Senior Professor and Head, Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, New Delhi, India.
Postgraduate, Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, New Delhi, India.
J Oral Maxillofac Surg. 2022 Jul;80(7):1158-1173. doi: 10.1016/j.joms.2022.03.008. Epub 2022 Mar 15.
A proper anatomical disc-condyle position is a prerequisite to prevent progressive deteriorating changes within the temporomandibular joint. Surgery becomes the primary treatment option for patients who do not recover with nonoperative management. The present study aimed to compare the clinical outcome of 2 different surgical procedures in patients with internal derangement of the temporomandibular joint.
A prospective clinical cohort study was conducted among patients presenting to outpatient department of Oral and Maxillofacial Surgery at Maulana Azad Institute of Dental Sciences. The study sample was alternatively allocated into 2 treatment groups; Group I: modified condylotomy (MC) and Group II: high-condylar shave with eminectomy (HCSE). The primary outcome variables included pain on function, tenderness on palpation, and maximum mouth opening. The secondary outcome variables included joint sounds, jaw deviation on opening, maximum protrusive jaw movement, maximum ipsilateral jaw movement, and maximum contralateral jaw movement. The covariates were age, sex of the patient, duration of illness, the diagnosis based on Wilkes's staging, and the laterality (whether unilateral or bilateral). Descriptive, comparative, and regression analyses were conducted.
Twenty-one patients with Wilkes Stage II, III, and IV were included in the study (MC: 10 patients and HCSE: 11 patients). The mean age of the study sample was 32.67 (±11.66) years. Among 21 patients recruited in our study, 18 were females. It was observed that after 1-year follow-up, patients in Group I had significantly lower pain on function (0.30 ± 0.48) compared with Group II (3.00 ± 1.18). (P < .001). Similarly, tenderness on palpation was significantly decreased in Group I (0.80 ± 0.48) compared with Group II (2.45 ± 0.93; P < .001). Joint sounds were significantly lower in Group I (1.20 ± 0.63) compared with Group II (2.27 ± 0.90) after 1 year (P < .001). Maximum protrusive jaw movement and maximum ipsilateral jaw movement were significantly higher in Group I compared with Group II after 1 year.
MC is a comparatively better surgical procedure than HCSE in patients with internal derangement of the TMJ.
适当的关节盘-髁突解剖位置是预防颞下颌关节进行性恶化的前提。对于非手术治疗后无法恢复的患者，手术成为主要的治疗选择。本研究旨在比较两种不同手术方法治疗颞下颌关节内紊乱患者的临床效果。
一项前瞻性临床队列研究在 Maulana Azad 牙科学院口腔颌面外科门诊进行。研究样本被交替分配到 2 个治疗组：I 组：改良髁突切开术（MC）和 II 组：高髁突切除术伴切除术（HCSE）。主要结局变量包括功能时疼痛、触诊时压痛和最大张口度。次要结局变量包括关节音、开口时下颌偏斜、最大前伸下颌运动、最大同侧下颌运动和最大对侧下颌运动。协变量包括年龄、患者性别、疾病持续时间、基于 Wilkes 分期的诊断以及偏侧性（单侧或双侧）。进行描述性、比较性和回归分析。
本研究纳入了 Wilkes 分期 II、III 和 IV 期的 21 例患者（MC 组：10 例，HCSE 组：11 例）。研究样本的平均年龄为 32.67（±11.66）岁。在我们研究中招募的 21 名患者中，有 18 名女性。研究结果显示，在 1 年随访后，I 组患者的功能时疼痛明显低于 II 组（0.30±0.48 比 3.00±1.18）。（P<0.001）。同样，I 组的触诊压痛明显低于 II 组（0.80±0.48 比 2.45±0.93；P<0.001）。1 年后，I 组的关节音明显低于 II 组（1.20±0.63 比 2.27±0.90）。（P<0.001）。1 年后，I 组的最大前伸下颌运动和最大同侧下颌运动明显高于 II 组。
在颞下颌关节内紊乱患者中，MC 是一种比 HCSE 更好的手术方法。
