Kaban L B, Perrott D H, Fisher K
Department of Oral and Maxillofacial Surgery, University of California, San Francisco.
J Oral Maxillofac Surg. 1990 Nov;48(11):1145-51; discussion 1152. doi: 10.1016/0278-2391(90)90529-b.
A management protocol for temporomandibular joint (TMJ) ankylosis consisting of 1) aggressive resection, 2) ipsilateral coronoidectomy, 3) contralateral coronoidectomy when necessary, 4) lining of the TMJ with temporalis fascia or cartilage, 5) reconstruction of the ramus with a costochondral graft, 6) rigid fixation, and 7) early mobilization and aggressive physiotherapy is presented. The protocol was retrospectively evaluated in the first 14 patients (18 involved TMJs) treated and followed postoperatively for at least 1 year. The facial asymmetries present in all unilateral cases remained corrected. The mean maximum postoperative interincisal opening at 1 year was 37.5 mm (292.36% mean increase), lateral excursions were present in 16 of 18 joints (vs 0 of 18 joints preoperatively), and pain was present in 2 of 18 joints (vs 13 of 18 preoperatively). The results of this study indicate that this protocol is effective for treatment of TMJ ankylosis.
本文介绍了一种颞下颌关节（TMJ）强直的治疗方案，包括：1）积极切除；2）同侧冠突切除术；3）必要时对侧冠突切除术；4）用颞肌筋膜或软骨衬垫颞下颌关节；5）用肋软骨移植重建下颌支；6）坚固内固定；7）早期活动及积极的物理治疗。该方案在最初接受治疗并术后随访至少1年的14例患者（18个受累颞下颌关节）中进行了回顾性评估。所有单侧病例中存在的面部不对称均得到矫正。术后1年时平均最大切牙间开口度为37.5 mm（平均增加292.36%），18个关节中有16个出现侧方运动（术前18个关节均无侧方运动），18个关节中有2个存在疼痛（术前18个关节中有13个存在疼痛）。本研究结果表明，该方案对颞下颌关节强直的治疗有效。
