下颌骨矢状劈开后退术对颞下颌关节的影响

目的:评价下颌骨矢状劈开后退术对颞下颌关节(TMJ)的影响.方法:研究我院50 例术前有颞下颌关节病(TMD),且行下颌骨矢状劈开后退术的患者,从关节压痛、弹响、张口度、张口型等方面量化评估术前、术后颞下颌关节症状变化情况.结果:从关节压痛、弹响、张口度、张口型等各方面评估均显示术后颞下颌关节症状评分均显著低于术前(P<0.05).结论:对于术前有颞下颌关节病的患者,行下颌骨矢状劈开后退术可以有效改善颞下颌关节症状.     

Condylar and temporomandibular joint disc positions after mandibular osteotomy for prognathism

PURPOSE: The purpose of this study was to compare the changes in temporomandibular joint (TMJ) morphology and clinical symptoms after sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO) with and without a Le Fort I osteotomy. PATIENTS AND METHODS: Of 43 patients with a diagnosed jaw deformity, 20 underwent IVRO without internal fixation and 23 underwent SSRO with rigid internal fixation. Some operations were performed in combination with a Le Fort I osteotomy. The TMJ symptoms and joint morphology, including the disc position, were assessed preoperatively and postoperatively using magnetic resonance imaging (MRI) and axial cephalography. RESULTS: A significant difference in the direction of condylar rotation was seen in horizontal axial cephalography images (P <.01). Fewer or no TMJ symptoms were reported postoperatively by 88% of the patients who underwent IVRO with or without a Le Fort I osteotomy and by 66.7% of patients who underwent SSRO with or without a Le Fort I osteotomy. In sagittal images, no change was seen in anterior disc displacement after SSRO; however, improvement was seen in 44.4% of patients with anterior disc displacement who underwent IVRO with or without a Le Fort I osteotomy. CONCLUSION: These results suggest that SSRO does not improve anterior disc displacement; IVRO improves anterior disc displacement in the initial postsurgical period, and both procedures may improve TMJ symptoms.     

MRI changes in the temporomandibular joint following mandibular setback surgery using sagittal split ramus osteotomy with rigid fixation

Objectives: This study examined the changes in temporomandibular joint dysfunction (TMD) symptoms and investigated the variations in the disc position, disc and condylar morphology following sagittal split ramus osteotomy (SSRO) with rigid fixation in patients with mandibular prognathism. Furthermore, the authors examined the correlation between mandibular setback and TMD symptoms.

Methods: The study included 24 Japanese patients with jaw deformities who were treated using bilateral SSRO and Le Fort I osteotomy. The clinical and magnetic resonance imaging findings in the temporomandibular joint were evaluated preoperatively and at three and six months postoperatively.

Results: The preoperative TMD symptoms were significantly associated with the prevalence of TMD symptoms at six months postoperatively. Anterior disc displacement improved in four joints with slight displacement and with no morphological change. There were no postoperative changes in condylar morphology. There was no significant correlation between mandibular setback and the postoperative TMD symptoms.

Conclusion: Postoperative TMD symptoms may be influenced mainly by preoperative TMD symptoms rather than mandibular setback using SSRO with rigid fixation. Therefore, patients with TMD symptoms require physical examination and MRI for appropriate diagnosis preoperatively.     

Complications after mandibular sagittal split osteotomy

Sagittal split osteotomy has been performed routinely for correction of mandibular prognathism, retrognathia, mild open bite, and asymmetry. Intraoperative and early or late postoperative complications were evaluated in 258 patients operated on by this technique. With meticulous performance of the operation and long-term maxillomandibular fixation, complications can be negligible, and relapse, the most problematic postoperative issue, can be significantly reduced.     

