中国口腔颌面外科杂志

中国口腔颌面外科杂志 ›› 2016, Vol. 14 ›› Issue (2): 144-148.

• 论著 • 上一篇    下一篇

保存10 mm髁突头及关节附件的下颌骨切除重建方法探讨

白果1, #, 杨驰1, *, 郑志伟2, #, 方一鸣2, *   

  1. 1.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,上海市口腔医学重点实验室,上海 200011;
    2.温州医科大学附属第一医院 口腔颌面外科,浙江 温州 325000
  • 收稿日期:2015-08-22 出版日期:2016-03-20 发布日期:2016-04-06
  • 通讯作者: 杨驰,E-mail:yangchi63@hotmail.com;方一鸣,E-mail:fangyiming2003@sina.com。 *共同通信作者
  • 作者简介:白果（1989-）,男,住院医师,E-mail:surgeonb@163.com;郑志伟（1989-）,男,住院医师,E-mail:516578221@qq.com。#并列第一作者
  • 基金资助:
    上海市科学技术委员会科研计划项目（14DZ2294300）; 上海市科学技术委员会学科带头人计划（13XD1402300）

Mandible resection and reconstruction with preservation of 10 mm condyle and temporomandibular joint attachment

BAI Guo1, YANG Chi1, ZHENG Zhi-wei2, FANG Yi-ming2   

  1. 1.Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology. Shanghai 200011; 2. Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Wenzhou Medical University. Wenzhou 325000, Zhejiang Province, China
  • Received:2015-08-22 Online:2016-03-20 Published:2016-04-06

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摘要： 目的:探讨颞下颌关节保存性手术治疗未累及髁突头的下颌骨病变的效果。方法:下颌骨巨大成釉细胞瘤患者1例,采用计算机辅助设计技术确定瘤体边界及与髁突关节面的关系,模拟测量并设计截骨方法,制作数字化导板,于术中指导截骨。利用肋骨配合重建钛板连接保存的髁突头及下颌支残端,维持盘-髁关系和咬合稳定。通过术中对重要结构的保护、术后关节-颌骨-咬合评价及影像学随访,评价颞下颌关节保存性外科技术的治疗效果。结果:术中截骨导板就位顺利,指导术者沿肿瘤边界分块截骨后将瘤体连同累及骨质一并取出。保存下牙槽神经血管束,保留髁突头10 mm及关节盘等附件,用肋骨连接髁突头并行下颌骨残端关节重建。术后CT显示,成釉细胞瘤累及骨质被彻底切除,保留的髁突头与肋骨愈合良好。术后随访1年肿瘤无复发,关节功能维持良好、面型对称且咬合稳定,患者面部无麻木等异常感觉。结论:在未累及髁突关节面的下颌骨病变中,应用颞下颌关节保存性外科理念,辅以数字化导板,可在精确实现病灶切除的基础上保护髁突头及关节附件,有利于关节功能的保存,维持关节-颌骨-咬合三位一体的关系,术后疗效稳定。

关键词: 颞下颌关节, 保存性手术, 数字化导板, 成釉细胞瘤

Abstract: PURPOSE: To explore the effect of temporomandibular joint (TMJ) preservation surgery in the treatment for a giant mandibular ameloblastoma with healthy condylar head. METHODS: For 1 case of a giant mandibular ameloblastoma, computer-assisted technology was applied to determine the margins of the tumor and its relationship with the condylar head. Then anatomical measurements and virtual osteotomy simulation were performed based on which digital templates were made to guide intra-operative osteotomy. The condylar head was preserved and connected to the remaining ramus by costochondral graft, fixed with a reconstructive titanium plate, in order to keep the original condyle-disc relationship and a stable occlusion. The clinical effects were evaluated by intra-operative preservation of important anatomical structures, postoperative joint function, joint-jaw-occlusion relationship, as well as results of imaging follow-ups. RESULTS: Digital osteotomy templates were smoothly positioned and attached to bone surface and guided the resection of the affected region along the pre-designed margin of the ameloblastoma. The inferior alveolar nerve bundle had been well preserved; TMJ disc and normal condylar head with a height of 10 mm was also saved for mandible reconstruction with costochondral graft. Postoperative CT showed complete elimination of the ameloblastoma and its affected mandible region. The preserved condylar head and rib graft grew into each other well. One-year follow-up CT showed no recurrence of the tumor, and the patient had satisfactory functional TMJ, symmetrical facial appearance as well as stable occlusion. No facial numbness or other complications occurred. CONCLUSIONS: In the treatment of mandibular benign lesion with healthy condylar head, the concept of TMJ preservation surgery should be advocated with the facilitation of digital templates. In this way, accurate resection of the affected bone with preservation of the condylar head as well as TMJ attachments could be realized. This procedure could help maintain TMJ function and three-dimensional joint-jaw-occlusion relationship with stable post-operative outcomes.

Key words: Temporomandibular joint, Preservative surgery, Digital template, Ameloblastoma

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