颞下颌关节间接性损伤后转归及其机理

颌面部损伤常问接造成颞下颌关节损伤,如不及时治疗,可引起颞下颌关节内紊乱(TMJID)、颞下颌关节骨关节病(TMJOA)及颞下颌关节纤维性或骨性强直等后遗症的发生。本文就间接性TMJ损 伤后的转归,及导致并发症的机理,TMJ损伤与TMJID和TMJOA之间的关系做一系统综述。     

创伤性颞下颌关节强直临床分析

目的 分析引发创伤性颞下颌关节(temporomandibular joint,TMJ)强直的高风险髁突骨折类型,初步探讨TMJ强直发生的可能性机制.方法 对18例创伤性TMJ强直进行临床、影像学检查及评估.取纤维性强直外侧变性的关节囊、关节间的致密纤维组织及骨性强直关节外侧骨块和内侧骨块,HE染色,光镜观察.结果 ...     

同种异体骨移植修复颞下颌关节

颞下颌关节（temporomandibular joint，TMJ）结构复杂，功能重要，损伤后修复困难，临床涉及TMJ的下颌骨肿瘤、TMJ强直、严重的关节创伤（如战伤）、先天性面部畸形等需要通过移植修复。由于使用异种材料修复TMJ可引起机体免疫反应，而自体组织移植会增加患者的痛苦和并发症，人们对异体骨移植修复TMJ进行了研究。     

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.     

关节盘在羊颞下颌关节强直中的作用

亦有研究证实,严重的颞下颌关节(TMJ)损伤和关节盘去除3个月内将引起羊TMJ关节内纤维性强直,出现一些钙化,但未有完全性的骨性强直。本文目的是评价关节盘在预防TMJ关节内强直中的作用。 将12只纯饲养merino成年羊平均分为2组,Ⅰ组:手术去除右侧TMJ颞骨和髁突关节面,保留关节盘。Ⅱ组:去除右侧TMJ关节面并摘除关节盘。每组中的1     

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。     

创伤性颞下颌关节强直的分类和治疗进展

颞下颌关节强直是一类严重影响口颌系统功能的疾病,会导致开口受限,严重者引起面部畸形和睡眠呼吸暂停综合征等。由于创伤是引起颞下颌关节强直的主要原因,本文就创伤性颞下颌关节强直的诊断、分类和治疗进展等进行综述。     

山羊颞下颌关节强直病理模型的建立

目的：建立山羊颞下颌关节强直病理模型,以进一步探讨颞下颌关节强直的病因。方法：取山羊9只,随机等分为3组。分别采用破坏关节表面软骨、破坏关节表面软骨＋去除关节盘、破坏关节表面软骨＋去除关节盘＋关节腔内植骨3种不同手段制作模型。术后3个月后观察颞下颌关节强直的形成情况。结果：关节软骨破坏＋去除关节盘组全部发生强直;保留关节盘者无一例发生强直;植骨组仅2只山羊发生关节黏连。强直者,光镜下表现为髁突与关节窝间类骨质形成;未强直者。光镜下表现为关节表面破坏。结论：去除关节盘＋关节软骨破坏形成的TMJ强直,具有可重复性、短期内发生以及良好的相似性,接近人类病变发生的过程．是一种较好的制作颞下颌关节强直模型方法。     

术中CT在颞下颌关节强直疗效评价中的应用

目的 探讨术中CT在颞下颌关节（temporomandibular joint,TMJ）强直手术治疗效果评价中的应用价值。方法 回顾分析2016年7月—2018年12月完成的4例颞下颌关节强直患者的临床资料,分析一般资料特点、强直类型、扫描时间、CT引导的术中修正及术后效果。结果 在术中CT的引导下,4例（5侧）颞下颌关节强直手术均顺利完成。术中CT平均耗时（10.2±3.3）min,3例进行了术中修正,修正率75%。所有患者术后创口愈合良好,开口度平均38.8 mm,患者满意度100%。结论 术中CT提高了TMJ强直手术的精确性,保证了手术的安全性和可靠性。     

