颞下颌关节继发性强直与幼年期髁状突纵行骨折的关系

背景：髁状突骨折作为一种较严重的颞下颌关节(temporomandibular joint．TMJ)损伤受到学者们关注。但是，受诊断方法限制，学者们一直对髁状突横断骨折研究较多，而对髁状突纵行骨折研究较少．对儿童髁状突纵行骨折了解更少。目的：探讨幼年期髁状突纵行骨折对TMJ继发性强直的影响。设计：随机对照的实验研究。单位：解放军总医院口腔科。材料：实验在解放军总医院实验动物中心完成。选择北京农业大学实验动物研究所培育的中国实验用小型猪12头，两三个月龄，体质量5～5．5kg，混合饲料喂养．随机分为3组。方法：小型猪于术前12h禁食水，以5．0～15．0mg／kg噻胺酮腹腔麻醉。麻醉成功后取右侧卧位，常规消毒，左耳前切口，横行切开关节囊，暴露髁状突，牵拉髁状突向下，用宽5mm小骨凿沿内侧1／3处纵行劈骨，造成前后矢状骨折。于术后3个月与6个月分批处死动物，取其髁状突标本进行观察。主要观察指标：①肉眼观察3组动物髁状突标本的形态学变化。②光镜观察3组动物髁状突标本的组织学改变。结果：术后3个月组可见关节盘与髁状突明显粘连(下称盘突粘连)，其中1例可见关节窝、关节盘、髁状突之间均出现粘连，2只动物形成双髁状突畸形，未见关节盘穿孔。术后6个月组见盘突粘连紧密，3只动物形成双髁状突畸形，关节盘则明显增厚光镜检查：骨折后3个月见盘突粘连明显，粘连部位与周围组织的界限不清，粘连区由纤维结缔组织组成，内含大量的软骨细胞，部分粘连区纤维结缔组织与骨小梁紧密结合．关节盘纤维排列紊乱，出现血管及脂肪细胞。骨折后6个月粘连组织内可见血管、大量的成纤维细胞及散在的软骨细胞。关节盘胶原纤维排列呈旋窝状．内含大量脂肪细胞并可见血管。在未粘连部位可见髁状突表面纤维软骨增厚，表面纤维排列紊乱。关节盘表面呈增生改变。结论：幼年期髁突纵行骨折对TMJ造成严重继发性损伤，髁突纵行骨折与关节强直关系密切。     

多功能生物撞击机致间接性幼年山羊颞下颌关节创伤模型的组织病理学变化

目的:运用多功能生物撞击机致间接性颞下颌关节(temporomandibularjoint,TMJ)创伤动物模型研究双侧TMJ损伤情况。方法:实验于2002-06/2003-04在解放军第四军医大学口腔医学院颌面外科创伤实验室完成,实验以幼年山羊作为研究对象,以1MPa气压推动0.845kg的圆柱形钢质抛射体对动物进行致伤,伤后3d,1,2,4,12周对双侧关节结构变化进行观察,并与正常关节对照。结果:伤后3d可见关节滑膜撕裂、颞骨和髁突骨质破坏、关节腔内积血,关节盘以及关节附着的断裂等;7d后,关节积血少见。2周后关节内出现明显的破坏性改变,关节腔内有渗出液。伤后1个月,部分动物的一侧关节盘完全破坏,髁突软骨层消失,关节腔内渗出;对侧关节结构紊乱,关节盘及髁突明显变形、不规则等改变。3个月后,多数关节结构基本正常,但关节内的破坏性改变仍然存在,关节内仍有明显的裂隙或囊状改变,软骨组织变薄,关节盘松解,关节腔扩张等。结论:创伤可导致山羊双侧关节结构不可逆性的破坏,使关节内环境发生改变,诱发TMJ疾病的发生;关节积血及关节盘的破坏在创伤性关节病的发病过程中起重要作用。     

