下颌升支矢状劈开截骨术后退和前徙下颌骨对下颌运动范围的影响

作者对接受下颌升支矢状劈开截骨术患者（下颌骨后退１１例，下颌骨前徙１０例）手术前自下颌运动范围进行了测量，并对颞下颌关节进行了临床检查。发现在术后６个月时，后退组患者的张口度已恢复到术前水平，前徙组患者的张口度仍低于术前，且差异有高度显著性（Ｐ＜０．０１），术后两组患者下颌前伸和侧向运动（左右）均无明显变化。提示下颌升支矢状劈开截骨术后退下颌骨对患者张口度影响较小，且术后恢复较快。     

下颌升支矢状截骨前徙术对颞下颌关节影响的近期观察

作者通过对１０例接受下颌升支矢状劈开截骨术前徙下颌骨患者手术前后颞下颌关节位置改变的分析，并结合临床检查，发现在术后６个月时，患者张口度小于术前，且差异有高度显著性，颞下颌关节前，上，后间隙也较术前有不同程序的改变，髁状突向后移位占１４／２０，向前移位占６／２０。术后多数患者颞下颌关节可通过调整，改建适应新的位置，而不出现临床症状，有的患者因术后髁状突位置改变使术前的关节症状消失。     

正颌外科治疗颞下颌关节强直伴阻塞性睡眠呼吸暂停综合征

目的 评价正颌外科手术治疗颞下颌关节强直伴阻塞性睡眠呼吸暂停综合征(OSAS)的效果。方法 12例颞下颌关节强直伴OSAS患者(男4例，女8例，年龄10～25岁，平均18．4岁；双侧颞下颌关节强直8例，单侧颞下颌关节强直4例)，采用颞下颌关节成形术、下颌矢状劈开前徙术、颏前徙成形术、舌骨悬吊术以及牵张成骨术移动下颌骨和舌骨。术后随访3～36个月。结果 12例患者张口度由术前的0～2mm增大到术后25～40mm；术后患者颜面形态明显改善；其连续血氧饱和度最低值由术前的42％提高至术后的90％以上，睡眠呼吸障碍解除和睡眠质量获得提高。结论 在颞下颌关节强直伴OSAS患者的治疗中，行颞下颌关节成形术的同时，辅助正颌外科手术，不仅可以增大患者的张口度，而且还能解决患者下颌后缩的畸形，同时解除上气道狭窄，从而缓解或纠正患者的低氧血症。     

双侧下颌骨矢状劈开截骨术矫正骨性Ⅲ类畸形对下颌支及颞下颌关节的影响

目的观察双侧下颌骨矢状劈开截骨术(BSSRO)后移下颌骨对下颌升支及颞下颌关节的影响.方法采用定位头颅后前位片及薛氏关节片,研究16例成人骨性Ⅲ类患者术前及术后下颌升支整体及关节间隙的变化.结果BSSRO术前与术后的下颌升支宽度减小,但无显著性差异.关节间隙在术后1月时有明显改变,6～12月后恢复为原位,且临床表现关节症状多有所缓解.结论 BSSRO矫治成人骨性Ⅲ类错(牙合)畸形对下颌升支及颞下颌关节无显著影响.     

双侧下颌骨矢状劈开截骨术矫正骨性Ш类畸形对下颌支及颞下颌关节的影响

目的观察双侧下颌骨矢状劈开截骨术(BSSRO)后移下颌骨对下颌升支及颞下颌关节的影响。方法采用定位头颅后前位片及薛氏关节片,研究16例成人骨性Ш类患者术前及术后下颌升支整体及关节间隙的变化。结果BSSRO术前与术后的下颌升支宽度减小,但无显著性差异。关节间隙在术后1月时有明显改变,6~12月后恢复为原位,且临床表现关节症状多有所缓解。结论BSSRO矫治成人骨性Ш类错畸形对下颌升支及颞下颌关节无显著影响。     

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.     

