安氏Ⅲ类错关节窝、髁突、关节盘位置及关节盘形态变化的研究

目的为探讨骨性和功能性Ⅲ类错与颞下颌关节紊乱病之间的关系。方法利用矫正薛氏位片对Ⅲ类骨性错19人，功能性错20人的双侧颞下颌关节的髁突居关节窝的位置进行评价，并依据髁突居关节窝中的位置（前移、居中、后移），从上述两类错中各选5人做双侧颞下颌关节矢状位核磁共振扫描，观察关节盘的位置及形态变化。结果每一类型错髁突居关节窝中的位置并不一致，但位置分布比较集中，Ⅲ类骨性和功能性错髁突明星居关节窝前位，当髁突居前位或中位时，关节盘位置在正常范围且形态为正常的双凹形，髁突居后位时，关节盘位置在正常范围或轻度前移，形态也都表现正常。结论Ⅲ类骨性和功能性错颞下颌关节结构基本正常，与颞下颌关节紊乱病关系不密切。     

54例正常人双侧颞下颌关节CBCT测量值分析

目的：探讨应用CBCT（cone-beamcomputedtomography）对成年人两侧颞下颌关节进行多项指标数据测量分析。方法：在TMJ成像与测量技术的基础上，筛选出正常成人54例，通过严格的TMJ临床检查确定为健康关节，利用Newtom9000CBCT对其ICP位颞下颌关节进行成像后测量分析。结果：在轴位测得髁状突水平角以及单侧髁状突距矢状中线的距离；平行于髁状突长轴的斜位，测髁状突长轴径，垂直角度，沿髁状突长轴顶内外极间任意角间隙宽度；垂直于髁状突长轴的斜位测量关节髁状突前中后任意角间隙宽度，关节凹深度和前斜面角度关节颈厚度；矢状位测关节髁状突前中后任意角间隙宽度，关节凹深度和前斜面角度关节颈厚度。结论：正常成人双侧髁状突位置及关节窝形态性别差异不明显，双髁状突位置及关节窝形态基本对称。     

安氏Ⅱ类错关节窝、髁突、关节盘位置及关节盘形态变化的研究

目的 :为探讨安氏Ⅱ1、Ⅱ2 错与颞下颌关节紊乱病之间的关系。方法 :利用矫正薛氏位X线片对Ⅱ1错16人 ,Ⅱ2 错 17人的双侧颞下颌关节的髁突居关节窝的位置进行评价 ,并依据髁突居关节窝中的位置 (前移、居中、后移 ) ,从上述两类错中各选 5人做双侧颞下颌关节矢状位核磁共振扫描 ,观察关节盘的位置及形态变化。结果 :每一类型错髁突居关节窝中的位置并不一致 :Ⅱ1错髁突居关节窝中位 ,但轻度前移 ;Ⅱ2 错髁突居关节窝后位。当髁突居前位及中位时 :关节盘位置在正常范围且形态表现为正常的双凹形 ;髁突居关节窝后位时 :部分关节盘位置明显前移 ,且形态也表现出异常的前带增厚。结论 :大多数Ⅱ1错颞下颌关节结构基本正常 ;而Ⅱ2错部分患者表现出颞下颌关节结构异常 ,提示与颞下颌关节紊乱病关系密切     

Forsus矫治器治疗安氏Ⅱ类下颌后缩患者颞下颌关节变化的CBCT分析

目的 通过CBCT研究Forsus矫治器对生长发育期患者颞下颌关节的影响。方法 选取28例（男性14例,女性14例）生长发育期的安氏Ⅱ类错(牙合)患者,采用直丝弓矫治配合Forsus矫治器导下颌向前。每位患者在治疗前后均行CBCT扫描,使用Invivo 5软件对患者治疗前后的颞下颌关节有关数据进行测量。结果 治疗后SNB增加,ANB减小;关节窝宽度增加,关节结节倾斜角减小;髁突顶部矢状面面积、髁突顶部冠状面面积增加,差异有统计学意义（P<0.05）;男性患者髁突体积、髁突顶部高度增加,髁突前后径减小,差异有统计学意义（P<0.05）。颞下颌关节窝面积、关节窝矢状总间隙面积、关节间隙、髁突内外径、髁突最大轴面面积不变（P>0.05）。结论 Forsus矫治器治疗后,髁突与关节窝相对位置关系不变,关节窝形态及髁突顶部形态改建,男性较女性髁突改建更明显。     