Changes in temporomandibular joint and ramus after sagittal split ramus osteotomy in mandibular prognathism patients with and without asymmetry

The purpose of this study was to examine the changes in the temporomandibular joint (TMJ) and ramus after sagittal split ramus osteotomy (SSRO) with and without Le Fort I osteotomy.The subjects consisted of 87 Japanese patients diagnosed with mandibular prognathism with and without asymmetry. They were divided into 2 groups (42 symmetric patients and 45 asymmetric patients). The TMJ disc tissue was assessed by magnetic resonance imaging (MRI) and the TMJ space, condylar and ramus angle were assessed by computed tomography (CT) preoperatively and postoperatively.Medial joint space on the deviation side in the asymmetry group was significantly larger than that in the symmetry group (P = 0.0043), and coronal ramus angle on the non-deviation side in the asymmetry group was significantly larger than that in the symmetry group preoperatively (P = 0.0240). The horizontal condylar angle on the deviation side in the asymmetry group was significantly larger than that in the symmetry group (P = 0.0302), posterior joint space on the non-deviation side in the symmetry group was significantly larger than that in the asymmetry group postoperatively (P = 0.00391).The postoperative anterior joint space was significantly larger than the preoperative value on both sides in both groups (the deviation side in the symmetry group: P = 0.0016, the non-deviation side in the symmetry group: P < 0.0001, the deviation side in the asymmetry group: P = 0.0040, the non-deviation side in the asymmetry group: P = 0.0024). The preoperative disc position could was not changed in either group.These results suggest that significant expansion of anterior joint space could occur on the deviation side and non-deviation side in the asymmetry group as well as on both sides in the symmetry group, although disc position did not change in either group.     

Changes in the temporomandibular joint position depending on the sagittal osteotomy technique and extent of mandibular movement

The bilateral sagittal split osteotomy (BSSO) and high oblique sagittal split osteotomy (HSSO) are common techniques for mandibular movement in orthognathic surgery. The aim of this study was to evaluate the influence of both techniques, as well as movement distances and directions, on the position of the temporomandibular joint (TMJ). A total of 80 mandibular movements were performed on 20 fresh human cadaver heads, four on each head. Pre- and postoperative cone beam computed tomography was used to plan the surgical procedure and analyse the TMJ. Reference measurements included the anterior, superior, and posterior joint spaces, intercondylar distances and angles in the axial and coronal planes, and the sagittal, coronal, and axial angulations of the proximal segment. Only minor differences were found between the BSSO and HSSO techniques, particularly in terms of the intercondylar angle in the axial plane (P < 0.03) and the condylar angle of the proximal segment in the sagittal plane (P < 0.011). Observed changes in the TMJ were mostly opposite when moving the mandible forwards and backwards and increased with increasing movement distance. BSSO and HSSO result in similar changes in TMJ position. The extent of the movement distance influences the position of the condyle more than the osteotomy technique.     

Radiography of the temporomandibular joint after oblique sliding osteotomy of the mandibular rami

abstract — A radiographic follow-up of the temporomandibular joint in 25 patients subjected to oblique sliding osteotomy of the mandibular rami showed a remodeling of the condylar head. Distinct double contours in the posterior part of the condylar heads were found in 30 out of 36 joints with a forward-inferior displacement of the condylar head.     

Postsurgical temporomandibular joint hypomobility: Rehabilitation technique

Specific techniques to treat temboromandibular joint (TMJ) hypomobility caused by capsular restriction are explained. Initially inflammation must be controlled. TMJ manipulation by condylar distraction during opening, protrusion, and lateral movements, and a simple stretching exercise to maintain increased mandibular range of motion, are described. Resistive opening and closing exercises at full opening to relax the lateral pterygoid muscles are prescribed. For all exercises five repetitions, repeated five times per day, are prescribed. These techniques are demonstrated in the successful treatment of a child with a presurgically and postsurgically hypomobile right TMJ.     

Transient facial nerve paralysis after mandibular sagittal osteotomy

Facial nerve injuries are rare complications after orthognathic surgery. A literature review shows that such damages can develop with various mechanisms and are usually transient. Two cases of delayed facial paralysis after mandibular osteotomy with spontaneous recovery are reported.     