多功能生物撞击机致间接性幼年山羊颞下颌关节创伤模型的组织病理学变化

目的：运用多功能生物撞击机致间接性颞下颌关节(temporomandibular jomt，TMJ)创伤动物模型研究双侧TMJ损伤情况。方法：实验于2002—06／2003—04在解放军第四军医大学口腔医学院颌面外科刨伤实验室完成，实验以幼年山羊作为研究对象，以1MPa气压推动0．845kg的圆柱形钢质抛射体对动物进行致伤，伤后3d，1，2，4，12周对双侧关节结构变化进行观察，并与正常关节对照。结果：伤后3d可见关节滑膜撕裂、颞骨和髁突骨质破坏、关节腔内积血，关节盘以及关节附着的断裂等；7d后，关节积血少见。2周后关节内出现明显的破坏性改变，关节腔内有渗出液。伤后1个月，部分动物的一侧关节盘完全破坏，髁突软骨层消失，关节腔内渗出；对侧关节结构紊乱，关节盘及髁突明显变形、不规则等改变。3个月后，多数关节结构基本正常，但关节内的破坏性改变仍然存在，关节内仍有明显的裂隙或囊状改变，软骨组织变薄，关节盘松解，关节腔扩张等。结论：创伤可导致山羊双侧关节结构不可逆性的破坏，使关节内环境发生改变，诱发TMJ疾病的发生；关节积血及关节盘的破坏在创伤性关节病的发病过程中起重要作用。     

间接性颞下颌关节损伤后的组织学变化(英文)

目的通过观察颞下颌关节(temporomandibularjoint,TMJ)间接性损伤后的组织结构改变及转归,探讨颞下颌关节损伤与颞下颌关节病(temporomandibularjointdisorder,TMJD)和颞下颌关节骨关节病(temporomandibularjointosteoarthrosis,TMJOA)的关系。方法选用四川简阳努比山羊20只,雌性8只,雄性12只,体重10～12kg,年龄4～6个月,均属生长期。按随机数字表法分为A、B、C、D4组,每组5只(雌性2只,雄性3只)。用自制撞击装置间接造成羊右侧关节损伤,左侧关节为对照。分别于伤后2h,1,3,6个月取材,通过组织学观察TMJ伤后病理改变。结果TMJ伤后2h出现关节囊内血肿,关节盘及滑膜撕裂;伤后1个月出现髁突表面软骨碎裂;伤后3,6个月出现髁突骨质吸收、破坏及骨赘形成,滑膜增生,关节盘纤维断裂,穿孔。结论一定程度的TMJ间接性损伤可导致TMJOA的发生。     

间接性颞下颌关节损伤后的组织学变化

目的 通过观察颞下颌关节（temporomandibular joint,TMJ)间接性损伤后的组织结构改变及转归，探讨颞下颌关节损伤与颞下颌关节病（temporomandibular joint disorder,TMJD）和颞下颌关节骨关节病（temporomandibular joint osteoarthrosis,TMJOA）的关系。方法 选用四川简阳努比山羊20只，雌性8只，雄性12只，体重10-12kg，年龄4-6个月，均属生长期，按随机数字表法分为A、B、C、D4组，每组5只（雌性2只，雄性3只）。用自制撞装置间接造成羊右侧关节损伤，左侧关节为对照。分别于伤后2h，1，3，6个月取材，通过组织学观察TMJ伤后病理改变。结果 TMJ伤后2h，1，3，6个月取材，通过组织学观察TMJ伤后病理改变。结果 TMJ伤后2h出现关节囊内血肿，关节盘及滑膜撕裂；伤后1个月出现髁突表面软骨碎裂；伤后3，6个月出现髁突骨质吸收、破坏及骨赘形成，滑膜增生，关节盘纤维断裂，穿孔。结论 一定程度的TMJ间接性损伤可导致TMJOA的发生。     

