Wolford Larry M, Karras Spiro, Mehra Pushkar
Oral and Maxillofacial Surgery, Baylor College of Dentistry, Texas A & M University System, Dallas, TX, USA.
J Oral Maxillofac Surg. 2002 Apr;60(4):356-62; discussion 362-3. doi: 10.1053/joms.2002.31220.
In the present study, we evaluated the outcome of concomitant temporomandibular joint (TMJ) and orthognathic surgery in patients with TMJ articular disc dislocation and coexisting dentofacial deformities.
The records of 70 patients treated with TMJ articular disc-repositioning surgery and concomitant orthognathic surgery (double jaw or only mandibular surgery) were retrospectively evaluated. Patients were divided into the following 3 groups: group 1 patients had mandibular advancement, group 2 patients had mandibular setback, and group 3 patients had a mandible that remained in the original position. Lateral cephalometric radiographs and lateral cephalometric tomograms were assessed at the following intervals: before surgery (T1), immediately after surgery (T2), 6 to 12 months after surgery (T3), and at the longest follow-up (T4). Lateral cephalometric tracings were superimposed to calculate surgical change (T2 - T1), short-term stability (T3 - T2), and long-term stability (T4 - T3) of the orthognathic surgery procedures. Maximum interincisal opening (MIO) and subjective TMJ pain (visual analog scales) were comparatively evaluated at T1 and T4.
Subjective TMJ pain levels and MIO improved in all 3 groups after surgery. Before surgery, 56 of 70 patients (80%) had pain and 14 of 70 patients (20%) had no pain. At the longest follow-up, 42 of 70 patients (60%) reported complete relief of TMJ pain. Only 5 of 70 patients (7%) had severe pain after surgery compared with 37 of 70 patients (53%) before surgery. At the longest follow-up, 6 of 70 patients (9%) showed less than 35 mm MIO, residual severe pain, or both. One patient had significant condylar resorption after surgery. The orthognathic procedures were found to be stable in the long term. Concomitant TMJ and orthognathic surgery had an overall success rate of 91.4% based on a greater than 35 mm MIO and a decrease in pain.
When indicated, TMJ and orthognathic surgery can be concomitantly performed with predictable results and a good success rate. Strong consideration should be given to early surgical intervention because the success rate decreases significantly with pre-existing TMJ dysfunction of greater than 48 months' duration.
在本研究中，我们评估了颞下颌关节（TMJ）关节盘脱位并伴有牙颌面畸形的患者同期进行颞下颌关节和正颌手术的效果。
回顾性评估了70例行TMJ关节盘复位手术及同期正颌手术（双颌手术或仅下颌手术）的患者记录。患者分为以下3组：第1组患者进行下颌前徙，第2组患者进行下颌后缩，第3组患者下颌位置保持不变。在以下时间点评估头颅侧位片和头颅侧位断层片：术前（T1）、术后即刻（T2）、术后6至12个月（T3）以及最长随访时（T4）。叠加头颅侧位描记图以计算正颌手术操作的手术变化（T2 - T1）、短期稳定性（T3 - T2）和长期稳定性（T4 - T3）。在T1和T4时比较评估最大切牙间开口度（MIO）和主观TMJ疼痛（视觉模拟量表）。
所有3组患者术后主观TMJ疼痛程度和MIO均有改善。术前，70例患者中有56例（80%）有疼痛，14例（20%）无疼痛。在最长随访时，70例患者中有42例（60%）报告TMJ疼痛完全缓解。与术前70例患者中的37例（53%）相比，术后70例患者中只有5例（7%）有严重疼痛。在最长随访时，70例患者中有6例（9%）MIO小于35mm、残留严重疼痛或两者皆有。1例患者术后出现明显的髁突吸收。发现正颌手术操作长期稳定。基于大于35mm的MIO和疼痛减轻，同期TMJ和正颌手术总的成功率为91.4%。
在有指征时，TMJ和正颌手术可同期进行，结果可预测且成功率良好。应强烈考虑早期手术干预，因为对于病程超过48个月的已有TMJ功能障碍患者，成功率会显著降低。
