正颌外科与颞下颌关节

牙颌面畸形是一种严重影响患者的咬合功能及颜面外形，并造成其精神创伤及心理异常的口腔常见多发病。据资料统计，约４０％的人群患者有错畸形，其中约５％属于颌骨发育异常所致，需要采取外科—正畸联合矫治的方法进行治疗。近１０年来正颌外科获得飞速发展，已经成为...     

偏颌畸形及其正颌手术对颞下颌关节的影响

<正>偏颌畸形(facialasymmetricdeformity)是颌骨畸形中比较常见的类型,包括先天性及发育性偏颌畸形,可分为偏侧小颌畸形及偏侧突颌畸形两类,多见于下颌骨,表现为面部左右不对称,上下中切牙的中线不一致,颏部及下颌中线偏向一侧,可有反或锁[1]。研究发现,偏颌畸形与颞下颌关节紊乱(temporomandibulardisorders,TMD)关系密切。TMD是颞下颌关节、咀嚼肌及周围相关结构表现的不同症状及体征的一个总称,临床表现主要包括关节区疼痛、关节杂音及功能障碍,伴或不伴有下颌骨运动受限、颞下颌关节(temporomandibularjoint,TMJ)及相关肌肉触痛等[2]。偏颌畸形严重影响患者的容貌、咀嚼和发音功能,随着正颌手术的顺利开展,正颌-正畸联合治疗不仅可以使偏颌患者恢复面容的正常和美观,而且可以使牙、、颌的形态和功能达到协调、美观和稳定,但正颌手术对其颞下颌关节的影响还在研究之中。     

正颌手术与颞下颌关节的关系研究进展

正颌手术改变颌骨间的位置关系后，将不可避免地影响到具有精细解剖结构的颞下颌关节。为明确二者间的关系，本文就正颌手术与颞下颌关节紊乱综合征、正颌手术引起的关节结构的改变以及坚固内固定和牵张成骨术对于关节的影响等问题的研究进展作一系统回顾。     

正颌手术对颞下颌关节影响的研究进展

正颌术术后的复发往往与颞下颌关节（TMJ）结构和位置异常有关，包括髁突移位、进行性髁突吸收和关节盘移位等。正颌外科作为一种创伤性的手术，对TMJ的结构和位置能产生一定的影响。由于牙颌面畸形患者往往术前即有TMJ的疾病，因此正颌手术本身对TMJ的影响是否导致了复发和产生颞下颌关节紊乱病（TMD）需要多项研究探索。有一些学者提出，正领手术同期行关节盘复位术可提高手术效果稳定性。对预防由于TMJ结构和位置异常引起的复发或TMD，目前临床尚无特定方法。鉴于此，本文将在正颌外科对TMJ结构的影响，与TMD的关系，以及预防术后复发和TMD的方法等三个方面进行综述。     

正畸治疗与颞下颌关节紊乱病的研究进展

颞下颌关节紊乱病(temporomandibular disorders, TMD)是一组影响颞下颌关节、咀嚼肌系统、牙齿咬合甚至全身多种结构的病症,因其病因机制不清、临床表现复杂,使其成为口腔医学领域的临床难点之一。TMD是正畸初诊患者中的常见症状之一,正畸医生在临床工作中不可避免地会接触到相关问题。因此正畸医生需要积极面对并通过深入地学习,更加深刻地理解TMD的分类、诊断及其发病机制并学习相关的治疗手段,积极应对临床中的TMD相关问题,并努力在TMD的多学科联合治疗中起到更加重要的作用。     

颞下颌关节紊乱病的正畸考量

颞下颌关节紊乱病（TMDs）是临床较为常见的口腔疾病,表现为疼痛、弹响、开口受限和下颌运动异常等。随着生活水平的提高和医疗知识的普及,越来越多的人开始认识和接受正畸治疗。近年来,关于能否通过正畸治疗改善患者咬合并进一步改善其关节症状,以及正畸治疗能否导致TMDs的发生等问题引起了国内外学者的广泛关注。流行病学研究发现,TMDs与很多类型的错牙合均有相关性。本文从咬合和颞下颌关节功能相关性的角度出发,分析错牙合畸形和TMDs的内在联系,探讨TMDs与正畸治疗以及正畸治疗后稳定性的关系,以期为正畸临床预防和治疗TMDs提供一定的理论参考。     

正畸治疗应如何规避颞下颌关节紊乱病的风险

颞下颌关节紊乱病是导致口颌面非牙源性疼痛的常见原因之一,但其病因机制尚未完全阐明.传统的牙合学理念认为咬合是其病因之一,改变患者咬合的正畸治疗也就被认为可能会导致颞下颌关节紊乱病.而由于正畸治疗持续2年左右,一旦患者在治疗中出现颞下颌关节病症状,就可能产生医患纠纷.因此,正畸医生如何在越来越多患者寻求正畸治疗的情况下,...     

下颌优先于双颌正颌手术中运用的研究进展

目前有两种常用的双颌正颌手术顺序:上颌优先和下颌优先.上颌优先即先行上颌骨截骨、定位和固定,再行下颌截骨,通过已固定的上颌定位下颌的位置;下颌优先则反之,以下颌骨的截骨、定位和固定为先,再行上颌手术.有研究发现下颌优先相比上颌优先具有很多优点,但上颌优先和下颌优先的运用范围和术后效果等方面仍存较多争议.本文就下颌优先的...     

