Gabbay Joubin S, Heller Justin B, Song Yun Y, Wasson Kristy L, Harrington Heidi, Bradley James P
Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, CA 90095, USA.
J Craniofac Surg. 2006 May;17(3):516-22. doi: 10.1097/00001665-200605000-00022.
Temporomandibular joint (TMJ) bony ankylosis with micrognathia is a rare congenital condition that is difficult to treat and may result in recurrence. In a series of affected patients, we compared two new methods of treatment: transport distraction osteogenesis and Matthews Device arthroplasty. All patients had computed tomography scan documented bilateral TMJ bony ankylosis. Group I (transport distraction osteogenesis) underwent distraction advancement of the mandible (for micrognathia) followed by resection of the condyles, recontouring of the glenoid fossas with interposition temporoparietal-fascial flaps, and transport distraction osteogenesis of mandibular rami segments. Group II (Matthews Device arthroplasty) underwent all of the above procedures except for transport distraction osteogenesis. Instead, the Matthews Devices were anchored to the temporal bone and mandibular rami. Hinged arms allowed for motion at the reconstructed TMJ. In both groups, patients underwent extensive postoperative therapy. Preoperative, postoperative, and follow-up lateral cephalograms were obtained, and incisor opening distances were recorded. All patients but one had severe micrognathia (n = 9). For group I (transport distraction osteogenesis), mean age was 6.8 years. and mean advancement was 28.5 mm. For group II (Matthews Device arthroplasty) mean age was 8.2 years, and mean advancement was 23.5 mm. In group I (transport distraction osteogenesis), mean incisor opening was 1 mm preoperatively and 27.5 mm postoperatively; however, it relapsed to 14.3 mm by 12.5 months follow-up (48% relapse). Mean incisor opening in group II (Matthews Device arthroplasty) was 3.9 mm preoperatively and 33.4 mm postoperatively and remained at 30.6 mm after 11.1 months follow-up (8% relapse). One patient in group I (transport distraction osteogenesis) underwent surgical revision because of relapse. Our data showed that for congenital TMJ bony ankylosis both transport distraction osteogenesis and Matthews Device arthroplasty techniques were successful initially; however, the Matthews Device arthroplasty avoided long-term relapse.
颞下颌关节（TMJ）骨性强直伴小颌畸形是一种罕见的先天性疾病，治疗困难且可能复发。在一系列受影响的患者中，我们比较了两种新的治疗方法：牵张成骨术和马修斯装置关节成形术。所有患者均经计算机断层扫描证实为双侧TMJ骨性强直。第一组（牵张成骨术）先进行下颌骨牵张前移（治疗小颌畸形），然后切除髁突，用颞顶筋膜瓣对关节窝进行重塑，并对下颌支节段进行牵张成骨术。第二组（马修斯装置关节成形术）进行了除牵张成骨术之外的上述所有手术。取而代之的是，将马修斯装置固定在颞骨和下颌支上。铰链臂允许在重建的TMJ处活动。两组患者术后均接受了广泛的治疗。获取了术前、术后和随访时的头颅侧位片，并记录了切牙开口距离。除1例患者外，所有患者均有严重小颌畸形（n = 9）。第一组（牵张成骨术）的平均年龄为6.8岁，平均前移距离为28.5 mm。第二组（马修斯装置关节成形术）的平均年龄为8.2岁，平均前移距离为23.5 mm。在第一组（牵张成骨术）中，术前平均切牙开口为1 mm，术后为27.5 mm；然而，到随访12.5个月时复发至14.3 mm（复发率48%）。第二组（马修斯装置关节成形术）术前平均切牙开口为3.9 mm，术后为33.4 mm，随访11.1个月后保持在30.6 mm（复发率8%）。第一组（牵张成骨术）中有1例患者因复发接受了手术翻修。我们的数据表明，对于先天性TMJ骨性强直，牵张成骨术和马修斯装置关节成形术在最初均取得了成功；然而，马修斯装置关节成形术避免了长期复发。
