Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, Key Laboratory of Stomatology, Shanghai, 200011, China.
Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center at San Antonio, TX, USA.
Sci Rep. 2017 Mar 24;7:45271. doi: 10.1038/srep45271.
Temporomandibular joint (TMJ) ankylosis is a refractory disease that is difficult to predictably treat. This study evaluated the prognosis of using standard alloplastic TMJ prostheses for the treatment of TMJ ankylosis in Chinese patients with severe mandibular deficiency. Patients treated from 2013 to 2015 were reviewed. The computer-aided design and manufacture (CAD/CAM) technique was used to guide bony mass removal and locate the TMJ prosthesis (Biomet, USA). Eleven patients were included in this study. All prostheses were successfully installed and stabilized intraoperatively. In 4 patients with severe mandibular deficiency, their mandibular ramus was elongated by the TMJ prosthesis and 2 patients were combined with Le Fort I osteotomy guided by digital templates. Their mean chin advancement was 10.19 mm. Their SNB and ramus heights were also significantly improved after operation (P < 0.05). There was no prosthesis loosening, breakage, or infection leading to removal after a mean follow-up period of 22 months (range, 12-31mos.). Mouth opening was significantly improved from 5.5 mm preoperatively to 31.5 mm postoperatively. TMJ reconstruction with standard alloplastic prosthesis is a reliable treatment for ankylosis, especially in recurrent cases. By CAD/CAM technique, it can correct jaw deformities simultaneously and produce stable results.
颞下颌关节（TMJ）强直是一种难治性疾病，难以进行预测性治疗。本研究评估了使用标准的全关节TMJ 假体治疗中国严重下颌骨缺损患者 TMJ 强直的预后。回顾了 2013 年至 2015 年期间接受治疗的患者。使用计算机辅助设计和制造（CAD/CAM）技术指导骨量切除并定位 TMJ 假体（美国 Biomet）。本研究纳入了 11 例患者。所有假体均成功地在术中安装和稳定。在 4 例严重下颌骨缺损的患者中，TMJ 假体延长了下颌支，2 例患者结合数字模板引导的 Le Fort I 截骨术。他们的平均颏部前伸为 10.19mm。术后 SNB 和下颌支高度也明显改善（P<0.05）。在平均 22 个月（范围 12-31mos.）的随访中，没有假体松动、断裂或感染导致假体取出。张口度从术前的 5.5mm 显著改善至术后的 31.5mm。使用标准的全关节假体进行 TMJ 重建是治疗强直的一种可靠方法，尤其是在复发性病例中。通过 CAD/CAM 技术，可同时矫正颌骨畸形，并获得稳定的结果。
