肋骨肋软骨移植重建颞下颌关节的临床研究

目的：探讨颞下颌关节真性强直的手术治疗和预防术后的复发。方法：采用自体肋骨肋软骨移植对32例颞下颌关节真性强直患者进行了关节重建术，术后通过测量张口度，计算手术前后张口度的差值、下颌前伸和侧向运动范围，以及颞下颌关节x线片检查等，综合评价手术治疗效果。结果：32例随访1～12年术前后张口度的差值均在2．0cm以上，效果优良，重建关节无骨质吸收，咬合关系良好，下颌具有前伸和侧向运动功能，无复发。结论：自体肋骨肋软骨移植的颞下颌关节重建术是治疗颞下颌关节真性强直的一种较理想方法。     

颞肌筋膜瓣联合冠突移植治疗颞下颌关节强直

目的:应用带蒂颞肌筋膜瓣联合冠突移植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6例颞下颌关节真性强直患者切除病变区骨质,形成骨间隙,采用带蒂颞肌筋膜瓣转移充填骨间隙和冠突切取植入构造新的“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4～28个月,开口度3.1～3.8cm,平均开口度3.5cm,效果满意。结论:带蒂颞肌筋膜瓣联合冠突移植治疗颞下颌关节真性强直具有多方面优势,是防止颞下颌关节术后复发的有效手术治疗方法。     

人工关节头应用于颞下颌关节骨性强直治疗的临床探讨

目的：回顾性研究分析人工关节头在颞下颌关节骨性强直治疗中进行关节重建的方法和临床治疗效果。方法：对2007年8月～2012年3月间收治的6例（10侧）颞下颌关节骨性强直患者进行人工关节头关节重建。对治疗方法和效果进行综合分析。结果：6例均采用人工关节头置换恢复颞下颌关节,术后患者张口度恢复理想。结论：人工关节头置换用于治疗颞下颌关节骨性强直具有可行性,并能达到良好的治疗效果。     

带血管整个关节游离移植重建颞下颌关节

颞下颌关节易受到多种病理的和外伤的损害使其丧失功能。颞下颌关节强直导致张口受限,咀嚼困难,影响说话和牙齿卫生。重建颞下颌关节的多种术式,包括假体置换和骨移植。这些技术没有致力于整个关节功能重建的问题。本文报告一例应用带血管的第二跖趾关节转移取代颞下颌关节和下颌升支。患者男性,33岁,4岁时双侧下颌髁状突骨折。未作即时治疗,后继发双侧颞下颌关节强直。前几年,采用多种方法治疗,均未成功。临床检查示切牙间开口度4mm。下颌后缩,并日益严重。X 线片示左颞下颌关节强直,右侧整个髁状突消失,下颌升支大部分吸收。术前,作一个上颌假体。术中先切除两侧疤痕组织,经耳前进路作右颞下颌关节骨分离,经类似进路松     

纯钛金属片为间置物防止颞颌关节强直术后复发

目的 通过植入纯钛金属片为间置物，观察是否能减少颞下颌关节真性强直术后的复发。方法 作者在1995－2000年的5年中对46例颞下颌关节真性强直患者在进行关节重建手术同时均以纯钛金属片做为间置物植入，并在手术后1年随访，测量并记录张口度。结果 46例患者中只有2例复发，术后复发为4％，复发率较低。结论 该方法可以有效地防止颞颌关节真性强直重建术后复发，操作简便而且技术容易掌握。     

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。     

个体化人工颞下颌关节置换术远期疗效报告

目的：随访2例3侧采用人工颞下颌关节置换的患者,随访时间分别为4年和4年半,以评价人工关节置换的远期临床疗效。方法：2例3侧采用人工颞下颌关节置换术进行骨关节病治疗的患者,分别进行了为期4年和4年半的临床随访。记录患者术后在关节疼痛、开口度等指标的变化及患者对治疗结果的主观评价。结果：2例患者术后受累关节疼痛、开口受限及咀嚼能力等方面均获得了满意的改善,开口度在术后4年均增加至35mm以上,未再出现明显颞下颌关节区疼痛．VAS疼痛评估为0-1。开口受限无复发,开口度维持良好。患者自觉咀嚼能力明显增强,生活质量明显提高。结论：人工关节置换术是重建颞下颌关节的一种良好术式,对恢复因骨关节病等导致的关节功能丧失是一种较理想的选择。     

喙突移植治疗双侧真性颞下颌关节强直

目的:观察喙突移植治疗真性颞下颌关节强直的手术效果。方法:对我院近十年行双侧喙突切除后左右侧交换移植成形双侧颞下颌关节治疗的4例双侧颞下颌关节强直患者进行回顾性分析。结果:全部病例经4～7年的临床随访,效果满意。结论:喙突切除移植成形双侧颞下颌关节术是防止关节强直复发的有效外科治疗方法。     

