髁突骨软骨瘤的正颌外科治疗

目的 探讨正颌外科技术在髁突骨软骨瘤治疗中的应用效果。方法 利用正颌外科方法治疗12例髁突骨软骨瘤患者,进行Le Fort Ⅰ型截骨术修正上颌骨,采用口内入路患侧升支垂直截骨术切除病变髁突,健侧行升支矢状切开术及颏成形术矫正咬合及偏斜。结果 12例患者术后面型均得到矫正,随访2年以上无1例复发。结论 利用正颌外科技术治疗髁突骨软骨瘤,可以避免常规口外切口面部留有的瘢痕,并在切除肿瘤的同时矫正了面型。     

内镜辅助下手术治疗髁突骨软骨瘤临床体会

目的 :利用内镜辅助行下颌支垂直截骨提升术治疗髁突骨软骨瘤,探讨其应用范围及效果。方法 :选择2013-04—2015-05间收治的单侧髁突骨软骨瘤患者,术前进行临床资料采集、咬合关系、面形及影像学检查,对其中无正颌需求或颏点偏斜<3 mm且口内咬合稳定的患者,予以髁突肿物切除术及内镜辅助的下颌支后缘垂直截骨提升术治疗。术后临床检查关节、颌骨、咬合情况,并进行远期影像学随访。结果:共纳入5例患者,采用改良耳颞切口行开放性手术切除髁突顶部肿物,再利用内镜辅助行下颌骨支后缘垂直截骨提升术及坚固内固定,保持原下颌升支高度,其中1例患者附加下颌下缘外形修整术。术后病理提示均为髁突骨软骨瘤。术后5例患者完成随访,其颞下颌关节功能恢复良好,咬合及面型稳定,术后平均28.6个月的CT随访显示无肿瘤复发。结论:在切除髁突骨软骨瘤后,内镜辅助下颌骨升支后缘垂直截骨术,对于咬合轻度偏斜且无法进行正颌手术的髁突骨软骨瘤患者,是一种有效手术方案。该手术设计实现了切除肿物的同时,恢复保留颌骨及咬合关系,同时减小了创伤,是传统手术方案的有力补充。     

髁突骨折两种手术方法的比较

目的:比较耳前进路行髁突骨折-翼外肌解剖复位与改良颌下进路下颌升支垂直截骨髁突游离体外复位固定回植术的优缺点,为髁突骨折合理选择手术方法、手术进路提供临床依据。方法:回顾我科收治的髁突骨折中采用手术治疗的33例(43侧)病例,按骨折位置高低、类型选择了2种不同的手术方法,其中26侧采用耳屏前切口髁突骨折-翼外肌解剖复位,17侧采用改良颌下切口、下颌升支垂直截骨髁突游离体外复位固定回植术。随访12～24月,对比分析2组病例的疗效。结果:全部切口Ⅰ期愈合,无1例关节强直;所有病人术后面部对称性好。发生下颌骨向健侧侧!运动受限的病例中,经下颌升支垂直截骨髁突游离体外复位固定术者5例(占45%),经耳屏前进路翼外肌解剖复位者3例(占14%);术后发生暂时性面瘫患者中,改良颌下进路术式1例(占9.09%),耳屏前进路4例(占18.18%),术后3～6个月均恢复正常;术后患侧关节区张口疼痛患者中改良颌下进路者2例(占18.18%),耳屏前进路者5例(占22.73%),术后3个月症状明显缓解。结论:从功能上看耳屏前进路髁突骨折-翼外肌解剖复位术明显优于下颌升支垂直截骨术;而从并发症发生看前者多于后者。临床上应根据患者具体情况,合理选择术式,以提高髁突骨折的治疗效果。     

口内进路下颌升支垂直截骨术在矫治牙颌面畸形中的应用

作者为１８例下颌前突、１２例单侧髁状突肥大患者施行了口内进路下颌升支垂直截骨术。术中２例升支近中骨段发生折断，１例下牙槽血管损伤，术后１例因颌间栓结方法不当致咬合关系错乱。文中介绍了手术设计及操作注意事项，并详细讨论了口内进路下颌升支垂直截骨术的适应证，搭配术式的选择以及并发症的处理，报道了３０例牙颌面畸形的治疗效果。     

髁突复位钢板在下颌升支矢状劈开术中的应用

为了防止正颌外科术后髁突位置变化引起颞下颌关节症状及畸形复发，作者对１７例颌骨畸形患者行下颌升支矢状劈开截骨术中，应用髁突复位钢板记录和恢复髁突术前位置。结果提示，１５例患者的３０侧髁突位置术后检查未发生移位，仅２例患者各有１侧髁突发生了内侧旋转移位。作者认为，髁突复位钢板对于记录和恢复髁突术前位置是行之有效的。     

