颞下颌关节强直的诊治方案：基于上海交通大学医学院附属第九人民医院颞下颌关节中心的经验

doi:10.3969/j.issn.1674-8115.2022.06.002

上海交通大学学报（医学版） ›› 2022, Vol. 42 ›› Issue (6): 702-708.doi: 10.3969/j.issn.1674-8115.2022.06.002

颞下颌关节强直的诊治方案：基于上海交通大学医学院附属第九人民医院颞下颌关节中心的经验

何冬梅(), 杨驰()

上海交通大学医学院附属第九人民医院口腔外科，上海交通大学口腔医学院，国家口腔医学中心，国家口腔疾病临床医学研究中心，上海市口腔医学重点实验室，上海 200011

收稿日期:2022-03-02 接受日期:2022-06-12 出版日期:2022-06-28 发布日期:2022-08-19
通讯作者: 杨驰，电子信箱：yangchi63@hotmail.com。
作者简介:何冬梅（1972—）女，教授，主任医师；电子信箱：lucyhe119@163.com。
基金资助:
国家自然科学基金(32071313);上海市科学技术委员会科研项目(20Y11903900)

Diagnosis and treatment protocol of temporomandibular joint (TMJ) ankylosis: experience from the TMJ Center of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine

HE Dongmei(), YANG Chi()

Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai 200011, China

Received:2022-03-02 Accepted:2022-06-12 Online:2022-06-28 Published:2022-08-19
Contact: YANG Chi, E-mail: yangchi63@hotmail.com.
Supported by:
National Natural Science Foundation of China(32071313);Science and Technology Commission of Shanghai Municipality Science Research Project(20Y11903900)

摘要/Abstract

摘要：

颞下颌关节强直以张口受限为特点，生长期发生会导致面部畸形和阻塞性睡眠呼吸暂停等，严重影响患者的外形和下颌功能，是临床难治疾病。随着新技术的出现和经验的不断积累，颞下颌关节强直的诊治取得很大进展。该文在文献回顾的基础上重点介绍上海交通大学医学院附属第九人民医院颞下颌关节中心的手术经验并提出诊疗方案，供临床医师参考。颞下颌关节强直的影像学诊断中，CT冠状重建是分类的主要依据，根据骨球内侧是否存在残余髁突结构及其大小可以分为4种类型，此外对颞下颌关节强直伴发的颌骨畸形、咬合关系紊乱和呼吸道结构紊乱可以进一步分类。颞下颌关节强直的手术治疗包括外侧间隙成形术和关节重建术。当骨球内侧存在髁突结构且其内外径≥正常髁突内外径的1/2时，选择外侧间隙成形术，以保留髁突及关节盘结构；其他类型选择关节重建术，包括自体骨移植、人工关节重建、牵引成骨术等。对合并的颌骨畸形可以同期或二期进行正颌外科手术。自体脂肪移植可以显著减少颞下颌关节强直的复发。

关键词: 颞下颌关节, 强直, 诊断, 治疗

Abstract:

Temporomandibular joint (TMJ) ankylosis is characterized by limited mouth opening, facial deformity when it happened during growth and obstructive sleep apnea. It is a refractory disease which will seriously affect the mandibular function and facial appearance of the patients. With the development of new technology and accumulating experience, the treatment results have been significantly improved. Based on the literature review, this paper concludes the surgical treatment experience from the TMJ Center of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, so as to provide reference for clinicians. In the imaging diagnosis of TMJ ankylosis, CT coronal reconstruction is fundamental for the classification of TMJ ankylosis. It can be divided into four types according to the presence and size of residual condyle structure on the medial side of the bony fusion. In addition, jaw deformities, occlusal relationship disorders and respiratory structural disorders associated with TMJ ankylosis can be further classified. Surgical treatment of TMJ ankylosis includes lateral gap arthroplasty (LAP) and joint reconstruction. When there is a condylar structure medially to the bony fusion, which is greater than or equal to 1/2 of the internal and external diameter of the normal condyle, LAP is selected to preserve the condyle and joint disc structure; other types of joint reconstruction include autogenous bone transplantation, artificial joint reconstruction, distraction osteogenesis, etc. Orthognathic surgery can be performed simultaneously or in the second stage to correct combined jaw deformities. Autologous fat transplantation can significantly reduce the recurrence of TMJ ankylosis.

Key words: temporomandibular joint (TMJ), ankylosis, diagnosis, treatment

中图分类号:

R782.2

何冬梅, 杨驰. 颞下颌关节强直的诊治方案：基于上海交通大学医学院附属第九人民医院颞下颌关节中心的经验[J]. 上海交通大学学报（医学版）, 2022, 42(6): 702-708.

HE Dongmei, YANG Chi. Diagnosis and treatment protocol of temporomandibular joint (TMJ) ankylosis: experience from the TMJ Center of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(6): 702-708.

图/表 2

图1 颞下颌关节强直的分类Note：A. Fibrous ankylosis. B. Fibrous or bony fusion on the lateral side of the joint, while the residual condyle fragment is greater than or equal to 1/2 of the condylar head on the medial side. C. The residual condylar fragment is smaller than 1/2 of the condylar head. D. Complete bony fusion of the joint.

Fig 1 Classification of temporomandibular joint ankylosis

图2 外侧间隙成形术手术过程示意图Note：A. Resection of the lateral bony fusion. B. Restoring the medially displaced condyle and disc. C. Fat packing in the lateral osteotomy space.

Fig 2 Schematic diagram of lateral gap arthroplasty operation process

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颞下颌关节强直的诊治方案：基于上海交通大学医学院附属第九人民医院颞下颌关节中心的经验

Diagnosis and treatment protocol of temporomandibular joint (TMJ) ankylosis: experience from the TMJ Center of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine

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