Toll Douglas Edward, Popović Nenad, Drinkuth Nicole
Orthodontic Joint Practice Douglas Toll, Bad Soden, Germany.
J Orofac Orthop. 2010 Jan;71(1):68-80. doi: 10.1007/s00056-010-0903-1. Epub 2010 Feb 5.
Occasionally, undesirable post-surgical symptoms of temporomandibular disorder (TMD) and pain have been observed. The aim of this paper is to show how often and to which degree TMJ pathologies occur in orthognathic surgery candidates before surgery, making it recommendable to consider these TMJ pathologies during treatment planning.
Between 2002 and 2004, Magnetic Resonance Imaging (MRI) of the TMJ were made in 58 randomly chosen orthognathic surgery patients. 69% of the patients were female, 31% were male. Age averaged 31.6 years (16-61 years). Gender and malocclusion (Class I, II and III) were looked at during analysis of the data (n = 58 patients, n = 116 TMJs). MRI scans were made at the beginning of treatment. We wanted to investigate the TMJ condition before surgery.
The largest patients group of this study were the female Class II patients (n = 25). Most patients displayed an Angle Class II (53.4%). The Class III patients followed (32.8%). A Class I molar relationship was found in 13.8% of the studied patients. A similar distribution could be observed in the parameters we studied: 1. condyle (position, degeneration), 2. disc (position, degeneration, prolapse and reduction). 76% of the TMJs (66.7%) showed dorsocranial condylar displacement. 26 of the 114 studied condyles (22.8%) were dorsally displaced. 108 of the studied joints (94.7%) showed condylar displacement. In 31 TMJs (28,4%) we found moderate, in 25 joints (22.9%) severe and in 26 joints (23.9%) we observed slight condylar degeneration. Most discs were displaced ventrally (31%). 22 of the studied 113 discs (19.5%) were displaced medially. 93% of the studied discs were not positioned correctly. 58 of the studied discs (58.6%) displayed flattening, in 8 (8%) we observed both flattening and disc adhesions. Two each of the studied TMJs had discs with perforations and adhesions or only perforations. In 57 (50.4%) of the studied discs we observed partial disc prolapse. Disc prolapse was total in 42.5% (n = 48 TMJs) of the TMJs. Eight TMJs (7%) of the 113 TMJs we analyzed showed no disc prolapse. Disc reduction was total in 71 (62.8%) of the studied TMJs. 15% (n = 17 TMJs) showed a partially reduced disc. 25 (22.1%) of the studied joints showed no disc reduction.
Apparently, MRI scans of the TMJ are necessary in almost all potential orthognathic surgery patients to achieve optimal surgical results. Female Class II patients recruited the largest patient group among the studied collective. It is this group that deserves the greatest caution before and after surgery (TMJ pathologies!). In patients with jaw discrepancies, a TMJ examination should be made prior to surgery in order to be able to include the condition of the TMJs in the planning of treatment. This examination best includes Magnetic Resonance Imaging (MRI) and Manual Functional Analysis (MFA).
偶尔会观察到正颌手术后出现颞下颌关节紊乱（TMD）和疼痛等不良症状。本文旨在说明在正颌手术候选者术前颞下颌关节（TMJ）病变出现的频率和程度，从而建议在治疗计划中考虑这些TMJ病变。
2002年至2004年期间，对58例随机选取的正颌手术患者进行了TMJ的磁共振成像（MRI）检查。69%的患者为女性，31%为男性。平均年龄31.6岁（16 - 61岁）。在数据分析过程中观察了性别和错牙合情况（I类、II类和III类）（n = 58例患者，n = 116个TMJ）。MRI扫描在治疗开始时进行。我们想在手术前调查TMJ的状况。
本研究中最大的患者群体是II类女性患者（n = 25）。大多数患者表现为安氏II类错牙合（53.4%）。其次是III类患者（32.8%）。13.8%的研究患者为I类磨牙关系。在我们研究的参数中也观察到了类似的分布：1. 髁突（位置、退变），2. 关节盘（位置、退变、脱垂和复位）。76%的TMJ（66.7%）显示髁突背颅移位。114个研究髁突中有26个（22.8%）背侧移位。108个研究关节（94.7%）显示髁突移位。在31个TMJ（28.4%）中我们发现中度髁突退变，25个关节（22.9%）为重度退变，26个关节（23.9%）观察到轻度髁突退变。大多数关节盘腹侧移位（31%）。113个研究关节盘中有22个（19.5%）向内侧移位。93%的研究关节盘位置不正确。58个研究关节盘（58.6%）显示扁平，8个（8%）观察到扁平且有关节盘粘连。每个研究的TMJ中有2个关节盘有穿孔和粘连或仅有穿孔。在57个（50.4%）研究关节盘中我们观察到部分关节盘脱垂。42.5%（n = 48个TMJ）的TMJ关节盘完全脱垂。在我们分析的113个TMJ中，8个（7%）未显示关节盘脱垂。71个（62.8%）研究TMJ的关节盘完全复位。15%（n = 17个TMJ）显示关节盘部分复位。25个（22.1%）研究关节未显示关节盘复位。
显然，几乎所有潜在的正颌手术患者都需要进行TMJ 的MRI扫描，以获得最佳手术效果。在研究群体中，II类女性患者构成了最大的患者群体。正是这一群体在手术前后最值得谨慎对待（TMJ病变！）。对于有颌骨差异的患者，术前应进行TMJ检查，以便能够在治疗计划中纳入TMJ的状况。这种检查最好包括磁共振成像（MRI）和手法功能分析（MFA）。
