颞下颌关节盘前移位的生物学基础

颞下颌关节盘前移位的病因,目前尚无统一认识,本文根据颞下颌关节盘前移位的胚胎发育、组织形态学特点,从生物学基础方面探讨颞下颌关节盘前移位的病因并结合近年来颞下颌关节盘前移位的动物实验,证实其病因的假设。     

关节盘前移位颞下颌关节仿真模型的建立

目的:通过CT及MR数据结合三维重建软件建立关节盘前移位颞下颌关节的数字化仿真模型。方法:根据马绪臣颞下颌关节病分类标准,选取成年颞下颌关节紊乱病志愿者1名,X线片及CT检查排除颌骨疾患及颌面部肿瘤,MR斜矢状位扫描明确右侧颞下颌关节盘分界角向前为12.21°,盘前分界超过关节结节顶点。通过Simpleware及Ansys等三维重建软件处理其右侧颞下颌关节的CT薄层扫描数据及3D-MR扫描数据,建立关节盘前移位颞下颌关节的数字化仿真模型。结果:建立了包括骨皮质、骨松质、软骨和关节盘在内的关节盘前移位颞下颌关节数字化仿真模型,客观反应了关节盘前移位时颞下颌关节的外形及解剖特点。结论:成功建立了关节盘前移位颞下颌关节的数字化仿真模型,为关节盘前移位的研究奠定了基础。     

颞下颌关节盘前移位的研究进展

颞下颌关节盘前移位在关节结构紊乱中较常见。因为关节盘前移位后,颞下颌关节内结构发生明显改变,各种炎性因子增多,并可见退行性变化,从而产生或不产生临床症状。因此,颞下颌关节盘前移位的研究越来越被人们所关注。     

颞下颌关节盘前移位的研究进展

颞下颌关节盘前移位在关节结构紊乱中较常见。因为关节盘前移位后，颞下颌关节内结构发生明显改变，各种炎性因子增多，并可见退行性变化，从而产生或不产生临床症状。因此，颞下颌关节盘前移位的研究越来越被人们所关注。     

可复性关节盘前移位患者的关节音特征

目的 比较青年人可复性关节盘前移位者和无颞下颌关节症状者的颞下颌关节音,探讨其关节音频谱图的特征和临床诊断价值.方法 运用BioJVA颞下颌关节振动分析仪记录21例可复性关节盘前移位患者与26例正常青年人节律性大开闭口运动中双侧颞下颌关节音;以临床诊断为标准,计算关节振动总能量,诊断可复性关节盘移位的灵敏度和特异性....     

颞下颌关节造影术在诊断不可复性关节盘前移位中的价值

自１９４４年Ｎｏｒｇａａｒｄ把颞下颌关节造影术应用于临床以来,颞下颌关节造影术已成为某些关节病特别是关节盘前移位诊断的重要手段。本文通过对３６例不可复性关节盘前移位患者的临床及影像学资料的分析,以探讨这种有创伤性的影像学诊断方法在不可复性关节盘前移位...     

颞下颌关节盘前移位后关节的适应性改建

颞下颌关节盘前移位是最常见的关节紊乱病,它的发病机制仍然不清楚,近年来,许多研究表明关节盘移位后,关节会发生适应性改建。充分了解这一变化,对于临床上治疗颞下颌关节盘前移位患者时,判断其是否需要进行手术复位,具有重要的指导意义。本文就关节盘移位后关节盘、髁突软骨的适应性改建,及目前研究的局限和展望作一综述。     

翼外肌对可复性颞下颌关节盘前移位的作用机制

目的 分析可复性关节盘移位中翼外肌作用下颞下颌关节的应力分布情况。方法 利用已建立的可复性关节盘前移位颞下颌关节数字化仿真模型,在单纯翼外肌加载下进行生物力学分析。结果 关节盘应力集中于关节盘中间带偏外侧区域;髁突及关节窝应力主要集中于与关节盘相接触的功能面。在颞下颌关节盘的位移分布中,从关节盘前带至关节盘中间带,位移趋势逐渐增大,关节盘中间带与关节盘后带之间出现位移撕裂带,从关节盘中间带至关节盘双板区位移逐渐递减;而颞下颌关节整体位移最大值出现在关节囊前份的翼外肌上头附着区。结论 在可复性关节盘前移位中翼外肌可导致关节盘中间带偏外侧区域的应力集中,可能导致此区域关节盘变薄、穿孔甚至撕裂。     

