青少年类风湿性关节炎侵及颞颌关节的错He研究

目的：研究青少年类风湿性关节炎侵及颞颌关节对患者He关系的影响。方法：研究组8名患有青少年类风湿性关节炎侵及颞下颌关节的病例，均为女性，分为三个阶段，第1阶段平均10岁，第2阶段平均12岁，第3阶段平均14岁。对照组8名患有青少年类风湿性关节炎未侵及颞颌关节的病例，相同的性别，年龄。对三个阶段的牙He模型进行测量。分析牙He关系的发展变化。用t检验检查两组间的差异。结果：研究组以Angle Ⅱ类错He为主，上下前牙拥挤，前牙开He，上颌前突明显高于对照组。使用功能矫正器治疗，拥挤可以解除，前牙开He，上颌前突．磨牙Ⅱ类错He得以缓解。结论：类风湿性关节炎侵及颞颌关节将导致患儿错He畸形。     

青少年类风湿性关节炎侵及颞颌关节的错牙合研究

目的研究青少年类风湿性关节炎侵及颞颌关节对患者牙合关系的影响.方法研究组8名患有青少年类风湿性关节炎侵及颞下颌关节的病例,均为女性,分为三个阶段,第1阶段平均10岁,第2阶段平均12岁,第3阶段平均14岁.对照组8名患有青少年类风湿性关节炎未侵及颞颌关节的病例,相同的性别,年龄.对三个阶段的牙牙合模型进行测量,分析牙牙合关系的发展变化.用t检验检查两组间的差异.结果研究组以Angle II类错牙合为主,上下前牙拥挤,前牙开牙合,上颌前突明显高于对照组.使用功能矫正器治疗,拥挤可以解除,前牙开牙合,上颌前突,磨牙II类错牙合得以缓解.结论类风湿性关节炎侵及颞颌关节将导致患儿错牙合畸形.     

类风湿性颞颌关节炎对儿童颌面部生长的影响

目的 动态地研究类风湿性关节炎少儿期侵及颞颌关节对患者颌面部形态和发育的影响。方法 研究组选择8例患有慢性类风湿性关节炎,双侧颞颌关节损伤发生在少儿期的生长期女孩。选择3个生长阶段,第一阶段平均10岁,为生长高峰前期,第二阶段平均12岁,为生长高峰期,第三阶段平均14岁,为生长高峰期后。观察期6年,每年进行临床检查,摄头颅正侧位定位X线片。对照组选择8例患有慢性类风湿性关节炎少儿期未见单、双侧颞颌关节受侵的相同时期女孩。测量两组3个阶段的头颅侧位片,取71个点,13条线,126个测量项目。输入计算机进行图像分析,研究两组面部形态的变化。结果 颞颌关节损伤组颌面部发育受限,上颌骨前、后高度均变短,下颌骨前面高增加,下颌骨围绕磨牙区旋转后缩,升支变短,下颌角前凹加深;软组织改变致鼻上翘,咽腔狭窄;颈椎变小。结论 类风湿性关节炎在少儿期侵及颞颌关节将影响患儿的颌面部生长,导致面部畸形。     

咬合功能障碍引起的颞颌关节病的诊断与治疗

颞颌关节病相当广泛,临床症状复杂,病因不易查明。作者研究咬合功能障碍引起的颞颌关节病的诊断与治疗,检查116例病人,年龄24～49岁,没有急性颞颌关节炎既往史,没有系统性疾病。第1组42例,一侧牙列缺损。第2组46例,牙列完整,一侧(牙合)关系紊乱。第3组28例,双侧(牙合)关系紊乱并有部分缺牙。对照组是40名没有颞颌关节病、牙列和(牙合)关系正常的人。进行口腔检查,在(牙合)架上分析研究模型,颞颌关节X线检查、血流图检查和咀嚼肌肌电图检查。研究结果:临床症状有颞颌关节运动减慢,关节杂音,长期负荷时疼痛,安静以后     

类风湿性颞下颌关节炎1例

类风湿性颞下颌关节炎 (temporomandibularjointinvolvementinrheumatoidarthritis)是一种以颞颌关节炎症为主要症状的全身系统性疾病。常常伴有全身游走性、多发性关节炎 ,尤其以四肢小关节最常受累 ,晚期可发生关节强直。本病临床并不少见。类风湿关节炎 (rheumatoidarthriti     

