板对颞下颌关节紊乱病治疗作用及对脑血流的影响

颞下颌关节（TMJ）为人体结构复杂的关节之一，参与咀嚼、语言等多项复杂性生理功能，活动很灵活，易受损伤，人群发病率很高，但统计数字差异较大。颞下颌关节紊乱病（TMD）症状复杂，一般有颞下颌关节区及相应的软组织包括肌肉的疼痛；下颌运动异常和伴有功能障碍；关节弹响、破碎声及杂音等三类症状，可伴有头痛、眼及耳部症状，影响咀嚼功能并可引起全身不适。颞下颌关节紊乱病针对不同的病因和致病机制有多种治疗方法，     

核素骨显像诊断颞下颌关节病变的临床价值

目的: 探讨利用放射性核素骨三相显像和SPECT检查颞下颌关节紊乱病患者的价值.材料和方法: 66例颞下颌关节紊乱病患者接受X线片、放射性核素骨三相显像和SPECT检查.通过骨扫描结果进行定性和半定量分析,选择23例患者接受外科手术治疗.结果: 选择保守治疗者43例,血池相和延迟相影像及SPECT两侧关节区影像对称.接受颞下颌关节重建术者23例,血池相和延迟相影像及SPECT影像两侧关节区影像不对称,患侧关节区放射性强度和髁状突放射性计数比值稍高于对侧;术中发现,髁状突表面软骨有破坏,术后患者症状缓解.结论: 骨扫描可以作为颞下颌关节紊乱病的早期器质性病变的检测手段,选择为治疗方法提供参考.     

超声引导关节腔内注射富血小板血浆治疗颞下颌关节紊乱的疗效分析

【摘要】　目的?评估超声引导下关节腔中注射富小板血浆（PRP）治疗颞下颌关节紊乱病的有效性。方法?2016年4月至2018年4月,门诊诊治45例确诊为颞下颌关节紊乱患者,超声引导将采集于患者自身的PRP注射于患者病变的颞下颌关节腔内。观察患者在治疗前和治疗后1、3和6个月的最大张口度,及颞下颌关节在静息、运动和咀嚼时VAS评分。结果?关节腔内注射PRP可有效改善最大口腔开放程度,颞下颌关节在静息,运动和咀嚼时VAS评分与治疗前相比显著降低。结论?超声引导下关节腔内注射PRP可显著改善颞下颌关节紊乱患者的体征和症状。     

弱激光联合颌垫治疗老年颞下颌关节紊乱病58例

颞下颌关节紊乱病(temporomandibular disorder,TMD)是口腔科常见病、多发病,主要表现为颞下颌关节区疼痛、弹响及功能异常等症状。过去多认为青壮年多见,目前发现老年人发病并不少见,多数老年患者到了出现颞下颌关节区疼痛、弹响及影响发音和咀嚼时才来治疗。目前,临床多采用镇痛、解痉、镇静、封闭、激光理疗,以及热敷等非手术治疗[1]。武警吉林总队医院于2010-06至2014-06采     

下颌骨双向牵张成骨治疗颞下颌关节强直伴小下颌畸形

目的:探讨牵张成骨技术在颞下颌关节强直伴小下颌畸形治疗中的应用效果。方法:对6例颞下颌关节强直伴严重小下颌畸形的患者采用一期下颌骨双向牵张成骨、二期颞下颌关节成形术进行治疗。结果:所有患者术后均顺利完成牵引计划,并在3个月后拆除牵张器,面容获得极大改善,张口度达到25mm以上,睡眠呼吸暂停症状消失,营养状况改善,口内咬合关系基本恢复。结论:牵张成骨技术为临床上治疗颞下颌关节强直伴严重小下颌畸形提供了有效方法。     

