关节复位与术后功能夹板治疗伴 II 类错颌青少年前盘移位的效果。

The effect of disc repositioning and post-operative functional splint for the treatment of anterior disc displacement in juvenile patients with Class II malocclusion.

机构信息

Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, 200011, China; National Clinical Research Center of Stomatology, Shanghai, 200011, China.

出版信息

J Craniomaxillofac Surg. 2019 Jan;47(1):66-72. doi: 10.1016/j.jcms.2018.09.035. Epub 2018 Nov 14.

DOI:10.1016/j.jcms.2018.09.035

PMID:30497948

Abstract

PURPOSE

To evaluate the effect of temporomandibular joint (TMJ) disc repositioning and post-operative functional splint for the treatment of anterior disc displacement (ADD) in juvenile patients with Class II malocclusion.

MATERIALS AND METHODS

Juvenile patients (≤20 years) who had bilateral TMJ ADD with and Class II malocclusion treated by disc repositioning and functional splints were included in the study. Magnetic resonance imaging (MRI) and cephalometric radiographs before surgery (T0), immediately after surgery (T1) and more than 3 months after surgery (T3) were obtained in all patients. Cephalometric values including condylar height, overjet, SNA, SNB and pogonion position etc. were measured and compared before and after disc repositioning by statistical analysis. Fourteen patients (13 female, 1 male) were included in this study. Their average age was 16.7 years (range, 12-20 years).

RESULTS

Seven patients with 14 joints had an MRI at least 6 months (6-24 months, mean 14.3) prior to disc repositioning. When compared to the MRI taken just prior to surgery, of those 14 joints, 9 condyles (64.3%) had evidence of bone resorption, 5 condyles (35.7%) had new bone formation mostly at the posterior part of the condyle (21.4%). These MRIs showed the condylar height was reduced 0.81 mm ± 0.61 (P = 0.013). Pre-operative cephalometric radiographs showed increased overjet (P = 0.039). The mean post-operative follow-up was 9.4 months (range, 4-13 months). Postoperative MRI showed the condylar height increased 1.74 ± 0.98 mm after disc repositioning (P < 0.001). Newly generated bone was observed on all condyles. 84.6% of the new bone was formed on the superior and posterior-anterior surfaces. Postoperative cephalometric radiographs showed the SNB angle increased 1.83 ± 1.56°(P < 0.001), pogonion position (pg'-G') moved anteriorly 2.18 ± 3.13 mm (P = 0.028) and incisor overjet decreased 3.55 ± 1.86 mm (P < 0.001), whereas significant changes were not found in SNA, Sn - G Vert, Y-Axis, U1 SN, IMPA (L1-MP) and U1-L1 (P > 0.05).

CONCLUSION

Conservative treatment for ADD with Class II malocclusion in juvenile patients may cause condyle resorption and aggravate the dentofacial deformity. Disc repositioning combined with post-operative functional splints can effectively promote condylar growth and help correct the dentofacial deformity.

摘要

目的

评估髁突再定位术和术后功能夹板对伴有 II 类错牙合的青少年关节盘前移位（ADD）的治疗效果。

材料和方法

本研究纳入了经髁突再定位术和功能夹板治疗的双侧 ADD 伴 II 类错牙合的青少年患者（≤20 岁）。所有患者均在术前（T0）、术后即刻（T1）和术后 3 个月以上（T3）获得磁共振成像（MRI）和头颅侧位片。通过统计分析，测量并比较髁突再定位前后的头颅测量值，包括髁突高度、覆盖、SNA、SNB 和颏顶点位置等。本研究共纳入 14 例患者（13 名女性，1 名男性），平均年龄 16.7 岁（12-20 岁）。

结果

7 例 14 个关节在髁突再定位术前至少 6 个月（6-24 个月，平均 14.3 个月）进行了 MRI 检查。与术前 MRI 相比，14 个关节中，9 个髁突（64.3%）有骨质吸收的证据，5 个髁突（35.7%）有新骨形成，主要位于髁突后部（21.4%）。这些 MRI 显示髁突高度降低了 0.81mm±0.61（P=0.013）。术前头颅侧位片显示覆盖增加（P=0.039）。平均术后随访时间为 9.4 个月（4-13 个月）。术后 MRI 显示髁突再定位后髁突高度增加 1.74mm±0.98mm（P<0.001）。所有髁突均有新骨生成。84.6%的新骨形成在上、后前表面。术后头颅侧位片显示 SNB 角增加 1.83°±1.56°（P<0.001），颏顶点位置（pg'-G'）向前移动 2.18mm±3.13mm（P=0.028），切牙覆盖减少 3.55mm±1.86mm（P<0.001），而 SNA、Sn-G Vert、Y 轴、U1 SN、IMPA（L1-MP）和 U1-L1 无显著变化（P>0.05）。