Yang Y T, Li Y F, Jiang N, Bi R Y, Zhu S S
State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China.
State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China.
Br J Oral Maxillofac Surg. 2018 Feb;56(2):107-112. doi: 10.1016/j.bjoms.2017.12.001. Epub 2017 Dec 15.
Injury to the mandibular condyle in children usually leads to malocclusion and disharmony of facial growth. Our aim was to study the facial growth after reconstruction of the mandibular condyle using autogenous coronoid process grafts in children with unilateral ankylosis of the temporomandibular joint (TMJ). We followed up 10 growing patients with unilateral bony ankylosis of the TMJ who had been admitted to the West China Hospital of Stomatology, Sichuan University (Chengdu, China) between 1 January 2008 and 31 December 2012. There were three boys and seven girls, age range 5-12 years at the time of operation. In each case, patients were treated by gap arthroplasty, reconstruction of the condyle with an ipsilateral coronoid process, and interposition of the pedicled temporalis fascial flap during one operation. The mean (range) postoperative follow up was 4.73 (3-6) years. Postoperative panoramic radiographs were taken, and the growth of the mandibular height and length on the affected side was measured and compared with the healthy side. All patients had an uneventful, normal recovery. The mean (range) maximal mouth opening at the end of follow up was 35.6 (32-41) mm. Both the height of the ramus and the length of the mandible continued to grow after successful treatment of the ankylosis (using autogenous coronoid process grafts for reconstruction of the condyle) but the deficit in growth was not completely made up. The final height of the ramus on the affected side (at the end of follow up) had increased by 25% (p=0.012) and the final length of the mandible on the affected side by 26% (p=0.010) compared with immediately after operation. For comparison of the rate of growth, the increased height of the ramus of the affected side was 47% lower (p=0.003), while the increased length of the mandible on the affected side was 27% shorter (p=0.008) compared with the healthy side. The mandible on the affected side continued to grow after successful treatment of the ankylosis, but the growth deficit was not made up completely. The rate of growth of the affected mandible seemed to be less than on the undisturbed side even after treatment of the ankylosis.
儿童下颌髁突损伤通常会导致错牙合畸形和面部生长不协调。我们的目的是研究在患有单侧颞下颌关节（TMJ）强直的儿童中，使用自体喙突移植重建下颌髁突后的面部生长情况。我们对2008年1月1日至2012年12月31日期间入住四川大学华西口腔医院（中国成都）的10例生长发育期单侧TMJ骨性强直患者进行了随访。其中男孩3例，女孩7例，手术时年龄范围为5至12岁。每例患者均在一次手术中接受了间隙关节成形术、用同侧喙突重建髁突以及带蒂颞肌筋膜瓣植入。术后平均（范围）随访时间为4.73（3 - 6）年。拍摄术后全景X线片，测量患侧下颌高度和长度的生长情况，并与健侧进行比较。所有患者均顺利、正常恢复。随访结束时平均（范围）最大开口度为35.6（32 - 41）mm。在成功治疗强直（使用自体喙突移植重建髁突）后，下颌升支高度和下颌长度均持续生长，但生长不足并未完全弥补。与术后即刻相比，随访结束时患侧下颌升支最终高度增加了25%（p = 0.012），患侧下颌最终长度增加了26%（p = 0.010）。为比较生长速率，与健侧相比，患侧下颌升支增加的高度低47%（p = 0.003），患侧下颌增加的长度短27%（p = 0.008）。患侧下颌在成功治疗强直后仍继续生长，但生长不足并未完全弥补。即使在治疗强直后，患侧下颌的生长速率似乎仍低于未受干扰的一侧。