安氏Ⅲ类错He关节窝,髁突,关节盘位置及关节盘形态变化的研究

目的 为探讨骨性和功能性Ⅲ类错Ｈｅ与颞下颌关节紊乱病之间的关系。方法 利用矫正薛氏位片对Ⅲ类骨性错Ｈｅ１９人，功能性错Ｈｅ２０人的双侧颞下颌关节的髁突居关节窝的位置进行评价，并依据髁突居关节窝中的位置（前移，居中，后移），从上述两类错Ｈｅ中各选５人做双侧颞下颌关节矢状位磁共振扫描，观察关节盘的位置及形态变化。结果 每一类型错Ｈｅ髁突居关节窝中的位置并不一致，但位置分布比较集中，Ⅲ类骨性和功能性错Ｈ     

安氏Ⅱ类错He关节窝,髁突,关节盘位置及关节盘形态变化的研究

目的 为探讨安氏Ⅱ＾１、Ⅱ＾２错Ｈｅ与颞下颌关节紊知病之间的关系。方法 利用矫正薛氏位Ｘ线片对Ⅱ＾１错Ｈｅ１６人,Ⅱ＾２错Ｈｅ１７人的双侧颞下颌关节的髁突居关节窝的位置进行评价,并依据髁突居关节窝中的位置（前移、居中、后移）,从上述两类错Ｈｅ中各选５人做双侧颞下颌关节矢状位核磁共振扫描,观察关节盘的位置及形态变化。结果 第一类型错Ｈｅ髁突居关节窝中的位置不一致;Ⅱ＾１错Ｈｅ髁突居关节窝中位,但轻度     

单侧弹响的颞下颌关节紊乱病患者双侧关节锥形束CT对比研究

目的:探讨仅有单侧弹响的颞下颌关节紊乱病(temporomandibular disorders,TMD),患者双侧颞下颌关节(temporomandibular joint,TMJ)在锥形束计算机体层摄影(cone-beam computed tomography,CBCT)成像上存在差异的参考层面,为TMD诊断和对比研究提供参考.方法:选取一侧TMJ仅有弹响的TMD患者10例,通过CBCT三维成像和重建,观察同一患者两侧TMJ重建后横断面的水平角;平行于髁突长轴的斜位关节间隙、髁突长轴径值、髁突垂直角;垂直于髁突长轴的斜位与矢状位的关节结节斜度、关节窝深度和关节间隙,采用SPSS13.0软件包对每位患者上述各测量指标做两配对样本t检验.结果:上述横断面的水平角;平行于髁突长轴的斜位关节间隙、髁突长轴径值、髁突垂直角;垂直于髁突长轴的斜位与矢状位的关节结节斜度、关节窝深度和关节间隙等观察指标在同一患者中,左右两侧测量值均无统计学差异(P＞0.05).结论:对于单侧TMJ仅有弹响的TMD患者,锥形束CT不具有对比研究意义上的参考价值.     

安氏Ⅱ类错(牙合)关节窝、髁突、关节盘位置及关节盘形态变化的研究

目的:为探讨安氏Ⅱ1、Ⅱ2错(牙合)与颞下颌关节紊乱病之间的关系.方法:利用矫正薛氏位X线片对Ⅱ1错(牙合)16人,Ⅱ2错(牙合)17人的双侧颞下颌关节的髁突居关节窝的位置进行评价,并依据髁突居关节窝中的位置(前移、居中、后移),从上述两类错(牙合)中各选5人做双侧颞下颌关节矢状位核磁共振扫描,观察关节盘的位置及形态变化.结果:每一类型错(牙合)髁突居关节窝中的位置并不一致:Ⅱ1错(牙合)髁突居关节窝中位,但轻度前移;Ⅱ2错(牙合)髁突居关节窝后位.当髁突居前位及中位时:关节盘位置在正常范围且形态表现为正常的双凹形;髁突居关节窝后位时:部分关节盘位置明显前移,且形态也表现出异常的前带增厚.结论:大多数Ⅱ1错(牙合)颞下颌关节结构基本正常;而Ⅱ2错(牙合)部分患者表现出颞下颌关节结构异常,提示与颞下颌关节紊乱病关系密切.     