异体肋软骨移植治疗颞下颌关节强直的临床研究

目的:评价应用异体肋软骨移植治疗真性颞下颌关节(TMJ)强直的效果。方法:选择6例颞下颌关节强直患者,经耳前进路,凿除关节区增生、融合的骨质,保持凿开间隙1.0cm。形成的假关节间隙内植入雕刻成型的、经液氮保存的同种异体肋软骨。结果:所有患者术后均未见排异反应发生,随访3年均无关节强直复发,开口度3.0～4.5cm,开口型无明显偏斜,面部外形无明显畸形。结论:同种异体肋软骨移植可以用于TMJ真性强直的治疗,其术后重建的颞下颌关节的功能和患侧面部形态令人满意,但其远期效果有待进一步研究。     

真性颞颌关节强直手术治疗进展

真性颞颌关节强直外科手术目的在于尽快恢复咀嚼功能，减轻颌面部继发畸形，颞颌关节成形术正确选择关节盘置换材料，髁突及升支的重建尤为重要。对继发性颌面部畸形外科矮治进机的掌握，择期手术等问题进行了讨论。对并发阻塞性睡眠呼吸暂停综合征的诊断和治疗方案，以及牵引成骨术和组织工程技术在颞颌关节真性强直治疗中的应用也作了介绍。     

Auricular cartilage graft interposition after temporomandibular joint ankylosis surgery in children.

PURPOSE: After surgery for temporomandibular joint (TMJ) ankylosis, relapse is frequently due to fibrosis and ossification occurring in the space of the joint. The object of this study was to evaluate the use of autogenous auricular cartilage graft as an interposition material after arthroplasty of the TMJ ankylosis. PATIENTS AND METHODS: Seven patients with TMJ ankylosis were treated with autologous auricular cartilage graft interposition arthroplasty. With 4 to 6 years of follow-up, the function of the TMJ was evaluated. RESULTS: In 7 patients with TMJ ankylosis treated with autologous auricular cartilage graft interposition arthroplasty, the function of the TMJ recovered well. At 6-year follow-up, no relapse had occurred and no deformities resulted in the ear from which the cartilage had been harvested. CONCLUSION: Autologous auricular cartilage interposition arthroplasty is an ideal method for the prevention of relapse of TMJ ankylosis.     

The sequential treatment of temporomandibular joint ankylosis with secondary deformities by distraction osteogenesis and arthroplasty or TMJ reconstruction

The purpose of this study was to evaluate the sequential treatment of patients with temporomandibular joint (TMJ) ankylosis and secondary deformities by distraction osteogenesis and subsequent arthroplasty or TMJ reconstruction. This study included 40 patients treated at a stomatological hospital in China; they ranged in age from 9 to 53 years (mean age 24.5 years). Ten of these patients were diagnosed with unilateral TMJ ankylosis and 30 with bilateral TMJ ankylosis. Twenty-seven patients also presented obstructive sleep apnoea–hypopnoea syndrome (OSAHS). All patients underwent distraction osteogenesis as the initial surgery, followed by arthroplasty or TMJ reconstruction. Some patients underwent orthognathic surgery to improve occlusion and face shape along with or after arthroplasty or TMJ reconstruction. The therapeutic effects were evaluated in terms of the improvements in maximum inter-incisal opening (MIO), appearance, and respiratory function. After the completion of treatment, all patients showed improvements in MIO and appearance, and the symptom of snoring disappeared. The airway space was significantly increased. Patient follow-up ranged from 6 to 85 months (mean 28.3 months), and four patients experienced relapse. This study suggests that treating TMJ ankylosis with secondary deformities by distraction osteogenesis as the initial surgery and arthroplasty or TMJ reconstruction as the second-stage treatment may achieve favourable outcomes, especially for patients with OSAHS; however, some patients may require orthognathic surgery.     

Evaluation of Functional and Esthetic Outcome After Correction of Mandibular Hypoplasia Secondary to Temporomandibular Ankylosis Treated by Distraction Osteogenesis

Patient with TMJ ankylosis are affected with mandibular hypoplasia which in turn causes functional and esthetic problems. Restoration of normal function and esthetics is the prime goal in treatment of such patients with distraction becoming an important treatment option. The present study also was conducted on patients with mandibular hypoplasia secondarily to TMJ ankylosis treated with distraction. Since function and esthetics improvement was the prime aim behind the treatment with distraction, evaluation of functional and esthetics outcome becomes an important aspect. Thus the study was indigenously designed and aimed at qualitative evaluation of the functional and esthetic outcome after correction of mandibular hypoplasia secondary to temporomandibular ankylosis with Distraction osteogenesis. Patients treated with distraction were evaluated on the basis of parameters for function and esthetics. Parameters for function were occlusion, airway, mouth opening and chewing-biting perception of patient pre and post distraction. Parameters for esthetics used were patient and panel perception. All parameters for function and occlusion improved with distraction in all the patients except one in whom occlusion and chewing- biting pattern worsened. It is concluded that distraction is a good option for improving patients functional and esthetic outcome in cases of mandibular hypoplasia secondary to temporomandibular ankylosis as the results achieved are stable with negligible chances of relapse.     