歼击机飞行员颞下颌关节紊乱病流行病学调查及与心理测量对照研究

目的：研究颞下颌关节紊乱病在歼击机飞行员中的发病情况,并对照心理测量结果,探索颞下颌关节紊乱病与焦虑心理的关系。方法：对112名歼击机飞行员与130名地面人员,检查颞下颌关节紊乱病发病情况,并对照焦虑自测量表（SAS量表）和SCL-90临床症状自评量表进行对照研究。结果：歼击机飞行员颞下颌关节紊乱病发病率高于地面人员（P〈0．05）,并与焦虑指数有相关关系（P〈0．01）。结论：颞下颌关节紊乱病在歼击机飞行员中有较高发病率,并与焦虑指数有相关关系,提示持续正加速度（＋Gz）与焦虑心理可能是飞行人员颞下颌关节紊乱病的主要致病因素。     

复合音频电超短波TDP治疗颞下颌关节紊乱综合征26例观察

目的：评价复合音频电超短波TDP治疗颞下颌关节紊乱综合症的临床疗效。方法：51例颞下颌关节紊乱综合征患者随机分为治疗组与对照组,分别以复合音频电超短波TDP与单纯电针治疗,比较治疗前后关节疼痛、张口度与关节弹响等症状的变化。结果：以复合音频电超短波TDP治疗颞下颌关节紊乱综合征,总有效率为96.16%而对照组为84%（P〈0.01）。结论：复合音频电超短波TDP是治疗颞下颌关节紊乱综合征的一种有效疗法。     

颞下颌关节紊乱病的心理因素研究进展

颞下颌关节紊乱(temporomandibular disorders,TMD)是口腔常见病、多发病,累及颞下颌关节区和(或)咀嚼肌系统,表现为下颌运动异常、疼痛及关节弹响等,还可出现头痛、眼及耳部症状,甚至引起全身不适。TMD是一种多因素疾病,多数学者认为,因素、免疫、关节解剖、医源性、心理等因素在颞下颌关节紊乱病中扮演着重要角色。随着生物-心理-社会医学模式不断完善,研究者逐渐重视心理     

颞下颌关节紊乱病术后板治疗的生物力学分析

合板作为颞下颌关节紊乱病（ＴＭＤ）严重器质病变患者关节重建术后重要的辅助治疗手段之一,可增加颞下颌关节（ＴＭＪ）间隙,减少髁突负荷,使临床治疗效果明显提高〔１、２〕。对于牙合板在关节重建术后的应用及术后修复的病理改变,已有报道〔３〕。但是,有关牙合板治疗行关节重建术的ＴＭＤ器质性改变患者下颌骨应力分布的变化,国内外尚未见报道。采用三维有限元分析方法,对关节重建术后患者牙合板戴前与戴后下颌骨应力分布分化进行定量分析,旨在探讨牙合板对关节重建术后患者治疗的生物力学作用机制。１　材料和方法　　选取ＴＭ…     

颞下颌关节慢性损伤(牙合)间矫治23例临床观察

颞下颌关节慢性损伤所致颞下颌关节紊乱病(Temporo-mandibular disorders,TMD)是临床上常见病,采用(牙合)间矫治的方法治疗该病的作用机制尚在探讨之中.本文运用该法对患者进行治疗与分析,并对疗效作出综合评价.     

腭裂修复术及年龄对中耳功能的影响

目的　探讨腭裂患者中耳功能障碍听力损失发病特点、腭裂修复术及术前年龄对听力的影响 ,了解腭裂患者分泌性中耳炎鼓室分泌物细菌培养情况 ,为临床治疗提供依据。方法　对住院 12岁以下腭裂患者 6 0例 ,在术前、术后 6个月分别用脑干听觉诱发电位 ,声阻抗进行听力及中耳功能检查 ,术前鼓室分泌物进行细菌培养。结果　腭裂患儿术前听力损失发生率为 74% ,异常鼓室图为 80 % ,3岁前达 81% ,术后 6个月患者听力有一定程度恢复 ,异常鼓室图占 42 % ,鼓室分泌物细菌培养 ,G+ ,G-细菌阳性率分别为 2 3% ,2 4% ,且多为低毒性条件致病菌。结论　腭裂患者听力损失在婴儿时期已经存在 ,且听力损失严重 ,随年龄增大听力有所改善 ,听力损失与腭裂部位类型无关 ,早期修复腭裂有助于咽鼓管功能恢复 ,避免或减少听力损失 ,有利于语言发育 ,腭裂伴有分泌性中耳炎的治疗 ,有别于化脓性中耳炎的治疗 ,早期中耳置管能改善听力 ,并对腭裂患者听力损失原因及腭裂修复时间进行了讨论。     