髁突骨折急性期颞下颌关节MRI表现

目的 探讨MRI在髁突骨折后颞下颌关节软组织损伤中的诊断价值.方法 选取我院急性单侧或双侧髁突骨折17例行MRI检查,根据受伤的严重程度及损伤的类型进行分类、分级,分析髁突损伤程度与颞下颌关节软组织损伤的相关性.结果 17例共23个髁突骨折,其中14个为髁突Ⅱ级损伤,9个为Ⅲ级损伤.Ⅱ级、Ⅲ级损伤中出现关节盘移位分别为8个（57.1％）、9个（100.0％）,关节内出血为5个（35.7％）、9个（100.0％）,组间比较差异有统计学意义（P＜0.05）;关节囊撕裂分别为1个（7.1％）、2个（22.2％）,组间比较差异无统计学意义（P＞0.05）.髁突骨折损伤程度与关节盘移位、关节内出血呈明显正相关性（r =0.691、0.643）,与关节囊撕裂无明显相关性（r=0.219）.结论 MRI可明确诊断髁突骨折患者颞下颌关节软组织损伤,且髁突损伤程度越重,关节盘移位、关节内出血概率越高.     

颞下颌关节盘前移位患者盘-髁复合体MRI特征及盘周附着半量化评级研究

目的 通过盘-髁复合体磁共振成像（magnetic resonance imaging, MRI）特征分析及盘周附着半量化评级法,探讨颞下颌关节可复性盘前移位（anterior disc displacement with reduction, ADDWR）与不可复性盘前移位（anterior disc displacement without reduction, ADDWoR）中关节盘形态、髁突形态及盘周附着处之间的相关性。材料与方法 回顾性分析2021年5月至2022年9月于福建省级机关医院行MRI检查确诊为颞下颌关节盘前移位74例患者共114侧,分为ADDWR组39侧和ADDWoR组75侧,比较关节盘形态Ⅰ～Ⅳ类型、髁突形态3类别及盘周附着处半量化评分分级6级。采用Kruskal-Wallis检验比较两组中不同关节盘形态类型、髁突形态类别及盘周附着分级之间差异。采用Mann-Whitney U检验比较两组之间关节盘形态、髁突形态、盘周附着处总评分及各处附着评分差异。采用Spearman秩相关分析关节盘形态、髁突形态、盘周附着处总评分及各附着与盘-髁复合体可复性与否的相关系数。采...     

口腔组织工程相关问题临床问答②

3如何对重度磨耗患者髁位重建正中关系的可重复性进行评价? 正中关系是指髁突与关节盘最薄区域相吻合,在前上位置正对关节结节后斜面时盘突复合体的位置,属于功能性的可复位.     

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。     

颞下颌关节盘变形与关节疼痛关系的MRI研究

目的:研究颞下颌关节盘变形与关节疼痛的关系。方法:利用MRI对44例单侧关节疼痛颞下颌关节紊乱病(TMD)患者88侧关节完成开闭口斜矢状位T1加权成像,观察盘突关系及盘形态改变;利用可视疼痛模拟标尺(VAS)进行疼痛程度的判定,比较盘变形组与无盘变形组有无差异。结果:正常盘突关系(NDCR)关节中9.6%(5/52)发生关节盘变形,全部表现为均厚型,在颞颌关节内紊乱(TMJID)中94.4%(34/36)发生关节盘变形,后带膨大型13例,折叠型7例,伸长型6例,圆型5例,均厚型3例。在44个疼痛关节中,经MRI确认盘变形为35个关节(88.6%),而44个非疼痛关节中仅4例表现为变形的关节盘占9%,经统计学分析,颞颌关节疼痛与盘变形有相关性(P<0.005);关节盘无变形组VAS平均值为40±29.5,关节盘变形组VAS平均值为43±20.1,关节盘变形组比关节盘无变形组高,但经t检验统计学分析两组无差别(P=0.763)。结论:关节疼痛与关节盘变形密切相关,但疼痛程度与其无关,提示TMD患者颞颌关节疼痛程度不能反映关节盘的损害程度,关节盘损害程度的确定尚需关节造影、MRI甚至关节镜检查。     

