颌关节脱位是一种常见病，其中由于颞颌关节结节过低，造成的脱位是比较常见的原因之一。历来多采用自体骨移植的方法行关节结节重建术。我们自1995年开始应用同种深冷冻胚胎骨进行关节结节重建术，经临床追踪，未再发生脱位，现将术中配合及护理报告如下。1临床资料本组3例，男2例，女1例，最大年龄36岁，最小28岁。患者颞下颌关节陈旧性脱位和复发性脱位，局麻下行胚胎骨植入关节结节增高术。术后随访患者颞颌关节功能恢复良好，张、闭口咬关系正常。2手术步骤及配合2．1手术设计与麻醉患者平卧在手术台上，头偏向健侧，患侧在上。根…     

颞颌关节应力改变致髁状突适应性变化的实验研究

目的：通过手术造成犬颞颌关节应力失衡，探讨髁状突适应性变化。方法：选用16只成年犬，截除下颌升支前份骨及喙突，使一侧颞肌与下颌骨分离，在术后1，3，6个月通过X射线、光镜及扫描电镜等方法观察关节因其力学改变而引起的髁状突适应性变化。结果：光镜下显示髁状突纤维层增厚，排列紊乱，增殖层细胞增多。扫描电镜下未见病理性损害。结论：下颌升支前份骨及喙突截除术可引起术侧髁状突的进行性改建，不会引起颞颌关节的病理性损害。表明除了关节本身位置变化及咬合关系改变可引起髁状突的改建外，任何涉及整个关节结构的任何部分改变都能引起髁状突软骨的反应。提示颞颌关节结构完整性的破坏可减少关节适应能力和增加关节紊乱的可能性。     

颞颌关节综合征10例误诊分析

颞颌关节综合征是口腔科的常见病之一．主要症状是颞颌关节弹响、疼痛，疼痛多由于肌肉痉挛所致．常出现嚼肌、颞肌、舌骨上肌群、翼外肌及颈后部诸肌群的持续性疼痛，亦可放射至颈部、肩部、咽喉部、枕部及颅顶部，呈间歇性疼痛．还可导致张口受限．下颌偏斜等。其原因复杂，与精神因素，不良的咀嚼习惯．he及he关系紊乱．颞颌关节的功能过度及创伤等有一定关系。     

关节镜治疗颞下颌关节紊乱病的远期疗效观察(英文)

目的评价应用颞下颌关节镜治疗颞下颌关节紊乱病的远期疗效。方法对保守治疗无效的22例临床表现为张口受限合并关节疼痛的颞下颌关节紊乱病患者行颞下颌关节镜手术治疗,分析术前、术后6月、术后2年不同时期患者的疼痛值、张口度的变化。结果治疗后张口度≥35mm的患者占90.9%(20/22),不同时期的张口度均较治疗前有显著差异(P0.05),治疗后不同时期的疼痛直观模拟标尺(VAS)均较治疗前明显降低,有显著差异(P0.001),所有病例均无并发症发生。结论颞下颌关节内镜手术能有效治疗颞下颌关节紊乱病,明显改善张口度和缓解疼痛。     

颞颌关节应力改变致髁状突适应性变化的实验研究

目的:通过手术造成犬颞颌关节应力失衡,探讨髁状突适应性变化。方法:选用16只成年犬,截除下颌升支前份骨及喙突,使一侧颞肌与下颌骨分离,在术后1,3,6个月通过X射线、光镜及扫描电镜等方法观察关节因其力学改变而引起的髁状突适应性变化。结果:光镜下显示髁状突纤维层增厚,排列紊乱,增殖层细胞增多。扫描电镜下未见病理性损害。结论:下颌升支前份骨及喙突截除术可引起术侧髁状突的进行性改建,不会引起颞颌关节的病理性损害。表明除了关节本身位置变化及咬合关系改变可引起髁状突的改建外,任何涉及整个关节结构的任何部分改变都能引起髁状突软骨的反应。提示颞颌关节结构完整性的破坏可减少关节适应能力和增加关节紊乱的可能性。     

