正常人和偏侧咀嚼者颞下颌关节核素骨显像的比较

目的:比较放射性同位素骨三相显像技术对正常人及偏侧咀嚼者颞下颌关节影像检查的差异.材料和方法:正常男性志愿者15名和偏侧咀嚼者20名,接受放射性核素骨三相显像检查,以分析、比较不同咀嚼方式对颞下颌关节及骨的血流和骨代谢的影响.结果:正常人及偏侧咀嚼者两侧颞下颌关节形态对称,偏侧咀嚼者两侧髁状突运动不一致.正常人下颌骨不同部位的骨血流和骨代谢有特定差异.偏侧咀嚼者骨扫描示上述部位差异改变,非咀嚼侧关节区放射性强度稍高于咀嚼侧.结论:放射性同位素骨三相显像可以准确显示颞下颌关节的功能变化.     

核素三相骨扫描监测小型猪髁突骨折后血流变化及修复过程

目的：观测髁突骨折后的血供变化、骨内代谢活性变化以及由此导致的修复状况。材料和方法：中国实验用小型猪９头，分别造成左侧髁突纵行和横行骨折模型，在不同时间进行核素三相骨扫描检查。结果：两种类型髁突骨折血流相的时间－放射性活度曲线术侧颞下颌关节（ＴｅｍｐｏｒｏｍａｎｄｉｂｕｌａｒＪｏｉｎｔ，ＴＭＪ）血流有较大变化，术侧ＴＭＪ区延迟相和血池相的放射性计数比值各个时间组均比健侧大，其中所有三相术侧的变化纵行骨折区大于横行骨折区。不同类型髁突骨折引起的关节血流变化不同，髁突纵行骨折比横行骨折变化更大。结论：核素三相骨扫描在骨折后修复过程中能为临床提供非常有用的信息，由此可反映出不同类型骨折后在不同时间的骨代谢、血供及修复过程的状况。     

核素骨显像诊断颞下颌关节病变的临床价值

目的: 探讨利用放射性核素骨三相显像和SPECT检查颞下颌关节紊乱病患者的价值.材料和方法: 66例颞下颌关节紊乱病患者接受X线片、放射性核素骨三相显像和SPECT检查.通过骨扫描结果进行定性和半定量分析,选择23例患者接受外科手术治疗.结果: 选择保守治疗者43例,血池相和延迟相影像及SPECT两侧关节区影像对称.接受颞下颌关节重建术者23例,血池相和延迟相影像及SPECT影像两侧关节区影像不对称,患侧关节区放射性强度和髁状突放射性计数比值稍高于对侧;术中发现,髁状突表面软骨有破坏,术后患者症状缓解.结论: 骨扫描可以作为颞下颌关节紊乱病的早期器质性病变的检测手段,选择为治疗方法提供参考.     

He夹板治疗髁状突纵形骨折对颞下颌关节血流影响的研究

目的：观察髁状突纵形骨折后及Ｈｅ夹板治疗时双侧颞下颌关节区的血流情况。探讨Ｈｅ夹板治疗机制。材料和方法：中国实验用小型猪１４头,分为髁状突纵形骨折未治疗组、Ｈｅ夹板治疗组及正常对照组。分别于髁状窦纵形骨折后２、３、４、１２周做核素三相骨扫描检查。结果 髁状穿纵形骨折侧颞下颌关节（Ｔｅｍｐｏｒｏｍａｎｄｉｂｕｌａｒ ｊｏｕｎｔ,ＴＭＪ）血流相的时间－放射性强度曲线改变大,峰值升高,峰时后延,以２周时     

颞颌关节MR扫描技术应用

目的 探讨在没有颞颌关节专用线圈情况下颞颌关节的MR扫描技术.方法 79例共158侧颞颌关节,其中35例70侧颞颌关节使用头线圈,44例88侧颞颌关节使用矩形表面大线圈,行斜矢状面的快速双回波自旋序列(Pd+T2_tse)、斜冠状面多回波序列(Multiple echo 2 dimension,Me_2d)扫描.结果 158侧颞颌关节图像皆可以满足诊断需要,应用矩形表面大线圈的图像质量明显好于头线圈,有较好的对比度、空间分辨率和较高的信噪比.158侧病例中,20侧正常,138侧符合颞下颌关节紊乱综合征的MR影像学诊断.结论 使用矩形表面大线圈,通过对扫描序列,扫描参数的设计,可以得到符合临床要求的高质量颞下颌关节的MR图像.     