下颌升支垂直截骨在髁状突手术中的应用

目的：观察下颌升支垂直截骨间接治疗髁状突疾患的疗效。方法：采用下颌升支垂直截骨方式间接治疗髁状突疾患19例，其中髁状突良性肥大2例，髁状突骨瘤4例，颞下颌关节骨性强直3例，髁状突骨折10例。结果：所有患者张口度均接近或达到正常，无关节疼痛及弹响症状，随访期内无1例复发。结论：下颌升支垂直截骨间接髁状突整复是治疗髁状突疾患的一种可选择的、有效的方法。     

髁状突骨折移位手术治疗分析

本文报告成人髁状突骨折移位手术治疗的３９例（４１侧）术式是依Ｘ线诊断，临床表现、骨折部位、移位程度及致伤时间所定，即传统直接复位１１例，不游离髁突的升支切开解剖复位１６例（１８侧），游离髁突的升支切开复位固定关节重建术８例，游离髁突和升支骨段倒置关节术２例，乙状切迹下升支倒Ｌ型前徙术２例，下颌升支矢状劈开１例，无１例髁状突摘除。本文讨论了手术指征、术式选择和手术程序。对手术术式进行改进，对１６例髁突中、低位伴前内移位病人施行不游离髁突的升支切开解剖复位术取得满意效果。这一术式因不剥离髁状突而保证翼外肌对其血供，更符合颞下颌关节正常生理解剖结构，是目前成人移位髁突骨折进行解剖复位比较有效方法。     

下颌升支垂直截骨在髁状突骨折治疗中的应用

目的　探讨下颌升支垂直截骨在髁状突中、高位骨折开放复位手术中的应用。方法　采用颌后切口 ,下颌升支垂直截骨 ,取出升支后缘骨块 ,将髁状突下拉直视下与升支后缘骨块固定 ,或将髁状突游离取出 ,体外与升支后缘骨块固定后再植入。结果　 8例 9侧采用本方法治疗 ,经追踪 ,面形及功能均满意。结论　髁状突中、高位骨折伴严重移位者 ,可采用本方法治疗。?     

下颌升支后缘上移联合面部轮廓整形术同期治疗髁突骨软骨瘤及继发颌骨畸形

目的：研究在髁突骨软骨瘤患者病变髁突切除后,联合采用下颌升支后缘切开上移术和面部轮廓整形术同期治疗其继发颌骨畸形的手术效果,并探讨其临床应用价值。方法选择8例髁突骨软骨瘤的患者,全部采用病变髁突切除+下颌升支后缘切开上移术重建髁突+下颌轮廓整形手术,并辅助术后正畸或颌间结扎,同期治疗患者的髁突疾病及面部不对称问题。结果所有患者对术后效果都比较满意,患者面型不对称畸形、咬合及关节功能异常均得到很大改善,且随访期间髁突骨软骨瘤未见复发。结论髁突骨软骨瘤的病变髁突切除术后同期采用下颌升支后缘切开上移术+下颌轮廓整形手术的联合使用不仅可以摘除肿瘤,还可以有效的改善患者的面容,取得良好的治疗效果。     

颌下切口下颌升支垂直截骨在髁突高位骨折手术中的应用

目的:探讨应用颌下切口下颌升支垂直截骨术治疗髁突高位骨折的效果。方法:对16例(19侧)下颌骨髁突高位骨折患者采用颌下切口下颌骨升支后缘垂直截骨取出升支后缘骨块将骨折的髁突游离后取出,体外直视下将骨折片与升支后缘骨块复位固定后再回植,行颞下颌关节重建。结果:于术后6、12、24个月复查全部患者的开口度为30～48 mm,平均34.92 mm。所有患者咬合关系良好,无关节疼痛症状。部分病人有轻度开口偏斜,均<3 mm,有1例患者有关节弹响。结论:颌下切口下颌升支垂直截骨是治疗髁突高位骨折的一种可选择方法,具有操作简便、复位准确、近期疗效满意等优点。     

髁突骨折手术治疗临床分析

目的:探讨髁突骨折手术治疗的不同术式、适应证、手术治疗程序,为临床治疗提供依据。方法:对112例髁突骨折临床资料进行分析,按照X线诊断、临床表现、骨折部位、移位程度、致伤时间等因素确定不同术式,观察其术后即期与远期效果,其中38例行传统切开复位内固定术,53例行不游离髁突的升支切开解剖复位术,18例行游离髁突和升支骨段倒置关节重建术,3例行游离髁突升支切开复位重建术。结果:各种不同的手术治疗方式均可获得较好的即期效果,但远期效果以不游离髁突的升支切开解剖复位术最佳。结论:对于大多数髁突骨折,尤其是中、低位骨折,脱位,移位或严重成角者以不游离髁突的升支切开解剖复位术效果最好。髁突粉碎骨折和陈旧骨折宜行游离髁突和升支骨段倒置关节重建术。髁突高位骨折宜行游离髁突升支切开复位重建术。     

