下颌骨折后不同手术固定方法对颞下颌关节的影响

目的：研究下颌骨折后不同手术固定方法对颢下颌关节的影响。方法：建立下颌角、下颌体部颏孔区及正中联合区3种单一线形骨折体外模型,用MNS104型钛小夹板及M2B单皮质螺钉采用不同方法进行骨折固定。对固定后的下颌骨骨折模型进行体外模拟功能负载。测定下颌功能活动时骨折侧髁状突的前后及左右的水平位移。用Origin6．0软件进行结果分析处理。结果：单一钛小夹板沿中线固定下颌角区,体部颏孔区及正中联合区,骨折侧髁状突均产生较大的向后的水平位移。应用单夹板外斜线固定下颌角骨折和双钛夹板固定体部颏孔区及正中联合区骨折,可明显降低骨折侧髁状突的向后水平位移。结论：任何骨折固定法必须有效对抗髁状突非生理性的位移,杜绝颞下颌关节微小创伤来源,降低病人患颢下颌关节紊乱病的风险因素。     

老年颞下颌关节紊乱综合征患者合夹板治疗前后CT影像的三维分析

通过对老年颞下颌关节紊乱综合征（ＴＭＪＤＳ）患者在治疗前后，戴与不戴夹板时正中位关节ＣＴ扫描的图像分析，发现老年颞下颌关节紊乱综合征患者的髁突不仅在矢状面发生了后移位，而且在水平面双侧髁突水平倾斜角亦呈不对称状态。而夹板对老年ＴＭＪＤＳ的矫治作用不仅为适当恢复垂直距离，主要在于消除了干扰，使后移位的髁突调整到关节凹的中位，并且平衡不对称的两侧髁突水平角。作者认为，本方法在颞下颌关节紊乱综合征的诊断及疗效判断方面，参考价值较大。     

前伸(牙合)时髁状突运行距离的探讨

目的 :推导切牙合功能时 ,髁状突向前下方运行的距离及生理意义。方法 :通过 5 0例头颈标本作经颞下颌关节区的断层摄影 ,测量影像的关节窝深度和关节窝前壁斜度后 ,结合前牙的覆盖距离 ,用三角公式推导髁状突在下颌前伸功能运动时 ,运行的可能范围。结果 :关节窝前壁平均长约 9mm ,与水平面夹角平均 46.6° ,关节窝前半径宽平均为 6.2mm ,关节窝平均深 6.5mm ;计算获得下颌前伸对刃时 ,髁状突向前下方滑行平均 5 .3mm的距离。结论 :在下颌的前伸功能运动中 ,髁状突的运行范围受限于关节窝前壁的制导作用 ,这对牙合稳定和关节健康有重要的生理意义。     

颞下颌关节紊乱综合征患者的髁突位置及对称性

目的:探讨伴有颞下颌关节紊乱综合征(temporomandibular disorders,TMD)的错(牙合)畸形患者的髁突位置及对称性.方法:在就诊的错(牙合)畸形患者中,选取有TMD症状的15例患者纳入实验组,并选取15例无症状患者作为对照组.分别对实验组和对照组行双侧颞下颌关节CT扫描,选取适当的断层并测量其关节间隙及对称性.采用SPSS17.0软件包对数据进行统计学处理.结果:实验组患者的髁突位置明显偏后位,而对照组患者的髁突位置稍前位.实验组患者患侧髁突水平倾斜角较健侧大(P＜0.05),而垂直倾斜角较健侧小(P＜0.05),两侧髁突内外径、前后径、髁突长轴、髁突中心至正中矢状面距离、两侧髁突前后距均无显著差异.结论:颞下颌关节紊乱综合征患者的髁突位置明显偏后位,且两侧髁突存在垂直向不对称.     