夹板治疗髁状突纵形骨折对颞下颌关节血流影响的研究

目的：观察髁状突纵形骨折后及夹板治疗时双侧颞下颌关节区的血流情况。探讨夹板治疗机制。材料和方法：中国实验用小型猪１４头,分为髁状突纵形骨折未治疗组、夹板治疗组及正常对照组。分别于髁状突纵形骨折后２、３、４、１２周做核素三相骨扫描检查。结果：髁状突纵形骨折侧颞下颌关节（Ｔｅｍｐｏｒｏｍａｎｄｉｂｕｌａｒｊｏｉｎｔ,ＴＭＪ）血流相的时间－放射性强度曲线改变大,峰值升高,峰时后延,以２周时最为明显,夹板治疗组各时间点均较未治疗组的ａ／β比值高。骨折侧血池相及延迟相计数比值升高,骨折后２周最高,然后逐渐下降。延迟相计数比值在夹板治疗组较未治疗组高。结论：夹板治疗髁状突纵形骨折有利于骨折后的血供,可能的作用机制是夹板减轻关节内及骨内压力,减轻静脉瘀血。     

保留髁突和关节盘治疗Ⅲ型颞下颌关节内强直的作用和疗效观察

目的 探讨保留髁突和颞下颌关节盘的术式对于治疗创伤性颞下颌关节内强直Ⅲ型的疗效.方法 创伤性颞下颌关节内强直Ⅲ型8例,男4例,女4例;年龄7～22岁,平均13.6岁.病程1～12年,开口度2～10 mm.手术方法为去除外侧髁突骨折断面形成的骨痂,将髁突磨改成形,在内侧寻找分离出移位的关节盘,松解后将关节盘的外侧端缝合固定至外侧关节囊或软组织.结果 术后随访6～38个月,患者开口度平均30 mm,无关节疼痛及弹响症状,随访期内无复发.结论 采用保留髁突和关节盘的方法治疗创伤性颞下颌关节内强直Ⅲ型,方法简单易行,创伤小,能有效防止复发.     

下颌骨双向牵张成骨治疗颞下颌关节强直伴小下颌畸形

目的:探讨牵张成骨技术在颞下颌关节强直伴小下颌畸形治疗中的应用效果。方法:对6例颞下颌关节强直伴严重小下颌畸形的患者采用一期下颌骨双向牵张成骨、二期颞下颌关节成形术进行治疗。结果:所有患者术后均顺利完成牵引计划,并在3个月后拆除牵张器,面容获得极大改善,张口度达到25mm以上,睡眠呼吸暂停症状消失,营养状况改善,口内咬合关系基本恢复。结论:牵张成骨技术为临床上治疗颞下颌关节强直伴严重小下颌畸形提供了有效方法。     

颞下颌关节真性强直2例报告

颞下颌关节强直较少见 ,现将我院遇到的 2例报告如下。例 1　女 ,14岁 ,10年前左耳流脓 ,治疗后好转 ,尔后逐渐张口困难。查体 :下颌偏左 ,面部不对称 ,张口度 0 .5cm ,双侧髁突动度 (± ) ,听力正常。CT扫描示 :左侧下颌骨升支短粗 ,髁状突呈球状肥大 ,颞颌关节窝浅平 ,异常肥大的髁突与关节窝形成的关节间隙明显变窄 ,关节面增生硬化 ,且有骨小梁通过关节间隙 (图 1,2 )。CT诊断 :左颞下颌关节畸形并关节强直。手术行左颞颌关节成形术 ,术后 2 0d ,张口度 1.5～ 1.8cm。例 2　男 ,13岁 ,10年前下颌部外伤后面部出现进行性畸形 ,近 2年张…     

颞颌关节直接矢状面CT检查

作者在10例病人行颞颌关节直接矢状CT 检查。病人仰卧于辅加扫描床上,后者端缘有缺口,置于扫描机架外侧同扫描机检查床约成30～55°角。扫描从颞颌关节的内侧至外侧,用连续2mm 厚度层面。最适宜的扫描是在闭口位、半开口位及最大开口位,并在关节弹响前及后重复扫描。可清楚显示关节盘的功能及位置、下颌髁状突活动及同关节凹的位置关系,颞颌关节的骨与软组织异常。作者认为;颞颌关节CT 检查比关节造影有很多优点:非损伤性、不需注射造影剂、检查没有疼     

