Yue Shijing, Zhao Jiong, Wu Siyu, Xie Qianyang, Luo Yi, Nie Xin, Chen Minjie, Bai Guo, Yang Chi
Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China.
Biostatistics Office of Clinical Research Unit, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Int J Surg. 2025 Jul 17;111(11):8079-87. doi: 10.1097/JS9.0000000000002926.
The primary controversy surrounding the treatment of anterior disc displacement (ADD) of temporomandibular joints (TMJ) stems from the unclear relationship between disc position and condylar adaptation. The long-term impact of varying disc position on condylar bone remodeling remains poorly understood.
A randomized controlled clinical trial was conducted to evaluate the effects of different disc positions on condylar bone modeling/remodeling at baseline (T0) and after an 18-month-follow-up (T1). Patients under 25 years of age diagnosed with TMJ ADD without reduction (ADDwoR) were enrolled and randomly assigned in a 1:1 ratio to either the disc displaced (DD) group or the disc reposited (DR) group. Participants in the DR group underwent arthroscopic disc repositioning surgery, whereas those in the DD group received no occlusal or surgery intervention. CT scans were obtained at T0 and T1 and three-dimensional condylar reconstructions were generated using Mimics21.0 software. Seven anatomical points were defined on the condylar surface to represent distinct regions. The condylar volume and vertical height of seven points were measured for analysis.
This study included 60 patients with ADDwoR. At T1, the DR group demonstrated a significant increase in total condylar volume of 279.6 mm3 per patient, compared to a slight 29.5 mm3 increase in the DD group (p <0.0001). Differential height changes were observed between groups, particularly at the posterolateral and lateral condylar surfaces (p <0.05). Besides, anterolaterally displaced discs were associated with bone resorption at the posteromedial condyle, in contrast to anteromedially displaced discs at T0 (p <0.01).
This study provides compelling evidence that ADDwoR restricts condylar bone growth in adolescents and young adults. Furthermore, disc position directly determines patterns of condylar bone modeling and remodeling in this population.
围绕颞下颌关节（TMJ）前盘移位（ADD）治疗的主要争议源于盘位置与髁突适应性之间的关系不明确。不同盘位置对髁突骨重塑的长期影响仍知之甚少。
进行了一项随机对照临床试验，以评估不同盘位置在基线（T0）和18个月随访后（T1）对髁突骨建模/重塑的影响。纳入25岁以下诊断为TMJ不可复性盘前移位（ADDwoR）的患者，并以1:1的比例随机分配到盘移位（DD）组或盘复位（DR）组。DR组的参与者接受了关节镜下盘复位手术，而DD组的参与者未接受咬合或手术干预。在T0和T1时进行CT扫描，并使用Mimics21.0软件生成三维髁突重建。在髁突表面定义了七个解剖点以代表不同区域。测量七个点的髁突体积和垂直高度以进行分析。
本研究纳入了60例ADDwoR患者。在T1时，DR组患者的髁突总体积显著增加，每人增加279.6 mm³，而DD组仅轻微增加29.5 mm³（p <0.0001）。两组之间观察到不同的高度变化，特别是在髁突后外侧和外侧表面（p <0.05）。此外，与T0时前内侧移位的盘相比，前外侧移位的盘与后内侧髁突的骨吸收有关（p <0.01）。
本研究提供了令人信服的证据，表明ADDwoR会限制青少年和年轻成年人的髁突骨生长。此外，盘位置直接决定了该人群中髁突骨建模和重塑的模式。