联合动态MRI和下颌运动轨迹描记仪分析健康人开闭口时下颌运动轨迹特征

目的：结合动态MRl分析健康人开闭口时下颌运动轨迹特征。方法：18例健康人最大开闭口过程进行动态MRI和下颌运动轨迹描记仪检查，分析髁状突及下颌前牙切点的运动特点及范围。结果：动态MRI显示闭口位关节盘本体部呈双凹形，本体部位于髁状突横嵴的前方（盘分界角〈10。）。健康人下颁前牙切点运动轨迹平滑，双侧运动中心运动轨迹左右对称；运动轴始终保持平行，呈现开闭口初、末时密度比开闭口中时大；运动中心运动距离（13．2±3．1）mm，切点运动距离（41．1±3．8）mm。结论：下颌运动轨迹描记能记录髁状突运动轨迹并且间接反映颞下颌关节的关节盘在开闭口运动中的位置变化情况，为初步建立下颌运动轨迹描记对辅助诊断关节病的参考标准奠定了基础。     

成人下颌偏斜患者颞下颌关节对称性研究

目的:了解下颌偏斜患者颞下颌关节形态学差异及相关性。方法:对21例下颌偏斜患者拍摄颞下颌关节中位断层片,选择描述髁突位置及髁突和关节窝形态的15个指标进行测量及统计分析。结果:下颌偏斜患者非偏斜侧的髁突在关节窝中的位置较偏斜侧向前下移位;非偏斜侧的髁突高度、髁突上部高度较偏斜侧高;非偏斜侧的髁突前斜面斜度、关节窝后斜面的斜度较偏斜侧大。双侧髁突前斜面斜度与关节前间隙、关节窝深度呈正相关;髁突上部高度与髁突高度呈正相关;偏斜侧髁突后斜面斜度与关节窝后斜面斜度呈正相关;非偏斜侧髁突后斜面斜度与关节上间隙、关节结节高度呈负相关。结论:下颌偏斜患者双侧颞下颌关节具有形态学差异。双侧髁突形态的变化与其同侧关节窝形态的变化及其在关节窝中的位置具有一定相关性。     

成人颅下颌骨解剖测量分析

目的: 应用三维CT对成人颞下颌关节解剖学数据进行初步测量分析,为标准型全颞下颌关节假体研发提供依据。方法: 选取无颞下颌关节疾病的受试者400例,应用螺旋CT扫描头颅骨（层厚0.625 mm,Dicom格式）,利用Simplant Pro 11.04软件对颞下颌关节相关解剖结构进行三维重建并测量,应用SAS 8.02软件包进行统计学分析。结果: 在三维重建头颅上测得颧弓宽度、颧弓弯曲弧度、关节窝内外径、关节窝前后径、关节窝前后斜面角度、髁突内外径、髁突前后径、髁突前后斜面角度、髁突颈部宽度、下颌孔距下颌支后缘距离、下颌角距下牙槽神经距离等相关数据。结论: 颞下颌关节相关解剖数据的测量及分析结果,可为标准型全颞下颌关节假体的研发提供数据支持。     

成人下颌偏斜患者颞下颌关节形态及位置的变化

目的：研究下颌偏斜患者颞下颌关节形态及其位置的变化.方法：对21例下颌偏斜患者和20例个别理想[牙合]志愿者拍摄颞下颌关节中位断层片,选择描述髁突位置及髁突和关节窝形态的15个指标进行测量及统计分析.结果：下颌偏斜患者双侧关节结节高度、关节窝指数增大,髁突后斜面与水平基准线的夹角减小;偏斜侧的关节前间隙、关节前后间隙面积比,髁突高度、髁突上部高度减小;对侧的关节上间隙、髁突高度、髁突上部高度、髁突前斜面与水平基准线的夹角、关节窝后斜面与水平基准线的夹角增大.结论：下颌偏斜患者的双侧髁突和关节窝形态及髁突在关节窝中的位置都发生了改变,尤其以非偏斜侧髁突变化较为明显.     

用发音确认水平颌位的研究

目的:通过发音时髁突位置的测定,筛选最接近于下颌正中咬合位和正中后退接触位的髁突位置时的发音.方法:选择能发出标准汉语拼音、英文26个字母、日文51个假名的个别正常耠成人10名,采用下颌运动测量仪(ARCUS Digma)记录发音时的下颌位及髁突位置,比较发音时的髁突位置和正中咬合位及正中后退接触位时髁突位置的差异,筛选出与下颌正中后退接触位最接近的发音.结果:当发汉语拼音"n"时下颌稍向后移动,张口度小而稳定,髁突位置最接近于正中后退接触位时的髁突位置;在前后方向的X轴和上下方向的Y轴上,发"n"音髁突位置和正中后退接触位时的髁突位置距离之差分别为0.94 mm及0.99mm.发"r"音时的髁突位置接近于下颌正中咬合位时的髁突位置.发"n","r"音和CR位时的髁突位置差异有显著性(P＜0.05).结论:发汉语拼音"n"时的髁突位置最接近于下颌正中后退接触位时的髁突位置,这一研究结果有助于临床上对下颌正中后退接触位的确定和验证.     

