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。     

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。?     

下颌升支垂直截骨内固定术治疗髁突高位骨折

目的:比较手术和非手术方法治疗单侧下颌骨髁突高位骨折的临床效果。方法:19例髁突高位骨折患者,其中10例行下颌升支截骨内固定术+颌间牵引术(手术组),其余9例单纯行颌间牵引术(非手术组),随访0.5～1年。结果:手术组和非手术组之间比较,开口度及前伸运动度均无显著性差异(P>0.05);侧方运动度手术组优于非手术组,有显著性差异(P<0.01)。非手术治疗的患者,下颌骨平面不对称,X线片显示髁突的解剖位置欠佳。手术患者,下颌下区存在线形疤痕,但下颌骨平面对称,X线片显示患侧髁突与健侧形态相似。19例中无1例出现明显的颞下颌关节紊乱综合征。结论:采用下颌升支垂直截骨内固定术+颌间牵引术治疗下颌骨髁突高位复杂骨折,兼顾美观和功能,手术简便,不失为一种理想的治疗方法。     

下颌升支垂直截骨术对髁状突影响的实验研究

本研究在60只Wistar大白鼠中施行升支垂直截骨术。结果表明近中骨段常规固定组髁状突的改变较轻,而过度外移固定组手术对髁状突的影响非常明显。     

双侧下颌升支垂直截骨术对髁状突影响的小型猪动物模型建立

目的建立髁状突移动对颞下颌关节产生影响的大型实验动物模型。方法本研究对4只小型猪分组施行双侧下颌升支垂直截骨术,将双侧髁状突向前移动3mm、6mm及向后移动3mm,应用螺旋CT扫描及组织学,初步观察髁状突向前或向后方向移动不同的距离后对颞下颌关节产生的影响。结果4只小型猪所建的模型在观察期内生长良好,观察指标能较好地反映此术式对髁状突的影响。结论本研究在小型猪上建立了双侧下颌升支垂直截骨术对颞下颌关节产生影响的大型实验动物模型,为进一步研究此术式对髁状突的影响打下基础。     

升支垂直截骨术的实验研究近中骨段不良就位对髁状突软骨的影响

下颌升支垂直截骨术中近中骨段不良就位(上移或下移),改变颞下颌关节的原有解剖功能关系后可引起髁状突软骨的适应性改建。上移组动物在实验期表现出比下移组明显的组织学、超微结构变化。     

口内下颌骨升支垂直截骨倒置治疗颞下颌关节强直

目的：应用口内下颌骨升支垂直截骨倒置及耳前切口去除骨球关节窝成形术治疗颞下颌关节真性强直,评价其重建颞下颌关节的效果。方法：对5例颞下颌关节骨性强直患者切除病变区骨质,形成关节窝,采用口内下领骨升支垂直截骨倒置升支后部构造新的”髁突”,重建颞下颌关节。手术后常规随访,评价其疗效。结果：全部病例术后随访3～24个月,开口度3．1～4．1cm,平均开口度3．6cm,效果满意。结论：应用口内下颌骨升支垂直截骨倒置及耳前切口去除骨球关节窝成形术治疗颞下颌关节真性强直具有多方面优势,减少了并发症的发生,是治疗颞下颌关节真性强直的有效手术治疗方法。     

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。     

Ramus Condyle Unit Reconstruction Using Vertical Ramus Osteotomy in Temporomandibular Joint Ankylosis

Introduction

Treatment of bony Temporomandibular Joint (TMJ) Ankylosis includes release of the ankylosis and creation of a gap with or without insertion of interposing material and complete reconstruction of the joint using e.g. costochondral, autogenous coronoid/ankylosed mass, sternoclavicular, clavicular bone grafts etc. As these are non-pedicled grafts, there is eventual resorption with subsequent decrease in height of the ramus, facial asymmetry, deviated mouth opening and reankylosis. The authors have applied the method of vertical ramus osteotomy (VRO) on the posterior border of the mandibular ramus for reconstruction of the ramus condyle unit (RCU) as a pedicled graft along with Myofascial Temporalis Interposition for the correction of TMJ Ankylosis.

Materials and methods

Ten patients of TMJ Ankylosis were included in this study. All ten patients were treated using VRO for the RCU reconstruction with posterior border of mandibular ramus after Gap Arthroplasty. Temporalis myofascial flap was used as an interpositional material in all patients. Patients were followed from 20 to 30 months (mean 24 months).

Results

As a result of successful procedure the post-operative maximal mouth opening of 32–45 mm (mean 37 mm) was achieved. No patient experienced pain and infection at surgical site. None of the patients had graft rejection and reankylosis at follow-up.

Conclusion

The results showed that VRO on the posterior border of the mandibular ramus seems to be an alternative and promising method for RCU reconstruction in patients with TMJ Ankylosis.     