单侧有一种症状的TMD患者双侧关节CBCT对比研究

目的：探讨单侧有一种症状的颞下颌关节紊乱病（ TMD）患者双侧颞下颌关节（ TMJ）在CBCT成像上可能存在差异的参考层面。方法：选取仅单侧有症状的TMD患者29例,通过CBCT三维成像和重建,观察两侧TMJ重建后横断面的水平角;平行于髁突长轴的斜位关节间隙、髁突长轴径值、髁突垂直角;垂直于髁突长轴的斜位与矢状位的关节结节斜度、关节窝深度和关节间隙,采用SPSS13．0软件对各测量指标做两样本配对t检验。结果：两侧TMJ在垂直位60°关节间隙时的测量值差异有统计学意义（P＜0．05）,其余测量值均无统计学意义（P＞0．05）。结论：对于单侧有一种症状的TMD患者,接近矢状位是较易观察到左右两侧有差异的位置,并可观察到患侧前间隙增大,在此层面重建对诊断和对比研究更有参考价值。     

青少年安氏Ⅱ类亚类错患者颞下颌关节形态及髁突位置分析

目的： 研究青少年安氏Ⅱ类亚类错牙合患者颞下颌关节的关节窝形态、髁突形态、髁突位置及关节间隙的锥形束CT（CBCT）表现,为临床诊疗提供参考。方法： 选择2018年6月—2019年12月来苏州口腔医院正畸科就诊的青少年安氏Ⅱ类亚类错牙合患者30例为实验组,青少年安氏Ⅰ类错牙合患者30例为对照组,比较2组患者关节长轴、关节短轴、髁突外嵴最突点到矢状中线距离、髁突水平角、关节内间隙、关节中间隙、关节外间隙、关节前间隙、关节上间隙、关节后间隙、髁突垂直高度、关节窝宽度、关节窝深度、关节结节后壁倾斜角及双侧髁突到水平线垂直距离差。采用SPSS 23.0软件包对数据进行统计学分析。结果： 实验组安氏Ⅱ类亚类错牙合患者中性侧与远中侧关节后间隙、髁突水平角、髁突垂直高度、关节窝宽度、关节窝深度、关节结节后壁倾斜角比较,差异均有显著意义(P<0.01);对照组安氏Ⅰ类错牙合患者左右两侧关节窝形态、髁突形态及髁突位置比较,差异均无统计学意义（P>0.05）。结论： 安氏Ⅱ类亚类错牙合患者可能在髁突位置、髁突形态及关节窝形态上与安氏Ⅰ类错牙合患者存在差异,正畸治疗中需对此类患者提高警惕,在临床初诊检查时应多关注颞下颌关节区的检查。     

采用锥形束CT分析安氏Ⅱ类1分类错牙合患者Twin-block矫治前后颞下颌关节的变化

目的 运用锥形束CT（CBCT）分析安氏Ⅱ类1分类错牙合在Twin-block矫治前后颞下颌关节位置及形态结构在三维方向上的变化。方法 选取20例处于生长发育高峰前期或高峰期的安氏Ⅱ类1分类错牙合患者,拍摄其功能矫治前后双侧颞下颌关节的CBCT片,运用InVivoDental软件对CBCT片进行三维重建并测量线距和角度,对测量结果进行统计学分析。结果 与治疗前相比,治疗后矢状向关节前间隙减小,关节上间隙和后间隙增大,冠状向关节上间隙增大（P<0.01）;髁突高度、矢状向髁突角度、横断面髁突前后径增加（P<0.01）。结论 采用Twin-block矫治器治疗安氏Ⅱ类1分类错牙合患者后,髁突在关节窝的位置和髁突部分骨性结构发生了一定程度的改变,髁突有新骨沉积,高度增加,在关节窝内的位置更向下和向前。CBCT的应用使颞下颌关节结构的变化得以量化,能对正畸治疗效果进行客观评价。     

A comparative assessment of mandibular condylar position in patients with anterior disc displacement of the temporomandibular joint.

PURPOSE: The purpose of this study was to determine whether the position of the mandibular condyle in patients with anterior disc displacement (ADD) is different from that of a control group with normal joints using a novel method to quantify the irregular shape of the temporomandibular joint (TMJ). MATERIALS AND METHODS: Twenty-six magnetic resonance images of TMJs with ADD were evaluated and compared with 14 normal joints. The position of the condyle was determined by using 2 different methods: 1) measuring the horizontal and vertical normalized distances in millimeters between the geometric centers of the glenoid fossa and the condyle and 2) calculating the anteroposterior joint space ratio. RESULTS: Using the first method, the horizontal distance between the centers of the condyle and the glenoid fossa was 14.0 +/- 11.1 in the ADD group and 5.3 +/- 10.9 in the control group (P <.001). The vertical distance was 64.7 +/- 22.7 in the ADD group and 68.3 +/- 32.9 in the control group (P =.015). The ratio of the horizontal and the vertical condylar displacement in the ADD group was 2.4. Using the second method, the anteroposterior joint space ratios in the ADD group and in the control group were 1.7 +/- 0.5 and 1.2 +/- 0.4, respectively (P =.001). CONCLUSION: This study found that condyles of patients with ADD were situated more posterior and superior in the fossa than those in the control group. Moreover, in the ADD group, the posterior condylar displacement was noted to be 2.4 times greater than the superior condylar displacement.     

