面部不对称畸形颞下颌关节盘的磁共振研究

目的旨在探讨面部不对称患者两侧颞下颌关节盘的形态和功能是否存在差异及面部不对称与关节盘内部结构紊乱之间可能存在的相关关系。方法对37名面部不对称者(10男,27女)的74个关节应用高清晰度的磁共振技术在矢状位(开口和闭口)和冠状位(闭口)进行扫描。将关节盘移位的类型分为部分前移位、前移位、旋转及侧向移位五种类型。将关节盘的功能分为正常、可复性移位和不可复性移位三组。在矢状向闭口位影像上将关节盘的形状分为双面凹、双面平、烟囱状和严重变形五种。同时对关节盘的位置、开口运动中的移位和旋转进行定量测量。对偏斜侧和非偏斜侧的差异进行统计学分析。结果本样本中约70%的面部不对称患者存在一侧或两侧的关节内部结构紊乱;关节盘前移位,特别是旋转性前移位在偏斜侧较多见(P<0.01);偏斜侧和非偏斜侧的关节盘形态有显著的统计学差异(p<0.01),偏斜侧形态异常者较多;偏斜侧关节盘的位置明显靠前、靠下(p<0,01);非偏斜侧关节盘在开口过程中表现出较大的运动幅度。结论面部不对称患者其两侧关节盘的形态和功能存在不同程度的差异,关节内部结构紊乱与面部不对称畸形的关系有待进一步研究。     

Osteoid osteoma of the eminence of the temporomandibular joint

We describe an osteoid osteoma in the articular eminence of the left temporomandibular joint of a 24-year-old woman. This is an uncommon tumour of the jaws, and has not previously been reported in this location. The mass was removed, she made a good recovery, and there are not signs of recurrence four years later.     

Inclination of the temporomandibular joint eminence and anterior disc displacement

The articular eminence angle of 179 temporomandibular joints (TMJ) with anterior disc displacement (ADD) in 179 patients was measured and compared with 200 left and 200 right joints of 400 young adults without TMJ dysfunction. A steeper inclination of the posterior slope of the articular eminence, with a mean difference compared to the control group of 14.5 degrees, was seen in joints with ADD. In the group of 179 joints with ADD of the TMJ, no difference was seen in the mean articular eminence angle between joints with an ADD with reduction, and an ADD without reduction, between conservatively or surgically treated joints, or between joints with different presumed causes of ADD.     

Intraoral mandibular distraction osteogenesis in facial asymmetry patients with unilateral temporomandibular joint bony ankylosis

Gap arthroplasty and costochondral rib bone graft are commonly performed by oral and maxillofacial surgeons to reconstruct the temporomandibular joint with ankylosis. However, unpredictable and unsatisfactory results such as re-ankylosis, growth disturbance, and facial asymmetry often occur. Even if the costochondral graft is successful, donor-site morbidity is inevitable. More recently, surgeons have become interested in distraction osteogenesis as a means of temporomandibular joint reconstruction. This case series presents the results of intraoral mandibular distraction osteogenesis and gap arthroplasty in two patients with facial asymmetry and unilateral temporomandibular joint bony ankylosis. Both patients had experienced failed gap arthroplasty and costochondral graft for the reconstruction of the temporomandibular joint. Distraction osteogenesis with gap arthroplasty proved successful in these two patients with follow-up of longer than 2 years.     

Synovial chondromatosis of the temporomandibular joint with articular eminence extension

Synovial chondromatosis (SC) of the temporomandibular joint is a rare benign lesion that can extend to the adjacent bony tissue. Most studies in the literature reported cases of SC of the temporomandibular joint with extension to the skull base, but there has been no report of intracranial extension through the articular eminence. The current study reports on the case of SC with articular eminence extension that was treated via combined trans-zygomatic tempora and preauricular approach and acquired good effect with 44 months of follow-up.     

Anatomy of the structures medial to the temporomandibular joint

OBJECTIVE: To define the relationship of the branches of the trigeminal nerve and the infratemporal vessels to the zygomatic arch and medial capsular ligament of the temporomandibular joint (TMJ). MATERIAL AND METHOD: In a study of 20 cadaveric dissections of the infratemporal fossa, measurements were obtained in anterior-posterior and transverse directions to identify the relationship of the trigeminal nerve, carotid artery, internal jugular vein, and middle meningeal artery to the zygomatic arch. The distance from the lateral to the medial aspect of the glenoid fossa was measured to further delineate the proximity of these structures to the medial portion of the capsule of the TMJ. RESULTS: The mean transverse distance from the zygomatic arch to the middle meningeal artery was 31 mm (range, 21 mm to 43 mm). The mean anterior-posterior distance from the height of the glenoid fossa to the middle meningeal artery was 2.4 mm (-2 mm to 8 mm). The transverse distance from the carotid artery to the zygomatic arch was a mean of 37.5 mm (29 mm to 48 mm) with the mean anterior-posterior distance of -6.5 mm (-21 mm to 6 mm). The mean distance from the internal jugular vein to the zygomatic arch was 38.3 mm (31 mm to 49 mm). The mean anterior-posterior distance was -8.7 mm (-20 mm to 7 mm). The transverse distance from the trigeminal nerve to the arch was a mean distance of 35 mm (24 mm to 46 mm). The mean anterior-posterior distance was 9.2 mm (1 mm to 25 mm). The mean medial to lateral width of the glenoid fossa was 18.7 mm (16 mm to 23 mm). CONCLUSION: The arteries, nerves, and veins are close to the medial aspect of the TMJ. A knowledge of these relationships can guide the surgeon on the medial aspect of the TMJ and can help to prevent complications associated with these structures.     

