间接创伤对幼年大白鼠颞下颌关节血供的影响

目的　探讨间接创伤对幼年鼠颞下颌关节的影响。方法　Wistar幼年大白鼠颞下颌关节间接创伤后,应用放射性同位素测定方法对其关节区进行动态观察。结果　与正常组比较,随着创伤后对颞下颌关节区不同时间段同位素测定,创伤后颞下颌关节区放射性强度随时间增加,两周达高峰,1月时放射性强度仍比正常对照组高,在任何时间段,创伤侧都较非创伤侧颞下颌关节区放射性强度高。结论　间接创伤可以引起幼年鼠颞下颌关节局部血流变化     

一侧缺牙对小型猪颞下颌关节血流的影响

一侧缺牙对小型猪颞下颌关节血流的影响胡敏周继林洪民田嘉禾颞下颌关节的功能状况及咬合的改变均可引起关节血流的变化，我们利用核素三相骨扫描技术，对小型猪一侧尖牙及后牙缺失后的颞下颌关节血流的动态变化进行相对定量分析，以了解在偏侧咀嚼状况下，颞下颌关节的血...     

SPECT-CT对成人下颌偏斜患者双侧颞下颌关节代谢及形态对称性研究

目的:利用SPECT-CT骨显像对成人下颌偏斜患者双侧颞下颌关节代谢及形态对称性研究。方法:对36例成人下颌偏斜患者行SPECT骨显像,对髁突、下颌升支、下颌角图像进行冠状面、矢状面、横断面采集进行三维重建,计算出放射性计数比值,并通过CT扫描三维重建后同机融合,根据双侧颞下颌关节解剖关系测量偏斜侧及对侧髁突的高度、内外径、后斜面倾斜角及后斜面长度的差异,进行对比观察。结果:颞下颌关节各区域(髁突、下颌升支、下颌角)放射性计数比值均有所不同,偏斜侧的放射性计数比值均低于对侧,且两侧放射性计数比值有显著差异(P＜0.05);偏斜侧髁突高度及内外径均较之对侧减小(P＜0.01);偏斜侧髁突后斜面长度、后斜面倾斜角较之对侧增大(P＜0.01)。结论:SPECT-CT骨显像对成人下颌偏斜疾病的诊断评估起到了至关重要的作用。     

小型猪单侧牙缺失对颞下颌关节影响的组织学研究

为了证实一侧后牙缺失导致颞下颌关节各部份负荷发生变化，从而引起相应的组织学变化。本研究在１２头小型猪拔除一侧上下尖牙及后牙并分别于１和３个月后处死动物取标本，以６头小型猪作为对照。结果发现，所有实验组动物的颞下颌关节组织均出现明显退行性改变，拔牙侧髁突可见玻璃样血栓形成，提示局部微循环障碍，一侧牙缺失可影响两侧颞下颌关节，失牙侧受累较非失牙侧明显，且随时间发展而加重。     

兔下颌骨骨折对颞下颌关节影响的实验研究

目的 观察下颌骨骨折对两侧颞下颌关节的影响，探讨损伤后颞下颌关节修复的机制。方法 采用新西兰大耳白兔30只。随机分为术后48h和1、3、5、8周5个时相组及一个对照组。每组5只，用多功能打击装王造成各组动物左侧下颌骨骨折。夹板坚固内固定骨折断，按时项处死动物取左侧颞下颌关节，观察伤侧颞下颌关节的组织学变化。用免疫组化方法检测髁状突软骨内VEGF及其受体Flt1的表达。结果 各时项标本均可见到颞下颌髁状突及关节盘不同程度的损伤，髁状突肥大细胞检测到VEGF及其受体Flt1的表达。结论 下颌骨骨折可致颞下颌关节损伤。VEGF和其受体Flt1可能参与颞下颌关节损伤的修复。     

成人骨性下颌偏斜患者与正常人下颌骨及颞下颌关节单光子发射型CT/CT同机融合骨显像的比较研究

目的 采用单光子发射型(single-photo Emission CT,SPECT)CT/CT同机融合骨显像技术对成人骨性下颌偏斜患者与正常人下颌骨及颞下颌关节的生长差异进行比较研究.方法 选取成人骨性下颌偏斜患者20例和正常成人志愿者15例,进行SPECT/CT同机融合骨扫描检查,以分析比较下颌偏斜患者与正常人两侧下颌骨及颞下颌关节骨血流和骨代谢的差异性.结果 成人骨性下颌偏斜患者下颌骨不同部位的骨血流和骨代谢存在特定性差异,正常人下颌骨不同部位的骨血流和骨代谢存在特定性差异;正常人下颌骨不同部位左右两侧放射性计数值比值均接近于1,对称性较好;与正常对照组相比,骨性下颌偏斜患者放射性强度均为对侧高于偏斜侧;髁状突差异最大(P＜0.01),其次为下颌角(P＜0.01),下颌升支中份差异最小(P＜0.05);不同部位两侧差异均有统计学意义.结论 SPECT/CT同机融合骨显像在精确解剖定位的基础上,能更加准确显示颞下颌关节的功能变化.

