杠杆原理在颞下颌关节脱位复位中的应用

目的:探讨杠杆原理在颞下颌关节脱位复位中的应用.方法:本组85例,急性脱位28例, 复发性脱位52例,陈旧性脱位5例.通过杠杆原理对急性前脱位和复发性脱位进行复位;对陈旧性脱位给予持续三类牵引及垂直牵引力复位.结果:急性前脱位和复发性脱位均成功复位;陈旧性脱位4例成功复位.结论:利用杠杆原理对急性前脱位及复发性脱位复位速度快,力量小,可以避免咬伤术者手指;对陈旧性脱位有较好效果,可作为首选复位方法.     

颞下颌关节急性前脱位手法复位治疗的体会

应用口内法对80余例颞下颌关节急性前脱位进行了复位治疗和力学分析,根据牙列情况将颞下颌关节急性前脱位分成3种类型,各种脱位类型复位时使用了不同的手法,但均应用了杠杆原理。与常规复位手法比较,本文的改进方法明显缩短了手法复位的时间,提高了复位成功率。     

Closed reduction of chronic bilateral temporomandibular joint dislocation: A case report

Attempts at manual reduction under general anesthesia of a chronically dislocated temporomandibular joint were unsuccessful. Light elastic traction was applied to modified dentures, and after 7 weeks the condyles were partially repositioned. Without further active reduction, the condyles were fully reseated by 9 months.     

Tethering technique using bone screws and wire for chronic mandibular dislocation: a preliminary study of refractory cases

A retrospective study was performed to determine the efficacy of a tethering procedure developed to achieve a more rigid fixation and more reliable outcome in patients with refractory dislocation of the temporomandibular joint. The cases of eight patients with dementia and systemic diseases who underwent this technique were reviewed. In these eight patients, the condyles of 13 joints were ligated using wire between screws placed in the eminence and condylar head. Additional screw–wire ligations were applied to reinforce the restraint of movement in five of the 13 joints with suspected uncontrolled dislocation. The procedure was performed successfully, and the patients were followed-up for an average of 25 months. In one patient, dislocation recurred 1 year postoperatively due to wire breakage. The five joints in which a double set of screw–wire tethering was applied showed no recurrence or wire disturbance. This technique may, therefore, have short-term efficacy in cases that are refractory to standard procedures, although the material used for ligation should be investigated further. This approach can contribute to the quality of life of patients, particularly those with a short life-expectancy.     

基于生物力学分析的分侧口内外联合法治疗颞下颌关节前脱位

目的 探讨分侧口内外联合法治疗颞下颌关节前脱位的临床效果。方法 利用口颌系统姿态肌链平衡理论对颞下颌关节复位过程进行生物力学分析,改进复位手法;运用分侧口内外联合法治疗87例颞下颌关节前脱位患者,对临床效果进行评价。结果 分侧口内外联合法可有效避免升颌肌群反射性收缩,提高复位效率;87例患者均成功复位,术程用力轻巧高效,髁突下降指征明确,患者并发症少。结论 分侧口内外联合法是一种高效、便捷、微创的颞下颌关节前脱位复位方法,在临床上有一定的推广应用价值。     

基于生物力学分析的分侧口内外联合法 治疗颞下颌关节前脱位

目的 探讨分侧口内外联合法治疗颞下颌关节前脱位的临床效果。方法 利用口颌系统姿态肌链平衡理论对颞下颌关节复位过程进行生物力学分析,改进复位手法;运用分侧口内外联合法治疗87例颞下颌关节前脱位患者,对临床效果进行评价。结果 分侧口内外联合法可有效避免升颌肌群反射性收缩,提高复位效率;87例患者均成功复位,术程用力轻巧高效,髁突下降指征明确,患者并发症少。结论 分侧口内外联合法是一种高效、便捷、微创的颞下颌关节前脱位复位方法,在临床上有一定的推广应用价值。     

关节镜辅助治疗陈旧性颞下颌关节脱位临床疗效研究

目的探讨借助关节镜采用微创的方法治疗陈旧性颞下颌关节脱位的临床价值。方法对2007年3月至2011年5月在中国医科大学口腔医学院口腔颌面外科手术治疗的19例陈旧性颞下颌关节脱位患者,按就诊顺序随机分为A、B两组,A组(10例)采用关节镜辅助微创手术治疗,B组(9例)采用传统的开放性手术治疗。通过术后随访及问卷调查来评价关节镜在治疗陈旧性颞下颌关节脱位的应用价值。结果经过术后6个月至2年的随访发现,两组患者在面瘫、颞下颌关节紊乱病(TMD)的发生率以及创口预后满意度和疼痛程度方面差异有统计学意义(P<0.05),在复发方面差异无统计学意义(P>0.05);关节镜辅助治疗组术后满意度高于传统手术组,而并发症远远低于传统手术组。结论关节镜辅助治疗陈旧性颞下颌关节脱位的方法安全可行。因其创伤小,并发症少,更适用于高龄患者。     

