颞下颌关节疾病的外科治疗

颞下颌关节疾病(temporomandibular joint disease,TMD)包括颞下颌关节紊乱病、颞下颌关节损伤、颞下颌关节脱位、颞下颌关节强直、先天性或后天性畸形、炎性疾病以及肿瘤等,治疗方法有保守治疗和外科治疗。基础研究有助于了解颞下颌关节疾病的致病机理,并为颞下颌关节疾病的治疗提供理论依据。虽然颞下颌关节疾病的治疗多年来存在争议,但随着对颞下颌关节疾病了解的加深,以及影像学的发展、关节镜和手术方法的改进,颞下颌关节疾病的外科治疗有了明显进步。本文对颞下颌关节紊乱病、颞下颌关节脱位、髁突骨折、颞下颌关节强直、先天性或后天性畸形以及肿瘤等颞下颌关节疾病的外科治疗现况及进展进行了阐述。     

颞下颌关节疾病的外科手术治疗

目的：颞下颌关节疾病的治疗包括保守治疗和外科手术治疗，本研究目的是探讨颞下颌关节疾病外科手术治疗的适应证以及手术方法。方法：对1988年至2000年共收治的765例颞下颌关节疾病患者进行回顾性研究。其中颞下颌关节紊乱病患者共418例，颞下颌关节外伤159例，颞下颌关节强直131例，髁状突肥大38例，颞下颌关节肿瘤18例，颞下颌关节感染1例，其中637例进行了外科手术治疗。结果：颞下颌关节紊乱病患中218例行颞下颌关节内窥镜术，21例行颞下颌关节盘复位术，91例行颞下颌关节盘修补术，11例行陈旧性关节脱位放复位术；131例行颞下颌关节成形术；109例行髁状突骨折开放复位术；38例行髁状突截骨术和正颌手术；18例行颞下颌关节肿瘤切除术。结论：颞下颌关节率乱病、损伤、关节强直、肿瘤、畸形以及其他关节疾病的手术适应证范围在不断地扩大，颞下颌关节外科的手术方法也在不断地改良。颞下颌关节科手术治疗正向着微创和恢复关节功能的方向发展。     

颞下颌关节疾病的外科手术治疗

目的 :颞下颌关节疾病的治疗包括保守治疗和外科手术治疗 ,本研究目的是探讨颞下颌关节疾病外科手术治疗的适应证以及手术方法。方法 :对 1988年至 2 0 0 0年共收治的 76 5例颞下颌关节疾病患者进行回顾性研究。其中颞下颌关节紊乱病患者共 4 18例 ,颞下颌关节外伤 15 9例 ,颞下颌关节强直 131例 ,髁状突肥大 38例 ,颞下颌关节肿瘤 18例 ,颞下颌关节感染 1例 ,其中 6 37例进行了外科手术治疗。结果 :颞下颌关节紊乱病患中 2 18例行颞下颌关节内窥镜术 ,2 1例行颞下颌关节盘复位术 ,91例行颞下颌关节盘修补术 ,11例行陈旧性关节脱位开放复位术 ;131例行颞下颌关节成形术 ;10 9例行髁状突骨折开放复位术 ;38例行髁状突截骨术和正颌手术 ;18例行颞下颌关节肿瘤切除术。结论 :颞下颌关节紊乱病、损伤、关节强直、肿瘤、畸形以及其他关节疾病的手术适应证范围在不断地扩大 ,颞下颌关节外科的手术方法也在不断地改良。颞下颌关节外科手术治疗正向着微创和恢复关节功能的方向发展     

老年颞下颌关节疾病

颞下颌关节解剖生理和功能的复杂性、颞下颌关节疾病诊断和治疗的复杂性以及老年人生理和病理的特殊性，构成了老年颞下颌关节疾病及其诊治的困难。老年人颞下颌关节、下颌骨以及口颌系统肌肉都会发生增龄性改变，老年人颞下颌关节的各种疾病的发生、发展以及诊治都与年轻人有所不同，本文对此进行介绍。     

肋骨肋软骨移植在颞下颌关节重建中的应用进展

颞下颌关节疾病如骨折、强直、肿瘤等,常会造成髁突破坏或缺损,需进行颞下颌关节重建。目前,肋骨肋软骨移植已成为颞下颌关节重建的首选方法。20世纪20年代首次将肋骨肋软骨移植应用于颞下颌关节重建,之后诸多学者在肋骨肋软骨选择、术后肋软骨生长情况以及如何减少手术创伤等方面做了大量研究。本文主要从以上几个方面,对肋骨肋软骨移植重建颞下颌关节的现状作一综述。     

