牵张成骨术治疗颞下颌关节强直后睡眠呼吸暂停综合征

目的 评估牵张成骨术(DO)治疗颞颌关节强直后睡眠呼吸暂停综合征(OSAS)的效果。方法 对8例患有颞颌关节强直后OSAS的患者采用DO技术进行治疗。手术在全麻下分两期进行。第一期行关节成形、下颌体部截骨,安置牵引器,前徙下颌矫正小颌畸形及OSAS;第二期在拆除第一期牵引器的同时,进行下颌升支后缘L型截骨,安置牵引器,通过牵引延长下颌升支。结果 8例患有颞颌关节强直后OSAS的患者的症状均有不同程度的改善。术后张口度可迭3cm～4cm,小颌畸形得以矫治,AHI指数由术前的20～40降至5以下,最低血氧饱和度由术前的68％提高至术后的96％,OSAS得以治愈。术后半年～两年随访,未见复发。结论 DO技术是治疗颞颌关节强直后OSAS理想方法。     

正颌外科技术治疗颞颌关节强直后睡眠呼吸暂停综合征(附9例报告)

目的：评估用正颌外科技术矫治９例颞颌关节强直所致睡眠呼吸暂停综合征的效果。方法：采用患侧关节成形,下颌升支、体部的“Ｌ”型半层截骨及健侧矢状截骨术,将患侧下颌升支加高固定,下颌前部整体前移。结果：９例颞颌关节强直后睡眠呼吸暂停综合征患者术后张口度达２．５～３．５ｃｍ,连续血氧饱和度最低值由术前的５８％提高至术后的９５％以上,唾眠呼吸暂停综合征得以治愈。结论：颞颌关节强直后睡眠呼吸暂停综合征患者通过正颌外科手术可以在关节成形的同时,解决患者下颌后缩的缺陷,解除上气道狭窄,从而缓解或纠正患者的低氧血症。     

正颌外科技术治疗TMJ后OSAS(英文)

目的 评估正颌外科技术矫治14例颞颌关节强直所致OSAS的效果。方法 手术采用患侧关节成形,下颌升支、体部的“L”形半层截骨及健侧矢状截骨术,将患侧下颌升支加高固定,下颌前部整体前移。结果14例颞颌关节强直伴OSAS患者术后张口度达2.5～3.5cm,术后2年随访张口度仍维持在2.5～3.2cm之间。所有患者的AHI指数下降了20以上,12例患者的打鼾症状消失,持续血氧饱和度平均提高了18.45％（P<0.01）,达到了正常人的范围,持续血氧饱和度最低值由术前的58％提高至术后的95％以上,OSAS得以治愈。结论 颞颌关节强直伴OSAS患者通过正颌外科手术可以在关节成形的同时,解决患者下颌后缩的缺陷,解除上气道狭窄,从而缓解或纠正患者的低氧血症。     

治疗颞颌关节强直后SAS的新方法及手术效果的评价

目的：用L值评估正颌外科技术矫治的12例颞颌关节强直所致SAS的效果。方法：手术采用患侧关节成形，下颌升支、体部的“L”型半层截骨及健侧矢状截骨术，将患侧下颌升支加高固定，下颌前部整体前移。上 颌骨Lefort I型截骨，向健侧旋转，纠正偏移，并行颏成形术。比较分析术前、术后的L值。结果：12例颞颌关节强直所致OSAS患者术后张口度达2．5－3．5cm，连续血氧饱和度最低值由术前的58％提高至术后的95％以上，术后L值较术前L值有较大的提高，术后AKI指数较术前AHI指数大幅下降，OSAS得以治愈。结论：颞颌关节强直所致OSAS患者通过正颌外科手术可以在关节成形的同时，解决患者下颌后缩的缺陷，解除上气道狭窄，从而缓解或纠正患者的低氧血症。     