颞下颌关节上腔造影双层显示对关节盘前移位的X线片影像分析

目的：探讨颞下颌关节上腔造影双侧显示的关节前移位的影像特点。方法：总结１９９４～１９９６ 年间在我院颞下颌关节门诊诊治的颞下颌关节前移位的１９７ 例进行双层显示的颞下颌关节造影。结果：可复性关节盘前移位８２例,占４１．６２％ 。不可复性关节盘前移位１１５ 例,占５８．３８％ ;关节前内移位者７４ 例,占３７．５６％ ,关节盘前外移位者８ 例,占４．０７％ ,单纯性关节前移位者１１５ 例,占５８．３７％ 。结论：颞下颌关节上腔造影双层显示不仅能诊断可复性盘前移和不复性盘前移,同时能够判断关节盘前移位过程中是否存在内外移位。     

颞下颌关节盘移位的临床地位

颞下颌关节盘移位是临床上常见的颞下颌关节囊内病变，目前国内外均以颞下颌关节盘移位为依据进行临床分类。诊断和治疗，近年来，有学者对关节盘移位与临床症状之间的关系提出疑问，本文对此进行综述。     

颞下颌关节灌洗术治疗不可复性关节盘前移位的临床研究

目的 评价颞下颌关节上腔灌洗术治疗不可复性关节盘前移位的临床疗效。方法 ３８例因不可复性关节盘多位引起张口受限的患者行关节上腔灌洗治疗,分析治疗不同时期患者的疼痛值、下颌运动度变化,通过关节造影判定治疗前后关节盘位置的变化。结果 治疗后不同时期的下颌运动均较治疗前的显著增加（Ｐ〈０．００１）,特别在治疗后１个月内增加明显,疼痛亦有显著缓解（Ｐ〈０．０１）。关节造影显示仅有２患者的关节盘部分复位。结     

颞下颌关节上腔封闭-扩张联合灌洗及粘弹补充治疗不可复性关节盘前移位

目的评价颞下颌关节上腔封闭-扩张术联合灌洗及粘弹补充疗法治疗不可复性关节盘前移位的临床效果.方法对29例不可复性关节盘前移位患者行关节上腔封闭-扩张治疗,3～5d后行灌洗术,结束时注入1%透明质酸钠1ml.在治疗的同时配合被动张口训练.以配对t检验对数据进行处理.结果封闭-扩张术后张口度及健侧侧向运动度较治疗前、灌洗及粘弹补充治疗术后张口度及健侧侧向运动度较灌洗术前均有显著增加(P＜0.01),疼痛基本消失.治疗过程中有5例患者出现健侧关节疼痛,经用封闭-扩张治疗后疼痛消失,张口度相应增加3～5mm.结论(1)颞下颌关节上腔封闭-扩张联合灌洗及粘弹补充疗法能有效改善不可复性关节盘前移位患者的张口度及侧向运动度,缓解关节疼痛.(2)封闭-扩张术与灌洗及粘弹补充疗法两者有互补及累加作用.(3)及时发现对侧关节的隐匿病变并进行治疗,能提高整体疗效.     

Relations between anterior disc displacement and maxillomandibular morphology in skeletal anterior open bite with changes to the mandibular condyle

In this study we investigated the relation between anterior disc displacement (ADD) and maxillomandibular morphology in skeletal anterior open bite with changes to the mandibular condyle. Thirty female patients (60 joints) with both conditions were evaluated. Magnetic resonance imaging of the temporomandibular joint (TMJ) was used to diagnose both ADD and changes to the mandibular condyle (erosion, osteophyte, and deformity). The relations among ADD, changes to the mandibular condyle, and maxillomandibular morphology were examined statistically. Changes to the mandibular condyle had a higher score than sym anterior open bite, the deviated side in asymmetric anterior open bite, and the non-deviated side. The score for disc displacement on the non-deviated side was lower than both the sym side and the deviated side. Unilateral changes to the mandibular condyle and unilateral disc displacement were not apparent in sym anterior open bite, but a unilateral non-displaced disc was seen only on the asymmetric side. Mandibular condylar changes were significantly more common on the deviated, than on the non-deviated, side. The SNB angle was significantly smaller, and the ANB, GZN, and SN-mandibular plane angles were significantly larger in sym anterior open bite. Overjet, ANB angle, GZN angle, and SN-MP angle were significantly larger, and the SNB angle was significantly smaller, in the presence of ADD without reduction and mandibular condylar deformity. We conclude that the prevalence of ADD without reduction and changes to the mandibular condyle were related to mandibular asymmetry and mandibular morphology in anterior open bite. This retrospective study suggests that ADD without reduction and mandibular condylar bone changes may be related to the progression of skeletal class II open bite and mandibular asymmetry in cases of skeletal open bite.     

