Li Shensui, Tian Xudong, Wu Yadong, Wang Weili, Tang Zhenglong
Dept. of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital of Guizhou Medical University, Guiyang 550004, China.
Dept. of Hematology, Affiliated Hos-pital of Guizhou Medical University, Guiyang 550004, China.
Hua Xi Kou Qiang Yi Xue Za Zhi. 2025 Jun 1;43(3):422-430. doi: 10.7518/hxkq.2025.2024337.
This retrospective study aimed to investigate factors influencing positional changes of the condyle and temporomandibular joint (TMJ) following mandibular defect reconstruction with bone flaps, and to evaluate the biomechanical impacts of flap reconstruction on condylar positioning, thereby providing evidence for optimizing surgical protocols and TMJ functional rehabilitation.
A retrospective study was conducted on 90 patients undergoing mandibular segmental resection with immediate bone flap reconstruction at Guizhou Medical University Affiliated Stomatological Hospital (June 2019 to May 2024). After strict screening, 50 cases with complete data were analyzed. Clinical parameters (defect size, location, reconstruction method) and craniofacial CT scans at four timepoints [preoperative (T0), 7-10 days (T1), 3 months (T2), and 6 months (T3) postoperatively] were collected. Mimics 20 software facilitated 3D reconstruction for measuring TMJ anterior/posterior/superior joint spaces (Kamelchuk method) and calculating condylar position via the Pullinger index [Ln (posterior/anterior space)]. Vitral and Krisjane methods quantified mandibular linear parameters (ramus length, condylar pole distances to the sagittal plane, angulation) and glenoid fossa morphology. Statistical analyses were performed using SPSS 21.0.
Mandibular defect size and location were significant factors influencing postoperative condylar position changes (<0.05). Compared to preoperative measurements, postoperative condylar anterior, posterior, and superior joint spaces were significantly increased (<0.001). The most pronounced anterior condylar displacement occurred within 7-10 days postoperatively (<0.05). In patients with condyle resection, postoperative joint space and angle changes were significant; in patients with condyle preservation, only superior and anterior joint space changes were statistically significant (<0.05). Additionally, from T1 to T2, the changes in condylar medial-lateral distance, superior joint space, and anterior joint space were negatively correlated with the preoperative condylar position. Compared with preoperative,in the T0-T1 period, condylar medial-lateral distance, posterior joint space, and articular tubercle angle changes were significantly negatively correlated with time (<0.05). Notably, the angle between the condylar long axis and the coronal axis showed a sustained negative trend from T1 to T3 (<0.05).
Condylar position changes after mandibular defect repair with bone flap reconstruction are associated with the size and location of the defect. Additionally, adaptive remodeling of the temporomandibular joint (TMJ) joint space occurs postoperatively. The phenomenon of anterior displacement of the condyle in the early postoperative period (7-10 days) shows a trend of reduction with prolonged follow-up time, and further sample size research is needed.
本回顾性研究旨在探讨影响下颌骨缺损骨瓣重建术后髁突及颞下颌关节（TMJ）位置变化的因素，并评估瓣状重建对髁突定位的生物力学影响，从而为优化手术方案和TMJ功能康复提供依据。
对贵州医科大学附属口腔医院2019年6月至2024年5月期间90例行下颌骨节段性切除并即刻骨瓣重建的患者进行回顾性研究。经过严格筛选，分析了50例数据完整的病例。收集临床参数（缺损大小、位置、重建方法）以及四个时间点[术前（T0）、术后7 - 10天（T1）、3个月（T2）和6个月（T3）]的颅面部CT扫描图像。利用Mimics 20软件进行三维重建，以测量TMJ的前/后/上关节间隙（Kamelchuk法），并通过Pullinger指数[Ln（后/前间隙）]计算髁突位置。Vitral和Krisjane方法量化下颌骨线性参数（升支长度、髁突极点到矢状面的距离、角度）以及关节窝形态。使用SPSS 21.0进行统计分析。
下颌骨缺损大小和位置是影响术后髁突位置变化的重要因素（<0.05）。与术前测量值相比，术后髁突的前、后和上关节间隙均显著增加（<0.001）。术后7 - 10天内髁突向前移位最为明显（<0.05）。在髁突切除的患者中，术后关节间隙和角度变化显著；在髁突保留的患者中，仅上关节间隙和前关节间隙变化具有统计学意义（<0.05）。此外，从T1到T2，髁突内外侧距离、上关节间隙和前关节间隙的变化与术前髁突位置呈负相关。与术前相比，在T0 - T1期，髁突内外侧距离、后关节间隙和关节结节角度变化与时间呈显著负相关（<0.05）。值得注意的是，从T1到T3，髁突长轴与冠状轴之间的角度呈持续负向趋势（<0.05）。
下颌骨缺损骨瓣重建修复术后髁突位置变化与缺损大小和位置有关。此外，颞下颌关节（TMJ）关节间隙术后发生适应性重塑。术后早期（7 - 10天）髁突向前移位的现象随着随访时间延长有减轻趋势，需要进一步扩大样本量研究。
