保存翼外肌附着的颞下颌关节肋骨-肋软骨移植重建术效果评价

doi:10.19438/j.cjoms.2018.05.007

中国口腔颌面外科杂志 ›› 2018, Vol. 16 ›› Issue (5): 420-424.doi: 10.19438/j.cjoms.2018.05.007

保存翼外肌附着的颞下颌关节肋骨-肋软骨移植重建术效果评价

王翔宇, 白果, 董敏俊, 霍亮, 郑吉驷, 陈敏洁^*, 杨驰^*

上海交通大学医学院附属第九人民医院·口腔医学院口腔外科,国家口腔疾病临床研究中心, 上海市口腔医学重点实验室,上海市口腔医学研究所,上海 200011

收稿日期:2018-03-12 出版日期:2018-09-20 发布日期:2018-11-06
通讯作者: 陈敏洁,E-mail: chenminjie00@126.com;杨驰,E-mail: yangchi63@hotmail.com。^*共同通信作者
作者简介:王翔宇(1992-),男,在读硕士研究生,E-mail:wxy_eric@hotmail.com
基金资助:
2016年上海市科学技术委员会西医引导项目（16411960800）; 上海市科学技术委员会“颞下颌关节病及颌面畸形诊治专业技术服务平台”项目; 2016年科技部国家重点研发计划项目子课题（2016YFC1100600）; 上海交通大学医学院Ⅳ类高峰学科项目（GXQ07）

Effect of modified costochondral graft in temporomandibular joint reconstruction with lateral pterygoid muscle preservation technique

WANG Xiang-yu, BAI Guo, DONG Min-jun, HUO Liang, ZHENG Ji-si, CHEN Min-jie, YANG Chi

Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology. Shanghai 200011, China;

Received:2018-03-12 Online:2018-09-20 Published:2018-11-06

摘要/Abstract

摘要： 目的: 探索一种保存翼外肌功能的颞下颌关节重建术式。方法: 对3例因严重颞下颌关节骨关节病行肋骨-肋软骨移植重建颞下颌关节的患者,采用髁突截骨下降的方法保存翼外肌附着,避免传统颞下颌关节置换术术中切断翼外肌对翼外肌功能所造成的损害。通过术后1年连续随访,从影像学结果与临床效果两方面评估该方法的稳定性与有效性。结果: 术后影像学检查证实,下降的髁突头与外侧移植的肋骨-肋软骨均贴合良好,无明显移位,肋骨-肋软骨与髁突头之间骨皮质连续,愈合良好;患侧翼外肌与髁突头附着紧密,肌束走行正常,未见明显肿胀、变形。术后连续1年的随访表明,采用保存翼外肌附着术式的患者,在开口度、前伸及侧方运动程度和饮食功能方面均恢复良好,且随着随访期的延长,下颌运动范围逐步增大。结论: 保留翼外肌附着的颞下颌关节重建术在术后下颌运动的恢复方面优于传统的颞下颌关节肋骨-肋软骨移植重建术。

关键词: 肋骨-肋软骨移植, 颞下颌关节, 翼外肌, 颞下颌关节重建

Abstract: PURPOSE: To explore a modified temporomandibular joint reconstruction which can preserve the maximum function of lateral pterygoid muscle. METHODS: In 3 cases with severe temporomandibular joint osteoarthrosis who received temporomandibular joint reconstruction with costochondral graft, we kept the integrity of condyle and lateral pterygoid muscle attachment and move them downwards to preserve the muscle function. Consecutive follow-ups, both radiographic and clinical, were carried out to evaluate its effectivity and reliability. RESULTS: Postoperative CT scan showed a satisfactory bone healing and almost normal lateral pterygoid muscle patterns. The one-year follow-up of 3 case series showed a desirable recovery of mouth opening, mandible movement range and diet quality. CONCLUSIONS: Lateral pterygoid muscle preservation technique showed an inspiring result of postoperative mouth opening recovery and improving range of lateral mandibular movement.

