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同期行 SSRO 联合 Le Fort I 截骨术治疗伴颌骨畸形的单侧颞下颌关节强直的全关节假体重建: 病例队列研究。

Simultaneous standard total joint prosthesis reconstruction with SSRO and Le Fort I osteotomy in the treatment of unilateral temporomandibular joint ankylosis with jaw deformity: a case cohort study.

机构信息

Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China.

National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011, China.

出版信息

Clin Oral Investig. 2024 Feb 21;28(3):163. doi: 10.1007/s00784-024-05543-3.

Abstract

OBJECTIVE

Unilateral temporomandibular joint ankylosis with jaw deformity (UTMJAJD) may require simultaneous total joint prosthesis (TJP) reconstruction, sagittal split ramus (SSRO), and Le Fort I osteotomies. The purpose of this study was to evaluate outcomes in patients treated with these procedures.

METHODS

Patients diagnosed UTMJAJD between 2016 and 2018 were selected for the study. Mandible-first procedure was performed after ankylosis release with TJP on the ankylosed side and SSRO on the contralateral side. Le Fort I osteotomy with and without genioplasty was lastly performed. Maximal incisor opening (MIO), facial symmetry, and jaw and condyle stability were compared before, after operation, and during follow-ups.

RESULTS

Seven patients were included in the study. Their average chin deviation was 9.5 ± 4.2 mm, and maxillary cant was 5.1 ± 3.0°. After operation, jaw deformity significantly improved, with chin deviation corrected 7.6 ± 4.1 mm (p = 0.015) and advanced 5.9 ± 2.5 mm (p = 0.006). After an average follow-up of 26.6 ± 17.1 months, MIO significantly increased from 11.4 ± 9.3 to 35.7 ± 2.6 mm (p = 0.000). The occlusion was stable with no significant positional or rotational changes of the jaw (p > 0.05). There was no obvious condylar resorption during follow-ups.

CONCLUSION

Simultaneous TJP reconstruction, SSRO, and Le Fort I osteotomy are reliable and effective methods for the treatment of UTMJAJD.

摘要

目的

单侧颞下颌关节强直伴颌骨畸形(UTMJAJD)可能需要同时进行全关节假体(TJP)重建、矢状劈开下颌骨(SSRO)和 Le Fort I 截骨术。本研究的目的是评估这些手术治疗患者的结果。

方法

选择 2016 年至 2018 年间诊断为 UTMJAJD 的患者进行研究。在强直侧进行 TJP 松解后,先进行下颌骨手术,再对对侧进行 SSRO。最后进行 Le Fort I 截骨术,伴或不伴颏成形术。比较术前、术后和随访期间的最大切牙开口度(MIO)、面部对称性以及颌骨和髁突的稳定性。

结果

本研究纳入了 7 名患者。他们的平均下巴偏斜为 9.5 ± 4.2mm,上颌前突为 5.1 ± 3.0°。术后,颌骨畸形明显改善,下巴偏斜纠正了 7.6 ± 4.1mm(p=0.015),并向前移动了 5.9 ± 2.5mm(p=0.006)。平均随访 26.6 ± 17.1 个月后,MIO 从 11.4 ± 9.3mm 显著增加至 35.7 ± 2.6mm(p=0.000)。咬合稳定,颌骨无明显位置或旋转变化(p>0.05)。随访期间无明显髁突吸收。

结论

同时进行 TJP 重建、SSRO 和 Le Fort I 截骨术是治疗 UTMJAJD 的可靠有效方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cb64/10881754/b565ff81380b/784_2024_5543_Fig1_HTML.jpg

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