Lemière E, Maes J M, Rousie D, Ruhin B, Vereecke F, Ferri J
Service de Stomatologie et Chirurgie Maxillo-Faciale, Hôpital Roger Salengro, CHRU de Lille, 59037 Lille.
Rev Stomatol Chir Maxillofac. 2002 Jun;103(3):148-50.
Assessment of temporomandibular joint (TMJ) surgery is a controversial topic. We analyzed our long-term surgical results in a set of patients who underwent TMJ surgery in our unit from January 1995 through December 1996. We used a simple methodology based on 4 criteria: pain, mouth opening, type of feeding and patient satisfaction.
We reviewed 21 operated patients who had been managed by an orthodontist after surgery. The post-surgical follow-up was 4 years. Patient age at surgery ranged from 14 to 51 years; the sex ratio was 1/9 M/F. Seventeen patients suffered a closed-lock, 2 had fibrous ankylosis of the disc. Fifteen patients underwent bilateral TMJ arthrotomy with joint fixation and, very often, mandibulo-condylar-plasty to counteract the bony compression inside the joint. We rated outcome as "very good" if four factors were found: resolution or improvement of pain, more than 40 mm post-surgery mouth opening or at least 10 mm improvement for patients with less than 40 mm post-surgical mouth opening, normal feeding, subjective satisfaction rated as very or quite good. Outcome was thus rated as very good (4 factors), quite good (3 factors), good (2 factors), poor (1 factor), failure (0 factors).
Resolution of pain was achieved in 55% of the patients with an improvement in the others. All patients recovered normal feeding. Mouth opening remained limited for two patients. Subjective patient satisfaction was very or quite good in 80% of the cases. Outcome was rated very good in 9 patients, quite good in 7, and good in 5. There were no patients with poor outcome or failure. Analysis of the good outcome group showed that 3 had experience a post-surgery trauma, one had not complied with rehabilitation therapy, and one suffered from undiagnosed rheumatoid polyarthritis.
According to the literature, TMJ surgery is an effective means of treating pain and reducing dysfunction. We obtained good and stable outcome in patients who participated in our postoperative follow-up. The TMJ is a fragile joint particularly susceptible to trauma.
颞下颌关节（TMJ）手术的评估是一个有争议的话题。我们分析了1995年1月至1996年12月在我们科室接受TMJ手术的一组患者的长期手术结果。我们采用了一种基于4项标准的简单方法：疼痛、开口度、进食类型和患者满意度。
我们回顾了21例术后由正畸医生管理的手术患者。术后随访4年。手术时患者年龄在14至51岁之间；男女比例为1/9。17例患者出现闭口锁，2例有盘状纤维性强直。15例患者接受了双侧TMJ关节切开术并进行关节固定，而且经常进行下颌髁突成形术以对抗关节内的骨质压迫。如果发现有以下四个因素，我们将结果评为“非常好”：疼痛缓解或改善、术后开口度超过40毫米或术后开口度小于40毫米的患者至少改善10毫米、正常进食、主观满意度评为非常好或相当好。因此，结果被评为非常好（4个因素）、相当好（3个因素）、好（2个因素）、差（1个因素）、失败（0个因素）。
55%的患者疼痛得到缓解，其他患者有所改善。所有患者恢复了正常进食。两名患者的开口度仍然受限。80%的病例中患者主观满意度为非常好或相当好。9例患者结果评为非常好，7例相当好，5例好。没有结果差或失败的患者。对良好结果组的分析表明，3例患者经历了术后创伤，1例未遵守康复治疗，1例患有未确诊的类风湿性多关节炎。
根据文献，TMJ手术是治疗疼痛和减少功能障碍的有效手段。我们对参与术后随访的患者取得了良好且稳定的结果。TMJ是一个脆弱的关节，特别容易受到创伤。