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目的 研究成人骨性安氏Ⅲ类错(殆)正畸-正颌联合治疗前后颞下颌关节(TMJ)变化.方法 选择2002-2010年在中国医科大学口腔医院正畸科就诊的成人骨性安氏Ⅲ类错(殆)患者30例,采用正畸治疗加双侧下颌升支矢状劈开后退术(BSSRO)的正畸-正颌联合治疗方案,分别在BSSRO术前、术后1个月、矫治结束时拍摄标准薛氏位片,采用Cohlmia测量法对关节片进行关节间隙及关节窝形态测量,观察髁突位置及关节形态的变化.结果 (1)关节间隙变化:与术前比较,术后1个月双侧关节各间隙均明显变大(P＜0.05);矫治结束后关节间隙测量值与术前比较,差异无统计学意义(P＞0.05).(2)髁突位置和关节窝形态变化:术后1个月髁突位置与术前比较,矢状向髁突位置后移,垂直向髁突位置下移.矫治结束后与术前比较,髁突位置各项指标差异无统计学意义(P＞005).反映关节窝形态的指标在术前、术后1个月和矫治结束后三者间比较差异均无统计学意义(P＞0.05).(3)30例患者中治疗前9例有关节弹响,治疗后5例弹响消失,术前无关节弹响者术后均未出现弹响,所有患者治疗前后均未出现关节疼痛及开口受限.结论 (1)BSSRO术后1个月关节间隙增大,髁突位置稍偏后,矫治结束后恢复正常.正畸-正颌联合治疗未引起关节窝形态的改变.(2)所有患者均未引起颞下颌关节紊乱病(TMD),且部分患者治疗后关节弹响消失,提示正畸-正颌联合治疗可能对TMD有一定的治疗作用.     

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.     

双侧下颌升支矢状劈开截骨后退术对下颌骨宽度及形态的影响

目的通过对下颌前突患者行双侧下颌升支矢状劈开截骨后退术前后头颅正侧位定位片硬组织结构变化的洲量分析,评价手术对患者下颌骨宽度及形态的影响。方法选择1997年至2001年在我中心行双侧下颌升支矢状劈开术的下颌前突患者18例,男性9例,女性9例,平均年龄22．22岁,所有患者手术前、术后一周、术后一年拍摄静止位头颅正侧位定位片,在正位片上测量下颌骨宽度(Go-Go),并从头颅正侧位定位片上测量与下颌骨宽度变化有关的参数数值。结果①下颌骨宽度由107．30mm±5．84mm(术前)增加至109．24mm±5．72mm(术后一周)、109．31mm±5．66mm(术后一年),其中有4例宽度减小,1例保持不变。13例增加,②下颌骨宽度术前、术后一用、术后一年的方差分析结果表明差别有显著性。③分析表明下颌骨宽度变化与各参数变化之间没有线性相关。结论①下颌骨宽度在双侧下颌升支矢状劈开截骨术后较术前有轻微增大,但对容貌没有大的影响。②下颌骨宽度变化机制可能与颞下颌关节功能改变有关。     

下颌支矢状劈开后退术对颞下颌关节影响的有限元研究

目的:分析骨性反牙合患者下颌支矢状劈开后退术前后,正中咬合最大咀嚼肌力状态下,颞下颌关节内的应力分布特征。方法:应用CT扫描技术分别建立骨性反牙合患者手术前后的颞下颌关节模型,以三维有限元方法分析手术前后关节内各结构的应力及位移变化特征。采用配对t检验进行手术前后应力比较。结果:术后颞下颌关节内各结构的VonMises应力较术前显著降低;各结构的最大、最小主应力和最大总位移也有降低;手术前后两侧关节承受的应力均呈对称分布。结论:骨性反牙合经过正颌-正畸联合治疗,正颌手术使下颌骨的空间位置发生变化后,颞下颌关节内各结构的应力环境也发生相应明显变化;这种变化对关节功能的发挥和健康的影响值得进一步研究。     

Evaluation of mandibular setback after bilateral sagittal split osteotomy with the hunsuck modification and miniplate fixation.

PURPOSE: This study was conducted to evaluate neurosensory disturbances (NSDs) and jaw movement after bilateral sagittal split osteotomy (BSSO) with the Hunsuck modification and miniplate fixation to correct mandibular prognathism. PATIENTS AND METHODS: A total of 63 patients who underwent Hunsuck-modified BSSO to correct mandibular prognathism were studied. Both 3-month and 6-month postoperative Schuller's temporomandibular joint (TMJ) views tracing the 63 patients were studied to analyze mandibular movement. The patients' NSD and TMJ symptoms were recorded. Data were analyzed using 1-way analysis of variance. RESULTS: The mean TMJ was 9.6% with clicking before surgery. At the evaluation 6 months after surgery, the clicking had reduced to 3.1%. The lip neuorsensory deficit increased to 23.8% at 6 months after surgery. The jaw position measurements before and after surgery showed statistically significant differences in mouth opening and jaw advancement (P < .05). The changes in mandibular lateral movement were not statistically significant (P > .05). CONCLUSIONS: The results of this study show reduced TMJ clicking, the presence of NSDs, and reduced mouth opening after Hunsuck-modified BSSO.     

