Schellhas K P, Piper M A, Omlie M R
Center for Diagnostic Imaging, St. Louis Park, MN 55416.
AJR Am J Roentgenol. 1990 Aug;155(2):373-83. doi: 10.2214/ajr.155.2.2115271.
One hundred patients with recently acquired, externally visible mandibular deformity and no history of previous extraarticular mandible fracture were selected for retrospective analysis. All had been investigated clinically and with radiography, tomography, and high-field surface-coil MR imaging to determine the presence or absence and extent of temporomandibular joint degeneration. Temporomandibular joint degeneration was found in either one or both joints of each patient studied. Chin deviation was always toward the smaller mandibular condyle or more diseased joint, and many patients either complained of or exhibited malocclusion, often manifested by unstable or fluctuating occlusion disturbances. Three radiologically distinct forms of degenerative vs adaptive osteocartilaginous processes--(1) osteoarthritis, (2) avascular necrosis, and (3) regressive remodeling--involving the mandibular condyle and temporal bone were identified in joints most often exhibiting meniscus derangement. Osteoarthritis and avascular necrosis of the mandibular condyle and temporal bone were generally associated with pain, mechanical joint symptoms, and occlusion disturbances. Regressive remodeling was less frequently associated with occlusion disturbances, despite remodeling of the facial skeleton, and appears to result from regional osteoporosis. Forty patients (52 joints) underwent open arthroplasty procedures, including either meniscectomy or microsurgical meniscus repair, at which time major radiologic diagnoses were confirmed. Surgical and pathologic findings included meniscus displacement, disk degeneration, synovitis, joint effusion, articular cartilage erosion, cartilage healing/fibrosis, cartilage hypertrophy, osseous sclerosis, osteophyte formation, osteochondritis dissecans, localized or extensive avascular necrosis, and decreased mandibular condyle mass and vertical dimension. We conclude that temporomandibular joint degeneration is the principal cause of both acquired facial skeleton remodeling and unstable occlusion in patients with intact dentition and without previous mandible fracture.
选取100例近期出现下颌骨外形畸形且既往无关节外下颌骨骨折史的患者进行回顾性分析。所有患者均接受了临床检查以及X线摄影、断层扫描和高场表面线圈磁共振成像检查，以确定颞下颌关节退变的有无及程度。在所研究的每位患者的一个或两个关节中均发现了颞下颌关节退变。颏部偏斜总是朝向较小的下颌髁突或病变更严重的关节，许多患者主诉或表现出咬合不正，常表现为不稳定或波动的咬合紊乱。在最常出现半月板紊乱的关节中，发现了三种放射学上不同的退行性与适应性骨软骨病变形式——（1）骨关节炎，（2）无血管性坏死，（3）退行性重塑——累及下颌髁突和颞骨。下颌髁突和颞骨的骨关节炎和无血管性坏死通常与疼痛、关节机械性症状和咬合紊乱有关。尽管面部骨骼发生了重塑，但退行性重塑与咬合紊乱的相关性较小，似乎是由局部骨质疏松引起的。40例患者（52个关节）接受了开放性关节成形术，包括半月板切除术或显微外科半月板修复术，此时主要的放射学诊断得到了证实。手术和病理结果包括半月板移位、盘状退变、滑膜炎、关节积液、关节软骨侵蚀、软骨愈合/纤维化、软骨肥大、骨质硬化、骨赘形成、剥脱性骨软骨炎、局限性或广泛性无血管性坏死以及下颌髁突质量和垂直尺寸减小。我们得出结论，颞下颌关节退变是牙列完整且既往无下颌骨骨折的患者获得性面部骨骼重塑和咬合不稳定的主要原因。