颞下颌关节盘移位自然转归的MRI评价

目的:借助磁共振技术,对未经治疗的颞下颌关节盘前移位患者的盘-髁距离、关节盘长度及髁突高度的变化进行定量测量分析,从而为制订治疗计划提供参考。方法:收集62例(83侧关节)在随访期间未经有创或不可逆治疗的颞下颌关节盘移位患者,在初诊及随访结束时拍摄MRI,分别对盘-髁距离、关节盘长度及髁突高度进行测量,采用SPSS13.0软件包对源数据进行t检验。结果:患者初次就诊时,平均年龄为30.4岁,平均随访时间10.9个月。初诊时,39侧关节为可复性关节盘前移位,其中27侧随访期结束时变为不可复性关节盘前移位。随访结束时,盘-髁平均距离从初诊时的5.28mm增加至6.73mm,而关节盘的平均长度从8.31mm缩短至6.91mm,髁突高度从5.21mm降为4.65mm,以上变化均存在统计学差异(P<0.01)。结论:在颞下颌关节盘前移位的自然转归过程中,关节盘前移距离逐渐增大,关节盘长度逐渐缩短,髁突高度逐渐下降,但需更长期的随访及分层研究。     

Conservative interdisciplinary treatment of a case with multiple facial and condyle fractures

The purpose of this case report is to describe an interdisciplinary approach for a 51‐year‐old male who underwent multiple facial fractures including bilateral condyle fractures. The patient underwent emergency surgery, which included open reduction of the maxilla and mandibular symphysis and closed reduction of the bilateral condyle fractures. Although the patient recovered a comfortable range of mouth opening and alleviation of the temporomandibular joint (TMJ) symptoms after surgery, he suffered from a large anterior–posterior discrepancy due to less stability on the condyle‐fossa relationships and from open bite with contacts only on both second molars and right second premolars. In this case, first, to increase the occlusal contact, comprehensive orthodontic treatment was completed. Second, occlusal equilibration was selectively performed to relieve the interferences and establish a stable range of mandibular movement without any changes in the vertical dimension. Third, both the upper central incisors and left lateral incisor were minimally restored with splinted and single zirconia crowns, which had modified lingual contours to provide adequate anterior guidance permitting the anterior–posterior discrepancy of the posterior teeth during protrusion. This conservative interdisciplinary treatment, including open and closed reduction, orthodontic treatment, occlusal adjustment, and minimal prosthetic restorations, resulted in a stable mandibular position and recovery of mastication function.     

健康人最大开口运动的研究

目的 探讨开口运动中髁突的运动及其与切点运动的关系。方法采用三维下颌运动轨迹描记仪ＭＴ－１６０２,记录３８名健康人髁突、切点标志点的运动数据,分析水平面髁突的运动曲线与速度。结果 研究结果表明：①髁突水平轨迹为直线、流畅曲线共存;②运动速度曲线似三角形,波峰前后的加速度恒定;③双侧髁突滑动速度不等者较常见;④开口初期速度与水平轨迹形态有一定关系,轨迹矢量偏向运动较快的一侧;⑤开口形受髁突水平轨迹和     

双颌手术升支截骨后退术后下颌稳定性及与关节关系的研究

目的　探讨升支矢状劈开截骨术(BSSRO)小钛板坚固内固定与口内入路升支垂直截骨术(BIVRO)下颌后退术后颌稳定性的不同规律,了解导致复发的有关因素特别是髁状突移位在不同手术后复发过程中的意义。方法　升支截骨手术后退下颌的患者共38例,皆为双颌手术,其中下颌BSSRO19例,BIVRO后退术19例。于手术前1周(T1),手术后1周(T2),3个月(T3)及1年(T4)分别拍摄定位头颅侧位片及定位颞下颌关节薛氏位片用于测量下颌移动幅度及关节髁状突的手术后移位。结果　双颌手术下颌升支截骨后退术后,BSSRO坚固内固定组1年时的复发率为25%,而BIVRO组大部分患者1年时下颌发生了与手术目的相同的移动,两组的不稳定主要发生在术后3个月内。结论　手术使髁状突移位术后位置的调整可导致BIVRO术后的下颌继续后移而不稳定,而髁状突近心骨段术中向后旋转术后位置的调整可导致BSSRO术后的下颌骨继续向前而不稳定     

The functional shift of the mandible in unilateral posterior crossbite and the adaptation of the temporomandibular joints: a pilot study.