Bilateral anterosuperior dislocation of intact mandibular condyles in the temporal fossa

Dislocation of the temporomandibular joint occurs when the mandibular condyle is displaced anteriorly beyond the articular eminence and represents 3% of all dislocated joints reported in the body. Superolateral dislocation of the condyle into the temporal fossa is well documented in the literature, but anterosuperior dislocation without an associated fracture is rarely described. This report documents the case of a middle-aged woman with bilateral anterosuperior dislocation of the intact mandibular condyle after a fall on the face. This report reviews the literature on dislocations, suggests a nomenclature, possible causative mechanism and documents the importance of early management.     

颞下颌关节脱位手术治疗的回顾性研究

目的 回顾分析颞下颌关节脱位的手术治疗病例,评价其治疗效果。方法 选择2012年5月—2016年4月间收治的颞下颌关节脱位患者17例,包括陈旧性脱位（ID）8例和习惯性脱位（RD）9例。分别进行关节镜下滑膜下硬化剂注射术5例9侧,钛板植入关节结节增高术7例12侧,髂骨移植关节结节增高术1例1侧,Medpore植入关节结节增高术3例6侧,关节结节切除术1例2侧。术后1~5年随访,统计各手术方法的成功率。结果 关节镜下滑膜硬化术的治愈率为 77.8%（7/9）,有效率100%;钛板植入关节结节增高术治愈率75%（9/12）,有效率100%;Medpore植入关节结节增高术的治愈率为100%（6/6）,髂骨移植关节结节增高术和关节结节切除术均治愈（1/1,2/2）。结论 应根据病情轻重来选择术式,对手术后复发者可选用Medpore植入关节结节增高术,该术式疗效确切,创伤相对较小、操作较简单。     

Association between temporomandibular joint disc position evaluated by magnetic resonance imaging and mandibular condyle inclination evaluated by computed tomography

Temporomandibular joint disc displacement is common in the world's population and could be associated with bone and functional characteristics of the temporomandibular joint. The aim of these study was to analyse the association between temporomandibular joint disc position evaluated by magnetic resonance imaging (MRI) and the inclination of the mandibular condyle evaluated by computed tomography (CT). One hundred and seventy temporomandibular joints (TMJ) were retrospectively analysed. The temporomandibular disc position was evaluated by MRI and classified into three types: normal (N), disc displacement with reduction (DDWR) and disc displacement without reduction (DDWoR). The mandibular condyle measurements evaluated by CT included horizontal, sagittal and coronal inclination. ANOVA followed by post hoc Tukey's test was used to evaluate the interaction between condylar inclination and disc position. There was an association between disc position and the horizontal and sagittal condylar inclination (P < .05). There are statistically significant differences in the mean of horizontal and sagittal inclination of the mandibular condyle between the DDWoR and the other disc positions (P = .002 and P = .004). Disc position was not statistical associated with coronal inclination of condyle (P > .05). These results indicate that the inclination of the mandibular condyle may be different in TMJ with various disc position. A more medial horizontal inclination and a more posterior sagittal inclination of the mandibular condyle are associated with DDWoR.     

Features and management of intracranial mandibular condyle dislocation after trauma

Background:

Dislocation of the mandibular condyle into the middle cranial fossa is rare in clinics. It often occurs when the mouth is open wide during the injury. It causes restriction of mandibular motion, lower facial asymmetry, pain in the temporomandibular joint (TMJ), etc.

Objective:

To introduce the features of intracranial mandibular condyle dislocation and discuss the management to this kind of trauma.

Major findings:

In this paper, the authors present two cases, describing the diagnosis, surgical management, and 1-year follow-up evaluation. The results of the authors' treatment to intracranial mandibular condyle dislocation were satisfactory and stable, and no surgical complications were detected.

Conculsion:

Advanced imaging studies are mandatory for exact diagnosis and successful treatment of intracranial mandibular condyle dislocation, and individualized management is recommended.     