Changes of Hyoid,Tongue and Pharyngeal Airway after Mandibular Setback Surgery by Intraoral Vertical Ramus Osteotomy

Objective:To assess changes in hyoid, tongue, pharyngeal airway, and head posture in patients who had mandibular setback surgery by intraoral vertical ramus osteotomy (IVRO) and to investigate the influence of LeFort I osteotomy.Materials and Methods:Sixty patients with skeletal Class III malocclusion were evaluated. All patients had mandibular setback surgery via IVRO, and 45 patients had additional maxillary impaction surgery via LeFort I osteotomy. Lateral cephalograms were taken before, immediately after, approximately 1 month after, and at least 1 year after surgery. Parameters indicating the hyoid, tongue, pharyngeal airway, and head posture were evaluated.Results:The hyoid significantly moved inferoposteriorly immediately after surgery and relapsed superoanteriorly during observation periods. The tongue significantly moved posteriorly during all periods. The final position of the hyoid and tongue was significantly posterior, and the final pharyngeal airway was significantly narrower compared with its presurgical position. Significant cervical hyperflection occurred during observation periods and was strongly correlated with anterior movement of the hyoid. The hyoid and tongue showed similar positions regardless of the presence of different genders or LeFort I osteotomy after the long-term observation period.Conclusions:The hyoid and tongue moved posteriorly after mandibular setback surgery via IVRO, and there was a tendency to relapse back to its original position. However, the final pharyngeal airway width remained narrower after the long-term observation period. Based on our results, careful monitoring of the airway may be needed after mandibular setback surgery via IVRO.     

双侧升支矢状劈开截骨后退下颌术中去骨的评估研究

目的:评估双侧升支矢状劈开截骨后退下颌术中去除的颊侧骨皮质形状与垂直截骨线的方向和前牙覆变化间的关系,指导临床去骨操作。方法:在头影测量侧位描记图的下颌体部设计3种不同方向的垂直截骨线,用头影测量裁剪预测方法先旋转再后退下颌到术前设计位置,分析最终垂直截骨线与初始垂直截骨线间的角度关系,运用几何学原理计算此角度的大小。评价后退下颌时所需要去除骨皮质大致形状同初始垂直截骨线方向及前牙覆变化间的关系。结果:近心骨段不发生矢状向移位情况下,最终垂直截骨线与初始垂直截骨线间的角度大小与上下颌平面交角保持一致,与初始截骨线的方向和下颌后退的距离大小无关。去除的骨皮质形状与前牙覆变化相关。结论:近心骨段去骨形状与前牙覆变化密切相关,与截骨线方向和下颌后退的距离大小无明显相关。     

下颌骨矢状劈开后退术对咽腔间隙及舌骨位置的影响

目的 :CBCT测量分析下颌后退手术治疗下颌前突畸形,对舌骨位置和气道间隙变化的影响。方法 :选取单纯下颌前突畸形患者50例为研究对象,均接受经口内下颌骨升支矢状劈开截骨术,于正颌手术前1周、术后2周、术后6个月拍摄锥形束CT,测量治疗前后咽腔最窄处的矢状径、冠状径、截面积,同时舌骨点的三维位置,分析咽腔间隙大小及及舌骨体位置变化。测量数值配对t检验。结果:所有患者术后咽腔间隙均呈现缩窄趋势。舌骨发生了后下移位,其中术后2周向后、向下平均移动距离分别为2.64、1.56 mm,术后6月向后、向下移位分别为0.97、0.99 mm。术后2周咽腔的矢状径、冠状径及咽腔间隙分别为11.71 mm、3.05 mm、320.67 mm~2,术后6月时分别为14.64 mm、3.23 mm、414.85 mm~2。即随时间推移,舌骨位置及咽腔间隙有恢复正常范围的趋势。结论:双侧下颌骨升支矢状劈开截骨后退术后,舌骨向后下移位,咽腔气道缩小,有可能导致睡眠呼吸暂停综合征的发生,临床需予以重视。     

心理干预在下颌升支矢状劈开截骨术后肌功能康复训练中的作用

目的:探讨心理干预在下颌升支矢状劈开截骨术(sagittal split ramus osteotomy,SSRO)矫治下颌前突畸形术后肌功能康复训练中的作用。方法:60例接受下颌升支矢状劈开术的患者随机分为实验组和对照组,2组均接受系统治疗和肌功能康复训练,实验组在此基础上增加心理干预,测量术前、术后2、4周的张口度;术前、术后4、8周的焦虑自评评分和力。结果:实验组术后4周时张口度已接近术前水平,术后8周时力接近术前水平,焦虑情绪改善,实验组各方面参数相比对照组都有明显提高。结论:系统地心理干预能有效地提高患者健康知识水平,改善认知态度,使焦虑情绪得以改善,医患配合度提高,从而提高治疗有效率。     

下颌发育过度外科矫治术式的选择

下颌发育过度是临床常见的一种牙颌面畸形,下颌支垂直骨切开术和下颌支矢状骨劈开术是用来矫治这种骨性Ⅲ类错(牙合)的常用术式。本文对这两种手术方法的优缺点进行比较与讨论,从而为下颌前突外科矫正术式的合理选择提供参考。