颞下颌关节疾病

调（牙合）对TMD慢性疼痛治疗效果的临床评价初探,义齿式（牙合）板治疗颞下颌关节紊乱病伴牙列缺损磨损探讨,调（牙合）治疗颞颌关节系乱病疼痛效果及其可能机制的初步研究,山羊颞下颌关节强直病理模型的建立,骨牵引技术治疗TMJ强直小下颌畸形伴阻塞性睡眠呼吸暂停低通气综合征,前侧方入路至颞下窝及邻近区域的临床解剖研究.[编者按]     

The relationship between temporomandibular joint ankylosis and condylar fractures

Trauma is the predominant causal factor for temporomandibular joint (TMJ) ankylosis. However, the relationship between condylar fracture and TMJ ankylosis is complicated. It is believed that post-traumatic TMJ ankylosis arises from TMJ intracapsular changes, including damaged cartilage, displaced or disrupted discs, haematoma formation and subsequent fibrosis and calcification in the joint. In this review, the relationship between TMJ ankylosis and condylar fracture is discussed based on clinical characteristics and animal studies. The management of TMJ ankylosis is also reviewed and discussed.     

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外伤是颞下颌关节强直最主要的病因,但髁突骨折与外伤性关节强直的关系一直存在争议。有研究表明,髁突囊内骨折可引起关节软骨损伤、关节盘移位或破损、关节积血,继发关节纤维化以及骨化,最终导致关节强直。本文从临床和实验角度探讨了髁突骨折与颞下颌关节强直的关系。     

牵引成骨和正颌外科技术在TMJ强直继发OSAS治疗中应用

目的　 30例 TMJ强直伴阻塞性睡眠呼吸暂停综合征 (OSAS)患者 ,单侧 TMJ强直 18例 ,双侧强直 9例 ,TMJ强直术后 3例。患者均有严重的小下颌畸形并伴轻度的上颌后缩畸形 ,睡眠呼吸暂停指数 AI>5 ,且睡眠时血氧饱和度都有不同程度的降低。方法　应用术前后临床检查、头影测量分析和夜间多导睡眠检测筛选患者和评价治疗效果。采用电脑辅助的诊断和手术模拟及预测系统 ,获得充分扩展口咽和纠正颌面畸形的最佳手术方案 ,以 TMJ重建、牵引成骨和正颌外科方法治疗患者。结果　本研究有 15例患者接受患侧下颌升支倒置 TMJ重建、植骨前移 ,健侧升支矢状劈开、下颌前移和颏前移成形术 ;其中有 3例行二期的上颌的 L e Fort 截骨术。 6例行双侧 TMJ重建、植骨前移下颌和颏成形术。 3例施行同期双颌截骨前移和颏成形术 ;6例行单或双侧 TMJ重建、牵引成骨术。全部病例创口均正常愈合 ,无一例感染。术后复查 (平均 5 .2 5年 ,最短 1年 ,最长 8年 ) :1例术后 TMJ强直复发 ,余张口度均在 3cm以上 ;术后颌面形态获得明显改善 ;2 9例患者眠眠呼吸障碍解除和睡眠质量获得提高 ;1例 AI>5 ,睡眠呼吸障碍改善不明显。结论　 TMJ强直继发 OSAS的治疗既要兼顾关节强直的解除 ,又要矫正牙颌面畸形 ,更不容忽视睡眠呼吸障碍的治疗 ;     

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.     

Poliomyelitis causing TMJ ankylosis?—report of two intriguing cases

Introduction

Temporomandibular joint (TMJ) ankylosis is one of the common diseases which affect the TMJ especially in children. We are reporting two rare cases of TMJ ankylosis which occurred along with poliomyelitis and which are not reported in literature so far.

Discussion

In this article, we discussed about the most probable causes which resulted in TMJ ankylosis in these patients.     

