Troulis Maria J, Williams W Bradford, Kaban Leonard B
Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA.
J Oral Maxillofac Surg. 2004 Apr;62(4):460-5. doi: 10.1016/j.joms.2003.09.012.
The purpose of this study was to evaluate early outcomes in patients who underwent endoscopic condylectomy and costochondral graft reconstruction (CCG) of the ramus/condyle unit (RCU).
A retrospective evaluation of 10 consecutive patients who underwent endoscopic condylectomy and CCG (n = 17 sides) for the treatment of idiopathic condylar resorption (n = 7), degenerative joint disease (n = 1), and malunion of a fractured condyle (n = 2) was completed. Patients were included who had 1) adequate documentation after endoscopic condylectomy and CCG reconstruction and 2) a minimum of 6-months follow-up. Patients with inadequate documentation or follow-up were excluded. The surgical technique included a 1.5-cm incision inferior to the mandibular angle. Blunt dissection was carried to the masseter muscle, which was incised using needle point electrocautery. An optical cavity was created for insertion of a Hopkins (Karl Storz, Culver City, CA) endoscope. The resection and reconstruction were carried out with endoscopic instrumentation. Preoperative (T0), postoperative (T1), and follow-up (T2) clinical examinations, lateral cephalograms, and panoramic radiographs were used to evaluate the outcomes.
In all 10 cases, condylectomy and CCG reconstruction (n = 17 sides) were successfully performed using the endoscopic approach. The mean follow-up period was 17 months (range, 8 to 38 months). All submandibular scars were aesthetically satisfactory, and there were no facial, inferior alveolar, or lingual nerve injuries. No other intraoperative or postoperative complications occurred. Postoperative RCU length, mandibular position, and correction of the occlusion were documented using lateral cephalometric and panoramic radiographs.
The results of this study indicate that endoscopic condylectomy and CCG reconstruction produce satisfactory clinical outcomes without significant morbidity. Long-term follow-up studies are in progress.
本研究旨在评估接受内镜下髁突切除术及下颌支/髁突单元（RCU）肋软骨移植重建（CCG）的患者的早期疗效。
对10例连续接受内镜下髁突切除术及CCG（共17侧）的患者进行回顾性评估，这些患者分别用于治疗特发性髁突吸收（7例）、退行性关节病（1例）和髁突骨折畸形愈合（2例）。纳入的患者需满足：1）内镜下髁突切除术及CCG重建后有充分的记录；2）至少随访6个月。记录不充分或随访时间不足的患者被排除。手术技术包括在下颌角下方做一个1.5厘米的切口。钝性分离至咬肌，用针状电灼器切开咬肌。创建一个光学腔以插入Hopkins（卡尔史托斯，加利福尼亚州卡尔弗城）内镜。使用内镜器械进行切除和重建。术前（T0）、术后（T1）和随访（T2）的临床检查、头颅侧位片和全景X线片用于评估疗效。
所有10例患者均成功采用内镜方法进行了髁突切除术及CCG重建（共17侧）。平均随访期为17个月（范围8至38个月）。所有下颌下瘢痕在美观方面均令人满意，未发生面部、下牙槽或舌神经损伤。未发生其他术中或术后并发症。使用头颅侧位片和全景X线片记录术后RCU长度、下颌位置和咬合矫正情况。
本研究结果表明，内镜下髁突切除术及CCG重建可产生令人满意的临床疗效，且并发症发生率低。长期随访研究正在进行中。
