Anchlia Sonal, Vyas Siddharth Mahesh, Dayatar Ramyata Girish, Domadia Hardi Laljibhai, Nagavadiya Vipul
Government Dental College and Hospital, Ahmedabad, Ahmedabad, India.
J Maxillofac Oral Surg. 2019 Sep;18(3):419-427. doi: 10.1007/s12663-018-1121-4. Epub 2018 Jun 28.
Treatment for TMJ Ankylosis aims at restoring joint function, improving the patient's aesthetic appearance and quality of life and preventing re-ankylosis. Mouth opening is achieved by gap arthroplasty with various options of interpositional materials. Ramus-condyle unit (RCU) reconstruction maintains the height of the ramus and prevents secondary occlusal problems. Advancement genioplasty corrects chin deformities as well as increases the posterior airway space (N-PAS) by the forward pull exerted on geniohyoid and genioglossus.
This prospective single-centre study on 43 joints in 25 adult patients with TMJ Ankylosis aimed at providing a single-staged management plan of ankylosis release, RCU reconstruction and extended advancement centering genioplasty. Interpositional arthroplasty was done using temporalis myofascial flap, abdominal dermis fat or buccal fat pad. RCU reconstruction was done either by vertical ramus osteotomy or L osteotomy.
Follow-up ranged from 12 to 20 months (mean 14.4). Average mouth opening at maximum follow-up was 34.36 mm with re-ankylosis in no case. Cephalometric parameters showed increase in point P to Pog, decrease in N perpendicular to Pog, angle N-A-Pog, Cg-ANS to Cg-Menton, neck-chin angle and labiomental angle. N-PAS increased, and average 50% improvement in AHI was seen in all patients with OSA. Most common complications involved transient paraesthesia of temporal and zygomatic branches of facial nerve.
Based on the findings of the above study, we propose treatment guidelines for treatment of TMJ ankylosis in adult patients with AHI < 20.
颞下颌关节强直的治疗旨在恢复关节功能、改善患者的美观及生活质量并预防再次强直。通过间隙关节成形术及多种置入材料选项来实现开口。升支髁突单位（RCU）重建可维持升支高度并预防继发性咬合问题。颏成形术可矫正颏部畸形，并通过对颏舌骨肌和颏舌肌施加向前拉力来增加后气道间隙（N-PAS）。
这项针对25例成年颞下颌关节强直患者43个关节的前瞻性单中心研究旨在提供一个一期治疗方案，包括强直松解、RCU重建及扩展的以颏部为中心的颏成形术。使用颞肌筋膜瓣、腹部真皮脂肪或颊脂垫进行置入关节成形术。通过垂直升支截骨术或L形截骨术进行RCU重建。
随访时间为12至20个月（平均14.4个月）。最大随访时的平均开口度为34.36毫米，无一例再次强直。头影测量参数显示P点至颏点距离增加，鼻根点至颏点垂线距离、鼻根点-关节点-颏点角、下颌角点-下牙槽座点至下颌角点-颏下点、颈颏角及唇颏角减小。N-PAS增加，所有阻塞性睡眠呼吸暂停患者的平均呼吸暂停低通气指数改善了50%。最常见的并发症是面神经颞支和颧支的短暂感觉异常。
基于上述研究结果，我们提出了针对成人呼吸暂停低通气指数<20的颞下颌关节强直患者的治疗指南。