颞颌关节内窥镜检查术损伤面神经、颞浅血管、关节盘和关节骨面的危险性

近年来,颞颌关节内窥镜检查术已用于临床。但施行这种检查术存在损伤紧邻关节的面神经、颞浅动静脉的危险。由于颞颌关节(?)小,关节镜插入关节囊时还可能损伤关节盘(?)关节骨面。为了探讨这种潜在的危险,作者在新鲜尸体上进行了颞颌关节上腔的关节内窥镜检查术,术后解剖局部组织并测量其穿刺部位与上述解剖结构的距离。材料和方法本研究随机选用31例新鲜尸体,年龄范围51岁～96岁(平均年龄77岁)。死前无炎症性疾病。左侧颞颌关节无任何临床症状,全部尸体皆以左侧TMJ作为研究材料。颞颌关节内窥镜检查术固定由一人施行。     

骨髓瘤病患者的颞颌关节损害

骨髓瘤病又称多发性骨髓瘤,常首先损害躯干骨骼,长期剧烈骨痛。作者观察以颞颌关节疼痛为首发症状的骨髓瘤病4例,均为女性,年龄分别为44,46,48和51岁。因双侧颞颌关节经常疼痛(3～4年)就诊,曾误诊为类风湿性关节炎,进行奴夫卡因局部封闭,离子导入和超高频电疗等无效。无关节运动障碍,开口不受限。颞颌关节X线摄影见关节间隙正常,下颌髁状突松质骨内有多个1～3mm大小的圆形或卵圆形透射区,界限清楚;骨皮质和关节盘无破坏,这可能是无关节运     

颞颌关节损伤

诊断和治疗非火器性颞颌关节损伤2053例,包括髁状突骨折2032例,颞颌关节脱位21例。进行颞颌关节X线体层摄影、碘油造影、CT和MR检查,查明下     

颞颌关节病的临床特点和治疗原则

颞颌关节病是口腔科常见病之一。根据临床和X线检查、肌电描记和形态检查以及文献资料作者提出了以下的分类方法和治疗原则。1.颞颌关节功能失调性综合征: ①神经肌肉性综合征; ②咬合和关节连接性综合征; ③习惯性脱臼。2.关节炎:     

颈牵引可能是医源性颞颌关节功能障碍的病因

颞颌关节功能紊乱综合征,最常见的原因有(牙合)失调。对于患有颈椎综合征的病员,采用颈牵引治疗时,可能引起医源性颞颌关节功能障碍,这一事实目前还没有被充分认识。颈牵引迫使颞颌关节负荷过重,这是与肌张力使其颞颌关节仅遭受轻微的负荷相比而言。     

Orofacial pain, jaw function, and temporomandibular disorders in women with a history of juvenile chronic arthritis or persistent juvenile chronic arthritis

OBJECTIVES: We sought to study the long-term outcome of juvenile chronic arthritis (JCA) in the temporomandibular joint (TMJ). STUDY DESIGN: Temporomandibular disorders, including TMJ involvement, were assessed in 42 women with pauciarticular or polyarticular JCA--on average 25.8 years from disease onset--and compared with those found in matched control subjects. Disease-related parameters associated with temporomandibular disorders were identified. RESULTS: The TMJ was involved in 66.7% of the patients, most severely in extended pauciarticular JCA. Temporomandibular disorders were more frequent in the patients than in the control subjects, especially in those with persistent disease. The TMJ involvement was positively correlated with disease duration and negatively correlated with jaw opening and occlusal support. Duration of active JCA and history of functional pain were identified as predictors of present TMJ involvement. CONCLUSION: In a long-term follow-up, TMJ involvement proved frequent in the studied patients and was associated with long disease duration and previous pain on jaw opening. The findings suggest that patients with JCA should undergo orofacial evaluation on a regular basis.     