Recurrent headaches in relation to temporomandibular joint pain-dysfunction

Magnusson, T. Carlsson, G.E. Recurrent headache in relation to temporomandibular joint paindysfunction.

Two groups of 80 patients, one referred because of mandibular dysfunction and one seeking dental treatment, completed questionnaires concerning recurrent headaches. The function of the masticatory system of all patients was afterwards examined clinically.

The investigation showed that clenching of teeth was correlated to the severity of headache. The frequency and severity of headache varied also with the severity of mandibular dysfunction. Of the variables included in the dysfunction index, only masticatory musculature painful to palpation was found to have a distinct relationship to headaches. This implies that functional treatment is indicated in patients with headaches and tenderness of the masticatory musculature. Functional examination of the masticatory system should therefore be included in investigations of recurrent headaches.     

Morphologic changes in the unloaded temporomandibular joint after mandibulectomy.

PURPOSE: The aim of this study was to examine intra-articular conditions in unloaded temporomandibular joints (TMJs) after mandibulectomy including the condyle or segmental mandibulectomy. PATIENTS AND METHODS: Seventeen joints were defined as unloaded TMJs. Eleven of the 17 joints were classified into the "without condyle" (WOC) group in which TMJs had the condyle removed but the disc and superior joint compartment were preserved, and remaining 6 joints were classified into the "with condyle" (WC) group in which TMJs were connected to the condylar process. Disc configuration, bony changes, and joint effusion were examined by magnetic resonance imaging. In 8 of the 17 joints, arthroscopic examination of the superior joint compartment was performed. Correlation between data of the WOC and WC groups was evaluated. The relationship between arthroscopic findings and joint effusion was also analyzed. RESULTS: Deformed discs were observed in 7 of the 11 joints (63.6%) of the WOC group but were not observed in the WC group, in which there was a normal relationship between the disc and condyle. Bony changes were not detected in any joints. Joint effusion and arthroscopically diagnosed fibrous adhesion were observed in nearly all joints of both groups. CONCLUSIONS: We conclude that alteration of the relationship between the disc and condyle is more important for the initiation of disc deformation than loading conditions on the disc. The present findings suggest that, in the unloaded TMJs, articular degeneration is induced by disturbance of synovial fluid metabolism but that bony conditions are not affected.     

兔下颌骨骨折对颞下颌关节影响的实验研究

目的 观察下颌骨骨折对两侧颞下颌关节的影响，探讨损伤后颞下颌关节修复的机制。方法 采用新西兰大耳白兔30只。随机分为术后48h和1、3、5、8周5个时相组及一个对照组。每组5只，用多功能打击装王造成各组动物左侧下颌骨骨折。夹板坚固内固定骨折断，按时项处死动物取左侧颞下颌关节，观察伤侧颞下颌关节的组织学变化。用免疫组化方法检测髁状突软骨内VEGF及其受体Flt1的表达。结果 各时项标本均可见到颞下颌髁状突及关节盘不同程度的损伤，髁状突肥大细胞检测到VEGF及其受体Flt1的表达。结论 下颌骨骨折可致颞下颌关节损伤。VEGF和其受体Flt1可能参与颞下颌关节损伤的修复。     

Recurrent headaches in relation to temporomandibular joint pain-dysfunction.

Two groups of 80 patients, one referred because of mandibular dysfunction and one seeking dental treatment, completed questionnaires concerning recurrent headaches. The function of the masticatory system of all patients was afterwards examined clinically. The investigation showed that clenching of teeth was correlated to the severity of headache. The frequency and severity of headache varied also with the severity of mandibular dysfunction. Of the variables included in the dysfunction index, only masticatory musculature painful to palpation was found to have a distinct relationship to headaches. This implies that functional treatment is indicated in patients with headaches and tendernes of the masticatory musculature. Functional examination of the masticatory system should therefore be included in investigations of recurrent headaches.     

Implant of articular eminence for recurrent dislocation of the temporomandibular joint.

Hypermobility of the temporomandibular joint is often caused by trauma, by opening the mouth too wide, by having a mouth forced open during general anesthesia procedures, or by dental procedures. The capsule may be stretched to an extent that dislocation occurs more easily thereafter. An implant of Vitallium mesh attached to the zygoma to restrict anterior movement of the condyle is used to prevent recurrent dislocation of the temporomandibular joint.