颞下颌关节前脱位口外法复位的临床观察

目的对比口内口外两种颞下颌关节脱位复位办法的优缺点。方法总结5年来运用口内法复位颞下颌关节脱位病例,并与运用口外法复位颞下颌关节脱位进行对比分析。结果口内法复位成功率90.63%,口外法复位成功率89.47%,χ2=0.02,P>0.05。口外法较口内法省力,患者不良反应轻。结论口外法省力且损伤很小,但对年轻偶发脱位的男性患者效果差,对其他患者效果很理想(发生关节粘连者除外),口内法可以对除发生粘连外的所有脱位复位,但费力、损伤大,临床上可首选口外法复位。     

颞下颌关节前脱位的口外手法复位及体会

颞下颌关节前脱位的口外手法复位及体会李容新，陈传俊颞下颌关节脱位，目前临床上仍以口内手法复位为主要方法。作者近几年来共施行颞下颌关节脱位口外手法复位８６例，认为口外手法复位不失为一种理想的复位方法。现报道如下。１临床资料本组８６例，其中男性２８例，女...     

颞下颌关节急性前脱位手法复位治疗的体会

应用口内法对80余例颞下颌关节急性前脱位进行了复位治疗和力学分析,根据牙列情况将颞下颌关节急性前脱位分成3种类型,各种脱位类型复位时使用了不同的手法,但均应用了杠杆原理。与常规复位手法比较,本文的改进方法明显缩短了手法复位的时间,提高了复位成功率。     

颞下颌关节前脱位的改良口外手法复位

颞下颌关节前脱位是口腔科常见急症。近年来,作者采用一种改良口外手法复位对62例颞下颌关节前脱位的患者进行复位,效果良好,报道如下。1临床资料1.1一般资料1996年10月-2004年11月,应用改良口外法复位颞下颌关节前脱位62例,其中男性23人,女性39人,年龄17～75岁。62例均为前脱位,其中双侧脱位者47例,单侧脱位者15例,急性脱位者36例,复发性脱位者26例。1.2复位方法复位前嘱患者尽量放松,消除其紧张情绪,取得患者的配合。请患者端坐在口腔治疗椅上(或普通无靠背座椅,后背及头部紧靠墙壁)。下颌牙合平面的位置应低于术者双臂下垂时肘关节水平。…     

颌间撬动法复位颞下颌关节脱位的临床效果评价

颞下颌关节前脱位临床上以急性和习惯性前脱位较常见。颞下颌关节脱位后,应及时复位。目前,治疗方法有口内法、口外法和颌间复位法等。我科自2007年11月以来,应用杠杆原理颌间撬动法复位颞下颌关节脱位病例78例,并利用调查表方式统计患者的主观评价。     

急性非创伤性颞下颌关节脱位的手法复位治疗现状与发展

髁突脱出关节窝以外,超越了关节运动的正常限度,以至于不能自行回复原位者,称为颞下颌关节脱位(temporomandibular joint dislocation)。急性非创伤性颞下颌关节关节脱位是颌面外科急症之一,严重影响患者日常生活与工作,如未能及时对脱位进行正确处理会导致陈旧性脱位。近年来,涌现了不少手法复位的新方法,本文主要综述针对这些新的手法复位方法及其特点进行综述。     

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。     

双侧陈旧性颞下颌关节脱位诊疗经验总结

目的:探讨并总结我院收治的双侧陈旧性颞下颌关节脱位(chronic protracted mandibular dislocation, CPMD)的病例特征、治疗方案及预后,为陈旧性颞下颌关节脱位的防治提供临床参考。方法:回顾性分析2019年12月～2023年5月于我院住院治疗的9例CPMD病例,总结并分析CPMD患者的基本资料、脱位类型、脱位时间及临床症状;发病时所伴随的其他系统疾病及意识状态;复位方法、复位用时、住院天数及并发症;出院随访张口度、咬合关系及复发情况。结果:9例CPMD患者平均年龄(67±11.3)岁,女性占比88.9%;脱位类型均为双侧前脱位,脱位平均时间(2.1±1.4)个月。神经系统损伤是CPMD发病联系最密切的危险因素,发病时意识不清的患者占77.8%,仅22.2%的患者在初期感知脱位症状;约88.9%的CPMD病例发病与医疗活动存在密切联系。8例患者在麻醉下手法复位,手法复位率达88.9%,平均时间(24.3±10.9)min, 1例患者行手术复位。复位后均给予弹性牵引及后期张口功能训练。除手术复位患者存在轻微张口受限及面神经损伤外,其他患者随访期间咬合关...     

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。     

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。     

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。     

老年人颞下颌关节脱位的病因分析及预防

目的：分析老年人好发颞下颌关节脱位的病因、治疗方法并提出预防措施。方法：总结近5年156例老年人颞下颌关节脱位的临床资料，针对好发病因、复位方法与保持、预防措施进行探讨。结果：本组病例中112例为口外法复位，44例为口内法复位，全部复位成功。修复牙列缺失，以咬合板诱导恢复咬合关系，加强咀嚼肌功能锻炼可预防颞下颌关节脱位的发生。结论：老年人颞下颌关节脱位多与老年人伴发脑血管病、脑萎缩，牙列缺失，营养失衡导致的咀嚼肌群功能与自主调节性减退有关。提高老年人生活质量，控制与延缓脑萎缩并加强咬合诱导锻炼，是预防老年人颞下颌关节脱位的关键。     

