He Dongmei, Yang Chi, Chen Minjie, Yang Xiujuan, Li Lingzhi, Jiang Qian
Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China.
J Oral Maxillofac Surg. 2011 Sep;69(9):2412-8. doi: 10.1016/j.joms.2011.04.001. Epub 2011 Jul 20.
We report a surgical method for the treatment of traumatic temporomandibular joint (TMJ) ankylosis with a medially displaced residual condyle and compare the long-term results with those obtained using different interpositional materials.
From 2001 to 2009, 60 patients and 82 joints diagnosed with traumatic TMJ ankylosis with a medially displaced residual condyle were included in the present study. Lateral arthroplasty (LAP) was performed, and either the masseter muscle flap (MMF) or the temporalis myofascial flap (TMF) was used as interpositional material to fill the lateral space. The long-term results of these treatments were compared by performing postoperative computed tomography scans and clinical follow-up examinations.
Of the 82 joints, 22 were treated with LAP, 28 with LAP and MMF, and 32 with LAP and TMF. Of the 60 patients, 38 (48 joints) participated in long-term follow-up (from 1 to 4 yr). Of the 11 joints treated with LAP, 4 (36.4%) developed reankylosis. Of the 17 joints treated with LAP and MMF, 3 (17.6%) developed reankylosis, and none of the 20 joints treated with LAP and TMF developed reankylosis. Compared with LAP alone, LAP with TMF significantly improved the maximal incisal opening during long-term follow-up.
LAP can preserve the residual TMJ structure. The TMF is a reliable interpositional material in LAP for the prevention of reankylosis.
我们报告一种治疗伴有内侧移位残留髁突的创伤性颞下颌关节（TMJ）强直的手术方法，并将长期结果与使用不同植入材料所获得的结果进行比较。
2001年至2009年，本研究纳入了60例患者共82个诊断为伴有内侧移位残留髁突的创伤性TMJ强直的关节。进行了外侧关节成形术（LAP），并使用咬肌肌瓣（MMF）或颞肌肌筋膜瓣（TMF）作为植入材料填充外侧间隙。通过术后计算机断层扫描和临床随访检查比较这些治疗的长期结果。
82个关节中，22个接受了LAP治疗，28个接受了LAP联合MMF治疗，32个接受了LAP联合TMF治疗。60例患者中，38例（48个关节）参与了长期随访（1至4年）。接受LAP治疗的11个关节中，4个（36.4%）发生了再强直。接受LAP联合MMF治疗的17个关节中，3个（17.6%）发生了再强直；接受LAP联合TMF治疗的20个关节中无一例发生再强直。与单纯LAP相比，LAP联合TMF在长期随访期间显著改善了最大切牙开口度。
LAP可保留残留的TMJ结构。TMF是LAP中预防再强直的可靠植入材料。
