Faculty of Dentistry, University of Manitoba and Health Science Centre, Winnipeg, Manitoba, Canada.
Int J Oral Maxillofac Surg. 2010 Apr;39(4):333-42. doi: 10.1016/j.ijom.2010.01.005. Epub 2010 Feb 10.
The study reports the authors' experience in managing TMJ ankylosis in Delta Nile, Egypt (1995-2006) and compares the surgical modalities used. 101 patients (109 joints) were reviewed in this retrospective study. Pre- and postoperative assessment included history, radiological and physical examination, and mouth opening. Age, sex, aetiology, joint(s) affected, surgical modality, complications and follow up periods were evaluated. Various types (fibrous, fibro-osseous and bony) of TMJ ankylosis were diagnosed; trauma was the commonest aetiology. The patients' age range was 2-41 years, 62% were female, and the follow up period ranged from 14 to 96 months. Average mouth opening was significantly increased from 5.3mm pre-operatively to 32.9 mm 12 months postoperatively (P=0.0001). Marked improvement in mouth opening was documented when the ramus-joint complex was reconstructed using distraction osteogenesis (34.7 mm), costochondral graft (34.4mm) and Surgibone (34.6mm). Gap arthroplasty showed least satisfactory mouth opening compared with other techniques (P=0.001). Minor and major complications were encountered in 33% of cases, including 5% recurrence rate. Early release of TMJ ankylosis; reconstruction of the ramus height with distraction osteogenesis or bone grafting combined with interpositional arthroplasty, followed by vigorous physiotherapy is successful for managing TMJ ankylosis.
本研究报告了作者在埃及尼罗河三角洲（1995-2006 年）管理颞下颌关节强直的经验，并比较了所使用的手术方式。在这项回顾性研究中，对 101 例患者（109 个关节）进行了回顾。术前和术后评估包括病史、影像学和体格检查以及张口度。评估了年龄、性别、病因、受累关节、手术方式、并发症和随访期。诊断出各种类型（纤维性、纤维骨性和骨性）的颞下颌关节强直；创伤是最常见的病因。患者年龄为 2-41 岁，62%为女性，随访期为 14-96 个月。平均张口度从术前的 5.3mm 显著增加到术后 12 个月的 32.9mm（P=0.0001）。当使用牵引成骨术（34.7mm）、肋软骨移植（34.4mm）和 Surgibone（34.6mm）重建髁突-关节复合体时，记录到张口度明显改善。与其他技术相比，关节切开术显示出最不满意的张口度（P=0.001）。33%的病例出现了轻微和严重的并发症，包括 5%的复发率。早期松解颞下颌关节强直；用牵引成骨术或骨移植重建髁突高度，结合间置关节成形术，然后进行积极的物理治疗，是治疗颞下颌关节强直的成功方法。