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     

2种不同牙合垫治疗颞下颌关节紊乱病的临床疗效分析

目的:对比分析稳定型牙合垫和再定位牙合垫对治疗颞下颌关节紊乱病的临床疗效。方法:对采用牙合垫治疗的32例颞下颌关节紊乱病患者进行随访分析,其中使用稳定型牙合垫治疗的病例18人,再定位牙合垫14人,对比分析2组患者在治疗前、治疗后、治疗后3个月、6个月、12个月时关节弹响、疼痛程度(VAS)的变化。结果:2组患者治疗后疼痛程度及关节弹响状况与术前比较均明显改善,差异均有统计学意义(P<0.05),两种牙合垫对关节弹响的治疗效果无显著性差异,稳定型牙合垫组患者治疗后及治疗后3个月、6个月、12个月时的VAS低于再定位牙合垫组,差异有统计学意义(P<0.05)。结论:2种牙合垫均可有效地治疗颞下颌关节紊乱病,再定位牙合垫主要用于治疗可复性关节盘前移位,稳定型牙合垫治疗关节疼痛的疗效优于再定位牙合垫。     

Treatment of temporomandibular joint dysfunction by intraoral vertical ramus osteotomy

The purpose of this study was to determine if the intraoral vertical ramus osteotomy is an effective treatment for anterior disk displacements with reduction and associated temporomandibular joint pain and dysfunction. Success with this procedure was predicated on producing a more functional articular disk-condyle relationship by anterior and inferior repositioning of the condyle. The prospective study was undertaken of nine (eight female and one male) patients (mean age of 25.8 years) with anterior disk displacement with reduction and associated temporomandibular joint pain and dysfunction (mean duration of pain of 6.8 years). History, clinical dysfunction, and pain indices were used to determine the frequency and severity of temporomandibular joint dysfunction. The incidence of ear pain, muscle fatigue, tinnitus, headaches, and clicking was also assessed. The severity of the pain experience in the masticatory muscles and temporomandibular joints was evaluated through the use of a pain index. The severity of the pain experience and temporomandibular joint dysfunction in all of the patients was significantly reduced or totally eliminated during the period of followup. Surgical treatment of anterior disk displacement with reduction by intraoral vertical ramus osteotomy resulted in improved temporomandibular joint function and resolution of symptoms.     

Solid-state temporomandibular joint imaging: accuracy in detecting osseous changes of degenerative joint disease and determining condylar spatial relations.

The purpose of this study was to evaluate the off-label use of an intraoral charge-coupled device (CCD) for extraoral transcranial radiography of the temporomandibular joint. Corrected linear tomograms and transcranial images made with conventional screen-film combinations and a CCD detector were compared with sectioned cadaver specimens. Radiation dosage, qualitative assessment of condylar degenerative features, and condylar position within the glenoid fossa of the 3 modalities were assessed and compared. The CCD method required special adjustments to achieve adequate quality, and it involved greater exposure than the other methods. This use of this intraoral system for extraoral imaging cannot now be recommended, but future refinements might make it more viable.     

A new approach to the reduction of acute dislocation of the temporomandibular joint: a report of three cases

Various methods of reduction of temporomandibular joint dislocation are reviewed. The utilisation of the gag reflex provides a new alternative treatment of acute dislocation. This method is simple, rapid and safe and can be advocated in all cases of acute dislocation. The advantages and the rationale of this approach are discussed. Three cases of acute dislocation treated by this method are presented.     

Jacob's disease: report of a rare case and literature review

Jacob's disease is a rare condition consisting of pseudojoint formation between enlarged coronoid process and the inner surface of the zygoma. The authors report a 45-year-old female patient who presented with limited mouth opening (5 mm) and swelling of the left zygoma. No temporomandibular joint disease was diagnosed. 3D computed tomography images showed a mushroom-shaped coronoid growth with pseudojoint formation medial and superior to the zygomatic arch. Under general anaesthesia, coronoidectomy was carried out through a combined extraoral and intraoral approach. Histopathological examination revealed normal trabecular bone covered with hyaline cartilage. To the best of the authors’ knowledge this case is the fifth typical mushroom-shaped Jacob's disease; only four similar cases have been reported. A review of the literature revealed only 39 histologically proved cases of Jacob's disease cases up to 2010. Aggressive physical treatment was given to improve function and maximum mouth opening, which had increased to 40 mm at 3 months follow-up. The literature concerning this condition's aetiology, pathogenesis, clinical characteristics, diagnosis, and treatment is reviewed.     

Surgical treatment of fractures of the mandibular condyle: a comparison of long-term results following different approaches - functional, axiographical, and radiological findings.

AIM: While functionally stable osteosynthesis is a generally accepted method to treat all dislocated fractures of the skull, open reduction and rigid fixation of fractures of the mandibular condyle are still controversial. The risks involved in the surgical approaches and the difficulties during reposition are the main controversies. Improvements made in surgical access and osteosynthesis materials as well as the development of special instruments were the reasons for re-evaluating the surgical results. METHODS: Forty patients with displaced or dislocated fractures of the mandibular condyle were re-examined. In 20 patients (21 fractures) an intraoral approach, in 20 more patients (24 fractures) an extraoral perimandibular approach was applied. The results were compared by means of axiography and radiology as well as clinically with regard to function 6 months postoperatively. RESULTS: While almost all fractures were correctly reduced following application of an extraoral access, reduction was correct in only 50% of the patients treated with an intraoral approach. Re-displacement and complications during osteosynthesis were the reasons. The group of patients treated via the intraoral approach showed less favourable results radiologically, clinically, and as judged by the patients' subjective feelings. Especially axiographical examination of the latter fractures revealed a restricted translation indicating that the fractures had not healed primarily. CONCLUSION: In order to avoid complications, the only fractures which should be treated intraorally are those which allow exact reduction even under the conditions of a limited view and reduced possibilities of surgical manipulation during reduction. This applies in general to fractures of the mandibular condyle with a laterally displaced condyle and a shortened ascending ramus. For all other dislocated or displaced fractures, extraoral reduction and osteosynthesis are the methods of choice.