颞下颌关节紊乱病与系统性疾病相关性研究进展

颞下颌关节紊乱病是口腔颌面部常见的疾病之一,颞下颌关节紊乱病并非指单一疾病,它是一类病因尚未完全清楚而又有相同或相似临床症状的一组疾病的总称。颞下颌关节紊乱病的发病机制尚未完全阐明,多数学者解释为多种致病因素相互作用下发生。近年来研究发现糖尿病、类风湿性关节炎、系统性红斑狼疮、强直性脊柱炎等全身系统性疾病与颞下颌关节紊乱病的发生相关,本文对颞下颌关节紊乱病与部分系统性疾病相关性研究进展进行阐述。     

颞下颌关节神经分布的研究进展

近年来从神经因素角度对颞下颌关节疾病发病机制进行了研究。本文综述了颞下领关节的神经起源及神经纤维的分布情况,并分析了颞下颌关节的神经分布与功能可能存在的联系,为进一步研究颞下颌关节中的神经分布对颞下颌关节疾病的影响提供了理论基础。     

口腔急诊颞下颌关节脱位发病特点及相关因素分析

目的:分析口腔急诊患者中颞下颌关节脱位的发病特点及相关因素,为防治颞下颌关节脱位提供临床依据.方法:研究对象为2008年1月至2012年10月在解放军第306医院口腔急诊就诊的颞下颌关节脱位患者94例.以问诊调查方式研究分析患者的基本情况、关节脱位的类型、性质、原因及治疗方法等.用x2检验,SPSS16.0数据包进行统计学分析.结果:在口腔急诊患者中颞下颌关节脱位患者占3.60％;年龄分布为8-92岁,20-29岁为40.42％;双侧前脱位为83例(88.30％);急性脱位61例(64.89％);有颞下颌关节疾病史、张口过大造成颞下颌关节脱位74例(78.72％).结论:在口腔急诊颞下颌关节脱位患者以急性、双侧前脱位多见,以有颞下颌关节疾病史加上张口过大,如打哈欠、咬硬物、大笑为诱因居多,手法复位加绷带制动为有效治疗手段,及时诊治颞下颌关节疾病,强化口腔健康宣教对防治颞下颌关节脱位是十分必要的.     

颞下颌关节损伤的早期MRI表现

目的:探讨MRI在颞下颌关节损伤中的应用价值.方法:对22例颞下颌关节损伤患者于3～14 d内行颞下颌关节MRI检查.结果:22例44侧颞下颌关节,共发现关节盘移位29侧,关节盘变形23侧,关节液改变19侧,关节骨异常9侧.结论:MRI能很好的显示颞下颌关节损伤情况,是颞下颌关节损伤的重要检查与评价手段,具有很高的临床应用价值.     

细胞凋亡在颞下颌关节中的研究进展

颞下颌关节是人体中最复杂的关节之一,是实现各种口腔功能的重要器官。近年来对颞下颌关节的发育和常见的颞下颌关节疾病等生理病理过程与细胞凋亡关系逐渐引起学者们的关注。本文对颞下颌关节的发育及其常见疾病中的细胞凋亡及凋亡因素作一综述。     

颞下颌关节内压的研究进展

颞下颌关节是口腔颌面部仅有的活动关节,颞下颌关节紊乱病是颌面部最常见的疾病之一。关节内压随着关节内结构的变化和功能运动而改变,关节内压的改变是引起颞下颌关节紊乱的重要因素。对关节内压的研究和测量对疾病的发展及治疗具有一定的指导意义。该文对近年来颞下颌关节内压的研究进行了总结,重点在于关节内压产生的机制、影响因素、关节内压的测定及其对于临床治疗的意义。     

Parotid gland malignancy presenting as temporomandibular joint pain or dysfunction

Temporomandibular joint pain and dysfunction is a common complaint and a frequent cause of referral to oral and maxillofacial surgeons. The importance of considering malignant disease in the differential diagnosis is illustrated by the following cases of parotid gland neoplasia which were referred as temporomandibular joint dysfunction.     