常见颞颌关节紊乱综合征的正畸治疗

正畸治疗是去除牙位、颌位异常的错Ｈｅ所致颞颌关节紊乱综合征（ＴＭＪＤＳ）的有效而稳定的方法。作者通过对经治的８０例患者加以分析，探讨了正畸患者ＴＭＪＤＳ的特点及所采用的正畸治疗方法。８０例患者的平均年龄为１６．８岁，男女性别比４：６。其中，毛氏Ⅰ＾１患者最多，共５６例；关节症状以弹响多见，其次为张口受限、夜磨牙、关节脱位等。关节开闭口片见：３０例开闭口片见：３０例关节间隙有改变，２０列关节凹和关节     

The efficacy of the orthodontic treatment of pathological dental abrasion complicated by temporomandibular joint dysfunction

A total of 426 patients, 215 female and 211 male ones, aged 40 to 65, were treated for abnormal abrasion of the teeth; 52 of these developed temporomandibular joint dysfunction. Orthodontic and physiotherapeutic methods were added to the complex of therapeutic measures for this patient population. Orthodontic treatment was aimed at normalization of the occlusion height (interalveolar space) and mandibular status and was carried out with a plastic cup attached to the denture for a period of up to 6 months. This was followed by rational prosthetics. Good late results were achieved in 48 patients (92.2 percent) with temporomandibular joint dysfunction. Four patients developed recurrences of such dysfunction in various periods after the treatment.     

Clinical study on the prevalence of temporomandibular joint dysfunction in orthodontic patients

The percentage of potential TMJ dysfunction is high in orthodontic patients. The prevalence of TMJ dysfunction during orthodontic treatment and the correlation between TMJ dysfunction occurrence and orthodontic appliances were studied. One hundred and twenty-five male and 183 female orthodontic patients between 7.2 and 38.3 years of age with a mean age of 13.1 years without TMJ dysfunction at first examination were examined for clinical symptoms. TMJ dysfunction was found in 26 patients (8.6%). The frequency of occurrence of TMJ dysfunction in patients treated with a chin cap appliance was 10.9% (14/129) and 6.7% (7/105) for those treated with a multibracket appliance. Chin cap appliance treatment was begun after the pubertal growth peak in eight patients, during the peak in three patients, and before the peak in three patients. Clinical symptoms continued in four patients who continued to use the appliance under the same conditions, and nine patients who were treated with proper countermeasures became free from clinical symptoms.     

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颞下颌关节紊乱病（TMD）是一种由关节结构、咬合、肌功能异常及精神心理等多种因素综合作用形成的口颌面部疾病。闭锁型深覆[牙合]、个别前牙与后牙反[牙合]、后牙锁[牙合]、一侧后牙反[牙合]、下颌偏斜、磨牙伸长、磨牙倾斜等是诱发TMD的高危险[牙合]因素。从整体分析,正畸治疗与TMD并无密切相关性,但部分病例TMD的发生仍可能与正畸治疗不当有关。良好的牙齿排列、正常的前牙覆[牙合]与覆盖关系及后牙尖窝对应关系、牙位与肌位一致、下颌前伸与侧[牙合]平衡是有效预防与缓解TMD的可靠保证。本文对错[牙合]畸形及正畸治疗与TMD的相关性研究文章进行系统回顾,结合正畸临床实际,分析错[牙合]畸形与TMD的内在联系,以及正畸治疗中TMD的风险和防治策略。     

正畸治疗与颞下颌关节症状的相关研究

目的：探讨正畸治疗和颞下颌关节紊乱病（TMD）的关系。方法：设计正畸组、错[牙合]组和正常组的调查表,用Visual Foxpro6．0建立相应的数据库,对173例已正畸治疗者、95例有错[牙合]畸形但未治疗者和32例正常对照进行TMD症状、体征及相关情况的问卷调查和专科检查,所得结果用基于Helkimo指数改良设计的数据库进行分析,采用SPSS10．0软件包进行成组设计两样本比较的秩和检验。结果：正畸组和错[牙合]组在主诉症状指数、临床症状指数和咬合指数的分布上存在显著差异（P〈0．001）;正畸组和正常组在主诉症状指数和临床症状指数的分布上有显著差异（P〈0．001）,但在咬合指数的分布上无显著性差异（P〉0．05）。结论：正畸治疗后患者在一定时期内易出现颞下颌关节紊乱病的症状和体征。     

Preventing adverse effects on the temporomandibular joint through orthodontic treatment

The temporomandibular joint is one of the most complicated working assemblies in the human body. We are just now beginning to understand it and give it the respect and careful treatment it deserves as an integral functioning part of the dental anatomy. No orthodontic procedure can be performed in isolation without considering its possible effect on the temporomandibular joint. Therefore, the following recommendations are made for diagnosis and treatment planning. Etiologic factors that might cause upward and backward pressures on the mandible should be reduced as much as possible. Mechanotherapy that may cause upward and backward pressures on the condyles is not recommended. Final detailed correction of dental abnormalities should always consider optimal temporomandibular health and function. Retention procedures should be planned to provide a proper path of closure to minimize or prevent possible retrogressive posttreatment changes. It is the author's hope that the hypotheses and suggestions in on TMJ problems and on the preventive role of orthodontics in the patient's treatment.