Zhang W, Yang X, Zhang Y, Zhao T, Jia J, Chang S, Liu Y, Yu Bo, Chen Y, Ma Q
State Key Laboratory of Military Stomatology and National Clinical Research Centre for Oral Diseases and Shaanxi Clinical Research Centre for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, China.
Department of Orthodontics, Savaid Medical Centre, University of Chinese Academy of Sciences, Beijing, China.
Int J Oral Maxillofac Surg. 2018 Aug;47(8):1052-1059. doi: 10.1016/j.ijom.2018.01.022. Epub 2018 Apr 27.
The purpose of this study was to evaluate the sequential treatment of patients with temporomandibular joint (TMJ) ankylosis and secondary deformities by distraction osteogenesis and subsequent arthroplasty or TMJ reconstruction. This study included 40 patients treated at a stomatological hospital in China; they ranged in age from 9 to 53years (mean age 24.5years). Ten of these patients were diagnosed with unilateral TMJ ankylosis and 30 with bilateral TMJ ankylosis. Twenty-seven patients also presented obstructive sleep apnoea-hypopnoea syndrome (OSAHS). All patients underwent distraction osteogenesis as the initial surgery, followed by arthroplasty or TMJ reconstruction. Some patients underwent orthognathic surgery to improve occlusion and face shape along with or after arthroplasty or TMJ reconstruction. The therapeutic effects were evaluated in terms of the improvements in maximum inter-incisal opening (MIO), appearance, and respiratory function. After the completion of treatment, all patients showed improvements in MIO and appearance, and the symptom of snoring disappeared. The airway space was significantly increased. Patient follow-up ranged from 6 to 85months (mean 28.3months), and four patients experienced relapse. This study suggests that treating TMJ ankylosis with secondary deformities by distraction osteogenesis as the initial surgery and arthroplasty or TMJ reconstruction as the second-stage treatment may achieve favourable outcomes, especially for patients with OSAHS; however, some patients may require orthognathic surgery.
本研究的目的是评估采用牵张成骨术以及随后的关节成形术或颞下颌关节重建术，对颞下颌关节（TMJ）强直和继发性畸形患者进行序贯治疗的效果。本研究纳入了在中国一家口腔医院接受治疗的40例患者；他们的年龄在9至53岁之间（平均年龄24.5岁）。其中10例患者被诊断为单侧TMJ强直，30例为双侧TMJ强直。27例患者还伴有阻塞性睡眠呼吸暂停低通气综合征（OSAHS）。所有患者均首先接受牵张成骨术，随后进行关节成形术或TMJ重建术。部分患者在关节成形术或TMJ重建术期间或之后还接受了正颌手术，以改善咬合和面部外形。从最大切牙间开口度（MIO）、外观和呼吸功能的改善情况方面对治疗效果进行评估。治疗结束后，所有患者的MIO和外观均有改善，打鼾症状消失。气道间隙明显增大。患者随访时间为6至85个月（平均28.3个月），4例患者出现复发。本研究表明，以牵张成骨术作为初始手术、关节成形术或TMJ重建术作为二期治疗，对伴有继发性畸形的TMJ强直患者进行治疗可能会取得良好效果，尤其是对于OSAHS患者；然而，部分患者可能需要接受正颌手术。