下颌升支截骨下颌骨前徙治疗小下颌畸形伴OSAS

目的 观察下颌升支截骨下颌骨前徙术治疗小下颌形伴阻塞性睡眠呼吸暂停综合征（OSAS）的疗效。方法 颞下颌关节强直伴小下颌畸形9例，第一鳃弓综合征下颌骨发育不良小下颌畸形2例，均伴有严重的OSAS症状，11例分别行下颌升支截骨、下颌骨体前徙术，同期施行成形术，其中5例施行了舌骨下肌群离断、舌骨悬吊术，手术截骨骨段以小钛板坚强内固定。结果 经过3个月－3年的随访观察，11例中张口度均恢复对3.0cm以上，面部外形明显改善，睡眠打鼾、憋醒、大汗症状消失或明显改善，睡眠时血氧饱和度由手术前的86－92％增加至手术后的98－99％。结论 下颌升支截骨下颌前徙术治疗小下颌畸形伴OSAS，对扩大口咽通气道，解除睡眠时呼吸阻塞症状，改善睡眠时呼吸功能可获得较满意的效果，并可同时改善面部容貌。     

联合运用牵张成骨及颏成形术矫治颞下颌关节强直继发小下颌畸形伴OSAHS

目的:探讨联合运用牵张成骨及颏成形术配合正畸治疗矫治颞下颌关节强直继发小下颌畸形伴阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的可行性.方法:9例双侧关节强直继发小下颌畸形伴OSAHS患者,一期通过关节成形术解除关节强直,完成正畸治疗后,二期运用牵张成骨及颏成形术矫治小下颌畸形伴OSAHS,随访8～36月,评价其治疗效果.结果:患者平均张口度由术前3.1mm提高到术后36.5 mm,小下颌畸形得到有效治疗,OSAHS得到同期治愈.结论:联合运用牵张成骨及颏成形术并配合正畸治疗,是矫治关节强直继发小下颌畸形伴OSAHS的有效治疗方案.     

牵引成骨术治疗儿童单侧颞下颌关节强直伴OSAHS 4例报道

目的:评价牵引成骨术治疗儿童单侧颞下颌关节强直伴阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的治疗效果。方法:4例儿童单侧颞下颌关节强直伴发OSAHS患者,男女各2例,年龄5～13岁(中位年龄6.5岁)。均采用颞下颌关节成形术以恢复开口功能,下颌体牵引成骨术治疗OSAHS;其中3例行同期手术,1例行分期手术;单侧和双侧下颌体牵引各2例。固定期约3个月时行呼吸监护仪监测(PSG)复查和牵引器拆除术。结果:4例患儿OSAHS症状均消失,平均AHI由术前的42.7降到4.9,平均最低血氧饱和度由术前的74.3%上升到89.8%;平均开口度由6.5mm增加至25.5mm;面部畸形得到满意矫正。经过平均38.1个月(13～58个月)的随访,无1例复发。结论:下颌骨牵引成骨术联合颞下颌关节成形术能够有效地治疗儿童单侧颞下颌关节强直及其伴发的OSAHS、面部不对称畸形,并且可以同期手术。     

双侧颞下颌关节强直继发阻塞性睡眠呼吸暂停综合征1例

颞下颌关节强直继发阻塞性睡眠呼吸暂停综合征(ob-structive sleep apnea syndrome,OSAS),严重影响患者的生理、心理健康。以往医生只注重关节强直及术后复发的问题,而对其继发疾病关注较少。近年来随着正颌外科的发展,颞颌关节强直的继发疾病越来越引起学者们的重视。笔者在临     

真性颞下颌关节强直的外科治疗进展

真性颞下颌关节强直是由于一侧或两侧颞下颌关节内发生病变,最后造成颞下颌关节内的纤维性或骨性粘连的一种疾病。真性颞下颌关节强直主要病因是损伤和炎症。临床的主要表现是开口困难、患侧下颌骨发育不足、牙合关系紊乱、髁突活动减弱或消失,有些幼年发病的患者因为严重的下颌骨发育不足而易继发阻塞性睡眠呼吸暂停综合征(obstructivesleep apnea syndrome,OSAS)。外科手术是治疗真性颞下颌关节强直的唯一方法,部分成年患者如存在小颌、OSAS,可同期进行正颌外科手术,既改善患者的开口度,恢复咀嚼功能,同时改善颌面畸形,对合并OSAS的…     