颞下颌关节肿瘤及瘤样病变致颜面部畸形的手术治疗

目的：探讨颞下颌关节肿瘤及瘤样病变致颜面部畸形有效的手术治疗方案,以及术后美容及对术后咬合功能的影响。方法总结82例颞下颌关节肿瘤及瘤样病变,其中良性肿瘤54例（骨瘤17例,骨软骨瘤8例,关节滑膜软骨瘤病21例,成釉细胞瘤3例,软骨瘤和骨巨细胞瘤各2例,软骨母细胞瘤1例）;瘤样病变25例（髁状突增生或肥大23例,髁状突囊性变2例）;恶性肿瘤3例。61例以面部畸形而就诊。所有患者均采用手术方法治疗,21例关节滑膜软骨瘤病行滑膜软骨瘤病变摘除术;以面部畸形而就诊的61例病例手术方式包括：①单纯施行肿瘤或瘤样病变切除34例;②肿瘤切除加即刻肋骨肋软骨移植9例;③患侧下颌升支垂直截骨、体外切除髁状突肿瘤后升支再植入3例;④髁状突下升支后缘“L”形截骨术3例;⑤双侧下颌升支垂直截骨术4例;⑥双侧下颌升支矢状劈开术3例;⑦双侧下颌升支矢状劈开加上颌骨Le FortⅠ型截骨术摆正平面术3例;⑧部分或半侧下颌骨切除2例。术后随访6个月～10年。结果以面部畸形而就诊的61例病例,58例良性肿瘤和瘤样病变病例均无复发;53例患者术后面容恢复基本对称,咬合关系正常,开口度正常,咬合功能得到恢复。但是,单纯行髁状突切除患者中,2例手术后咬合不稳定而出现一系列症状,3例面容改善不理想。3例恶性肿瘤,2例情况稳定,1例死亡。结论单纯切除颞下颌关节肿瘤与瘤样病变是主要的手术方式,但少量病例手术治疗效果不理想,应根据具体情况采用多手段相结合的治疗方法,以恢复正常的面形、咬合关系和颞下颌关节功能。     

下颌支后缘垂直切开上移重建髁突治疗骨软骨瘤

目的:评价下颌支后缘垂直骨切开术用于治疗髁突骨软骨瘤的临床效果.方法:对我院2004-2009年间9例应用髁突切除术及带蒂下颌支后缘上移重建髁突治疗髁突骨软骨瘤的患者进行随访,并通过影像学、咬合关系及颞下颌关节功能进行综合评估.结果:经过至少8个月的随访,所有患者髁突重建后的咬合关系、面形及关节功能均恢复良好.影像学检...     

Evaluation of treatment with unilateral mandibular sagittal split ramus osteotomy and maxillary osteotomy in patients with condylar osteochondroma and mandibular asymmetry: A retrospective case series

The aim of the study was to describe an approach where condylar resection with condylar neck preservation was combined with Le Fort I osteotomy and unilateral mandibular sagittal split ramus osteotomy (SSRO).Patients with a unilateral condylar osteochondroma combined with dentofacial deformity and facial asymmetry who underwent surgery between January 2020 and December 2020 were enrolled. The operation included condylar resection, Le Fort I osteotomy and contralateral mandibular sagittal split ramus osteotomy (SSRO). Simplant Pro 11.04 software was used to reconstruct and measure the preoperative and postoperative craniomaxillofacial CT images. The deviation and rotation of the mandible, change in the occlusal plane, position of the “new condyle” and facial symmetry were compared and evaluated during follow-up. Three patients were included in the present study. The patients were followed up for 9.6 months on average (range, 8–12). Immediate postoperative CT images showed that the mandible deviation and rotation and occlusion plane canting decreased significantly postoperatively; facial symmetry was improved but still compromised. During the follow-up, the mandible gradually rotated to the affected side, the position of the “new condyle” moved further inside toward the fossa, and both the mandible rotation and facial symmetry were more significantly improved.Within the limitations of the study it seems that for some patients a combination of condylectomy with condylar neck preservation and unilateral mandibular SSRO can be effective in achieving facial symmetry.     

The treatment of hemimandibular hyperplasia preserving enlarged condylar head.