鼓室穿刺治疗腭裂渗出性中耳炎的临床评价

目的　探讨腭裂修复同期 ,鼓室穿刺对腭裂伴分泌性中耳炎患者中耳功能及听力损失的影响。方法　将 80例 ( 14 6耳 )患有分泌性中耳炎的腭裂患者 ,随机分为实验组 ( 78耳 ) :常规腭裂修复术 ,术毕作鼓室穿刺。对照组 ( 68耳 ) :单纯腭裂修复术。术后 6个月两组均进行鼓室图、脑干听觉诱发电位检查 ,并进行比较。结果　实验组术后无论与术前比较 ,还是与对照组术后比较 ,鼓室图、V波反应阈值及轻、中度听力损失 ,均有显著进步 (P <0 0 1) ;术后半年内实验组听力恢复早 ,而且治愈率高 ( 96 2 % ,75 /78) ,明显优于对照组 ( 3 8 2 % ,2 6/68)。结论　腭裂修复同期鼓室穿刺 ,不仅有助于改善伴有分泌性中耳炎腭裂患者的中耳功能 ,提高听力 ;而且可避免或减少粘连性中耳炎的发生     

咽扩约肌成形术治疗腭咽闭合不全临床研究

目的　了解咽扩约肌成形术对腭裂术后腭咽闭合不全的治疗作用。方法　选择腭裂修复术后 1年以上 ,经语音训练仍有语言障碍 ,分别令其朗读《汉语腭裂字表》同时录音 ,然后 7名听力语音正常的医护人员试听录音并计算正确率 ,正确率在 70 %以下患者 3 0例 ,分别行咽扩约肌成形术治疗。结果　术前语音正常 0人 ,基本正常 0人 ,中度发音异常1 1人 ,明显发音异常 1 4人 ,严重发音异常 5人。术后语音正常 1 6人 ,基本正常 1 1人 ,中度发音异常 2人 ,明显发音异常1人 ,严重发音异常 0人。结论　咽扩约肌成形术能使腭裂术后仍有腭咽闭合不全患者语音明显改善。     

Facial skeleton remodeling due to temporomandibular joint degeneration: an imaging study of 100 patients

One hundred patients with recently acquired, externally visible mandibular deformity and no history of previous extraarticular mandible fracture were selected for retrospective analysis. All had been investigated clinically and with radiography, tomography, and high-field surface-coil MR imaging to determine the presence or absence and extent of temporomandibular joint degeneration. Temporomandibular joint degeneration was found in either one or both joints of each patient studied. Chin deviation was always toward the smaller mandibular condyle or more diseased joint, and many patients either complained of or exhibited malocclusion, often manifested by unstable or fluctuating occlusion disturbances. Three radiologically distinct forms of degenerative vs adaptive osteocartilaginous processes--(1) osteoarthritis, (2) avascular necrosis, and (3) regressive remodeling--involving the mandibular condyle and temporal bone were identified in joints most often exhibiting meniscus derangement. Osteoarthritis and avascular necrosis of the mandibular condyle and temporal bone were generally associated with pain, mechanical joint symptoms, and occlusion disturbances. Regressive remodeling was less frequently associated with occlusion disturbances, despite remodeling of the facial skeleton, and appears to result from regional osteoporosis. Forty patients (52 joints) underwent open arthroplasty procedures, including either meniscectomy or microsurgical meniscus repair, at which time major radiologic diagnoses were confirmed. Surgical and pathologic findings included meniscus displacement, disk degeneration, synovitis, joint effusion, articular cartilage erosion, cartilage healing/fibrosis, cartilage hypertrophy, osseous sclerosis, osteophyte formation, osteochondritis dissecans, localized or extensive avascular necrosis, and decreased mandibular condyle mass and vertical dimension. We conclude that temporomandibular joint degeneration is the principal cause of both acquired facial skeleton remodeling and unstable occlusion in patients with intact dentition and without previous mandible fracture.     