Changes in the functional shift of the mandibular midline and the condyles were studied during treatment of unilateral posterior crossbite in six children, aged 7-11 years. An expansion plate with covered occlusal surfaces was used as a reflex-releasing stabilizing splint during an initial diagnostic phase (I) in order to determine the structural (i.e. non-guided) position of the mandible. The same plate was used for expansion and retention (phase II), followed by a post-retention phase (III) without the appliance. Before and after each phase, the functional shift was determined kinesiographically and on transcranial radiographs by concurrent recordings with and without the splint. Transverse mandibular position was also recorded on cephalometric radiographs. Prior to phase I, the mandibular midline deviated more than 2 mm and, in occlusion (ICP), the condyles showed normally centred positions in the sagittal plane. With the splint, the condyle on the crossbite side was displaced 2.4 mm (P < 0.05) forwards compared with the ICP, while the position of the condyle on the non-crossbite side was unaltered. After phase III, the deviation of the midline had been eliminated. Sagittal condylar positions in the ICP still did not deviate from the normal, and the splint position was now obtained by symmetrical forward movement of both condyles (1.3 and 1.4 mm). These findings suggest that the TMJs adapted to displacements of the mandible by condylar growth or surface modelling of the fossa. The rest position remained directly caudal to the ICP during treatment. Thus, the splint position, rather than the rest position should be used to determine the therapeutic position of the mandible.     

Masticatory mandibular movements for different foods textures related to onomatopoetic words

This study aimed to investigate the effects of different sensory-evaluated food textures on masticatory movements, and to identify meaningful factors that correspond to different food textures. Masticatory movements of three healthy subjects were evaluated with a jaw movement tracking device using five different test foods: almond, hard and light rice crackers, apple, and chewing gum. The movements of the incisor point, working and non-working condyle and the entire mandible at the occlusal phase in the horizontal plane were analyzed. For harder foods, the incisor entered the intercuspal position from a rear and lateral, the working condyle showed anterior and noticeable medial movements as the entire mandible translated posteriorly and medially. For soft foods, the incisor movements were nearly coincidental with the lateral border movements, and the mandible rotated towards the inner side near the working condyle. Although the overall paths of the mandibular movements are individually different, it appeared that jaw movement at the final closure is particular to the food texture. From the standpoint of mandibular movements, it is suggested that masticatory movements during the occlusal phase in the horizontal plane is useful for revealing the relationship between mandibular movements and food textures that were evaluated with onomatopoetic words.     

恒牙牙冠与牙根长度发育完成时间及性别差异探讨

目的 确定不同恒牙(除第三磨牙外)的牙冠与牙根长度的发育完成时间,探讨牙冠与牙根长度发育完成时间的性别差异。方法 选择3304例3~18岁儿童与青少年全口曲面体层片,应用Haavikko法分别记录每个恒牙的发育分期,采用SPSS 25.0软件包计算男女不同恒牙的牙冠与牙根长度发育完成时间的中位数,利用Mann-whitney U检验进行男女性别间差异比较。结果 中切牙和第一磨牙的牙冠发育完成时间无性别差异,P值分别为0.143(上颌中切牙)、0.122(上颌第一磨牙)、0.191(下颌中切牙)和0.558(下颌第一磨牙),其余牙女性均显著早于男性。上颌中、侧切牙、第二前磨牙和第二磨牙的牙根长度发育完成时间无性别差异,P值分别为0.057、0.130和0.294;下颌中,第二前磨牙和第二磨牙的牙根长度发育完成时间无性别差异,P值分别为0.428、0.057;上、下颌其余牙牙根长度发育完成时间女性均显著早于男性。结论 恒牙牙冠与牙根长度发育完成时间女性普遍早于男性,上、下颌恒牙牙冠与牙根长度发育完成时间的性别差异相似。     