颞下颌关节滑膜软骨瘤病的MRI表现

目的:探讨和描述颞下颌关节(TMJ)滑膜软骨瘤病的MRI表现特点。材料和方法:回顾性观察和分析13例经手术病理证实的TMJ区滑膜软骨瘤病的MRI表现。所有病例均在术前行闭口矢状面和冠状面PDWI、开口矢状面T_2WI检查。结果:所有滑膜软骨瘤病均发生于TMJ上腔。病变的MRI表现:关节上腔异常积液(13例,100%);关节囊明显扩张(11例,84.6%);关节腔内有多发软骨样小体的形成(11例,84.6%);关节囊或滑膜组织增厚(8例,61.5%)和颞骨关节面骨质破坏(4例,30.8%)。MRI未显示病变有下颌髁突侵蚀、关节囊外软组织侵犯、大脑颞叶脑膜和脑实质侵犯。结论:颞下颌关节滑膜软骨瘤病的MRI表现具有一定特点,主要表现为关节上腔异常积液,伴关节囊扩张、多发软骨样结节小体形成和滑膜组织增厚。     

Comparison of the T2 Relaxation Time of the Temporomandibular Joint Articular Disk between Patients with Temporomandibular Disorders and Asymptomatic Volunteers

BACKGROUND AND PURPOSE:T2 relaxation time is a quantitative MR imaging parameter used to detect degenerated cartilage in the knee and lumbar intervertebral disks. We measured the T2 relaxation time of the articular disk of the temporomandibular joint in patients with temporomandibular disorders and asymptomatic volunteers to demonstrate an association between T2 relaxation time and temporomandibular disorder MR imaging findings.MATERIALS AND METHODS:One hundred forty-four patients with temporomandibular disorders and 17 volunteers were enrolled in this study. An 8-echo spin-echo sequence for measuring the T2 relaxation times was performed in the closed mouth position, and the T2 relaxation time of the entire articular disk was measured. Patients were classified according to the articular disk location and function, articular disk configuration, presence of joint effusion, osteoarthritis, and bone marrow abnormalities.RESULTS:The T2 relaxation time of the entire articular disk was 29.3 ± 3.8 ms in the volunteer group and 30.7 ± 5.1 ms in the patient group (P = .177). When subgroups were analyzed, however, the T2 relaxation times of the entire articular disk in the anterior disk displacement without reduction group, the marked or extensive joint effusion group, the osteoarthritis-positive group, and the bone marrow abnormality–positive group were significantly longer than those in the volunteer group (P < .05).CONCLUSIONS:The T2 relaxation times of the articular disk of the temporomandibular joint in patients with progressive temporomandibular disorders were longer than those of healthy volunteers.

Disorders of the temporomandibular joint (TMJ) are characterized by intra-articular positional and/or structural abnormalities.¹ MR imaging is the preferred imaging technique for diagnosing temporomandibular disorders (TMD).² It has been reported that the diagnostic accuracy of MR imaging for the assessment of the articular disk position and articular disk formation is 95% and for the assessment of osseous changes is 93% in postmortem examinations.³ Numerous studies of TMD by using MR imaging have reported qualitative and morphologic evaluations, because the most important subgroup of articular abnormalities in patients with TMD includes different forms of articular disk displacement and deformation of the articular disk, either with normal bony joint components or accompanied by degenerative joint diseases such as osteoarthritis.⁴ Other MR imaging findings of TMD, including joint effusion and bone marrow abnormalities, have also been evaluated qualitatively and morphologically.^5,6The T2 relaxation time is a quantitative MR imaging parameter derived from multiecho spin-echo sequences. Measuring the T2 relaxation times by using MR imaging has been reported to detect degenerated cartilage in the knee and lumbar intervertebral disk.^7–11 The T2 relaxation time of the articular disk of the TMJ in healthy volunteers has been previously described by using a 3T MR imaging system,¹² but the T2 relaxation time of the articular disk of the TMJ in patients with TMD has not been reported, to our knowledge.We hypothesized that the T2 relaxation time of the articular disk of the TMJ correlates with the qualitative and morphologic variations in the pathology of the TMJ. The aims of this study were to measure the T2 relaxation time of the articular disk of the TMJ in patients with TMD and asymptomatic volunteers to demonstrate any association between T2 relaxation time and MR image findings of TMD.     

Imaging of temporomandibular joint ankylosis. A new radiographic classification.

OBJECTIVES: To compare the pre-operative clinical and radiographic findings of temporomandibular joint (TMJ) ankylosis with those found at operation and propose new classification. METHODS: Thirty-three patients were treated for TMJ ankylosis. There were 18 unilateral and 12 bilateral cases. All patients underwent pre-operative clinical and radiographic examination, (consisting of a panoramic radiograph, axial and coronal CT. The surgical findings were compared with the imaging features. RESULTS: Post-contrast coronal CT was the best imaging modality for planning surgery as it displayed the anatomical relationship between the ankylosed segment and the surrounding vital structures, particularly where the sphenoid and temporal bones were involved. CONCLUSIONS: Surgical planning should be based on coronal and axial CT. A new classification of TMJ ankylosis based on the CT findings is proposed.     