颞下颌关节强直伴颏畸形的同期外科处理

颞下颌关节强直的外科治疗文献报导较多，我科自1989年5月～1995年5月对17例颞下颌关节强直合并小下颌，或（和）倔颌的畸形患者，在作下颔升支后缘垂直截开倒置行关节重建术的同时，切取喙突和部分下颌升支骨块，移植于领部骨截开前徙的骨创内行额成形术，获得了满意的疗效。现报告如下：临床资料1对象17例颞下颌关节强直合并颁畸形患者，在关节重建术的同时完成额成形术。17例中男7例，女10例；年龄最大38岁，最小13岁；I型关节强直3例，11型8例，皿型6例；术前张日度0～0·2cm者9例，0．2～0．5cm者8例；单侧关节强直10例，双侧关节强直…     

牵引成骨和正颌外科技术在TMJ强直继发OSAS治疗中应用

目的　 30例 TMJ强直伴阻塞性睡眠呼吸暂停综合征 (OSAS)患者 ,单侧 TMJ强直 18例 ,双侧强直 9例 ,TMJ强直术后 3例。患者均有严重的小下颌畸形并伴轻度的上颌后缩畸形 ,睡眠呼吸暂停指数 AI>5 ,且睡眠时血氧饱和度都有不同程度的降低。方法　应用术前后临床检查、头影测量分析和夜间多导睡眠检测筛选患者和评价治疗效果。采用电脑辅助的诊断和手术模拟及预测系统 ,获得充分扩展口咽和纠正颌面畸形的最佳手术方案 ,以 TMJ重建、牵引成骨和正颌外科方法治疗患者。结果　本研究有 15例患者接受患侧下颌升支倒置 TMJ重建、植骨前移 ,健侧升支矢状劈开、下颌前移和颏前移成形术 ;其中有 3例行二期的上颌的 L e Fort 截骨术。 6例行双侧 TMJ重建、植骨前移下颌和颏成形术。 3例施行同期双颌截骨前移和颏成形术 ;6例行单或双侧 TMJ重建、牵引成骨术。全部病例创口均正常愈合 ,无一例感染。术后复查 (平均 5 .2 5年 ,最短 1年 ,最长 8年 ) :1例术后 TMJ强直复发 ,余张口度均在 3cm以上 ;术后颌面形态获得明显改善 ;2 9例患者眠眠呼吸障碍解除和睡眠质量获得提高 ;1例 AI>5 ,睡眠呼吸障碍改善不明显。结论　 TMJ强直继发 OSAS的治疗既要兼顾关节强直的解除 ,又要矫正牙颌面畸形 ,更不容忽视睡眠呼吸障碍的治疗 ;     

Clinical investigation of early post-traumatic temporomandibular joint ankylosis and the role of repositioning discs in treatment

This study investigated the development of temporomandibular joint (TMJ) ankylosis after condylar fracture and the functional results of surgery that included repositioning of the articular discs. In a total of 18 patients, there were 13 cases of fibrous ankylosis (type I) and 11 of partial bony ankylosis (type II). CT scans for both groups and MRI scans for type I patients were analysed. Intraoperative inspection of the damaged disc, the sites of adhesion or bony fusion, and remaining intra-articular movement was recorded. After release arthroplasty and repositioning of discs, follow-up was for 1 to 3.5 years (mean 2.2 years). Post-traumatic TMJ ankylosis was highly associated with sagittal and comminuted condylar fractures. Type I ankylosis usually formed in the 4th to 5th month post-trauma with mean interincisal opening distance of 18.3+/-5.5mm. Progression from type I to II ankylosis occurred 1 year post-trauma and caused a reduction of 5mm in the range of mouth opening. The disc was displaced for each of the involved joints, and intra-articular adhesions or ossification initiated at the site where there was no intervening disc present. After surgical repositioning of the disc, stable joint function and mouth opening from 30 to 45 mm were obtained in all patients but one (recurrence due to dislocation). Sagittal and comminuted condylar fractures predispose the TMJ to ankylosis, and the displacement of the articular disc plays a critical role. Early surgical intervention to reposition the disc was successful for early trauma-induced TMJ ankylosis.     