Pre- and posttreatment analysis of clinical symptoms of patients with temporomandibular disorders.

OBJECTIVE: This study treated patients with temporomandibular disc displacement with reduction (with pain, limited mandibular movement, and clicking sound symptoms) using a combination of analgesics, injection, mandibular exercise, and occlusal splints. METHOD AND MATERIALS: Twenty-five patients with temporomandibular joint (TMJ) disorders were evaluated for pretreatment complaints and clinical findings, such as TMJ sounds, mandibular deviation, limited mouth opening, and bilateral magnetic resonance imaging results. Diagnostic treatment was then planned; all patients received occlusal splints, and 10 patients received injections. RESULTS: Evaluations were conducted 1 year after the initial diagnosis and treatment. Complaints (especially of pain) by the patients who received injections had reduced significantly. After 6 months of occlusal splinting, clinical findings of patients with TMJ disc displacement had greatly improved. To manage parafunctional habits of the patients, night plate usage was continued. Therefore, clinical symptom reduction was maintained. CONCLUSION: The use of mandibular manipulation technique can decrease the anterior disc displacement of the TMJ.     

急性颞下颌关节盘不可复性前移患者手法复位结合综合物理疗法的近期疗效观察

目的: 观察手法复位结合综合物理疗法治疗急性颞下颌关节盘不可复性前移患者的近期临床疗效。方法: 总结我院康复医学科门诊自2017年1月—2017年12月收治的急性开口受限（病程在2个月以内）且经MRI证实颞下颌关节盘不可复性关节盘前移40例患者（男4例,女36例）的临床资料。治疗首先施予健康教育、物理因子治疗（超短波治疗、超声治疗、激光治疗）,随后予手法复位,即刻配戴硬质热塑再定位垫,同时进行运动疗法（软管盘复位训练、关节稳定性训练和颈椎姿势训练）。每周5次,连续治疗2周。所有患者均于治疗前和治疗后采用最大主动开口度（mm）、视觉类比评分（visual analogue pain score,VAS）（0~10分）、下颌功能损害问卷评分（mandibular function impairment questionnaire,MFIQ）进行疗效评估。治疗结束后MRI复查盘-髁关系。采用SPSS22.0软件包对数据进行配对t检验和Wilcoxon符号秩检验。结果: 治疗结束后即刻,最大主动开口度从（24.5±6.4）mm 增加到（40.1±4.4）mm,开口末VAS从2（0,3）分下降到0（0,0）分,咀嚼VAS从1（0,3）分下降到0（0,0）分,下颌功能损害问卷评分从（25.0±6.5）分下降到（12.3±6.4）分,均具有统计学意义（P<0.05）。静息VAS 从0（0,0）分下降到0（0,0）分,无统计学差异（P>0.05）。40例患者在治疗结束后平均（3.6±3.1）周MRI 显示正常盘-髁关系23例（占 57%）,可复性关节盘前移位9例（占23%）,不可复性盘前移位 8例（20%）。结论: 手法复位结合综合物理疗法治疗急性颞下颌关节盘不可复性前移可以即刻增加开口度,缓解疼痛,改善TMJ功能,并对维持正常盘-髁关系有一定作用。     