Temporomandibular joint: magnetic resonance imaging

Magnetic resonance (MR) imaging of the temporomandibular joint was performed in two subjects using a 1.5 T experimental imaging system equipped with a 6.5 cm surface coil antenna. Normal and pathologic anatomy were demonstrated with exquisite detail. Anterior displacement of the joint meniscus was clearly visible in the symptomatic subject, consistent with arthrographic confirmation.     

多排螺旋CT在颞颌关节形态研究中的应用

目的探讨多排螺旋CT(mu ltislice helical CT,MSCT)在颞颌关节(temporom and ibu lar joint,TM J)形态研究中的应用价值。方法MSCT对10具尸体,30名志愿者共80侧TM J扫描,在多层面后重建(mu ltip lanar reform ation,MPR)图像上,测量TM J骨性形态参数、关节盘厚度、关节间隙,对尸体TM J进行解剖测量,结果用SPSS软件分析。结果TM J MPR图像骨皮质边界清晰,关节间隙显示清楚,关节盘依稀可辨,TM J骨性形态参数2种测量结果间有显著的正相关关系,关节盘厚度2种方法间有较大的正相关关系,获得了正常TM J形态的参考值。结论MSCT配合MPR技术,可以全面、精确地测量TM J的骨性形态,准确地测量关节间隙,粗略地测量关节盘的厚度。     

Temporomandibular joint synovial osteochondromatosis: CT manifestations

Synovial osteochondromatosis is a rare arthropathy of the temporomandibular joint. We report the computed tomographic findings in two subjects with this disorder. Both patients had increased soft-tissue density in the joint with multiple small calcified densities, many of which displayed peripheral calcification. Extensive erosions of the surrounding bony structures were present, affecting the condylar process and fossa, and, in one instance, the walls of the external auditory and carotid canals were thinned. We believe that computed tomography is superior to conventional imaging techniques and is useful in the depiction of disease and surgical planning in patients with temporomandibular joint synovial osteochondromatosis.     

Temporomandibular joint: relationship between MR evidence of effusion and the presence of pain and disk displacement.

OBJECTIVE. The purpose of this study was to correlate MR evidence of joint effusion in the temporomandibular joint with symptoms of joint pain and the presence of disk displacement and arthrosis. SUBJECTS AND METHODS. The temporomandibular joints of 379 patients with clinical symptoms of temporomandibular joint disorders and 11 asymptomatic volunteers were imaged bilaterally. Sagittal and coronal proton density-weighted and T2-weighted images were obtained. Imaging findings of joint effusion were correlated with the presence of disk displacement and arthrosis and the symptom of pain. RESULTS. MR showed effusion in 7% of the joints with normal superior disk position, 40% of the joints with disk displacement with reduction, 50% of the joints with disk displacement without reduction, and 27% of the joints with arthrosis. Two of the control subjects had disk displacement with reduction; MR did not show joint effusion in any of the control subjects. A strong association was seen between joint effusion and joint pain. Joint effusion was seen in 46% of the joints on the more painful side and in 13% of the joints on the less painful side. CONCLUSION. The results show that temporomandibular joint effusions primarily occur in joints with disk displacement and are strongly associated with joint pain.     

Temporomandibular joint injuries

The clinical and radiologic findings in 30 patients who sustained injuries to the temporomandibular joint (TMJ) were retrospectively analyzed. Imaging consisted of variable combinations of radiography, tomography, two-compartment arthrography, computed tomography, and magnetic resonance imaging and was performed 2 days to 24 months after injury. Indications for imaging included acquired and/or unstable occlusal disturbances, cephalalgia, facial pain, otalgia, TMJ pain, tinnitus, dizziness, hearing disturbance, masticatory dysfunction, and muscle atrophy. Radiologic findings included internal derangement of the TMJ meniscus, swelling of retrodiskal tissues, joint effusion, mandibular condyle and condylar neck fractures, osteochondritis dissecans, avascular necrosis, degenerative condylar remodeling, osteoarthritis, musculotendinous injuries, and atrophy of masticatory muscles. After imaging studies, seven patients underwent surgery, at which time imaging findings were confirmed; one patient underwent successful aspiration of a painful hemarthrosis. TMJ injuries may result in joint derangement, radiologically demonstrable joint degeneration, masticatory muscle dysfunction, pain, and progressive clinical disability.