下颌髁状突肥大55例临床分析

目的：探讨髁状突肥大的临床特点及手术方法。方法：总结本院１９７０～１９９７年间收治的髁状突肥大５５例,按其是否伴有下颌升支、体部及邻近颅面骨增大将其分为四型,分别施行髁状突切除术、髁状突下升支后缘“Ｌ”形截骨术、下颌升支垂直截骨术等。结果：男性３４例,女性２１例,男女之比为１．７：１;男性好发年龄为２０～３０岁年龄组,女性为３０～４０岁年龄组。主要表现为髁颈增长,并引起面部非对称性畸形。单纯髁状突切除术难以获得较好的功能。结论：Ⅰ、Ⅱ型施行髁突下“Ｌ”形截骨术,Ⅲ、Ⅳ型施行升支垂直截骨及必要的搭配手术可获得良好的外形及功能。     

下颌髁状突肥大55例临床分析

目的：探讨髁状突肥大的临床特点及手术方法。方法：总结本院１９７０￣１９９７年间收治的髁状突肥大５５例,按其是否伴有下颌升支、体部及邻近颅面骨增大将其分为四型,分别施行髁状突切除术、髁状突下升支后缘“Ｌ”形截骨术、下颌升直垂直截骨术等。结果：男性３４例,女性２１例,男女之比为１．７：１;男性好发年龄为２０￣３０岁年龄组,女性为３０￣４０岁年龄组。主要表现为髁颈增长,并引起面部非对称性畸形。单纯髁状突     

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。?     

计算机导航辅助下口内入路髁突切除术的临床应用

目的 探讨计算机导航技术在口内喙突切除入路髁突切除术中的应用.方法 在计算机导航技术辅助下,采用口内喙突切除入路共完成8例患者的髁突病变切除手术治疗,患者年龄16 ～56岁,男性2例,女性6例,其中3例为髁突骨瘤,5例为半侧颌骨肥大畸形伴发的髁突良性肥大.6例同期进行上颌LeFoa Ⅰ型截骨术、5例双侧下颌升支矢状劈开截骨术、1例健侧下颌升支矢状劈开截骨术、4例颏成形术及6例下颌骨体或下颌角修整术,以恢复面部的对称性.结果 经术后CT验证,所有患者均按术前设计方案成功完成了髁突病变切除术,术后咬合关系、面部对称性恢复良好,颞下颌关节疼痛及弹响症状减轻或消失.开口度术前平均38 mm,术后1个月恢复为41 mm.患者随访3 ～12个月,疗效稳定.结论 计算机导航技术可精确辅助完成口内入路的髁突切除术,手术创伤小,能较好地保存颞下颌关节的结构及功能.     

口腔内入路髁突切除术的临床应用研究

目的探讨经口腔内入路行髁突切除术并重建颞下颌关节的可行性。方法经口腔内入路行患侧升支垂直截骨术,将带有髁突的近心骨段取出至体外,切除病变的髁突,再将近心骨段的余部重新植入重建颞下颌关节。自1998年至2006年共完成经口腔内入路的髁突切除术并重建颞下颌关节23例,其中髁突良性肥大2例;髁突骨软骨瘤13例;半侧颌骨肥大畸形6例;髁突陈旧性骨折2例,最大的髁突骨软骨瘤直径达5cm。部分患者同期经口腔内入路行正颌外科手术矫治伴发的面部不对称畸形。结果23例患者均顺利完成手术,术后伤口正常愈合,面颈部皮肤无疤痕遗留,无面神经受损症状出现,面部不对称畸形矫治效果良好。经平均4.5年的随访,术后开口度均达35mm,髁突骨软骨瘤及髁突肥大均未见复发。结论自口腔内入路切除病变髁突并重建颞下颌关节,避免了常规口外入路时,术后皮肤遗留斑痕和易损伤面神经的缺点。     

口内入路髁突切除术的两种术式初探

目的 总结髁突切除术口内入路的两种术式及初步临床效果.方法 采用口内入路髁突切除术共治疗35例患者,年龄22～57岁,其中21例为髁突骨瘤,14例为半侧颌骨肥大畸形伴发的髁突良性肥大.32例经口内下颌升支垂直截骨入路,3例经口内喙突切除人路.结果 35例患者术后咬合关系及咬合功能、开口度、面部对称性恢复良好,颞下颌关节紊乱症状减轻或消失.术后随访6～36个月,32例口内下颌升支垂直截骨人路髁突切除术及关节重建的患者因游离移植的骨段发生了不同程度吸收,1例面部不对称畸形复发.3例口内喙突切除人路的患者术后功能恢复快,髁突塑形改建未见不对称畸形复发.结论 髁突切除术的两种口内入路方法均可恢复患者的功能及外形,但术者需有较好的手术操作技巧并严格掌握适应证.     