Craniomandibular function in juvenile chronic arthritis. A clinical and radiographic study

Craniomandibular function was studied in 70 subjects with juvenile chronic arthritis (JCA). The subjects represented the total group of children and adolescents with the diagnosis JCA in a Swedish county. At examination, the median age of the subjects was 11.9 years and the median duration of the disease was 2.6 years. The most important finding of the study was the high prevalence (41%) of radiographic signs of temporomandibular joint (TMJ) pathology. Few subjects showed the typical craniofacial abnormalities associated with JCA, like mandibular micrognathia, facial asymmetries and open bite. Subjective symptoms of dysfunction were almost absent in subjects younger than seven years but were reported by 56% of the older subjects. TMJ sounds and pain on jaw movements were the most frequent symptoms reported. At the clinical examination, TMJ crepitations and restricted horizontal jaw movements were noted in 26% and 32% respectively. The high prevalence of TMJ involvement found in this study underlines the importance that dentists become part of the medical team responsible for the treatment of children and adolescents with JCA.     

The mandibular condyle in juvenile chronic arthritis patients with mandibular hypoplasia: a clinical and histological study

In 12 JCA patients with severe mandibular hypoplasia, who all strongly demanded early treatment, 21 mandibular condyles were replaced by costochondral grafts. All of them had radiographic morphological changes in the mandibular condyles with varying degrees of destruction of the articular cartilages. Severe pathological changes in the lower joint compartments were consistently observed at surgery. Hence, the lower joint compartments were obstructed with granulomatous tissue, whereas the upper compartments were without macroscopic pathological changes. These findings indicated a polarized involvement of the temporomandibular joint (TMJ) in juvenile chronic arthritis (JCA). The extent of condylar articular surface destruction at histological examination varied from focal to total cartilage destruction. Inflammation of the subchondral bone marrow was a frequent finding. In spite of considerable arthritic destruction of the condyles, only one patient had TMJ pain, while a restricted mouth opening capacity was a more frequent finding. Thus, TMJ pain did not seem to constitute a reliable symptom of serious arthritic destruction of the mandibular condyle.     

Post-traumatic TMJ internal derangement: impact on facial growth (findings in a pediatric age group)

Many clinical studies have shown how jaw injuries sustained during impact trauma to the face or mandible are the single most important cause of TMJ subsequent internal derangement. Proper function of the masticatory system is certainly the most influential variable in the TMJ remodelling; once a TMJ is internally deranged, adaptative or degenerative osteocartilagineous processes take place in the mandible, temporal bones and muscles. To evaluate relationships between consequences of post-traumatic TMJ internal derangement and disturbed facial skeleton growth in children, 25 patients (16 boys 9 girls), 14 year of age or younger, were selected out of a group of 74 and analysed. They all had been treated by physiotherapy and had undergone combined clinical and radiographic examination for five years. Symptoms included either individually or in various combination, pain, mechanical TMJ dysfunction and facial skeletal abnormalities, such as mandibular retrognathia and lower facial asymmetry manifested by chin deviation from the midline. Seventeen patients were found to have at least one abnormal and internally deranged TMJ on imaging studies; in twelve of them a mandibular asymmetry with chin deviation from the midline to the smaller or more degenerated TMJ was evident. Of the eight retrognathic patients, five were found to have bilateral TMJ derangement. In three patients both TMJ(s) were normal with normal facial structure. These data suggest that TMJ derangement in children may potentially have an impact on facial growth and lead to the development of retrognathia, with or without asymmetry, in many cases.     

Management of temporomandibular joint arthritis in children and adolescents: An introduction for orthodontists

Juvenile idiopathic arthritis (JIA) is the most common inflammatory rheumatic disease of childhood. JIA can affect any joint and the temporomandibular joint (TMJ) is one of the joints most frequently involved. TMJ arthritis impacts mandibular growth and development and can result in skeletal deformity (convex profile and facial asymmetry), and malocclusion. Furthermore, when TMJs are affected, patients may present with pain at joint and masticatory muscles and dysfunction with crepitus and limited jaw movement. This review aims to describe the role of orthodontists in the management of patients with JIA and TMJ involvement. This article is an overview of evidence for the diagnosis and treatment of patients with JIA and TMJ involvement. Screening for the orofacial manifestation of JIA is important for orthodontists to identify TMJ involvement and related dentofacial deformity. The treatment protocol of JIA with TMJ involvement requires an interdisciplinary collaboration including orthopaedic/orthodontic treatment and surgical interventions for the management of growth disturbances. Orthodontists are also involved in the management of orofacial signs and symptoms; behavioural therapy, physiotherapy and occlusal splints are the suggested treatments. Patients with TMJ arthritis require specific expertise from an interdisciplinary team with members knowledgeable in JIA care. Since disorders of mandibular growth often appear during childhood, the orthodontist could be the first clinician to see the patient and can play a crucial role in the diagnosis and management of JIA patients with TMJ involvement.     

