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特发性髁突吸收的诊断与治疗:文献综述

Diagnosis and management of idiopathic condylar Resorption: A review of literature.

作者信息

Alali Yasser S, Al Habeeb Khaled M, Al Malhook Khaled A, Alshehri Sami

机构信息

Department of Oral and Maxillofacial Surgery, College of Dentistry, King Saud University, Riyadh 11545, Saudi Arabia.

Department of Biomedical Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia.

出版信息

Saudi Dent J. 2024 Nov;36(11):1397-1405. doi: 10.1016/j.sdentj.2024.09.013. Epub 2024 Sep 13.

Abstract

BACKGROUND AND OBJECTIVES

Idiopathic condylar resorption (ICR) can be described as a dysfunctional remodeling of the temporomandibular joint (TMJ). It is clinically characterized by morphological changes in TMJ including reduced ramus height, accelerated mandibular retrusion and reduced growth in juveniles. With a strong predilection towards females (90 %) within an age group of 10 to 40 years, diagnosis and management of ICR is a critical clinical challenge. The aim of this study is to present a comprehensive review of diagnosis and management strategies for ICR.

MATERIALS AND METHODS

Literature search based on keywords relating to ICR was conducted on PubMed (Medline) database. Studies fulfilling the inclusion criteria (reports based on clinical diagnosis and management of ICR) were selected for comprehensive review.

RESULTS

253 articles were identified through literature search. After abstract screening and full-text review, 54 studies were selected for qualitative synthesis. Diagnosis of ICR is established by combination of clinical and radiographic findings, patient history, and exclusion of all known local/systemic factors contributing to condylar resorption. Management of ICR depends on condylar activity and surgeon's ability to preserve the articular disc and mandibular condyle, and could either be surgical or non-surgical. Surgical treatment can be either by orthognathic surgery alone or through a combination of orthognathic and TMJ surgeries.

CONCLUSION

Based on the present review, it may be concluded that diagnosis and management of ICR requires adequate clinical understanding of the condition. Identifying the stage of ICR is important in deciding optimum treatment plan. While early-stage ICR could be managed non-surgically by orthodontic and splint therapies, advanced stage disease require simultaneous TMJ Surgery with orthognathic correction for skeletal stability. Future research should focus on elucidating underlying mechanisms of ICR, refining diagnostic criteria, and optimizing treatment protocols to enhance patient outcomes.

摘要

背景与目的

特发性髁突吸收(ICR)可被描述为颞下颌关节(TMJ)的功能失调性重塑。其临床特征为TMJ的形态变化,包括下颌升支高度降低、下颌后缩加速以及青少年生长发育减缓。ICR在10至40岁年龄组中强烈偏向女性(90%),其诊断和治疗是一项关键的临床挑战。本研究的目的是对ICR的诊断和治疗策略进行全面综述。

材料与方法

在PubMed(Medline)数据库上基于与ICR相关的关键词进行文献检索。选择符合纳入标准(基于ICR临床诊断和治疗的报告)的研究进行全面综述。

结果

通过文献检索确定了253篇文章。经过摘要筛选和全文审查,选择了54项研究进行定性综合分析。ICR的诊断通过临床和影像学检查结果、患者病史以及排除所有已知的导致髁突吸收的局部/全身因素来确立。ICR的治疗取决于髁突的活动情况以及外科医生保留关节盘和下颌髁突的能力,治疗方式可以是手术治疗或非手术治疗。手术治疗可以单独通过正颌手术,也可以通过正颌手术和TMJ手术联合进行。

结论

基于本综述,可以得出结论,ICR的诊断和治疗需要对该疾病有充分的临床认识。确定ICR的阶段对于决定最佳治疗方案很重要。早期ICR可以通过正畸和夹板治疗进行非手术管理,而晚期疾病则需要同时进行TMJ手术和正颌矫正以实现骨骼稳定。未来的研究应侧重于阐明ICR的潜在机制、完善诊断标准以及优化治疗方案以改善患者预后。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/855e/11605711/ed89ab7d3d90/gr1.jpg

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