骨性下颌偏斜患者翼外肌形态的MRI研究

目的：研究下颌偏斜患者双侧翼外肌形态的差异,探讨翼外肌形态变化与下颌偏斜的关系,为临床治疗提供一定的参考。方法：采用磁共振成像技术,对20例下颌偏斜患者与10例正常对照闭口位、最大开口位双侧翼外肌长度、厚度及面积进行测量,比较三者之间的差异。结果：闭口位翼外肌上头长度、厚度及面积均呈现出偏斜对侧高于偏斜侧,同时高于正常对照（P〈0.05）;翼外肌下头长度、面积偏斜对侧均高于偏斜侧（P〈0.05）,而3组间厚度无明显差异。最大开口位,下颌偏斜患者翼外肌上、下头呈现出相同的趋势,即长度、面积偏斜对侧均高于偏斜侧（P〈0.05）,而3组间厚度无明差异。结论：下颌偏斜患者双侧翼外肌形态存在明显差异,这可能是由于双侧髁突位置、形态的不对称造成的,也可能是偏斜侧与偏斜对侧长期咬合不对称造成的。     

A relatively minor adult case becomes significantly complex: A lesson in humility.

A 41-year-old white woman with no particular concerns about facial esthetics was first seen with bilateral Class II molar relationship, a Class I right canine, and a Class II left canine. Overjet was 3 mm and overbite was 0.5 mm, with no incisor contact. A maxillary right premolar was missing for unknown reasons and all 4 third molars had previously been extracted. The maxillary midline was 2 mm to the right of the facial midline, and the mandibular midline was 3.5 mm to the left of the maxillary midline. There was 7 mm of crowding in the maxillary arch and 6 mm of crowding in the mandibular arch, with an increased curve of Spee. The patient had a well-positioned maxilla, a retrognathic mandible with increased convexity, a Class II denture base relationship, and a vertical facial pattern. The treatment plan consisted of extracting the maxillary left first premolar and the mandibular left central incisor. After 4 months of treatment, an open bite from second premolar to second premolar was noted. After 6 months of treatment, the patient expressed concern with her chin position and mentalis hyperactivity. It was apparent that the orthodontic treatment had resulted in molar extrusion, which the musculature was not able to withstand. Treatment continued and the case was set up for posterior maxillary impaction and mandibular advancement surgical procedures.     

前伸平衡的相关因素及各因素间的相互关系

目的：探讨前伸He平衡的相关因素间的相互关系，方法：从前伸He平衡的基本要求及前伸He运动过程中，下颌后牙颊尖的运动轨迹，提出牙尖运动斜度这一新的概念，并运用数学轨迹及坐标轴转换原理推导出牙尖运动斜度的计算公式。结果：牙尖运动斜度等于牙尖工作斜面斜度是获得前伸He平衡的首要条件。牙尖运动斜度与髁道斜度、切道斜度和牙坐标值成正比例关系，牙尖工作斜面斜度与牙尖斜度和牙长轴倾斜度成正比例关系。结论：牙尖运动斜度是前伸He平衡中最基本、最重要的因素。     

基于CBCT的下颌前牙区颌骨形态学研究

[摘要]目的：利用锥形束CT（codebeamcomputedtomography,CBCT）图像研究测量下颌前牙区的颌骨形态和宽度,为临床种植手术提供治疗依据。方法：选取2011年--2013年间50名成年受试者的CBCT检查结果,利用CBCT图像对下颌前牙区颌骨外形、唇舌侧宽度、近远中距离等进行观察和测量。结果：1．下颌前牙区颌骨形态唇侧均为凹形,最凹点位于下颌骨上中份,舌侧外形多样化,凸形比例最高。2．下颌骨前牙区颌骨唇舌侧宽度在下颌骨中1／2和下颌骨下缘较宽,在牙槽嵴顶和根尖区较窄。3．左右尖牙、侧切牙、中切牙于牙槽嵴顶的近远中距离是4．46～6．94mm,尖牙最长,侧切牙次之,中切牙最小。结论：下颌前牙缺失后,尤其是下颌侧切牙或中切牙个别缺失,如行种植修复近远中距离可能不足,易损伤邻牙;植入种植体等手术时应当注意下前牙区颌骨外形,避免因倒凹导致唇舌侧穿通;CBCT可作为下颌前牙区种植手术术前的常规影像学检查手段。