正颌外科患者术前的颞下颌关节功能评价

目的　了解正颌患者颞下颌关节 (TMJ)的功能状况 ,探讨牙颌面畸形与颞下颌关节之间的关系。方法正颌外科发育性牙颌面畸形 12 3例患者 ,平均年龄 2 3.8岁 ,男性 45例 ,女性 78例。颞下颌关节功能的检查方法采取问诊与检查相结合 ,颞下颌关节功能记分采取 Helkim o指数记分方法。结果　 (1)牙颌面畸形患者颞下颌关节紊乱病 (TMD)各种症状发生率明显高于对照组人群。(2 )男性患者弹响症状发生率高于女性 ,而女性患者关节触诊疼发生率高。(3) 16～ 2 5岁患者张口受限发生率较高 ,但大多数为轻度张口受限。(4 )不对称畸形 (下颌前突偏斜 )者弹响症状发生率较高 ,而且相应偏斜侧最大侧向移动度小。而下颌后缩组开口度明显小于其他各组 ,提示其关节功能受损较严重。结论　牙颌面畸形患者的颞下颌关节功能不同于正常人 ,部分下颌偏斜与后缩患者关节功能受损     

Rehabilitation of patients with lower asymmetrical macrognathia

Unilateral subcondylar vertical osteotomy of the mandibular ramus was performed in 26 patients with asymmetric mandibular prognathism (AMP). 16 of 26 patients had temporomandibular joint (TMJ) symptoms before surgery. Asymmetric mandibular prognathism was combined with maxillary micro-retrognathism in 15 patients. Condyle position was evaluated by pre- and postoperative computed tomography (CT) data. Unlike mandibular sagittal split osteotomy with rigid fixation, the vertical subcondylar osteotomy with wire osteosyntheses allows to keep preoperative condylar head position on the side of hypertrophy and thus to prevent and eliminate TMJ symptoms postoperatively. Wire osteosynthesis promotes the most complete mechanism of adaptation and self-regulation of TMJ elements in surgical treatment of patients with asymmetric mandibular prognathism. All 26 patients had no TMJ symptoms postoperatively.     

The craniocervical connection: a retrospective analysis of 300 whiplash patients with cervical and temporomandibular disorders

Because the concept of whiplash as a causative factor for temporomandibular disorders (TMD) is highly controversial, we decided to do a retrospective analysis of patients treated in our office who had sustained whiplash injuries and were treated for cervical and temporomandibular disorders. The records of 300 patients with TMD preceded by a motor vehicle accident were examined retrospectively. The most common presenting symptoms, in order, were: jaw pain, neck pain, post-traumatic headache, jaw fatigue, and severe temporomandibular joint (TMJ) clicking. The most common TMD diagnoses were: masseter trigger points, closing jaw muscle hyperactivity, TMJ synovitis, opening jaw muscle hyperactivity, and advanced TMJ disk derangement. Based primarily on the physical examination, we concluded that the TMJ and surrounding musculature should be examined similarly to other joints, with no preconceived notion that TMD pathology after whiplash is unlikely.     

The influence of pre- and intraoperative positioning of the condyle in the centre of the articular fossa on the position of the disc in orthognathic surgery. A magnetic resonance study

OBJECTIVE: We investigated the changes in the temporomandibular joint (TMJ) after bilateral sagittal split osteotomy of the mandible for orthognathic surgery and the influence of positioning of the condylar process in the centre of the articular fossa before and during the operation for preventing changes in the TMJ postoperatively. STUDY DESIGN: A total of 28 patients with mandibular retrognathism had bilateral sagittal split osteotomies for mandibular advancement. In one group of 14 patients (28 TMJ), the condyles were placed in the centre of the articular fossa before and during the operation, and in the other group they were not. Differences on magnetic resonance imaging (MRI) were calculated and the results were evaluated. RESULTS: The main differences were found at maximal mouth opening. 15/28 TMJs (54%) that had not been positioned changed the position of the disc from physiological to anterior disc derangement with and without reduction postoperatively. In the 28 that had been positioned, changes were found in only 3 TMJs (11%) postoperatively. CONCLUSIONS: Fixing the condylar process in the centre of the articular fossa intraoperatively before bilateral sagittal split osteotomy is a factor in preventing postoperative structural changes in the temporomandibular joint.     

