正颌外科治疗后颞下颌关节改变的X线研究

目的 了解正颌外科手术后颞下颌关节（ｔｅｍｐｏｒｏｍａｎｄｉｂｕｌａｒ ｊｏｉｎｔ,ＴＭＪ）形态的改变,探讨手术方式不同对ＴＭＪ的影响。方法 正颌手术患者５７例,术前、术后１周、１年分别拍摄定位许勒位片用于观察髁突位置及关节形态的变化。结果 ①正颌手术可导致髁突移位,但大多数关节适应后并不发生病变,术后１年髁突位置已调整到术前相似的位置。②手术方式不同髁突位置的变化也不尽相同。③８６．４％的患者关节无明显变化或发生了适应性改建;１３．６％患者关节发生了退行性改变。结论 正颌手术可对ＴＭＪ产生影响,但大部分处于关节的正常适应范围内。

Changes of the temporomandibular joint following orthognathic surgery on radiography

OBJECTIVE: To investigate the effect of different operative techniques and fixed methods on the TMJ condylar position and remolding process. METHODS: The standard Schuller's position radiographs were used to examine the postoperative temporomandibular joint form and condylar position changes of 57 cases within one week and one year after orthognathic surgery. The form changes were divided into three types. Type I was that the joint form was normal or abnormal before the operation and no significant change was found after the operation. Type II was that the joint form was abnormal before but after the operation it was improved. Type III was that the joint form was normal before but after the operation it changed into abnormal or it was abnormal before but after the operation it worsened. RESULTS: 1. Changes of the condylar position had happened after the operations, but within one year the condyles had resumed the same position as the preoperative. The condylar displacements were not beyond the TMJ adaptabilities. Different operative techniques had different effects on the condylar positions. 2. In 86.4% of cases, TMJs had undergone adaptable remolding (Type II) or no significant changes (Type I). Only 13.6% of cases, degenerative changes were found (Type III). CONCLUSIONS: The effect of orthognathic surgery on the condylar position and TMJ form is significant, but most of the changes are within the normal adaptability of TMJ.