成年人下颌骨髁突骨折不同类型两种治疗方法的疗效比较

目的：对成年人下颌骨髁突骨折不同类型进行两种治疗方法的疗效比较。方法：对4年来髁突骨折267例患者进行前瞻性研究,全部病例治疗前均为咬合错乱,开口受限Ⅱ～Ⅲ度,且正侧位轴向髁突移位,但≤30°,或髁突向下移位,但≤5 mm。按骨折类型分3类：囊内骨折;髁颈骨折;髁颈下骨折。每类分2型：单侧骨折和双侧骨折。同类型病例按就诊顺序随机分为闭合性治疗组和开放性治疗组。结果：开放性治疗后的双侧囊内骨折、单双侧髁颈骨折、双侧髁颈下骨折咬合功能疗效评估满意度高于闭合性治疗组,差异有显著性（P〈0.05）。结论：下颌骨髁突骨折伴有髁突移位者,开放性治疗有利于咬合功能的恢复,尤其是伴有双侧骨折者效果显著。     

无线整合型MR放大器用于颞下颌关节高分辨MR成像

目的 观察以无线整合型MR放大器（WAND）耦合头颈联合线圈行颞下颌关节（TMJ）高分辨成像的价值。方法 采用头颈联合线圈、WAND耦合头颈联合线圈分别对16名健康青年人行双侧TMJ扫描。观察2组图像TMJ关节盘前带、中间带、后带、前附着、后附着及双板区、关节腔及髁突骨质，对图像质量进行主观评分，评估图像信噪比（SNR）和对比噪声比（CNR），并进行组间比较。结果 共纳入15名受试者。相比单纯头颈联合线圈，WAND耦合头颈联合线圈显示TMJ关节盘前带、中间带、后带、前附着、后附着及双板区、关节腔及髁突骨质更佳（P均<0.05），图像中TMJ关节盘及盘后组织的CNR、SNR显著升高（P均<0.05）。结论 采用WAND耦合头颈联合线圈可提高MRI显示TMJ质量。     

间接性颞下颌关节损伤后白介素-8的表达及意义

目的通过观察羊颞下颌关节(TMJ)间接创伤后不同时期髁突软骨中白介素-8(IL-8)的表达,探讨IL-8在TMJ创伤后导致TMJ骨关节病过程中的作用。方法选用陕西关中地区山羊25只(雌性10只,雄性15只),体重15～20kg年龄6～8个月,均属生长期。以数字表法随机分为A、B、C、D、E5组,每组5只(雌性2只,雄性3只)。用自制撞击装置造成山羊双侧颞颌关节间接性创伤。分别在伤后2h,7d,1、3个月取材,并以正常TMJ做为对照,用免疫组化法进行观察。结果TMJ创伤后髁突软骨中IL-8的表达明显强于正常对照组,其着色程度越靠近结构破坏区越明显。结论IL-8在TMJ创伤后导致TMJ骨关节病过程中起重要作用。     

Basic fibroblast growth factor enhances osteogenic and chondrogenic differentiation of human bone marrow mesenchymal stem cells in coral scaffold constructs

Temporomandibular joint (TMJ) disorders are commonly occurring degenerative joint diseases that require surgical replacement of the mandibular condyle in severe cases. Transplantation of tissue-engineered mandibular condyle constructs may solve some of the current surgical limitations to TMJ repair. We evaluated the feasibility of mandibular condyle constructs engineered from human bone marrow-derived mesenchymal cells (BMSCs). Specifically, human BMSCs were transfected with basic FGF (bFGF) gene-encoding plasmids and induced to differentiate into osteoblasts and chondroblasts. The cells were seeded onto mandibular condyle-shaped porous coral scaffolds and evaluated for osteogenic/chondrogenic differentiation, cell proliferation, collagen deposition and tissue vascularization. Transfected human BMSCs expressed bFGF and were highly proliferative. Osteogenesis was irregular, showing neovascularization around new bone tissue. There was no evidence of bilayered osteochondral tissue present in normal articulating surfaces. Collagen deposition, characteristic of bone and cartilage, was observed. Subcutaneous transplantation of seeded coral/hydrogel hyaluran constructs into nude mice resulted in bone formation and collagen type I and type II deposition. Neovascularization was observed around newly formed bone tissue; bFGF expression was detected in implanted constructs seeded with bFGF expressing hBMSCs. This report demonstrates that engineered porous coral constructs using bFGF gene-transfected human BMSCs may be a feasible option for surgical transplantation in TMJ repair.     