Mouse genetic models for temporomandibular joint development and disorders

The temporomandibular joint (TMJ) is a synovial joint essential for hinge and sliding movements of the mammalian jaw. Temporomandibular joint disorders (TMD) are dysregulations of the muscles or the TMJ in structure, function, and physiology, and result in pain, limited mandibular mobility, and TMJ noise and clicking. Although approximately 40–70% adults in the USA have at least one sign of TMD, the etiology of TMD remains largely unknown. Here, we highlight recent advances in our understanding of TMD in mouse models.     

Surgical orthodontic treatment of skeletal Class III malocclusion with anterior disc displacement without reduction (ADNR): a case report

A female patient with skeletal problems and left temporomandibular joint (TMJ) derangement was treated with an occlusal splint, arthroscopic irrigation, and orthodontic surgery. The left side disc was displaced anteriorly without reduction; and mobility of the left condylar head was restricted. With arthroscopic irrigation, the jaw functions were recovered, but the disc position remained the same. After TMJ therapy, orthodontic and orthognatic surgery treatments were performed to correct the dentofacial deformity. Stable facial esthetics and occlusion devoid of temporomandibular joint disorder (TMD) symptoms were obtained and the patient's progress was monitored over a 5-year period.     

Temporomandibular disorders in patients with mandibular fractures: a preliminary comparative case-control study between South Australia and Oman

The status of temporomandibular disorders (TMD) in subjects with previously treated mandibular fracture was evaluated in two centres: South Australia (SA) and Oman (O). TMD status was evaluated using Mandibular Function Impairment Questionnaire (MFIQ), Helkimo index for clinical dysfunction (HI), RDC/TMD and Wilkes’ classification. Data were retrieved for adult patients treated for mandibular fracture over 3 years from January 2004 to December 2006. Thirty-six subjects participated from SA and 23 from O. Their results were compared with matched controls. The incidence of TMD symptoms in SA injured and control groups was higher compared with the O groups. There was statistically significant difference on all evaluation indices for SA injured subjects compared with controls (MFIQ/P 0.04, HI/P 0.0015, RDC/TMD/P 0.05, Wilkes classification/P 0.03). These TMD symptoms were clinically insignificant for most subjects and all were internal derangement of the temporomandibular joint (TMJ). There was no significant difference in all evaluation indices for O injured subjects compared with controls. For SA injured subjects who reported clinically significant TMD symptoms, assault and bilateral mandibular fractures were predominant features. The study shows that most mandibular injuries fully recover and the associated TMJ trauma usually has low clinical significance in the long term.     

Association between temporomandibular joint symptoms, signs, and clinical diagnosis using the RDC/TMD and radiographic findings in temporomandibular joint tomograms

AIM: To identify associations between clinical symptoms of temporomandibular joint disorders and radiographic findings. METHODS: Two hundred four adult patients (156 women, 48 men, mean age 40 years) with temporomandibular joint (TMJ) pain/sounds or changes in mandibular motion were examined according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Bilateral sagittal corrected TMJ tomograms in closed and open positions were assessed for the presence of flattening, erosion, osteophytes, and sclerosis in the joint components and the range of mandibular motion. Logistic regression analyses were performed with the radiographic findings as the dependent variables and the following clinical variables as independent variables: opening pattern, maximal jaw opening, TMJ sounds, number of painful muscle/TMJ sites, duration of pain, presence of arthritic disease, depression and somatization scores, graded chronic pain, and age and gender. RESULTS: Coarse crepitus on opening/closing (odds ratio [OR] > or = 3.12), on lateral excursions (odds ratio > or = 4.06), and on protrusion (OR > or = 5.30) was associated with increased risk of degenerative findings in tomograms. A clinical diagnosis of osteoarthritis increased the risk of radiographic findings (OR > or = 2.95) and so did increasing age (OR > or = 1.03 per year) and the female gender (OR > or = 2.36). Maximal assisted opening and maximal opening without pain (< 40 mm) was associated with a posterior condyle-to-articular tubercle position (OR > or = 2.60). No other significant associations were observed. CONCLUSION: Age, gender, and coarse crepitus, but no pain-related variables, were associated with increased risk of degenerative findings in TMJ tomograms. Maximal opening < 40 mm was associated with a posterior condyle-to-articular tubercle relation on opening.