国际颞下颌关节外科发展史

随着人类的进化,颌骨的形态不断发生变化,颞下颌关节的问题一直伴随人类左右。作为口腔颌面外科的常见病和多发病,颞下颌关节疾病是口腔颌面外科的重要内容之一。从早期的文字记载开始,颞下颌关节外科经历了漫长的发展历程。如今,颞下颌关节外科取得的长足进步,离不开无数前人的尝试和努力。本文总结梳理了国际上颞下颌关节外科的发展历程,追溯其中具有里程碑意义的事件,以为广大读者提供参考。     

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随着锥形束CT在口腔颌面部应用的开展,锥形束CT也逐渐应用于颞下颌关节疾病的影像诊断中。本文介绍锥形束CT在颞下颌关节疾病中的应用现状,包括颞下颌关节紊乱病、颞下颌关节发育畸形、关节创伤、关节强直以及关节肿瘤等,结果表明锥形束CT作为一种有价值、有前途的影像检查方法,可以用于颞下颌关节疾病特别是关节骨性改变的评估中。     

Dissertations 25 years after the date 7. Temporomandibular joint ankylosis

Ankylosis of the temporomandibular joint and the possibly associated deformation of maxillofacial bones are functionally and aesthetically serious problems. Despite the developments in oral and maxillofacial surgery, treatment of patients with ankylosis of the temporomandibular joint still remains challenging. This article presents a review of the developments in this treatment, 25 years after the publication of the thesis 'Temporomandibular joint ankylosis'. Nowadays, computer-tomography is the standard for imaging assessment, possibly combined with stereolithography. Resection of the ankylotic mass is the surgery method of choice. The gap is filled by interpositional tissue transfer of temporalis muscle or a fascia flap. Early mobilisation and intensive physiotherapy are needed. In case of maxillofacial asymmetry, distraction osteogenesis has proved to be successful.     

Parameters of radiologic care: An official report of the American Academy of Oral and Maxillofacial Radiology

The American Academy of Oral and Maxillofacial Radiology developed these Parameters of Care to provide national guidelines for the use of radiographs prescribed for the diagnosis of disease, treatment planning, and follow-up care of patients with abnormalities of the oral and maxillofacial region. The Parameters cover radiographic techniques, imaging of the temporomandibular joint, imaging of diseases of the jaws, and imaging of dental implant sites.     

The use of hypnosis in treating the temporomandibular joint pain dysfunction syndrome. Report of two cases.

This article, jointly authored by an oral and maxillofacial surgeon and a psychiatrist, presents two case studies of conjoint treatment of the temporomandibular joint pain dysfunction syndrome. The authors present a short review from the literature that supports the multifactorial etiology of temporomandibular joint dysfunction and provide, in two case studies, a combination of conservative dental treatment and hypnotherapy. The two case studies show a successful resolution of temporomandibular joint dysfunction with hypnosis in one case and failure of hypnotherapy to relieve the pain in a second case. Reasons for the success and failure are discussed. The article closes with some thoughts and ideas that dental practitioners can use in treating temporomandibular joint pain via hypnosis.     

富血小板血浆在颞下颌关节骨关节炎的作用机制及应用研究进展

过去几十年中,富血小板血浆（PRP）因其再生医学潜力而被广泛应用于运动医学及口腔颌面外科。近年来,越来越多的研究集中于PRP对骨关节炎（OA）软骨修复的作用,包括膝关节和颞下颌关节（TMJ）等。TMJ与膝关节等全身关节不同,文章针对PRP应用中的一些争议及其在颞下颌关节骨关节炎（TMJOA）中的作用机制与应用做一综述。     

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??Platelet-rich plasma has ??PRP?? been widely used in sports medicine and oral and maxillofacial surgery for the past few decades owing to its potential ability in regenerative medicine.In recent years??more and more studies have focused on the cartilage repair of PRP in osteoarthritis??such as knee joint and temporomandibular joint. However??temporomandibular joint and knee joint are not the same??so the purpose of this paper is to summarize some of the controversies in PRP and the mechanism and application of PRP in temporomandibular joint osteoarthritis.     

A woman with ankylosis of the temporomandibular joint

A 56-year-old woman was referred to an oral and maxillofacial surgeon because of facial stiffness and restricted mouth opening, 13 years after receiving multiple mandible fractures in a car accident. After clinical investigation and computer tomography, ankylosis of the right temporomandibular joint was diagnosed. The patient was treated by means of gap-arthroplasty, in which a myofascial flap of the temporalis muscle was used as an interposition transplant. After a period of physiotherapy, an acceptable recovery of the mouth opening was achieved. Traumatic injury is by far the most prevalent etiology of temporomandibular joint ankylosis, followed by an infection of the temporomandibular joint. Treatment consists basically of a gap-arthroplasty, with or without interposing a transplant between the ramus mandibulae and the joint socket or resection of the ankylotic tissues followed by reconstruction of the mandibular caput with an autologue transplant or an alloplastic material.