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目的    研究不同年龄阶段口腔癌患者外周血单核细胞来源的树突状细胞（dendritic cell,DC）的形态、表型差异并分析其临床意义。方法    将2007—2010年兰州大学第一医院及第二医院口腔科住院的口腔鳞癌初诊患者30例,分为40～50岁及≥60岁2组,每组各15例。取患者外周血单核细胞经重组人粒细胞集落刺激因子（rhGM-CSF）、重组人白细胞介素4（rhIL-4）及肿瘤坏死因子-α（TNF-α）诱导培养,获取成熟树突状细胞,光镜观察细胞形态,流式细胞仪检测细胞表面协同刺激分子CD1a、CD83、CD80、CD86的表达。结果    培养7d后,2组均诱导出典型形态和表型的树突状细胞,其中≥60岁组DC培养过程中细胞逐渐死亡,培养至第7天大部分细胞死亡,获得的DC数量较少,有3例未能培养出DC;而40～50岁组培养细胞的活力保持较好,至第7天均可获得数量较多的DC。结论    2组口腔鳞癌患者外周血单核细胞来源的DC经细胞因子诱导培养,均能扩增出成熟DC,但较40～50岁组,≥60岁组外周血培养的DC体外生长活力明显降低,可能与老年患者免疫功能明显降低有关。     

Dental and skeletal maturation in female adolescents with temporomandibular joint osteoarthritis

Occurrence of temporomandibular disorders (TMDs) and temporomandibular joint (TMJ) osteoarthritis (OA) during adolescence may have interactions with mandibular and dental development. The aim of the present study was to investigate relationships between occurrence of TMD and TMJ OA and extents of dental and skeletal development in juvenile female patients. In total, 95 female adolescents (age range, 11–15 years) were selected. Among them, 15 subjects (control) had no signs of TMD, 39 TMD patients did not have OA (TMDnoOA), 17 TMD patients were at initial stage of TMJ OA (TMJOA), and 27 patients showed progressive stage of TMJ OA (TMJOA). Dental age was estimated by Demirjian's stages used in a previous study with Korean adolescents. Craniofacial parameters and cervical vertebrae maturation (CVM) stages, representing skeletal maturity levels, were measured using lateral cephalograms. The estimated dental age was significantly lower than chronological age in all groups, but CVM differences were not statistically significant. Dental age was the lowest, and differences between the chronological age and estimated dental age were the highest among initial stage of TMJOAs followed by progressive stage of TMJOAs, TMDnoOAs and control and were not associated with CVM stages. Cephalometric parameters revealed significant clockwise rotation of the mandible among the TMJOAs compared with controls and TMDnoOAs and were not associated with CVM stages as well. The juvenile female patients with TMD, particularly TMJ OA, showed retarded dental development, mandibular backward positioning and hyperdivergent facial profiles. The TMJ OA may be associated with retarded dental development but not with skeletal maturations.     

恒牙早期安氏Ⅱ类1分类错牙合畸形患者矫治后鼻部形态变化的研究

[摘要] 目的 本回顾性研究通过头颅侧位片测量来探讨正畸治疗和生长发育对恒牙早期安氏Ⅱ类1分类错牙合畸形患者鼻部形态的影响。方法 收集60例处于生长发育高峰期(11～14岁)病例,分为非拔牙组30例和拔牙组30例,矫治前为T1期,矫治后为T2期;30例已过生长发育高峰期的未治疗病例为阴性对照组1,1～14岁时为T1期,当前为T2期。拍摄两期头颅侧位片,定点测量与鼻部形态相关的15项指标,数据输入SPSS16.0分析软件包,组内采用自身配对t检验,组间采用最小显著差数法进行多重比较分析。结果矫治组矫治前后线距测量指标变化明显(P<0.05),阴性对照组鼻背宽度、鼻底长度、鼻厚度变化明显(P<0.05),治疗组与未治疗组组间比较鼻背长度、鼻底高度、鼻前角变化明显(P<0.05)。结论 正畸治疗能促进鼻部垂直方向上的发育,对鼻部形态影响不大。