Radiographic changes of the temporomandibular joint after oblique sliding osteotomy of the mandibular rami

64 patients with mandibular prognathism were operated upon with oblique sliding osteotomies of the mandibular rami. The patients were followed with cephalometric and temporomandibular joint (TMJ) radiographs for 3 years. 60% of the TMJs showed skeletal remodelling 3 years postoperatively. The condylar remodelling was significantly correlated to the degree of postoperative displacement of the condyle. The average condyle displacement postoperatively was about 3 mm inferiorly and anteriorly, but the position was almost completely back to normal during the control period, due to a combination of reverse movement of the condyle and remodelling. Mandibular relapse was not correlated to postoperative displacement of the condyle or condylar remodelling. The range of condylar movement was unchanged at follow-up.     

Skeletal remodelling in the temporomandibular joint after oblique sliding osteotomy of the mandibular rami

Skeletal remodelling of the temporomandibular joints took place in 80% of cases after oblique sliding osteotomies of the rami. The new bone formation was found in both the condylar and temporal parts of the joint. It was mostly located on the posterior surface of the condyle and in the roof of the temporal part of the joint. No differences in skeletal remodelling were found between wiring and nonwiring cases.     

Modified coronoid process grafts combined with sagittal split osteotomy for treatment of bilateral temporomandibular joint ankylosis.

PURPOSE: This article describes the use of autogenous coronoid process grafts for lengthening the ramus in patients with long-standing temporomandibular joint (TMJ) ankylosis and severe mandibular retrognathia. PATIENTS AND METHODS: A retrospective clinical study of 6 cases of bilateral TMJ ankylosis surgically treated during a 3-year period from June 1996 to March 1999 was performed. All patients were treated by condylectomy, mandibular sagittal split osteotomy, and immediate autogenous coronoid process grafts. Clinical examination, radiographs, and photographs were used postsurgically to evaluate the grafts, condylar function, and facial appearance. RESULTS: Very satisfactory postsurgical results were obtained in terms of function of the TMJ, the airway, and aesthetics. CONCLUSION: In children suffering from TMJ ankylosis, the coronoid process can be used for mandibular lengthening.     

颞下颌关节上腔囊内黏连的内镜手术方法及疗效

目的：介绍颞下颌关节（TMJ）镜下治疗囊内黏连（IA）的术式,评价关节镜手术治疗TMJ上腔IA的疗效。方法：对142例（159侧）关节镜下证实有黏连的关节行黏连松解术、囊内清扫修整术或射频消融术,其中110例（123侧）伴随关节盘移位者,行关节盘复位固定术。术后随访检查包括患者的颌骨运动度、VAS疼痛测量值及自我评价。疗效分为优、良、差3级,将优、良定为手术有效;采用SPSS11.0软件包对手术前、后颌骨运动度和VAS疼痛测量值分别进行配对t检验。结果：平均随访期10.3个月（1～27个月）。疗效评价优33.80%（48/142）,良56.34%（80/142）,差9.86%（14/142）;总有效率90.14%（128/142）。93.66%（133/142）的患者自主症状较术前明显改善。术前平均开口度（23.14±5.93）mm（10～40mm）,术后平均开口度（37.48±3.51）mm（30～40mm）,较术前显著改善,经统计学处理有显著性差异（P〈0.01）。疼痛的VAS测量值术前平均28.94±23.54（0～80）,术后平均4.44±10.10（0～50）,手术前、后VAS测量值有显著差异（P〈0.05）。结论：关节镜手术治疗TMJIA疗效肯定,能增大患者的开口度,改善功能,减轻颌骨运动时的疼痛。     

Time-course change in temporomandibular joint space after advancement and setback mandibular osteotomy with Le Fort I osteotomy

Purpose

The purpose of this study was to compare time-course changes in temporomandibular joint (TMJ) space between mandibular advancement surgery and setback surgery after sagittal split ramus osteotomy (SSRO) and Le Fort I osteotomy.

Surgical treatment of mandibular hypomobility.

Mandibular hypomobility may be the result of a number of intra- and extra-articular conditions. Its treatment, predicated on an accurate diagnosis, varies from minor manipulative maneuvers to several surgical procedures. The applicability of coronoidectomy, in certain conditions, has become increasingly important.