颞下颌关节肿瘤及瘤样病变致颜面部畸形的手术治疗

目的：探讨颞下颌关节肿瘤及瘤样病变致颜面部畸形有效的手术治疗方案，以及术后美容及对术后咬合功能的影响。方法总结82例颞下颌关节肿瘤及瘤样病变，其中良性肿瘤54例（骨瘤17例，骨软骨瘤8例，关节滑膜软骨瘤病21例，成釉细胞瘤3例，软骨瘤和骨巨细胞瘤各2例，软骨母细胞瘤1例）；瘤样病变25例（髁状突增生或肥大23例，髁状突囊性变2例）；恶性肿瘤3例。61例以面部畸形而就诊。所有患者均采用手术方法治疗，21例关节滑膜软骨瘤病行滑膜软骨瘤病变摘除术；以面部畸形而就诊的61例病例手术方式包括：①单纯施行肿瘤或瘤样病变切除34例；②肿瘤切除加即刻肋骨肋软骨移植9例；③患侧下颌升支垂直截骨、体外切除髁状突肿瘤后升支再植入3例；④髁状突下升支后缘“L”形截骨术3例；⑤双侧下颌升支垂直截骨术4例；⑥双侧下颌升支矢状劈开术3例；⑦双侧下颌升支矢状劈开加上颌骨Le FortⅠ型截骨术摆正平面术3例；⑧部分或半侧下颌骨切除2例。术后随访6个月～10年。结果以面部畸形而就诊的61例病例，58例良性肿瘤和瘤样病变病例均无复发；53例患者术后面容恢复基本对称，咬合关系正常，开口度正常，咬合功能得到恢复。但是，单纯行髁状突切除患者中，2例手术后咬合不稳定而出现一系列症状，3例面容改善不理想。3例恶性肿瘤，2例情况稳定，1例死亡。结论单纯切除颞下颌关节肿瘤与瘤样病变是主要的手术方式，但少量病例手术治疗效果不理想，应根据具体情况采用多手段相结合的治疗方法，以恢复正常的面形、咬合关系和颞下颌关节功能。

Surgical treatment for facial deformity caused by temporomandibular joint tumors and condylar tumor-like le-sions

Objective To investigate the effective surgical methods for facial asymmetrical deformity caused by temporomandibular joint tumors and condylar tumor-like lesions as well as the post-surgical influence on cosmetic as-pects and occlusal function. Methods The study included 82 cases with temporomandibular joint tumors and condylar tumor-like lesions from 1995 to 2015 in the Hospital of Stomatology, Sun Yat-sen University. Among them, 54 cases (65.9%) were diagnosed with benign tumor, 25 cases (30.5%) with tumor-like lesions (hyperplasia of condyle) and 3 cas-es with malignant neoplasm (3.7%). 61 cases with the chief complaint of progressive facial deformity underwent surger-ies, including: simple resection of neoplasms and hyperplasia condyle for 34 cases; resection of neoplasms plus repair with costochondral graft for 9 cases; vertical ramus osteotomy of the affected side (EVRO) and re-implantation of con-dyle after tumor excision for 3 cases;subcondylar ramus"L"-shaped osteotomy for 3 cases;bilateral ramus vertical oste-otomy for 4 cases; bilateral sagittal split ramus osteotomy for 3 cases; bilateral sagittal split ramus osteotomy (BSSRO) plus LeFortⅠosteotomy for correction of the upper occlusal plane for 3 cases. Resection of partial or hemimandible for 2 cases. All patients were followed up from 6 months to 10 years after operation. Results During the follow-up period, no recurrence was found in the 58 cases with benign tumor, and 53 cases got satisfactory restoration in appearance and occlusal function. Among the cases who underwent simple resection of tumors and condyle, two patients appeared a seri-al of clinical symptoms because of unstable occlusal relationship, three cases did not obtain satisfied appearance. Among the three cases with malignant neoplasm, two cases got stable results and one died. Conclusion Simple resec-tion of the temporomandibular joint neoplasms is the main surgical methods for facial asymmetrical deformity caused by temporomandibular joint tumors and condylar tumor-like lesions. But results of some cases are not satisfied. Compre-hensive surgical techniques could be applied in the treatment of asymmetric deformity of face based on different scenari-os to improve the appearance, occlusal relationship and temporomandibular joint function.