Key words: Costochondral graft, Temporomandibular joint, Lateral pterygoid muscle, Temporomandibular joint reconstruction

中图分类号:

R782.2

王翔宇, 白果, 董敏俊, 霍亮, 郑吉驷, 陈敏洁, 杨驰. 保存翼外肌附着的颞下颌关节肋骨-肋软骨移植重建术效果评价[J]. 中国口腔颌面外科杂志, 2018, 16(5): 420-424.

WANG Xiang-yu, BAI Guo, DONG Min-jun, HUO Liang, ZHENG Ji-si, CHEN Min-jie, YANG Chi. Effect of modified costochondral graft in temporomandibular joint reconstruction with lateral pterygoid muscle preservation technique[J]. China J Oral Maxillofac Surg, 2018, 16(5): 420-424.

参考文献

[1] Clark GT, Sanders B, Bertolami CN.Advances in diagnostic and surgical arthroscopy of the temporomandibular joint[J]. Implant Dent, 1993, 2(2): 136.
[2] Lieblich SE, Kleiman MA, Zak MJ.Parameters of care: clinical practice. Guidelines for oral and maxillofacial surgery(AAOMS ParCare 2012)[J]. J Oral Maxillofac Surg, 2012, 70(Suppl 3): e50-e71.
[3] Sidebottom AJ.Guidelines for the replacement of temporomandibular joints in the United Kingdom[J]. Br J Oral Maxillofac Surg, 2008, 46(2): 146-147.
[4] MacIntosh RB, Henny FA. A spectrum of application of autogenous costochondral grafts[J]. J Oral Maxillofac Surg, 1977, 5(4): 257-267.
[5] Saeed NR, Kent JN.A retrospective study of the costochondral graft in TMJ reconstruction[J]. Int J Oral Maxillofac Surg, 2003, 32(6): 606-609.
[6] Siemssen SO.Temporomandibular arthroplasty by transfer of the sterno-clavicular joint on a muscle pedicle[J]. Br J Plast Surg, 1982, 35(3): 225-238.
[7] Qiu Y, Yang C, Chen M.Endoscopically assisted reconstruction of the mandibular condyle with a costochondral graft through a modified preauricular approach[J]. Br J Oral Maxillofac Surg, 2010, 48(6): 443-447.
[8] Huang D, Lu C, Yao Z, et al.A comparison of the effect between coronoid process graft and costochondral graft in the reconstruction of temporomandibular joint[J]. J Craniofac Surg, 2016, 27(2): e197-e200.
[9] Mercuri LG.Condyle replacement after tumor resection: comparison of individual prefabricated titanium implants and costochondral grafts[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2009, 108(2): 153-155.
[10] Saeed N R, Hensher R, McLeod N, et al. Reconstruction of the temporomandibular joint autogenous compared with alloplastic[J]. Br J Oral Maxillofac Surg, 2002, 40(4): 296-299.
[11] 张晓虎, 杨驰, 陈敏洁, 等. 2例个体化人工关节用于颞下颌关节置换的初步效果评价[J]. 中国口腔颌面外科杂志, 2006, 4(6): 412-415.
[12] Collins CP, Wilson KJ, Collins PC.Lateral pterygoid myotomy with reattachment to the condylar neck: an adjunct to restore function after total joint reconstruction[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2003, 95(6): 672-673.
[13] Wilkes CH.Internal derangements of the temporomandibular joint: pathological variations[J]. Arch Otolarynchol Head Neck Surg, 1989, 115(4): 469-477.
[14] Hiraba K, Hibino K, Hiranuma K, et al.EMG activities of two heads of the human lateral pterygoid muscle in relation to mandibular condyle movement and biting force[J]. J Neurophysiol, 2000, 83(4): 2120-2137.
[15] McNamara JA Jr. The independent functions of the two heads of the lateral pterygoid muscle[J]. Am J Anat, 1973, 138(2): 197-205.
[16] Rasse M, Kermer C, Undt G.Functional reconstruction in a case of osteoblastoma of the mandibular condyle[J]. Int J Oral Maxillofac Surg, 1996, 25(5): 344-345.

保存翼外肌附着的颞下颌关节肋骨-肋软骨移植重建术效果评价

Effect of modified costochondral graft in temporomandibular joint reconstruction with lateral pterygoid muscle preservation technique

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