Facial skeleton remodeling due to temporomandibular joint degeneration: an imaging study of 100 patients

One hundred patients with recently acquired, externally visible mandibular deformity and no history of previous extraarticular mandible fracture were selected for retrospective analysis. All had been investigated clinically and with radiography, tomography, and high-field surface-coil MR imaging to determine the presence or absence and extent of temporomandibular joint degeneration. Temporomandibular joint degeneration was found in either one or both joints of each patient studied. Chin deviation was always toward the smaller mandibular condyle or more diseased joint, and many patients either complained of or exhibited malocclusion, often manifested by unstable or fluctuating occlusion disturbances. Three radiologically distinct forms of degenerative vs adaptive osteocartilaginous processes--(1) osteoarthritis, (2) avascular necrosis, and (3) regressive remodeling--involving the mandibular condyle and temporal bone were identified in joints most often exhibiting meniscus derangement. Osteoarthritis and avascular necrosis of the mandibular condyle and temporal bone were generally associated with pain, mechanical joint symptoms, and occlusion disturbances. Regressive remodeling was less frequently associated with occlusion disturbances, despite remodeling of the facial skeleton, and appears to result from regional osteoporosis. Forty patients (52 joints) underwent open arthroplasty procedures, including either meniscectomy or microsurgical meniscus repair, at which time major radiologic diagnoses were confirmed. Surgical and pathologic findings included meniscus displacement, disk degeneration, synovitis, joint effusion, articular cartilage erosion, cartilage healing/fibrosis, cartilage hypertrophy, osseous sclerosis, osteophyte formation, osteochondritis dissecans, localized or extensive avascular necrosis, and decreased mandibular condyle mass and vertical dimension. We conclude that temporomandibular joint degeneration is the principal cause of both acquired facial skeleton remodeling and unstable occlusion in patients with intact dentition and without previous mandible fracture.     

MR of osteochondritis dissecans and avascular necrosis of the mandibular condyle

We studied 40 patients exhibiting radiologic changes of either osteochondritis dissecans (OCD) or avascular necrosis (AVN) involving the mandibular condyle to evaluate the structural changes associated with these lesions when using high-field-strength MR imaging. Various clinical indications for imaging each patient with routine radiography, tomography, and surface-coil MR included headache, temporomandibular joint (TMJ) and/or ilsilateral facial pain, joint crepitus, clicking, locking, and either recently acquired or changing (unstable) occlusal disorder. Radiologic findings included alterations in condyle morphology and MR signal characteristics compatible with either OCD or AVN or, in some cases, both. Previous nonsurgical mandibular trauma was temporally related to the onset of symptoms in eight patients. Five patients exhibiting either unilateral or bilateral AVN involving the condyles and condylar necks had undergone previous orthognathic surgery, including sagittal split mandibular osteotomies followed by intermaxillary fixation. One patient exhibiting condylar AVN with articular surface collapse and osseous destruction had undergone previous TMJ meniscectomy followed by insertion of a permanent Proplast implant. Thirty-one of 34 patients with no prior surgery and MR changes of condylar OCD/AVN had associated internal derangement of the TMJ meniscus. There was surgical confirmation of findings in 10 joints. We assert that OCD and AVN are relatively common, clinically significant lesions of the mandibular condyle often associated with preexisting internal derangement of the temporomandibular joint.     

