Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia.
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, National University of Singapore, Singapore.
Br J Oral Maxillofac Surg. 2024 Nov;62(9):857-865. doi: 10.1016/j.bjoms.2024.08.003. Epub 2024 Aug 19.
Complex functional issues arising from temporomandibular joint (TMJ) ankylosis are associated with abnormal mandibular growth secondary to the condylar-glenoid fossa and its surrounding structures. These include severe limited mouth opening, micrognathia, mandibular asymmetry, and obstructive sleep apnoea (OSA), which necessitate effective treatment to allow optimum functional rehabilitation. This article aims to present a comprehensive systematic review of the surgical strategy for patients who present with a triad of TMJ ankylosis, micrognathia and OSA via a literature search of PubMed, Google Scholar, and Scopus following PRISMA guidelines. The outcomes of interest were difference in maximum mouth opening, incidence of reankylosis, amount of mandibular advancement, posterior airway space, preoperative and postoperative apnoea/hypopnoea index, and arterial oxygen saturation, as well as changes in other cephalometric or polysomnographic variables. Thirty four studies involving 360 patients were included. Surgical interventions included distraction osteogenesis (DO), release of TMJ ankylosis and mandibular advancement, simultaneous arthroplasty and DO, pre-athroplasty DO, and post-arthroplasty DO. Most studies reported functional post-intervention mouth opening, with reankylosis reported in four. Mandibular advancement was between 6 mm and 34 mm. All studies reported improvement in the various polysomnographic variables measured. In conclusion, the systematic review was conducted based on a low level of literature evidence. Even though various surgical strategies were reported, effective case-specific management of TMJ ankylosis with micrognathia and OSA requires comprehensive assessment and careful consideration of surgical options that promote mandibular advancement and airway improvement.
颞下颌关节（TMJ）强直引起的复杂功能问题与髁突-关节窝及其周围结构继发的下颌骨异常生长有关。这些问题包括严重的张口受限、小颌畸形、下颌骨不对称和阻塞性睡眠呼吸暂停（OSA），需要有效的治疗以实现最佳的功能康复。本文旨在通过 PRISMA 指南对 PubMed、Google Scholar 和 Scopus 进行文献检索，对 TMJ 强直、小颌畸形和 OSA 三联征患者的手术策略进行全面系统的综述。主要的研究结果为：最大张口度的差异、再强直发生率、下颌骨前伸量、后气道空间、术前和术后呼吸暂停/低通气指数以及动脉血氧饱和度的变化，以及其他头影测量或多导睡眠图变量的变化。共有 34 项研究纳入 360 例患者。手术干预包括牵张成骨（DO）、TMJ 强直松解和下颌骨前伸、同时关节成形术和 DO、预关节成形术 DO 和后关节成形术 DO。大多数研究报告了术后干预后的张口功能，有 4 项研究报告了再强直。下颌骨前伸量为 6-34mm。所有研究均报告了各种多导睡眠图变量的改善。总之，该系统评价基于低水平的文献证据。尽管报告了各种手术策略，但对于 TMJ 强直伴小颌畸形和 OSA 的有效个体化治疗需要全面评估，并仔细考虑促进下颌骨前伸和气道改善的手术选择。
