Rikhotso Risimati E, Sekhoto Mmathabo G
Department of Maxillofacial and Oral Surgery, School of Oral Health Science, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
J Craniofac Surg. 2024 May 14;35(6):e536-40. doi: 10.1097/SCS.0000000000010223.
To evaluate and compare outcomes of patients with temporomandibular joint ankylosis (TMJA) treated by gap arthroplasty, costochondral graft, and total alloplastic joint reconstruction.
A retrospective cohort study reviewed and analyzed data from patients with TMJA from January 1, 2009 to December 31, 2019, at the Maxillofacial and Oral Surgery Department, University of the Witwatersrand. Patients with TMJA were treated either with gap arthroplasty, costochondral graft, or total alloplastic joint reconstruction. Data collected included age, sex, etiology of ankylosis, sides involved, preoperation and postoperation mouth opening (MO), treatment type, complications, and revision surgery. Patients were followed up for at least 18 months after the surgical procedure. Comparison of means across the treatment groups was analyzed using paired t tests or analysis of variance test. A P value of less than 0.05 was considered statistically significant.
The study sample comprised of 36 patients [bilateral, n=22; unilateral, n=14 (21 male, 15 female)]. Trauma was the most common etiology (n=27, 75%), followed by chronic infections (n=4, 11.11%) and juvenile arthritis (n=3, 8.3%). A paired t test revealed no statistical significance between treatment modality and postoperative MO and complications over 18 months (P=0.5316 and P=0.426, respectively). The mean MO increased from 4 to 28 mm. Reankylosis was the most common complication (n=5).
All 3 treatment options yield acceptable outcomes in patients with TMJA. Irrespective of surgical technique, early postoperative exercises, active physiotherapy, and follow-up are imperative for successful rehabilitation and prevention of reankylosis.
评估并比较间隙成形术、肋软骨移植术和全人工关节重建术治疗颞下颌关节强直（TMJA）患者的疗效。
一项回顾性队列研究，对2009年1月1日至2019年12月31日在威特沃特斯兰德大学颌面与口腔外科就诊的TMJA患者的数据进行回顾和分析。TMJA患者接受间隙成形术、肋软骨移植术或全人工关节重建术治疗。收集的数据包括年龄、性别、强直病因、受累侧、术前和术后开口度（MO）、治疗类型、并发症和翻修手术。手术后对患者进行至少18个月的随访。使用配对t检验或方差分析对各治疗组的均值进行比较分析。P值小于0.05被认为具有统计学意义。
研究样本包括36例患者[双侧，n = 22；单侧，n = 14（男性21例，女性15例）]。创伤是最常见的病因（n = 27，75%），其次是慢性感染（n = 4，11.11%）和幼年关节炎（n = 3，8.3%）。配对t检验显示，治疗方式与术后18个月的MO及并发症之间无统计学意义（P分别为0.5316和0.426）。平均MO从4毫米增加到28毫米。再次强直是最常见的并发症（n = 5）。
所有3种治疗方案对TMJA患者均产生可接受的疗效。无论手术技术如何，术后早期锻炼、积极的物理治疗和随访对于成功康复及预防再次强直至关重要。
