经髁突和盘后附着进路切除5例颞下间隙肿物

中国口腔颌面外科杂志 ›› 2016, Vol. 14 ›› Issue (4): 361-365.

经髁突和盘后附着进路切除5例颞下间隙肿物

叶周熹, 杨驰, 陈敏洁

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 200125

出版日期:2016-08-20 发布日期:2016-12-08
通讯作者: 杨驰,E-mail:yangchi63@hotmail.com
作者简介:叶周熹（1990-）,女,口腔医学七年制学生,E-mail:450219713@qq.com
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项目（13XD1402300）

A novel transcondylar approach combined with posterior disc attachment release for neoplasms near temporomandibular joint

YE Zhou-xi, YANG Chi, CHEN Min-jie

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,China

Online:2016-08-20 Published:2016-12-08

摘要/Abstract

摘要： 目的提出一种经髁突及盘后附着进路,归纳该术式的适应证、手术要点和评价临床效果。方法 2006—2014年对5例位于颞下颌关节（TMJ）旁肿物采用上述进路。5例肿物符合以下条件 —累及髁突后内侧颞下间隙较大的包膜完整的非恶性肿物,计算机模拟手术示单纯髁突离断旋转或后移无法充分暴露肿物。结果 5例肿物均得以彻底切除,未损伤重要神经,未输血。5例病例平均随访30个月,未见复发迹象。术后无继发牙颌面畸形,神经功能正常。随访时开口度平均为34 mm,均较术前有所增加（术前开口度平均为27 mm）,CT示髁突固定良好,无吸收。结论经髁突和盘后附着进路适于切除累及髁突后内侧较大的非恶性肿物,计算机设计和模拟手术有助于选择进路和适应证。

关键词: 颞下颌关节旁肿物, 颞下间隙, 经髁突进路, 关节盘后附着

Abstract: PURPOSE: To introduce a novel transcondylar approach and discuss its indications, surgical procedures and preliminary clinical effects. METHODS: The novel approach was used in 5 cases from January 2006 to December 2014. The common characteristics of the 5 masses were: ①non-malignant encapsulated neoplasm involving the postero-medial region to the condyle; ②surgical exposure was incomplete by rotating or moving backward of the condyle based on the digital surgical simulation. RESULTS: All masses were resected successfully by using the novel approach with no damage to the critical nerves and vessels. The average follow-up period was 29.8 months (range 6-56 months). No recurrence, secondary deformity or facial paralysis were found. The average of mouth opening was improved from 27 mm to 34 mm after surgery. The condyles were fixed well with no resorption shown on CT scans. CONCLUSIONS: The transcondylar approach combined with posterior disc attachment release could be used for resection of non-malignant neoplasms involving the postero-medial region to the condyle. 3D reconstruction of CT and surgical simulation can help to determine the indications.

Key words: Neoplasm close to temporomandibular joint, Infratemporal space, Transcondylar approach, Posterior disc attachment

中图分类号:

R782.1

叶周熹, 杨驰, 陈敏洁. 经髁突和盘后附着进路切除5例颞下间隙肿物[J]. 中国口腔颌面外科杂志, 2016, 14(4): 361-365.

YE Zhou-xi, YANG Chi, CHEN Min-jie. A novel transcondylar approach combined with posterior disc attachment release for neoplasms near temporomandibular joint[J]. China J Oral Maxillofac Surg, 2016, 14(4): 361-365.

参考文献

[1] Tiwari R, Quak J, Egeler S, et al. Tumors of the infratemporal fossa [J]. Skull Base Surg, 2000, 10(1): 1-9.
[2] Yang XJ Jr, Yang C, Chen MJ, et al. Preauricular transcondylar approach for basal cell adenoma of parotid coexist with ganglion cyst of the ipsilateral temporomandibular joint [J]. J Craniofac Surg, 2011, 22(6): e23-e26.
[3] Bai G, He D, Yang C, et al. Effect of digital template in the assistant of a giant condylar osteochondroma resection [J]. J Craniofac surg, 2014, 25(3): e301-e304.
[4] Huang D, He DM, Yang C, et al. Computer-assisted local resection for exostosis osteochondroma of the mandibular condyle[J]. J Craniofac Surg, 2013, 24(4): e446-e449.
[5] Chen Y, Cai XY, Yang C, et al. Pigmented villonodular synovitis of the temporomandibular joint with intracranial extension [J]. J Craniofac Surg, 2015, 26(2): e115-e118.
[6] Carlson E. Parameters of care: clinical practice guidelines for oral and maxillofacial surgery (AAOMS ParCare 2012) [J]. J Oral Maxillofac Surg, 2012, 70(Suppl 3): e204-e231.
[7] Jiang B, Yang C, Chen MJ, et al. Synovial condromatosis of the temporomandibular joint with articular eminence extension [J]. J Craniofac Surg, 2012, 23(3): 716-718.
[8] Chen M, Yang C, He D, et al. Soft tissue reduction during open treatment of intracapsular condylar fracture of the temporomandibular joint: our institution's experience [J]. J Oral Maxillofac Surg, 2010, 68(9): 2189-2195.
[9] Iizuka T, Lindqvist C, Hallikainen D, et al. Severe bone resorption and osteoarthrosis after miniplate fixation of high condylar fractures. A clinical and radiologic study of thirteen patients [J]. Oral Surg Oral Med Oral Pathol, 1991, 72(4): 400-407.
[10] Zhang Y, He DM. Clinical investigation of early post-traumatic temporomandibular joint ankylosis and the role of repositioning discs in treatment [J]. Int J Oral Maxillofac Surg, 2006, 35(12): 1096-1101.
[11] Chuong R, Piper MA. Open reduction of condylar fractions of the mandible in conjunction with repair of discal injury: a preliminary report [J]. J Oral Maxillofac Surg, 1988, 46(4): 257-263.
[12] Chen M, Yang C, Qiu Y, et al. Superior half of sternoclavicular joint pedicled with sternocleidomastoid muscle for reconstruction of the temporomandibular joint: a preliminary study with simplified technique and enlarged indications [J]. Int J Oral Maxillofac Surg, 2015, 44(6): 685-691.