Abstract：

Objective To investigate mandible and temporomandibular joint (TMJ) in adults with and without mandible deviation using SPECT/CT fusion imaging. Methods SPECT/CT fusion imaging over bilateral mandible and TMJ was performed in 20 adult patients with mandibular deviation and 15 adult volunteers without mandibular deviation. Results Compared with the control group, the radioactive intensity of contralateral side was higher than that of the deviated side in patients with mandibular deviation. The biggest difference was found in the condyle process (P＜0. 01) and the mandibular angle (P＜0. 01). Conclusions Based on accurate anatomical localization, SPECT/CT fusion imaging was very sensitive in detecting functional alteration in TMJ.     

颞下颌关节的血流变化与其病变的关系

颞下颌关节的血流变化与其病变的关系胡敏周继林洪民血液循环是机体的重要生理机能之一，通过血液循环，组织器官获得氧和各种营养物质并排除二氧化碳和各种代谢产物，一旦发生血液循环障碍，则可引起器官的代谢紊乱、功能失调和形态改变。１．颞下颌关节的血流：颞下颌关...     

曲安缩松封闭治疗致面部凹陷一例报告

患者邢某某,女,18岁,两侧颞下颌关节弹响1年.1月前开口受限,左侧颞下颌关节区疼痛并有被阻挡感.在当地医院诊治,给予曲安缩松40 mg进行左侧颞下颌关节封闭,4 d封闭1次,同时理疗.4次后开口受限明显改善,之后患者发现左侧面部凹陷,特来就诊.     

磁共振影像颞下颌关节三维有限元模型的建立

目的：探讨在颞下颌关节区及下颌骨磁共振(MR)影像的基础上建立颞下颌关节三维有限元模型的可行性，观察对关节盘建模的效果。方法：在对颞下颌关节区和下颌骨进行MR扫描的基础上，应用图像处理和转换技术，运用ANSYS有限元程序建立颞下颌关节区包括下颌骨的三维有限元模型。结果：建成后的模型具有良好的形态，与关节区及下颌骨的MR三维图像均具有良好的相似性。关节盘具有较真实的形态位置。结论：在对关节区及下颌骨进行MR扫描及三维重建的基础上建立三维有限元模型是切实可行的，尤其对关节盘能进行真实模拟。     

单侧髁突骨折对下颌骨应力分布的影响

目的 探讨单侧髁突骨折对下颌骨应力分布的影响,用以分析颞下颌关节损伤引起颞下颌关节紊乱病的生物力学机制。方法 采用三维有限元应力分析方法,对模拟正中咬合状态下的健康人及右侧髁突颈部骨折、错位愈合所致颞下颌关节紊乱病患者下颌骨的应力分布特征进行对比、定量分析。结果 该患者两侧下颌骨相对应部位最大、最小主应力大小及性质均有差异。骨折侧下颌骨应力明显大于非骨折侧,呈不对称性应力分布,尤以髁突应力异常最为     

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颞下颌关节(TMJ)是人体全身关节中解剖结构与功能最为复杂、精细的关节之一,而颞下颌关节功能紊乱病(TMD)又是人体好发的疾病之一且病因尚不明确。因此,在临床检查及治疗中及时观察TMJ形态、位置尤其重要。临床常用的X线片不能清晰准确地显示TMJ骨性结构的形态及变化。多层螺旋CT是近几年发展起来的影像技术,以其独特的技术,如骨最大密度投影法、表面遮盖法、多层面重建术、容积成像等,对TMJ进行三维显影,使TMJ形态及其骨性结构更为准确清晰,但其对关节盘的显影有一定的局限性。本文对多层螺旋CT在TMJ中的应用做一综述,以期对临床有所帮助。     

颞下颌关节紊乱病关节盘与髁突改变的MRI表现及相关性研究现状

正常的关节盘–髁突关系对于颞下颌关节的健康十分重要，它的改变在临床上具有重要意义。磁共振成像（MRI）被认为是颞下颌关节盘–髁突关系紊乱及软组织形态成像的金标准，被广泛地用于颞下颌关节特征的评估、协助诊断以及治疗方式的选择中。目前多数研究表明颞下颌关节紊乱病（TMD）早期阶段可能表现为关节盘的前外侧移位、双凹形态的改变。关节盘形态、位置的改变进一步导致髁突长度、高度及旋转角度等发生变化，使疾病向更严重的阶段发展。TMD患者关节盘的位置和形态改变、髁突的解剖学变化与关节盘移位具有相关性，被认为引起是TMD最常见的原因。     

Imaging of the temporomandibular joint: A position paper of the American Academy of Oral and Maxillofacial Radiology

Various imaging techniques for the temporomandibular joint are discussed with respect to uses, strengths, and limitations. An imaging protocol is outlined for evaluating patients with a wide variety of temporomandibular joint related signs and symptoms.     