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。     

颌后切口入路髁突骨折的手术治疗

目的分析颌后切口入路髁突骨折的治疗方法及疗效。方法颌后切口入路,剖开腮腺下极,显露下颌升支及髁突。低位骨折,切口内直接对位固定;中位骨折,先切口内复位,预弯制钛板使之与骨面贴合,标志出螺钉钻孔位置后,将髁突夹持向下牵拉,垂直骨面钻孔,固定钛板,再复位固定升支部;高位骨折,下颌升支垂直斜形截骨,游离升支后缘骨块,并游离出髁突,体外将髁突与升支后缘骨块复位固定,将其回植于关节窝,后缘固定升支截骨线。结果35例均恢复正常咬合关系,张口度达3.5～4.0cm,面部对称。结论颌后切口手术治疗髁突骨折,显露充分,效果可靠。     

下颌偏斜畸形术后髁突位置改变的研究

目的:观察下颌双侧升枝矢状劈开术Bilateral Sagittal Split Ramous Osteotomy(以下简称BSSRO)矫治下颌偏斜畸形术后髁突位置的变化.方法:通过定位薛氏位片研究BSSRO矫治20例下颌偏斜畸形病例术前、术后1周及术后1年关节间隙的改变.结果:BSSRO术后1周髁突位置发生变化,1年后髁突位置恢复到术前状态,关节弹响症状多数缓解.结论:BSSRO矫治下颌偏斜畸形术后髁状突位置远期无明显改变.     

口腔入路人工颞下颌关节置换术

目的：探讨应用定量截骨锯行口腔入路髁突骨软骨瘤切除人工颞下颌关节置换术。方法：采用口内下颌骨矢状截骨手术入路,用定量截骨锯下颌骨升支后缘垂直截骨,将升支后缘骨块和髁突及骨软骨瘤游离取出,体外直视下病变髁突及骨软骨瘤切除后,人工颞下颌关节与升支后缘骨块固定,再从口腔原切口回植,颞下颌关节重建。5例5侧采用本方法治疗,配合术中术后调[牙合]或矫治器矫治,调整咬合关系。结果：术后6月、12月、24月复查,全部患者开口范围25mm～35mm,平均30．3nm,1例有早接触,下切牙中线过矫正1mm。另1例张口约25mm,轻度受限。3名患者6月复查主诉张口时人工关节侧有异常声响,无疼痛。12月复查时,异常响声基本消失,无主诉关节疼痛与弹响症状。全部患者无面神经、耳大神经损伤,无涎瘘,面颈皮肤无手术疤痕。结论：髁突骨软骨瘤造成面下1／3歪斜畸形,口腔入路具有无外部疤痕优势,且不会损伤面神经。定量截骨锯定量准确,截骨速度较快。     

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.     

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。     

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.     

渐进性髁突吸收致下颌后缩正颌外科的治疗进展

病因及发病机制仍不明确的渐进性/特异性髁突吸收(PCR/ICR),是一种发生在髁突的罕见的骨吸收性疾病,临床表现为髁突形态改变、体积减小和下颌升支高度降低等,后期往往出现比较严重的下颌后缩畸形及咬合功能障碍.手术作为一种治疗牙颌面畸形的有效方案,可以达到功能性及面型美观的改善.本文就PCR致下颌后缩的正颌外科治疗作一综述.     

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。     

正颌外科手术后的牵引原则

目的:对各类牙颌面畸形患者正颌手术完成后行安氏、、类牵引的重要性予以讨论分析。方法:24例各类牙颌面畸形患者正颌术后进行了安氏、、类牵引。结果:经术后安氏、、类牵引后,术后3～6月手术效果稳定,为术后正畸进一步的建,提供了良好的条件。结论:牙颌面畸形正颌手术后,由于功能和肌张力的改造往往落后于畸形的改造,易致畸形的复发,术后牵引可帮助肌肉系统的改建,建立新的平衡机制,确保美观和功能的一致。     

Three-dimensional computed tomography evaluation of postsurgical condylar displacement after mandibular osteotomy

