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
• 口腔外科专题 • 上一篇
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
E-mail:lucyhe119@163.com;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:
Received:
2022-03-02
Accepted:
2022-06-12
Online:
2022-06-28
Published:
2022-08-19
Contact:
YANG Chi
E-mail:lucyhe119@163.com;yangchi63@hotmail.com
Supported by:
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。
中图分类号:
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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