带蒂颞筋膜瓣治疗颞下颌关节强直及围手术期护理

颞下颌关节强直主要表现为患者开口受限或完全不能开口,严重影响患者咀嚼、吞咽、语音等生理功能。如果发生在儿童时期,还可造成成年后颌面发育畸形、咬合关系紊乱和睡眠呼吸暂停综合征。真性颞下颌关节强直的主要治疗方法是手术,国内外治疗颞颌关节强直的手术方法大体有:髁状突切除术(高位、低位),裂隙式关节成形术,嵌入式关节成形术和骨移植关节成形术,但术后均有一定复发。文献提示其复发率约20%,个别病例甚至可复发2~3次以上[1]。因此,复发一直是临床医师关注的重要课题。近3年来,我们采用带蒂颞筋膜瓣转移重建颞下颌关节,在减少术后再次强直方面取得满意效果,现报道如下。1材料与方法1.1一般资料2005年1月~2008年1月在我科确诊的真性颞下颌关节强直患者12例,其中男10例,女4例。年龄15~33岁。双侧9例,单侧3例,均为外伤所致。10例开口度为0 mm,2例开口度为2 mm。12例中,2例因复发曾行1次骨间隙关节成形术,1例因复发曾行2次骨间隙关节成形术。1.2手术方法1.2.1麻醉经鼻腔盲插气管内全麻。1.2.2切口颞下颌关节强直手术切口在耳屏前向上发际内2~3 cm头皮切开,形成手杖形切口。耳屏前切口长约4 cm,...     

体外冲击波联合运动疗法对颞下颌关节紊乱病的疗效观察

目的 观察冲击波结合运动疗法治疗颞下颌关节功能紊乱病的临床效果。 方法 选取颞下颌关节功能紊乱病Ⅲ类患者40例,按随机数字表法随机分为观察组（n=20例）和对照组（n=20例）,观察组给予冲击波配合运动疗法,对照组给予超短波配合运动疗法。2组患者均于治疗前和治疗4周后（治疗后）采用疼痛视觉模拟评分（VAS）、最大张口度、Fricton颞下颌关节功能指数分别评定患者的疼痛程度、最大张口度和颞下颌关节的功能。 结果 治疗后,2组患者的VAS评分、最大张口度和颞下颌关节的功能各项指标与组内治疗前比较,差异均有统计学意义（P<0.05）。治疗后,观察组的VAS评分和最大张口度分别为（0.95±1.15）分和（3.23±0.37）cm,与对照组治疗后比较,差异均有统计学意义（P<0.05）,且观察组治疗后颞下颌关节功能的各项指标与对照组治疗后比较,差异均有统计学意义（P<0.05）。 结论 体外冲击波联合运动疗法可显著缓解颞下颌关节紊乱病患者的解疼痛程度,最大张口度和颞下颌关节功能。     

针刺阿是穴并超短波治疗颞颌关节紊乱症36例

颞颌关节紊乱症是临床上的常见疾病，该症好发于青壮年，既可单侧发病，也可双侧同时发病。患者临床表现为张口及咀嚼食物时颞下颌关节疼痛，部分患者伴有关节处弹响及张口受限，严重者可影响进食及说话等。我科自2000年以来，应用针刺阿是穴并超短波治疗36例该症患者，临床疗效满意。现报道如下。     

颞肌筋膜瓣移植重建颞下颌关节盘19例

背景:颞肌筋膜瓣移植是颞下颌关节紊乱病不可缺少的的治疗方法,但如何选择合适的适应证及移植方式方能达到理想的治疗目的是月前临床正在探讨的热门课题.目的:为对病变严重敛不能保留的关节盘进行重建,报道应用带蒂颞肌筋膜瓣移植治疗颞下颌关节紊乱患者的方法和随访结果,对相关问题进行探讨.设计、时间及地点:病例分析,于2005-12/2007-06山东省滨州医学院附属医院口腔颌面外科完成.对象:选择14例(16侧)不可复性关节盘移位和5例(5侧)关节盘穿孔,共19例(21侧)颞下颌关节紊乱病患者进行手术治疗.方法:19例(21侧)颞下颌关节紊乱病患者经耳颞部切口行关节盘切除并应用带蒂颞肌筋膜瓣移植重建.对所有患者移植前与移植后随访的临床资料进行比较,并分析MRI资料.主要观察指标:随访观察带蒂颞肌筋膜瓣移植重建关节盘后患者张口度、咬合关系、颞部丰满度、关节区疼痛的数据化测定值、患者满意度等及MRI影像T1、T2加权像矢状位与冠状位移植物信号变化及连续性.结果:19例患者随访时间平均17个月,患者症状显著改善.统计学比较发现患者主要临床症状移植前后差异有显著性意义(P<0.01):MRI检查可见关节间隙内移植物呈中等信号带状影像且边界较清晰,未见中断或呈片段状.结论:带蒂颞肌筋膜瓣移植重建颞下颌关节盘能恢复关节功能、防止关节粘连,并且制备方便、无明显供区并发症,是一种可行方式.     