Simultaneous genial distraction and interposition arthroplasty for management of sleep apnoea associated with temporomandibular joint ankylosis

Temporomandibular joint (TMJ) ankylosis affects the growth of the mandible and results in gross facial deformities. A critical clinical feature of long-standing TMJ ankylosis is retrogenia, which when combined with an inability to open the mouth leads to severe compromise of the airway. A case is presented of obstructive sleep apnoea syndrome secondary to TMJ ankylosis that was corrected by a new technique employing simultaneous genial distraction along with interposition arthroplasty.     

Surgical induction of temporomandibular joint ankylosis: an animal model.

PURPOSE: The aim of this study was to develop an animal model of temporomandibular joint (TMJ) bony ankylosis for future evaluation of surgical reconstructive methods. MATERIALS AND METHODS: An animal model was selected on the basis of 2 sequential experiments. Four goats and 4 minipigs were used in the first experiment, in which 1 goat and 1 minipig served as control animals. Condylectomy with disc preservation was performed on 1 side of 3 animals in each group. On the contralateral TMJ, condylectomy with discectomy was performed, and the arthroplasty gap was filled with the autogenous bone chips. In the second experiment, TMJ ankylosis was induced bilaterally in 3 additional animals of the species that achieved better ankylosis results in the first experiment. All animals were killed postoperatively at 3 months, and the TMJ complexes were examined by plain radiography, computed tomography, and histological evaluation. RESULTS: In the first experiment, only fibrous ankylosis was observed in the bone-grafted side of 2 goats and 3 minipigs, whereas fibro-osseous ankylosis was achieved in the remaining goat. The extent of ankylosis was found to be more severe in the goats than the minipigs. Hence, goats were selected for bilateral surgery in the second experiment, which achieved consistent bony ankylosis of the TMJ in all animals. CONCLUSIONS: Goats provide a better TMJ bony ankylosis model than minipigs. Consistent bony ankylosis can be induced by bilateral condylectomy, disectomy, and bone grafting of the arthroplasty gap.     

Ankylosis of the temporomandibular joint caused by rheumatoid arthritis: a pathological study and review

Rheumatoid arthritis (RA) of the temporomandibular joint (TMJ) in a 59-year-old Japanese woman is reported, including details of clinical, histopathological and radiological findings. The patient had been diagnosed as having RA of the right knee joint 41 years previously, and suffered from arthralgia of the right TMJ. Radiological examination showed a radiopaque lesion of the mandibular head and mandibular fossa in the right TMJ and ankylosis of the right TMJ was diagnosed on the basis of the clinical and radiological findings. Condylectomy was performed. Pathological examination of material from the joint region revealed a marked increase of collagen fibers associated with slight capillary dilatation and hemorrhage. The final diagnosis was ankylosis of the right TMJ due to RA. The literature on TMJ ankylosis secondary to RA is reviewed and discussed.     

The interpositional dermis-fat graft in the management of temporomandibular joint ankylosis

The aim of this retrospective clinical study is to present the clinical experience of using dermis-fat interpositional grafts in the surgical management of temporomandibular joint (TMJ) ankylosis in adult patients. Eleven adult patients who presented with ankylosis of the TMJ were identified and included in the study. All patients underwent a TMJ gap arthroplasty which involved the removal of a segment of bone and fibrous tissue between the glenoid fossa and neck of the mandibular condyle. The resultant gap was filled with an autogenous dermis-fat graft procured from the patient's groin. All patients were followed up for a minimum of 2 years. Five of the 11 patients were found to have osseous ankylosis while 6 patients had fibro-osseous ankylosis. Two patients had bilateral TMJ ankylosis that were also treated with costochondral grafts which were overlaid with dermis-fat graft. The average interincisal opening was 15.6 mm on presentation which improved to an average of 35.7 mm following surgery. Patients were followed up from 2 to 6 years post-operatively (mean 41.5 months) with only 1 re-ankylosis identified out of the 13 joints treated. This study found that the use of the autogenous dermis-fat interpositional graft is an effective procedure for the prevention of re-ankylosis up to 6 years following the surgical release of TMJ ankylosis.