Efficacy of temporomandibular joint arthroplasty and insertion of a Matthews device as treatment for ankylosis of the joint: a case series

Temporomandibular joint (TMJ) ankylosis is a condition in which bony or fibrous adhesion of the anatomical joint components results in loss of function. This is particularly distressing and debilitating for patients who struggle to maintain good oral hygiene, which results in additional pain, oral disease, and ultimately, a poor aesthetic profile. A retrospective chart review was carried out to document the cases of three patients who attended a single centre for the management of ankylosis of the TMJ. Consent for chart review and use of photographs was gained from each one. Charts were obtained, records reviewed, and each of the cases written up for presentation in a case series. All three underwent arthroplasty of the TMJ and insertion of Matthews devices (two patients unilateral, one bilateral). All were followed up postoperatively. They experienced significant improvements in vertical mouth opening which have been maintained to the present. The Matthews device allows movement and physiotherapy postoperatively whilst maintaining the surgically created space. This prevents impingement on the tissues placed between the glenoid fossa and mandible, and appears to prevent relapse and further ankylosis. To our knowledge, few studies to date have documented the use of the Matthews device following interpositional arthroplasty of the TMJ.     

Autogenous auricular cartilage graft in temporomandibular joint ankylosis—an evaluation

Purpose

Recurrence is a major problem after release of temporomandibular joint (TMJ) ankylosis. The purpose of this study was to evaluate the use of autogenous auricular cartilage graft as an interposition material after arthroplasty for TMJ ankylosis.

Materials and methods

Ten patients (M?=?4; F?=?6) with TMJ ankylosis were treated with autogenous auricular cartilage graft interposition arthroplasty. Minimal follow-up was 2 years. The possible reasons for ankylosis and pre- and postoperative mouth opening at final follow-up were recorded.

Results

There was a single case of bilateral ankylosis, and a total of 11 joints were operated. The cause of ankylosis could be traced to trauma (n?=?7) and ear infection (n?=?3). The ages at operation ranged from 6 to 23 years. Postoperative mouth opening was satisfactory in all patients except one in whom relapse occurred. No donor site deformity was observed in any of the patients.

Conclusion

Autogenous auricular cartilage graft is a good interposition material for successful treatment of TMJ ankylosis.     

牵张成骨在颞下颌关节强直及其继发畸形矫治中的应用

儿童时期发生的颞下颌关节强直可以导致不同程度的颌面部骨骼发育障碍,并引起自卑、社交障碍等一系列心理问题,其矫治是口腔颌面外科医生面临的一大挑战. 牵张成骨( distraction osteogenesis,DO)一直被国内外学者用于颞下颌关节(temporomandibular joint,TMJ)强直及其继发畸形的矫治,并取得了良好的临床效果.笔者所在科室每年大概收治50~60例TMJ强直患者,对DO技术在TMJ强直及其继发畸形矫治中的应用积累了较为丰富的临床经验. 本文中,笔者对DO技术在TMJ强直及其继发畸形矫治中的优缺点及相关问题进行述评.     

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目的观察采用下颌升支垂直截骨上推术治疗真性颞颌关节强直的疗效。方法对2004年12月至2008年5月山西医科大学第一临床医院口腔颌面外科收治的19例真性颞颌关节强直患者采用下颌升支垂直截骨上推术治疗,并按期随诊,监测指标,观察其疗效。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,随访期内无一例复发。结论根据国内外文献及术后观察,下颌升支垂直截骨上推术是治疗真性颞颌关节强直的一种可选择的、有效的方法。     

Inverted arthroplasty of the temporomandibular joint with the posterior segment of the ramus

With vertical osteotomy of ascending ramus we have performed arthroplasty with inverted posterior segment for 13 cases of true ankylosis. There were 10 cases with more than 2.5 centimeters of Maximum Incisal Opening for more than six months, without open bite secondary to the operation. X-ray examination showed excellent union between the inverted segment and the rest of ramus and satisfactory appearance. There were some advantages of this operative technique; it is easy to operate and is able late the height of the ascending ramus, to form a new TMJ with point to surface contact which is similar to the normal anatomy of TMJ, and help rehabilitate the function of TMJ.     

关节盘复位在创伤性颞下颌关节强直治疗中的作用

目的　探讨创伤性颞下颌关节强直关节成形术中关节盘复位的手术方法及其临床效果。方法　 19例创伤性颞下颌关节强直患者接受关节成形术时进行了关节盘复位。术中在关节附近寻找分离出移位的关节盘并将其复位至髁突顶端的解剖位置 ,最后将关节盘的外侧端缝合固定至颧弓根部的软组织。结果　平均随访 2 3 7个月 ,患者的张口度为 2 4～ 4 3mm (平均为 32 6mm) ,所有的患者张口度均接近或达到正常 ,无关节疼痛及弹响症状 ,随访期内无一例患者复发。结论　在创伤性颞下颌关节强直的治疗中 ,关节盘复位可行有效 ,是重建关节结构、恢复关节功能和预防复发的好方法。