颞颌关节强直续发OSAS外科治疗的进一步探讨

通过采用颞颌关节重建与不同的正颌外科术式组合的方法治疗１０例颞颌关节强直续发ＯＳＡＳ患者，结果表明：颞颌关节强直续发ＯＳＡＳ的治疗既要兼顾关节强直的解除，又要矫正畸形颌骨对面容及牙牙合造成的影响，更不容忽视其对口咽通气道所造成的影响；颞颌关节重建与不同的正颌外科术式组合的方法是治疗该病的有效手段     

Total alloplastic temporomandibular joint replacement: the Czech-Slovak initial experience

In 2004, total alloplastic temporomandibular joint (TMJ) replacement began in the Czech Republic and Slovakia. This paper presents initial subjective and objective data compiled between 2005 and 2009 from those cases. Data were collected from 27 patients (38 joints) reconstructed with the Biomet-Lorenz stock and custom TMJ prostheses during a mean follow-up period of 24 months. The variables of pain and mouth opening were evaluated pre- and postoperatively. Patients classified pain on a scale of 0-5 (none - unbearable). The extent of opening was investigated by a physician (the distance between the points of the incisors on the upper and lower jaw was measured). The most common indication for replacement was ankylosis. There was an improvement in pain score in 15 patients. 4 patients reported worsening of pain and 8 patients did not complain of pre- or postoperative pain. Mandibular opening increased from a mean of 17.7 mm preoperatively to a mean of 29.1mm postoperatively. There were complications related to the surgery, but no significant complications related to the devices. Total alloplastic TMJ replacement appears to be a safe and effective method of reconstruction in the patients in this initial study.     

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.     

Piezoelectric osteoarthrectomy for management of ankylosis of the temporomandibular joint

We describe the use of a piezoelectric osteotome for removal of bone in patients with ankylosis of the temporomandibular joint (TMJ) and its advantages over conventional techniques. We studied 35 patients with ankylosis of 62 TMJ (27 bilateral and 8 unilateral, 2 recurrent) who were treated by gap arthroplasty between 1 January 2011 and 31 December 2012. We used a preauricular, with extended temporal, incision in all cases. The ankylosis was released with a piezoelectric scalpel. There were 23 men and 12 women, mean (SD) age 16 (9) years. We noticed a substantial reduction in bleeding with the piezoelectric bone cutter compared with the dental drill, though the operating time was longer. We noticed no bleeding from the maxillary artery or pterygoid plexus. Mean (SD) bleeding/side was 43 (5) ml, and mean (SD) operating time was 77 (8) minutes for a single joint. At 6 months’ follow-up mean (SD) passive mouth opening was 35 (3) mm. Piezoelectric bone removal for the release of ankylosis of the TMJ is associated with minimal bleeding, few postoperative complications, and satisfactory mouth opening at 6 months’ follow up.     

颞颌关节强直续发OSAS患者术前后睡眠变化

作者对１０例颞颌关节强直续发ＯＳＡＳ患者有后的睡眠检测结果比较分析，指出术后患者睡眠呼吸暂停指数、睡眠时血氧饱和水平、氧饱度和下降至９０％以下次数均得到改善，同时睡眠质量获得提高，证明颞颌关节重建与正颌技术结合的方法是治疗颞颌关节强直续发ＯＳＡＳ的有效措施。     

术中CT在颞下颌关节强直疗效评价中的应用

目的 探讨术中CT在颞下颌关节（temporomandibular joint,TMJ）强直手术治疗效果评价中的应用价值。方法 回顾分析2016年7月—2018年12月完成的4例颞下颌关节强直患者的临床资料,分析一般资料特点、强直类型、扫描时间、CT引导的术中修正及术后效果。结果 在术中CT的引导下,4例（5侧）颞下颌关节强直手术均顺利完成。术中CT平均耗时（10.2±3.3）min,3例进行了术中修正,修正率75%。所有患者术后创口愈合良好,开口度平均38.8 mm,患者满意度100%。结论 术中CT提高了TMJ强直手术的精确性,保证了手术的安全性和可靠性。