Evaluation of condylar position from temporomandibular joint radiographs

This investigation evaluated the accuracy of three different transcranial TMJ radiographic records of condylar position and joint space dimension. In addition, the study evaluated how reliably observers determined condylar position and joint space dimensions from the radiographs. The results of this investigation support the following conclusions. The classification of condylar position is not the same at different sagittal locations within a TMJ. Skull position and radiographic projection must be identical if joint space measurements from serial radiographs are to be compared. The actual joint space dimensions and the anatomic anterior/posterior position of the condyles in the glenoid fossae cannot be accurately recorded by the radiographic techniques used in this investigation. Condyle/fossa relationships cannot be classified reliably by subjective evaluation of TMJ radiographs.     

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.     

Temporomandibular joint growth changes in hyperdivergent and hypodivergent Herbst subjects. A long-term roentgenographic cephalometric study.

The aim of this long-term study was to assess the amount and direction of glenoid fossa displacement, condylar growth, and "effective" temporomandibular joint (TMJ) changes (= the sum of glenoid fossa displacement, condylar growth, and condylar position changes in the fossa) in 3 vertical facial-type groups of Class II Division 1 malocclusions treated with the Herbst appliance. A comparison was made between 38 normodivergent (ML/NSL= 26.5 degrees -36.5 degrees), 17 hypodivergent (ML/NSL or= 37 degrees ) subjects. Lateral headfilms from before, after, and 5 years after treatment were scrutinized. Glenoid fossa displacement, condylar growth, and "effective" TMJ changes were analyzed. Treatment changes: in all facial-type groups, the glenoid fossa was displaced anteriorly and inferiorly. No differences existed between the 3 groups. Condylar growth and "effective" TMJ changes were directed posteriorly and superiorly. The changes in posterior direction were more apparent in the hyperdivergent group than in the normodivergent and hypodivergent groups. Posttreatment changes: in all facial-type groups, the fossa was displaced posteriorly. No differences existed between the 3 groups. Condylar growth and "effective" TMJ changes were directed more vertically compared with the treatment changes. The changes in posterior direction were more pronounced in the hyperdivergent group than in the other 2 groups. It was found that the amount and direction of TMJ growth changes (fossa displacement, condylar growth, and "effective" TMJ changes) were only temporarily affected favorably in the sagittal direction by Herbst treatment. Condylar growth and "effective" TMJ changes were directed more posteriorly in hyperdivergent than in hypodivergent Herbst subjects. This was true for both treatment and posttreatment period changes.     

术前正畸对颞下颌关节关节盘及髁突位置和形态的影响

目的 探讨术前正畸对颞下颌关节关节盘及髁突位置和形态的影响。方法 选择骨性错畸形患者30例,在颞下颌关节磁共振图像上进行测量。通过关节间隙测量,判定髁突位置;通过髁突头长度、宽度和高度测量,判定髁突形态;关节盘位置和形态由直接观察判定,采用SPSS 24.0软件包对所得数据进行统计学分析,比较骨性Ⅰ、Ⅱ和Ⅲ类畸形患者在术前正畸前、后关节盘及髁突位置和形态变化。结果 术前正畸前、后关节间隙和关节间隙指数,髁突头长度、宽度和高度、关节盘前移角及关节盘形态差异均无统计学意义（P>0.05）。结论 术前正畸治疗不会导致骨性错畸形患者关节盘及髁突位置和形态改变。     

Preservation of disc for treatment of traumatic temporomandibular joint ankylosis.