Objective. The purpose of this study was to examine both condylar displacement of the temporomandibular joint after sagittal split ramus osteotomy with rigid osteosynthesis and intraoral vertical ramus osteotomy without osteosynthesis in patients with mandibular prognathism by means of three-dimensional computed tomography.Study design. In this pilot study, five patients treated with sagittal split ramus osteotomy and 5 patients treated with intraoral vertical ramus osteotomy were evaluated. A technique to superimpose a postoperative three-dimensional computed tomography image on its corresponding preoperative image was designed. Postoperative condylar displacement, rotation, and tilting were measured in three-dimensional computed tomography images.Results. Within 3 to 6 months after surgery, changes in the inclination of the condylar axes were distinctly seen, although changes in the position of the condyles within the joints were minimal. In particular, outward rotation of the condylar long axes after intraoral vertical ramus osteotomy was a frequent finding.Conclusions. The three-dimensional computed tomography superimposition technique was a practical method of evaluating post-surgical condylar displacement after mandibular osteotomy.     

Evaluation of condylar resorption rates after orthognathic surgery in class II and III dentofacial deformities: A systematic review

The purpose of this study was to perform a systematic review of morphological alterations in the condyles after orthographic surgery involving a sagittal split ramus osteotomy (SSRO), with or without surgery on the maxilla. Searches were performed on three databases and registered in the PROSPERO. The selected studies fulfilled the criteria established by the following PICO model: (1) population: individuals with skeletal dentofacial deformities (class II or III facial patterns), without asymmetry; (2) intervention: orthognathic surgery for mandibular setback using an SSRO, with or without a Le Fort I osteotomy, and fixed with bicortical screws or plates and screws; (3) comparison: orthognathic surgery for mandibular advancement using an SSRO, with or without a Le Fort I osteotomy, and fixed with plates and screws or bicortical screws; and (4) outcome: condylar resorption rate and relapse. Initially, 1,371 articles were identified and 636 articles were screened after elimination of duplicates, and 6 articles were selected for qualitative analysis based on the inclusion and exclusion criteria. Five studies had data regarding the rate of condylar resorption, varying from 0.0% to 4.2%. In conclusion, condylar resorption and relapses were present in a small percentage of patients studied.     

A three-dimensional study of hemimandibular hyperplasia,hemimandibular elongation,solitary condylar hyperplasia,simple mandibular asymmetry and condylar osteoma or osteochondroma

PurposeTo investigate the morphological features of hemimandibular hyperplasia (HH) in comparison to other condylar hyperplasia-associated asymmetries, including hemimandibular elongation (HE), solitary condylar hyperplasia (SCH), simple mandibular asymmetry (SMA) and condylar osteoma or osteochondroma (COS).Materials and methodsA total of 31 HH, 9 HE, 6 SCH, 10 SMA and 10 COS patients were included in this study. Clinical documentation, panoramic radiography and computed tomography data were retrospectively reviewed. The three-dimensional measurements were performed on multi-planar reformation images and volume rendering images. The accuracy of the subjective radiological signs was evaluated using sensitivity, specificity and receiver operating curve analysis. Discriminant analysis was performed to generate predictive formulas using quantitative data.ResultsThe condyles in HH were regularly or irregularly enlarged, with significantly enlarged anterior-posterior length [16.2/5.29 (mean/SD, mm) P < 0.001] and volume [5.3/2.9(mean/SD, cm³) P < 0.001] compared to the normal values. The condyles in HE and SMA were normally shaped, and the quantitative measurements were within the normal range. The ramus heights in the HH patients [55.7/5.4(mean/SD, mm)] were enlarged in comparison to the contralateral side (P < 0.001) and normal values (P < 0.001). The ramus heights in the HE [52.4/7.1 (mean/SD, mm), P < 0.001] and SMA [50.3/5.0(mean/SD, mm), P = 0.002] patients were enlarged in the contralateral side comparison but were within the normal range. The mandibular body heights in HH were enlarged in the premolar [16.6/1.3 (mean/SD, mm), P < 0.001] and molar [24.8/1.4 (mean/SD, mm), P < 0.001] regions. The inferior convexity of the lower mandibular border and inferiorly displaced mandibular canal produced high specificity, sensitivity and area under the curve for the diagnosis of HH. Discriminant analysis could predict the diagnoses with a cross-validation accuracy rate of 85.7%.ConclusionsHH is a distinct clinical entity characterized by enlargement of the condyle, ramus and mandibular body. The inferior convexity of the lower mandibular border and inferiorly displaced mandibular canal is accurate and specific for the diagnosis of HH. The condyles in HE are not hyperplastic. The term “condylar hyperplasia” alone cannot be used to refer to HH or HE.