可复性关节盘前移位患者的关节音特征

目的比较青年人可复性关节盘前移位者和无颞下颌关节症状者的颞下颌关节音,探讨其关节音频谱图的特征和临床诊断价值。方法运用BioJVA颞下颌关节振动分析仪记录21例可复性关节盘前移位患者与26例正常青年人节律性大开闭口运动中双侧颞下颌关节音;以临床诊断为标准,计算关节振动总能量,诊断可复性关节盘移位的灵敏度和特异性。结果病例组两侧颞下颌关节的振动总能量、频率小于300 Hz的振动能量、频率大于300 Hz的振动能量、频率大于300 Hz的振动能量与频率小于300 Hz的振动能量之比、峰振幅、峰频率、中间频率均明显大于对照组（P＜0.05）;病变关节随着关节盘移位程度的增加,各项关节振动参数也随之增加,振动总能量明显增加（P＜0.05）;关节振动总能量对关节盘前移位的诊断灵敏度和特异性分别为0.86和0.85。结论可复性关节盘前移位患者关节音振动的各参数明显高于正常人,不同病变阶段的关节音也不同。     

Evaluation of temporomandibular joint in patients with hemifacial microsomia.

OBJECTIVE: The purpose of this study was to elucidate positional relationships between temporomandibular joint (TMJ) components, including the articular discs, using magnetic resonance imaging (MRI) in patients with hemifacial microsomia (HFM). SUBJECTS AND METHODS: Twenty TMJs in 10 patients with HFM were examined at closed- and open-mouth positions using an MRI scanner. The condyle-fossa and disc-condyle relationships, disc configuration at the closed-mouth position, and the reduction of the disc at the open-mouth position were evaluated. RESULTS: On the unaffected side, the condyle-fossa and disc-condyle relationships appeared fairly normal at the closed mouth position. The disc-condyle relationship at the open-mouth position was also normal. The TMJ disc showed normal biconcave configurations at both closed- and open-mouth positions. On the affected side, there was considerable variation in the state of the TMJ. At the closed-mouth position, 5 of the 10 patients revealed fairly normal disc-condyle relationships, one patient showed anterior displacement of the disc, and four patients had no disc. Two patients appeared biconcave, three patients appeared biplanar, and one patient was hemiconvex. At the open-mouth position, the condyle and disc moved in harmony in five patients with normal disc-condyle relationships, but the disc was reduced in a patients with anterior disc displacement. The degree of the TMJ disc dysplasia did not necessarily correspond with the degree of mandibular dysplasia. CONCLUSIONS: The present study contributes to an improved understanding of TMJ pathology in patients with HFM. The results suggest that, in HFM patients, the examination of the TMJ using MRI is helpful for determining treatment procedures in mandibular distraction osteogenesis.     

Sound analysis of temporomandibular joint internal derangements with phonographic recordings

STATEMENT OF PROBLEM: Temporomandibular joint (TMJ) sound recordings could be analyzed to assess the state of TMJ internal derangements. PURPOSE: The aim of the study was to assess the value of sound analysis in the diagnosis of the type of the TMJ internal derangements. MATERIAL AND METHODS: After clinical and radiologic examinations, phonographic sound recordings on mandibular excursions were obtained in 52 patients with TMJ internal derangements and 12 control individuals. Sound correlations were made on the basis of opening-closing, protrusive-retrusive, and lateral excursions of the mandible. RESULTS: Clicking was a consistent finding of anterior disc displacement with reduction, whereas crepitation was found in varying degrees in anterior disc displacement and osteodegenerative arthritis. Silent TMJs were the feature of normal TMJs, except for the situations of acute lock. Although in 29 TMJs opening click was followed by a closing click (reciprocal clicking), 46 TMJs with opening click also had clicking on protrusion. On the other hand, 19 TMJs with opening click also had clicking on ipsilateral motion, and 40 TMJs with opening click had clicking on contralateral motion of the mandible. The sound patterns were found to be similar in opening-protrusive clicks and opening-contralateral clicks. The lack of protrusive clicking in the presence of opening click was considered an indication of late disc reduction on opening. Crepitation was observed in advanced cases of TMJ internal derangements. CONCLUSION: Within the limitations of this study, the results suggest that TMJ sound analysis on mandibular excursions was indicative for diagnosis and establishment of severity of TMJ internal derangements. Clicking and crepitation may be looked on as signs of abnormal joint disorder, clicking indicating anterior disc displacement with reduction, and crepitation, indicating progression from anterior disc displacement without reduction to osteodegenerative arthritis.     

Adaptive change in temporomandibular joint tissue and mandibular morphology following surgically induced anterior disc displacement by bFGF injection in a rabbit model

Purpose

The purpose of this study was to examine the effect of injecting basic fibroblast growth factor following surgical induced anterior disc displacement in temporomandibular joints (TMJ).