Prasad Cheruvathur, Deepa M, Triveni Palani, Arunkumar Kamalakaran
Department of Oral and Maxillofacial Surgery, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India.
Ann Maxillofac Surg. 2022 Jan-Jun;12(1):39-45. doi: 10.4103/ams.ams_77_22. Epub 2022 Aug 16.
Temporomandibular joint (TMJ) ankylosis is a pathologic condition where the mandible is fused to the fossa by bony or fibrotic tissues. Haemorrhage is one of the major complications during TMJ surgery especially in ankyloses due to altered anatomy. The aim of the study was to analyse the proximity of the vasculature to the TMJ region in TMJ ankylosis patients using magnetic resonance imaging (MRI).
Noncontrast-enhanced MRI images of seven patients were assessed. The distance between maxillary artery and neck of condyle/ankylotic mass was measured using coronal sections and distance between the internal carotid artery (ICA), internal jugular vein (IJV) and medial edge of condyle/bony mass were measured using axial sections.
The mean distance of internal maxillary artery (IMA) to medial edge of ankylotic mass was 1 ± 0.57 mm and 2 ± 1.2 mm-left and right condylar regions respectively (range: 0-4 mm).The mean distance from lateral aspect of ankylotic mass to IMA was 8.2 ± 1.4 mm and 8.7 ± 2.8 mm-right and left condylar regions respectively (range: 3-11 mm).The mean distance from medial edge of condyle to ICA was 18.8 ± 1.3 mm and 18.2 ± 1.1 mm-right and left condylar regions respectively (range: 17 mm-20 mm).The mean distance from the medial edge of condyle to IJV was 16.4 ± 1.1 mm and 14.5 ± 2.9 mm-right and left condylar regions (range: 11 mm-19 mm).
These measurements were used as a guide to plan the steps during surgery in order to minimise the intraoperative haemorrhagic complications. Hence, MRI may be considered as a valuable tool in assessing the juxtaposition of vascular bed to TMJ region, though contrast MRI and a larger sample is needed to standardise.
颞下颌关节强直是一种病理状态，即下颌骨通过骨组织或纤维组织与关节窝融合。出血是颞下颌关节手术期间的主要并发症之一，尤其是在因解剖结构改变导致的关节强直手术中。本研究的目的是使用磁共振成像（MRI）分析颞下颌关节强直患者血管系统与颞下颌关节区域的接近程度。
评估了7例患者的非增强MRI图像。使用冠状面测量上颌动脉与髁突颈部/强直块之间的距离，使用横断面测量颈内动脉（ICA）、颈内静脉（IJV）与髁突/骨块内侧边缘之间的距离。
上颌内动脉（IMA）至强直块内侧边缘的平均距离分别为左侧髁突区域1±0.57mm和右侧髁突区域2±1.2mm（范围：0 - 4mm）。强直块外侧至IMA的平均距离分别为右侧髁突区域8.2±1.4mm和左侧髁突区域8.7±2.8mm（范围：3 - 11mm）。髁突内侧边缘至ICA的平均距离分别为右侧髁突区域18.8±1.3mm和左侧髁突区域18.2±1.1mm（范围：17mm - 20mm）。髁突内侧边缘至IJV的平均距离分别为右侧髁突区域16.4±1.1mm和左侧髁突区域14.5±2.9mm（范围：11mm - 19mm）。
这些测量结果可作为手术步骤规划的指导，以尽量减少术中出血并发症。因此，MRI可被视为评估血管床与颞下颌关节区域毗邻关系的有价值工具，不过需要对比增强MRI和更大样本量来进行标准化。
