口腔内入路髁突切除术的临床应用研究

目的探讨经口腔内入路行髁突切除术并重建颞下颌关节的可行性。方法经口腔内入路行患侧升支垂直截骨术,将带有髁突的近心骨段取出至体外,切除病变的髁突,再将近心骨段的余部重新植入重建颞下颌关节。自1998年至2006年共完成经口腔内入路的髁突切除术并重建颞下颌关节23例,其中髁突良性肥大2例;髁突骨软骨瘤13例;半侧颌骨肥大畸形6例;髁突陈旧性骨折2例,最大的髁突骨软骨瘤直径达5cm。部分患者同期经口腔内入路行正颌外科手术矫治伴发的面部不对称畸形。结果23例患者均顺利完成手术,术后伤口正常愈合,面颈部皮肤无疤痕遗留,无面神经受损症状出现,面部不对称畸形矫治效果良好。经平均4.5年的随访,术后开口度均达35mm,髁突骨软骨瘤及髁突肥大均未见复发。结论自口腔内入路切除病变髁突并重建颞下颌关节,避免了常规口外入路时,术后皮肤遗留斑痕和易损伤面神经的缺点。

Clinical study of condylectomy and reconstruction of temporomandibular joint with an intraoral approach

Objective To evaluate the feasibility of the condylectomy and the reconstruction of temporomandibular joint with an intraoral approach.Methods From 1998 to 2006,the condylectomy and the reconstruction of temporomandibular joint were performed with an intraoral approach in 23 cases.There were 2 cases of condylar hyperplasia,6 cases of hemimandibular hyperplasia,13 cases of condylar osteochondroma and 2 cases of secondary condylar fracture in our series.Orthognathic surgical procedures were performed simultaneously in 21 cases to correct their facial asymmetry.Results The postoperative process of all patients was uneventful.Their facial asymmetry was obviously corrected.There were no patients suffered permanent facial never damage in postoperative period.After operation,Mouth opening was more than 35mm in all patients.There were no reoccurrence of ocndylar lesions in our series.Conclusion The condylectomy and the reconstruction of temporomandibular joint can be successfully performed with an intraoral approach.