改良耳屏内切口在颞下颌关节盘锚固手术中的应用  

Application of modified tragus incision in temporomandibular joint disc anchoring surgery

作　　者：郭燕军[1] 闫威[1] 崔泽坤 陈勇[1] 温凯 胡雅琦 GUO Yanjun;YAN Wei;CUI Zekun;CHEN Yong;WEN kai;HU Yaqi(Department of Oral and Maxillofacial Surgery,Cangzhou Central Hospital,Cangzhou 061000,China)

机构地区：[1]河北省沧州市中心医院口腔颌面外科,沧州061000

出　　处：《口腔颌面外科杂志》2024年第5期386-392,共7页Journal of Oral and Maxillofacial Surgery

摘　　要：目的:介绍改良耳屏内切口颞下颌关节盘锚固术手术方法并评估其临床疗效。方法:对2017年2月—2021年10月期间我院收治的264例(328侧关节)中晚期颞下颌关节盘不可复性前移位(anterior disc displacement without reduction,ADDWoR)患者,采用改良耳屏内切口行颞下颌关节盘锚固术。具体方法为:通过改良耳屏内切口手术入路,依次分离颞浅筋膜、颞深筋膜浅层及关节囊,在颧弓根部切开关节囊,暴露关节盘,使用1颗Mini Mitek锚固钉固定在髁突后下极,采用2条Orthocord缝线进行水平褥式缝合,将前移的关节盘进行复位。术前及术后7 d内行颞下颌关节磁共振成像(magnetic resonance imaging,MRI)检查,术后3个月复查MRI评价关节复位情况,记录患者术后1周、1个月、3个月张口度,采用视觉疼痛模拟评分法(visual analogue scale,VAS)记录患者术后3个月颞下颌关节疼痛缓解情况,温哥华瘢痕量表评估患者术后3个月术区瘢痕情况。结果:术后3个月MRI评价显示,306侧(249例)关节复位疗效评价为“优”,20侧(14例)关节复位疗效评价为“良”,2侧(1例)关节复位疗效为“差”,成功复位率为99.39%(326/328侧);仅有1例患者术后关节复位疗效评价为“差”,占0.61%(2/328侧)。术后3个月复诊,所有患者张口受限均改善,疼痛评分小于2分,瘢痕评价小于3分。结论:改良耳屏内切口位置隐蔽,颞下颌关节盘复位效果良好,是一种可推广的颞下颌关节盘锚固术手术入路。Objective:To introduce the surgical technique of temporomandibular joint disc anchoring through a modified tragus incision.Methods:From February 2017 to October 2021,264 patients(328 sides of joints)with advanced anterior disc displacement without reduction(ADDWoR)admitted to our hospital were treated with temporomandibular joint disc anchorage using a modified tragus approach.The specific method was as follows:Use a modified intraauricular approach to separate the superficial temporal fascia and the deep and superficial layers of the deep temporal fascia,as well as the joint capsule,cut the joint capsule at the root of the zygomatic arch,expose the joint disc,using a Mini Mitek anchor screw to fix it at the posterior and lower pole of the condylar process,and using two Orthocor sutures for horizontal mattress suture to reposition the anterior displaced joint disc.Magnetic resonance imaging(MRI)of the temporomandibular joint was performed before and within 7 days after surgery.The facial nerve condition was observed from 1 to 7 days after surgery,follow-up MRI was performed 3 months after surgery,and the mouth opening degree was recorded at 1 week,1 month,and 3 months after surgery.The visual analog scale(VAS)was used to record the relief of temporomandibular joint pain in patients at 3 months after surgery.The vancouver scar scale was used to evaluate the scar condition in the surgical area at 3 months after surgery.Results:According to the evaluation of postoperative MRI,306 joints(249 cases)were evaluated as"excellent",20 joints(14 cases)were evaluated as"good",and 2 joints(one case)were evaluated as"poor".The successful reduction rate was 99.39%(326/328 sides).Only one patient evaluated as"poor"after surgery,accounting for 0.61%(2/328 sides).At the 3-month follow-up after surgery,all patients showed improvement in limited mouth opening,with pain scores below 2 and scar evaluations below 3.Conclusion:Improving the concealed position of the incision inside the tragus and achieving good results in the reduction

关 键 词：改良耳屏内切口 颞下颌关节内紊乱 锚固术 颞下颌关节盘 

分 类 号：R782[医药卫生—口腔医学]