同期关节重建及下颌体牵张成骨治疗颞下颌关节强直3例报道

目的:对伴有严重牙颌面畸形的颞下颌关节强直患者,采用自体肋骨软骨移植重建关节,同期运用牵张成骨术行下颌骨牵张成骨延长下颌体长度,治疗下颌后缩和阻塞性睡眠呼吸暂停低通气综合征(OSAHS),评价治疗计划的可行性及短期效果。方法:3例颞下颌关节强直患者,平均年龄17.5岁,发生关节强直的平均年龄为3.6岁,病程平均为13.9a,开口度均为0,均伴有严重牙颌面畸形和OSAHS。根据头影测量结果,预先设计患侧下颌支下降的长度和下颌体延长长度;采用关节成形术加双侧冠突切除,术中取模制备板,进行同期自体肋骨软骨移植重建颞下颌关节和双侧下颌体牵张成骨术。术后第7天开始牵引,每天2次,牵引速率为0.8mm/d。结果:3例患者均顺利完成手术,术后未出现感染等严重并发症。顺利完成牵张成骨。下颌骨牵引长度平均为22.5mm(20.5～25mm)。术后3个月开口度平均为28mm(26～32mm),患者面形及OSAHS获得良好改善。结论:肋骨软骨移植关节重建同期进行下颌体牵张成骨具有良好的稳定性,该设计有利于缩短治疗周期和治疗费用,在短期内可同时解决开口、面形和OSAHS等问题,为后续矫正咬合关系奠定了基础。

One-stage temporomandibular joint reconstruction and mandibular distraction osteogenesis in management of temporomandibular joint ankylosis: Report of 3 consecutive cases

PURPOSE:The purpose of this study was to evaluate the possibility and the effect of combined autogenic costochondral grafts and simultaneous mandibular distraction osteogenesis in the treatment of maxillofacial deformity secondary to temporomandibular joint ankylosis.METHODS:3 patients,2 females and 1 male,with an average age of 17.5 years old,were diagnosed as unilateral bony ankylosis by X-ray film.Presurgical mouth opening was 0 in all patients.All the patients had significant mandibular retrognathism and symptoms of OSAHS.Autogenic costochondral grafts and simultaneous mandibular distraction osteogenesis were designed for these patients as the first surgical approach.Bilateral coronoidectomy was performed during operation.Distraction was started 7 days postoperatively with a velocity of 0.8mm per day.RESULTS:All the operations were successfully performed without any severe complications.Distraction was finished with an average increment of 22.5mm(20.5-25mm).Maximum interincisal opening(MIO)arranged to an average of 28mm(26-32mm)3 months after distraction.CONCLUSION:One-stage treatment with autogenic costochondral grafts and mandibular distraction osteogenesis is proved feasible to treat severe maxillofacial deformity secondary to TMJ ankylosis.The results show a significant improvement in both the function and the appearance of the patients.