PURPOSE: A new operating method was used to treat traumatic temporomandibular joint (TMJ) ankylosis, to restore the structure of the TMJ, to improve the secondary maxillofacial deformity, and prevent recurrence of TMJ ankylosis. PATIENTS AND METHODS: Thirty-six patients (20 females, 16 males; aged 5 to 54 years old) with TMJ ankylosis type II or III of 1 to 16 years' duration, with a maximal mouth opening from 0 to 15 mm preoperatively participated. The new method was to separate bony fusion between condyle and glenoid fossa, remove the condylar fragment that displaced medially or anteroinferiorly, mobilize the remains of the disc over the condylar stump and suture it with articular capsule, and shave the surface of the condylar stump and glenoid fossa smooth. RESULTS: Follow-up was performed from 1 to 7 years postoperatively in 21 cases. No recurrences occurred in patients whose TMJ disc was retained during operation. Patients had an average maximal mouth opening of 33.7 mm postoperatively. An 11-year-old patient showed an improved facial symmetry after surgery. CONCLUSION: By restoring the normal structure of the TMJ and preservation of the disc, recurrence of traumatic TMJ ankylosis and facial deformity in younger patients can be prevented.     

保留颞下颌关节盘治疗外伤性颞下颌关节强直

目的：应用保留颞下颌关节盘的手术方法治疗外伤性颞下颌关节强直,达到恢复颞下颌关节结构、改善面部外形和防止术后复发的目的。方法：对36例外伤所致Ⅱ型和Ⅲ型颞下颌关节强直病例进行手术,男16例,女20例,年龄5～54岁,病程1～16a,最大开口度0～1.5cm。新的手术方法是凿开关节窝与髁突之间的骨性融合,凿除前内侧移位的髁突骨折碎片,将残余的关节盘向外牵拉、复位,与外侧关节囊缝合,同时将髁突与关节窝磨改光滑。结果：36例病例中,21例术后随访1～7a,保留关节盘手术的病例均无复发,术后平均开口度为3.37cm。1例11岁患儿术后面部畸形得到改善。结论：保留颞下颌关节盘正常结构在防止外伤性颞下颌关节强直手术后复发以及生长发育期患者面部畸形中具有重要作用。     

髁突在关节窝中的位置及其在临床诊断治疗中的意义

临床治疗中,特别是髁突外伤骨折、正颌手术、修复咬合重建、正畸治疗以及在颞下颌关节紊乱病的诊断和治疗中,要考虑髁突在关节窝中的位置变化。本文通过文献回顾,结合我们的研究成果,讨论髁突在关节窝中的正常生理位置及其在颞下颌关节紊乱病特别是关节盘移位的诊断和治疗中的意义。目前多项研究认为,健康成年人髁突平均位置为基本中性,但存在较大变异;髁突后移可能是关节盘前移位的危险因素,关节盘前移位也可导致髁突后移;在关节盘移位的牙合垫治疗中,髁突在牙合垫戴入后显著向前、下移位,可有效改善盘突关系;稳定牙合垫使髁突前下移位不明显,改善盘突关系的效果有限。此外,再定位牙合垫使髁突前下移位还可促进髁突骨质的改建。     

A radiographic and histologic study of the topographic relations in the temporomandibular joint region: implications for a nerve entrapment mechanism

A radiographic and histologic investigation was performed in 18 temporomandibular joint (TMJ) autopsy specimens. Disc position was determined arthrotomographically. The pathway of the nerve branches in the vicinity of the joint was reconstructed from serial sagittal or frontal histologic sections. The relationship between the joint components and the different nerves running in the vicinity of the joint was studied. The results revealed the existence of topographical prerequisites for mechanical influence upon the nerve branches passing in the TMJ region. In two joints, both with a displaced disc, the auriculotemporal nerve trunk was almost in contact with the medial aspect of the condyle instead of having its normal sheltered course at the level of the condylar neck, thus exposing the nerve to the risk of mechanical irritation during condylar movements in an anteromedial direction. Two joints with normal disc position had an extension of the medial fossa wall in a caudal direction. In these joints the auriculotemporal nerve had its course between the condyle and the elongated fossa wall, exposing it to the risk of mechanical irritation during medial disc displacement. Compression of the masseteric nerve anterior to the TMJ was found in one joint with excessive condylar translation. The deep posterior temporal nerves may pass close to the anterior insertion of the joint capsule on the temporal bone, exposing them to the risk of mechanical irritation when there is condylar hypermobility. It was also found that the inferior alveolar and the lingual nerves may pass close to the medial part of the condyle. In joints with this nerve topography, a medially displaced disc could interfere mechanically with these nerves. These findings could offer an explanation for the sharp, shooting pain felt locally in the joint with jaw movements and the pain and other sensations projecting to the terminal area of distribution of the nerve branches in the vicinity of the TMJ such as the ear, temple, cheek, tongue, and teeth.