Magnetic resonance imaging of the temporomandibular joint

Correct diagnosis of internal derangements of the temporomandibular joint requires both a comprehensive clinical and radiographic evaluation. Plain film tomography, transcranial radiography, arthrography and computed tomography have all been used to assess the status of the joint structures. Magnetic resonance imaging is a relatively new modality used for imaging many different organ systems. Magnetic resonance imaging of the temporomandibular joint has certain distinct advantages over previously used techniques in evaluating patients for internal joint derangements. The applicability of magnetic resonance imaging in the diagnosis of internal derangements will be discussed.     

A hematogenous spread brain abscess invading the right damaged temporomandibular joint

We report a rare case of a brain abscess which drained spontaneously in a temporomandibular joint damaged by osteoarthritis. The female patient presented to our hospital with a severe headache and pain in the temporomandibular joint. She showed elevated inflammatory parameters with unknown cause. Magnetic resonance imaging of her whole body revealed a large temporal brain abscess extending into the glenoid fossa of the temporomandibular joint. The brain abscess was incised and drained by neurosurgeons in our hospital and in the same operation we resected the articular disc and the affected part of the right temporomandibular joint. Histological examination confirmed a chronic arthrosis in the resected bone of the temporomandibular joint and an inflammatory abscess in the resected brain tissue.The patient recovered well and the inflammation resolved as seen in postoperative investigations. Magnetic resonance imaging a month later confirmed local consolidation in the brain with no sign of residual inflammation.     

640层动态容积CT对颞下颌关节紊乱病诊断的意义

目的探讨640层动态容积CT建立颞下颌关节运动影像对颞下颌关节紊乱病（TMD）诊断的意义。方法选择存在TMD的患者11例，使用Toshiba Aquilion One 640层动态容积CT对双侧颞下颌关节采用Jiont-Move ＆ Shot序列进行动态扫描。应用640层动态容积CT工作站进行图文处理及数据测定，包括4D实时动态显示、容积再现、MPR图像重建等。结果建立11例TMD患者颞下颌关节4D多角度和各个断层动态影像。结论通过640层动态容积CT建立运动影像能清晰、直观的从多角度观察上下颌的异常运动，对于完善TMD诊断具有重要的指导意义。     

Nondiscogenic Causes of Temporomandibular Joint Pain

Magnetic resonance imaging of the temporomandibular joint is a topic of recent interest and has gained widespread use for the assessment of internal derangement and other temporomandibular joint-related symptoms. In this article the authors present six proven cases of pathologic abnormalities of the temporomandibular joint region that may clinically mimic internal derangement. These cases demonstrate the importance of the monitoring of studies by a radiologist and also the utility of computed tomography as an adjunctive modality. Magnetic resonance imaging and computed tomography are often complimentary in diagnosing etiologies that may mimic internal derangement. Because abnormalities other than internal derangement are often encountered during the use of magnetic resonance imaging, it is essential for the radiologist to assume an active role in monitoring such cases.     

Magnetic Resonance Imaging in the Diagnosis of Temporomandibular Disorders with a Report of Two Cases

Magnetic resonance imaging for the temporomandibular joint has moved from an experimental stage to a routine procedure at some institutions. The use of this technique for evaluation of the joint will increase as more institutions acquire this new diagnostic device. Magnetic resonance imaging has some unique properties that provide data unavailable by conventional imaging methods. An improved technique of magnetic resonance imaging is the use of the surface coil which greatly increases the detail and diagnostic accuracy. In addition to the surface coil, we have used a number of pulse sequences to better characterize the tissues.

Two cases of the use of magnetic resonance imaging in the evaluation of temporomandibular joint disorders are described in this paper. Surgical confirmation, arthrographic, and tomographic findings were available. Magnetic resonance imaging was used to image the interarticular disk and surrounding joint structures, and to provide pathophysiologic information on the tissues.     

Accuracy of clinical diagnosis for TMJ internal derangement and arthrosis.

This study investigated the accuracy of clinical examination in determining the status of the temporomandibular joint with respect to internal derangement and arthrosis. A series of 110 patients was given standard clinical examinations followed by bilateral imaging with arthrography and/or magnetic resonance imaging. There was agreement between the clinical diagnosis and the imaging finding in 95 joints (43%). In the other 125 joints (57%), the clinical diagnosis did not agree with imaging findings. There were false-positive clinical diagnoses in 39 joints and false-negative clinical diagnoses in 31 joints. In the other 55 joints the clinical diagnosis correctly indicated that the joint was abnormal but was incorrect about the stage of abnormality. On the basis of the overall diagnostic accuracy of 43%, it was concluded that a clinical examination is not reliable for determining the status of the joint in patients with signs and symptoms of temporomandibular joint internal derangement.     

Temporomandibular joint involvement in a patient with centronuclear myopathy

We describe here the temporomandibular joint and masticatory muscle abnormalities disclosed by computed tomography and magnetic resonance imaging in a 25-year-old man with centronuclear myopathy (a congenital myopathy) who presented with marked limitation of jaw movements. We found an intense and general fatty replacement of the masticatory muscles, and magnetic resonance imaging signals indicated articular fibrosis. We conclude that in centronuclear myopathy, the presence of weakness and hypomotility of the masticatory muscles can induce chronic abnormalities of the temporomandibular joint.