Dislocation of the mandible: a case report

Dislocation of the mandible is a possible complication of direct tracheal laryngoscopy. The temporomandibular joint (TMJ) is unique in that any movement of the bone always causes movement in both joints simultaneously. The entire TMJ is surrounded by a ligamentous capsule and is stabilized by 3 ligaments. Four muscles of mastication move the mandible with great power. The lateral pterygoid muscle has nearly horizontal muscular fibers and is chiefly responsible for dislocating the mandibular condyle and articular disc past the articular eminence into the infratemporal fossa, causing the patient great pain and distress. If mandibular dislocation should occur, prompt recognition and treatment of the dislocation is recommended. There are steps, used by dentists, which can be employed by the nurse anesthetist to relocate the mandible. The technique for intraoral bimanual relocation of the mandible is described.     

Reduced mechanical load decreases the density,stiffness, and strength of cancellous bone of the mandibular condyle

OBJECTIVE: To investigate the influence of decreased mechanical loading on the density and mechanical properties of the cancellous bone of the human mandibular condyle. DESIGN: Destructive compressive mechanical tests were performed on cancellous bone specimens.Background. Reduced masticatory function in edentate people leads to a reduction of forces acting on the mandible. As bone reacts to its mechanical environment a change in its material properties can be expected. METHODS: Cylindrical bone specimens were obtained from dentate and edentate embalmed cadavers. Mechanical parameters were determined in the axial and in the transverse directions. Subsequently, density parameters were determined according to a method based on Archimedes' principle. RESULTS: The apparent density and volume fraction of the bone were about 18% lower in the edentate group; no age-related effect on density was found. The decrease of bone in the edentate group was associated with a lower stiffness and strength (about 22% and 28%, respectively). The ultimate strain, however, did not differ between the two groups. Both groups had similar mechanical anisotropy; in axial loading the bone was stiffer and stronger than in transverse loading. CONCLUSIONS: Reduced mechanical load had affected the density and herewith the mechanical properties of condylar cancellous bone, but not its anisotropy. RELEVANCE: The change in material properties of the cancellous bone after loss of teeth indicate that the mandibular condyle is sensitive for changes in its mechanical environment. Therefore, changes in mechanical loading of the condyle have to be accounted for in surgical procedures of the mandible.     

Clinical management of a patient following temporomandibular joint arthroscopy.

This case report describes a patient in whom arthroscopic surgery of the temporomandibular joint (TMJ) was used to break up adhesions between the TMJ disc and the articular eminence and therefore improve mobility of the joint. Postsurgical physical therapy procedures used were high voltage electrical stimulation, transcutaneous electrical nerve stimulation, moist heat, ultrasound, ice, mobilization, and therapeutic exercises. Postsurgical goals included normalization of range of motion, elimination of pain, elimination of inflammation, and mandibular function without restriction. Special emphasis is given to an unusually effective mobilization technique used to decrease tenderness in the TMJ. The conservative therapy described may be used for persons with similar symptoms and evaluation findings who do not require surgery. [Waide FL, Bade DM, Lovasko J, Montana J. Clinical management of a patient following temporomandibular joint arthroscopy.     

Diagnostic imaging assessment of temporomandibular joint pain

INTRODUCTION: In the diagnostic process imaging is frequently performed for confirmation of pain symptoms or imaging-based signs were used for conclusions on pain. Therefore, the aim of this review was to show evidence about the association between temporomandibular joint (TMJ) pain - as a subgroup of orofacial pain conditions - and findings on TMJ images. METHODS: By handsearch and computer-based search statements of clinical studies, especially of the past 20 years, were collected and critically assessed. RESULTS AND CONCLUSIONS: In the literature there exist some references to and indications for an association between TMJ pain and structure-based findings on TMJ images, i.e. morphology of the condyle, condyle-fossa relationship, form and position of the disc, signs of effusion of the upper resp. lower joint compartment, bone marrow signal abnormalities of the condyle, signal characteristics of the retrodiscal tissue. Despite some hints the relation between TMJ pain and so-called abnormalities on TMJ images remains unclear, complex and little predictive in individual cases.