Frequency of bilateral temporomandibular joint disc displacement in patients with unilateral symptoms: a 5-year follow-up of the asymptomatic joint. A clinical and arthrotomographic study

Bilateral arthrotomography was performed in 50 consecutive patients with unilateral symptoms of disc displacement to evaluate the frequency of temporomandibular joint disc displacement in asymptomatic joints. Using well-defined clinical criteria, there were no false-positive findings of either reducing or non-reducing discs. On the other hand, a risk of false-negative diagnosis of non-reducing disc was apparent. Sixty per cent of the patients had a non-reducing displaced disc in the asymptomatic joint. Most of these patients could recall a previous spell of discomfort from this joint. Severe or moderate deformation had taken place in non-reducing discs, while reducing discs were normal in shape or had, at most, a thickening of the posterior band. The duration of symptoms was significantly correlated with the degree of deformation in the symptomatic joints (P less than 0.01). Perforation was statistically, significantly correlated with disc deformation and, in symptomatic joints, hard tissue changes. Fifty-seven per cent of the asymptomatic joints with displaced discs developed pain following the onset of symptoms from the contralateral side, most within 2 years. Less than half of them were free of pain at the end of the 5 year follow-up period. In view of this tendency for an asymptomatic joint with a displaced disc to subsequently develop pain refractory to treatment, such a joint must be considered a weakened link in the craniomandibular system, vulnerable to changes in mandibular function such as, for instance, displacement of the disc on the contralateral side.     

咽扩约肌成形术治疗腭裂临床效果评价

目的　了解咽扩约肌成形术在治疗腭裂中临床效果。方法　腭裂修复时同期咽扩约肌成形 ,并对部分 3年以上患者 36人与同期用咽后壁瓣移植术后患者 30人进行比较 ,分别令其朗读《汉语腭裂字表》同时录音 ,然后 7名听力语音正常的医护人员试听录音并计算正确率。结果　咽扩约肌成形组 :语音正常 2 5人 (6 9.4% ) ,基本正常 8人 (2 2 2 % ) ,中度发音异常 2人 (5 6 % ) ,明显发音异常 1人 (2 8% ) ,严重发音异常 0人。咽后壁瓣移植组 :语音正常 15人 (5 0 0 % ) ,基本正常 7人 (2 3 3% ) ,中度发音异常 5人 (16 7% ) ,明显发音异常 2人 (6 7% ) ,严重发音异常 1人 (3 3% )。结论　咽扩约肌成形术后能使腭裂患者语音明显改善 ,临床效果优于咽后壁瓣移植术     

MR imaging of the juvenile temporomandibular joint: preliminary report.

Thirty-two children were evaluated by means of medical history and physical examination for signs and symptoms of internal derangement (ID) of the temporomandibular joint (TMJ) and mandibular dysfunction. These children also underwent magnetic resonance (MR) imaging of the TMJs. The study was double blind. At clinical examination, 19 patients (59%) had at least one positive finding of ID of the TMJ and/or mandibular dysfunction. MR images of the TMJ obtained in 60 of the 64 TMJs demonstrated 57 normal joints (95%) and three abnormal joints (5%). Two of these three joints had a mild anterior-lateral disk displacement, and one joint had an anterior dislocated disk. There were no false-positive MR examinations. MR imaging failed to depict abnormalities in 16 patients who had positive findings at history and/or physical examination. Although MR imaging may fail to depict ID of the TMJ in some patients, clinical techniques commonly used in population surveys probably overstate the prevalence of ID of the TMJ in children.     

腭裂早期修复手术问题的探讨：附105例报告

总结<2周岁早期腭裂手术105例,无瘘孔、裂开及死亡。具有出血少、术后反应轻、愈合能力强等优点,介绍了手术操作及术后管理的要点,指出早期手术是安全可行的,除语言效果好外,且有利于患儿的心理发育,并认为唇腭裂患者的上颌骨发育障碍,尚与唇裂的手术方法有关。