Treatment of chronic mandibular dislocations using a new miniplate

Temporomandibular joint (TMJ) dislocation is defined as an excessive forward movement of the condyle beyond the articular eminence with complete separation of the articular surfaces and fixation in that position. The aim of this study was to describe a modified miniplate designed for treating chronic mandibular dislocations and evaluate the results of its placement in one patient, who was followed for 18 months. The treatment of chronic mandibular dislocation using this modified miniplate was shown to be efficient in relation to the postoperative maximal mouth opening, recurrence and articular function.     

外伤致下颌骨髁突颅内移位：病例报告及文献复习

下颌骨髁突颈部结构薄弱,受外力作用时容易折断,从而通过缓冲创伤能量,避免颅中窝及颅脑等重要解剖部位受到损伤,可视为人体的一种自我保护机制。本文报告1例较为少见的髁突颅内移位外伤病例,髁突在未发生骨折的情况下向上移位,突破颅中窝底进入颅内,并结合相关文献,就其发生机制、临床表现、诊断及治疗进行讨论。     

颞下颌关节前脱位的改良口外手法复位

颞下颌关节前脱位是口腔科常见急症。近年来,作者采用一种改良口外手法复位对62例颞下颌关节前脱位的患者进行复位,效果良好,报道如下。1临床资料1.1一般资料1996年10月-2004年11月,应用改良口外法复位颞下颌关节前脱位62例,其中男性23人,女性39人,年龄17～75岁。62例均为前脱位,其中双侧脱位者47例,单侧脱位者15例,急性脱位者36例,复发性脱位者26例。1.2复位方法复位前嘱患者尽量放松,消除其紧张情绪,取得患者的配合。请患者端坐在口腔治疗椅上(或普通无靠背座椅,后背及头部紧靠墙壁)。下颌牙合平面的位置应低于术者双臂下垂时肘关节水平。…     

Analysis of MRI findings in minimum invasive treatment for habitual temporomandibular joint dislocation by autologous blood injection around the temporomandibular joint capsule

The aim of this study was to investigate magnetic resonance imaging (MRI) findings following autologous blood injection (ABI) for habitual temporomandibular joint (TMJ) dislocation. MRI was performed one hour and four and twelve weeks after ABI, revealing three types of significant findings. The first type was similar to hematoma and/or joint effusion in the articular capsule of the TMJ (type I). The second showed sporadic and diffuse T2 emphasis around the TMJ capsule (type II). The third involved a decreased range of condyle movement compared to before ABI (type III). Furthermore, we analyzed the three types of significant MRI findings.At one hour after ABI, type I was Grade 0 in 0 of 14 patients, Grade 1 in 8, Grade 2 in 2, and Grade 3 in 4. Type II was seen in 9 of the 14 cases and type III in 8. After twelve weeks, all cases of type I were Grade 0, no type II cases were evident, and type III was seen in 11 cases. Injecting autologous blood into surrounding TMJ tissues is an important factor in ABI. Minimally invasive treatment for habitual TMJ dislocation using ABI around the TMJ capsule appears to represent a very effective and safe treatment.     

颏部骨折伴髁突外上方脱位的治疗体会(附10例报告)

颏部骨折合并髁突骨折伴前内侧移位临床上常见,但颏部骨折伴髁突外上方脱位非常少见,容易漏诊和误诊,治疗不当易导致关节强直等后遗症.该文回顾10例颏部骨折伴髁突外上方脱位,并结合文献讨论其发生机制,诊断特征和临床治疗.     

Sliding reconstruction of the condyle using posterior border of mandibular ramus in patients with temporomandibular joint ankylosis

The traditional approach for ankylosis is gap arthroplasty or interpositional arthroplasty followed by reconstruction of the condyle using, for example, costochondral grafts. As these are non-pedicled grafts, there is eventual resorption with subsequent decrease in height of the ramus, facial asymmetry and deviated mouth opening. The authors have applied the method of total and partial sliding vertical osteotomy on the posterior border of the mandibular ramus for reconstruction of the mandible condyle as a pedicled graft for the correction of temporomandibular joint (TMJ) ankylosis. From 2004 to 2008, 18 patients who were diagnosed with TMJ ankylosis underwent operations for resection of the ankylosed condyle. Two methods were performed depending on the level of osteotomy on the posterior part of the mandibular ramus. All patients were followed-up for an average of 36 months (range 24-48 months). All patients showed apparent improved joint function with no cases of re-ankylosis. The results showed that sliding vertical osteotomy on the posterior border of the mandibular ramus seems to be an alternative and promising method for condylar reconstruction in patients with TMJ bony ankylosis.