儿童颞下颌关节强直及其继发畸形的矫治  

Management of Temporomandibular Joint Ankylosis with Dentofacial Deformities in Children

作　　者：梅杰 蒋扬眉 李运峰[1] 毕瑞野[1] 姜楠[1] 祝颂松[1] MEI Jie;JIANG Yang-mei;LI Yun-feng;BI Rui-ye;JIANG Nan;ZHU Song-song(State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China)

机构地区：[1]口腔疾病研究国家重点实验室国家口腔疾病临床医学研究中心四川大学华西口腔医院正颌与关节外科,四川成都610041

出　　处：《口腔医学研究》2018年第3期274-277,共4页Journal of Oral Science Research

基　　金：国家自然科学基金(编号:81470763);四川省科学技术基金(编号:2015JY0258)

摘　　要：目的:探讨儿童颞下颌关节强直及其继发畸形的治疗方法及疗效。方法:回顾分析18例颞下颌关节强直继发牙颌面畸形患儿的临床资料,对患儿手术前后口腔功能、颜面外形及影像学资料进行分析,随访12~40月。结果:所有患儿均实施重建髁突的关节成形术,重建材料包括肋骨肋软骨移植、冠突移植及牵张成骨术,并同时进行牙颌面畸形的矫治。未发现感染、面神经损伤和复发病例。所有患儿的术后张口度明显增大(术前平均2.83mm,术后12月平均30.5mm,Z=3.733,P<0.05),咀嚼、吞咽、发音和呼吸等口腔功能在长期随访期间得到明显改善。多数患儿的牙颌面畸形得到不同程度的改善。结论:本研究为儿童颞下颌关节强直继发牙颌面畸形的治疗提供参考,早期治疗和定期复查对于儿童颞下颌关节强直及其继发畸形的治疗至关重要。Objective：To explore the treatment of TMJ ankylosis with secondary dentocacial deformities.Methods：This was a retrospective analyze of 18 pediatric patients with TMJ ankylosis and secondary dentofacial deformities.Clinical outcomes were evaluated in terms of oral function,medical photography,and radiography.Patients were followed up for 12-40 months.Results：The patients underwent different types of arthroplasty with condylar reconstruction by costochondral bone,autogenous coronoid process or distraction osteogenesis.The dentofaical deformities were treated simultaneously.No infections had occurred during or after hospitalization.No patients with re-ankylosis or permanent facial nerve damage were found during the follow-up period.All patients achieved significant improvements in MIO（2.83 mm preoperative to 30.5 mm 12 months postoperative,P〈0.05）and in oral function including chewing,swallowing,pronunciation,and respiration with long-term follow-up.The dentofacial deformities in most patients were improved to varying degrees.Conclusion：Our results provided more useful information for the management of the pediatric patients with TMJ ankylosis and secondary dentofacial deformities.Early treatment and close follow-up play an important role in the management of these patients.

关 键 词：颞下颌关节 关节强直 牙颌面畸形 牵张成骨 

分 类 号：R782.6[医药卫生—口腔医学]