Yun Pil-Young, Kim Young-Kyun
Department of Oral and Maxillofacial Surgery, Section of Dentistry, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Gyeonggi-do 463-707, Korea.
J Oral Maxillofac Surg. 2005 Nov;63(11):1576-83. doi: 10.1016/j.joms.2005.05.318.
Facial trauma has been suggested as a possible etiologic factor of temporomandibular joint disorder. However, there is little information on the role of macrotrauma. The main purpose of this study was to validate facial trauma as a potential etiologic factor for temporomandibular joint (TMJ) disorder. Multidirectional approaches were applied for the evaluation of the changes of TMJ after TMJ macrotrauma.
Analysis of TMJ status including arthroscopic examination, histomorphologic examination, and synovial fluid biochemical analysis were performed on the patients with mandibular fractures. Additionally, the efficacy of arthrocentesis for the patients of mandibular fracture was evaluated from the functional point of view.
In arthroscopic examinations, evidence of synovitis with variable degrees was found. The representative findings are fibrillation and ecchymosis. On histomorphologic examination, bloody smear, degenerated cells and cartilage, inflammatory cells, and crystal were observed. In biochemical analysis, considerable amounts of prostaglandin E(2) and leukotriene B(4) were detected in the synovial fluid of the patients.
The inflammatory and degenerative changes of TMJ can develop after facial trauma. Trauma can be a possible etiologic factor in cartilage degeneration, and biochemical and intra-articular pathology. Clinicians should recognize the etiologic importance of macrotrauma, and long-term evaluation of the TMJ as well as adequate treatment is required for patients with facial trauma.
面部创伤被认为是颞下颌关节紊乱病的一个可能病因。然而，关于严重创伤作用的信息很少。本研究的主要目的是验证面部创伤作为颞下颌关节（TMJ）紊乱病的潜在病因。采用多方向方法评估TMJ严重创伤后TMJ的变化。
对下颌骨骨折患者进行TMJ状态分析，包括关节镜检查、组织形态学检查和滑液生化分析。此外，从功能角度评估关节穿刺术对下颌骨骨折患者的疗效。
在关节镜检查中，发现了不同程度滑膜炎的证据。典型表现为纤维蛋白形成和瘀斑。在组织形态学检查中，观察到血性涂片、退变细胞和软骨、炎性细胞及晶体。在生化分析中，患者滑液中检测到大量前列腺素E(2)和白三烯B(4)。
面部创伤后TMJ可发生炎症和退行性改变。创伤可能是软骨退变、生化及关节内病理改变的一个可能病因。临床医生应认识到严重创伤的病因学重要性，对面部创伤患者需要对TMJ进行长期评估并给予适当治疗。