OBJECTIVE: To present a case of hemimandibular hyperplasia (HH) treated with orthognathic surgery that preserves the condyle without disturbing mandibular function. METHODS: A 27-year-old woman with HH was treated with orthognathic surgery preserving the enlarged condylar head. Radiographic examination showed typical enlargement of the right condyle, elongation of the right ascending ramus and mandibular body, and tilted occlusal plane. A mandibular sagittal split osteotomy on the unaffected side and subcondylar ramus osteotomy on the affected side, Le Fort I wedge osteotomy to relevel the tilted occlusal plane, and contouring of the lower mandibular margin were performed. RESULTS: Excellent results in the full-face appearance and occlusion were obtained. There was no change in the size of the reserved condylar head 4 years postoperatively. In a series of examinations of jaw function with electromyography, mandibular kinesiography, and computer-aided diagnostic axiography, more favorable findings were obtained postoperatively. CONCLUSIONS: In a case of HH without abnormally high growth activity, orthognathic surgery preserving hypertrophic condyle produced functional improvement in addition to good occlusal and aesthetic outcomes.     

Computer-assisted surgical planning and simulation for condylar reconstruction in patients with osteochondroma

We describe the use of computer-assisted three-dimensional surgical planning in condylar reconstruction by vertical ramus osteotomy for patients with osteochondroma, and its clinical effects. Seventeen patients with osteochondroma of the mandibular condyle who were seen from March 2005 to March 2009 were divided into 2 groups treated by condylectomy and condylar reconstruction using vertical sliding osteotomy of the mandibular ramus with and without three-dimensional simulation using Surgicase CMF Materialise software. Clinical examination, radiographs, photographs, and details of operation and outcome were used postoperatively to evaluate the clinical effects of the technique. Satisfactory mouth opening was achieved in all cases. Mean (SD) osteotomy and fixation time, duration of intermaxillary fixation, and degree of postoperative numbness of the lower lip were considerably reduced among patients who had three-dimensional simulation. The combined use of computer-assisted three-dimensional surgical planning and simulation with vertical ramus osteotomy to reconstruct the condyle for patients with osteochondroma after excision of the tumour makes the operation more accurate and more convenient, and avoids damage to vital structures.     

Sliding reconstruction of the condyle using posterior border of mandibular ramus in patients with temporomandibular joint ankylosis

The traditional approach for ankylosis is gap arthroplasty or interpositional arthroplasty followed by reconstruction of the condyle using, for example, costochondral grafts. As these are non-pedicled grafts, there is eventual resorption with subsequent decrease in height of the ramus, facial asymmetry and deviated mouth opening. The authors have applied the method of total and partial sliding vertical osteotomy on the posterior border of the mandibular ramus for reconstruction of the mandible condyle as a pedicled graft for the correction of temporomandibular joint (TMJ) ankylosis. From 2004 to 2008, 18 patients who were diagnosed with TMJ ankylosis underwent operations for resection of the ankylosed condyle. Two methods were performed depending on the level of osteotomy on the posterior part of the mandibular ramus. All patients were followed-up for an average of 36 months (range 24-48 months). All patients showed apparent improved joint function with no cases of re-ankylosis. The results showed that sliding vertical osteotomy on the posterior border of the mandibular ramus seems to be an alternative and promising method for condylar reconstruction in patients with TMJ bony ankylosis.     

Sequential changes of postoperative condylar position in patients with facial asymmetry

Objective:To evaluate sequential images of the condylar position in relation to the glenoid fossa after orthognathic surgery in patients with facial asymmetry using cone beam computed tomography.Materials and Methods:A total of 20 adult patients (11 men and 9 women; mean age, 22.1 ± 4.02 years) with facial asymmetry who underwent sagittal split ramus osteotomy with rigid fixation were involved. Cone beam computed tomography scans were obtained before treatment (T0), 1 month before the surgery (T1), and 1 day (T2), 3 months (T3), 6 months (T4), and 12 months (T5) after the surgery. The condyle position was evaluated.Results:At 1 day after surgery (T2), the condylar position on both sides significantly changed posteriorly, inferiorly, and laterally, but no significant difference was observed between the nonaffected and affected sides. The condyle on the nonaffected side had a tendency to recover its preoperative position at 3 months after surgery (T3) and inclined slightly laterally up to 1 year after the surgery (T5). The condyle on the affected side returned more closely to the glenoid fossa than to its pretreatment position at 3 months after surgery (T3). Thereafter, it showed a more backward and downward position (T5).Conclusions:The overall condylar position after an orthognathic surgery in patients with facial asymmetry was relatively stable at 1 year after surgery. However, the condyle on the affected side during the first 3 months after surgery should be carefully monitored for surgical stability.