Pain in temporomandibular joint dysfunction

The temporomandibular joint (TMJ) structure alteration may be genetic or acquired. If genetic, the deformity is usually severe and leads to marked functional disorders. In other cases, alterations may be induced by trauma, tumor, infection, or radiation. TMJ morphofunctional alterations may also be caused by occlusal disorders or muscle dysfunction. TMJ lesions induce pain through the auriculo-temporal nerve nociceptors in the joint capsule and retrodiscal attachment. Moreover, TMJ lesions may provoke muscle function alterations with increased contraction of the elevator muscles during opening. This eccentric contraction may induce mechanical damage to the muscle and delayed onset of muscle soreness as a consequence.     

Breathing and temporomandibular joint disease

Temporomandibular joint disease (TMD) refers to a collection of pain related conditions in the masticatory muscles and temporomandibular joint. Occlusal factors have been implicated in TMD pathogenesis, yet despite decades of research no causal relationship between occlusion and TMD has been found. The significance of psychosocial factors in both the assessment and the long-term management of patients with TMD is receiving increased recognition. The teaching of relaxation skills and coping strategies are effective, proven TMD therapies. The role of breathing re-education in temporomandibular joint (TMJ) disorders is rarely mentioned. A focus on breathing patterns and their disorders potentially explains how biomechanical factors associated with psychosocial influences might lead to pathophysiological changes within the TMJ as well as in the associated muscles. Attention to factors such as breathing and postural rehabilitation provides health professionals valuable, additional tools to help care for patients with TMD.     

颞下颌关节紊乱综合征的X线诊断（附34例报告）

颞下颌关节紊乱综合征（Temporomandibular disor-ders）在颞下颌关节疾病中最为常见,X线检查可以为临床诊断确诊提供影像学支持。本文搜集典型34例X线检查阳性的病例,就其X线表现进行分析,总结颞下颌关节紊乱综合征的影像学特点。1材料与方法1.1病例资料34例中男性14例,女性20例,年龄19～54岁,平均39岁。病程4月-20年不等。     

Anatomy of the temporomandibular joint.

The temporomandibular joint (TMJ), also known as the mandibular joint, is an ellipsoid variety of the right and left synovial joints forming a bicondylar articulation. The common features of the synovial joints exhibited by this joint include a fibrous capsule, a disk, synovial membrane, fluid, and tough adjacent ligaments. Not only is the mandible a single bone but the cranium is also mechanically a single stable component; therefore, the correct terminology for the joint is the craniomandibular articulation. The term temporomandibular joint is misleading and seems to only refer to one side when referring to joint function. Magnetic resonance imaging has been shown to accurately delineate the structures of the TMJ and is the best technique to correlate and compare the TMJ components such as bone, disk, fluid, capsule, and ligaments with autopsy specimens.     

Postoperative imaging of the temporomandibular joint

Postoperative axiography is compared to preoperative findings and repeated regularly. Postoperative arthroscopy is avoided because of its invasiveness. Plain films comprise panorama views, the axial skull view, the Schüller view in closed and open mouth position, and the Clementschitsch view. They are done in the early postoperative phase (2 days), before and after removal of osteosynthetic material, and after 1 year. Early postoperative computed tomography control is done in patients with intra-articular fractures to look for intra-articular fragments and to check for the position of the affected bones or radiopaque alloplastic materials. Routine magnetic resonance imaging is performed 6 months after disk surgery as a baseline study or whenever symptoms suggest missing recapture of the disk or if there is a discrepancy between clinical and radiological findings. Postoperative internal disk structure may become hyperintense centrally on T1 and T2 due to mucoid degeneration. Postoperative adhesions can be suspected when the disk lacks mobility.     

Neurological influences of the temporomandibular joint

This study reviews recent advances in temporomandibular joint (TMJ) or masticatory system related neurology, and suggests the TMJ as a neurological window and lever.The TMJ is integrated with the brainstem centers via the sensorimotor system, including the body balance and coordination control systems. A dysfunctioning TMJ may reflect not only local problems, but also the underlying remote or systemic problems. Neurological examination, including balance testing, for example, may reveal the contributing imbalances and provide an additional evaluation of the appropriateness of TMJ therapeutics being attempted.Repetitive or tonic sensory stimulations involving the TMJ may be related to therapeutic interventions, contributing to neural plasticity, which may be adopted as a therapeutic approach in treatment of neurological disorders, including dystonia and movement disorders.TMJ related therapeutics, such as use of an occlusal splint, cranial manipulation, muscle/myofascial therapy, and acupuncture, ideally need to be practiced along with neurological monitoring, to ensure neurologically desirable effects.