摘要
目的:探讨应用定量截骨锯行口腔入路髁突骨软骨瘤切除人工颞下颌关节置换术。方法:采用口内下颌骨矢状截骨手术入路,用定量截骨锯下颌骨升支后缘垂直截骨,将升支后缘骨块和髁突及骨软骨瘤游离取出,体外直视下病变髁突及骨软骨瘤切除后,人工颞下颌关节与升支后缘骨块固定,再从口腔原切口回植,颞下颌关节重建。5例5侧采用本方法治疗,配合术中术后调牙合或矫治器矫治,调整咬合关系。结果:术后6月、12月、24月复查,全部患者开口范围25mm～35mm,平均30.3mm,1例有早接触,下切牙中线过矫正1mm。另1例张口约25mm,轻度受限。3名患者6月复查主诉张口时人工关节侧有异常声响,无疼痛。12月复查时,异常响声基本消失,无主诉关节疼痛与弹响症状。全部患者无面神经、耳大神经损伤,无涎瘘,面颈皮肤无手术疤痕。结论:髁突骨软骨瘤造成面下1/3歪斜畸形,口腔入路具有无外部疤痕优势,且不会损伤面神经。定量截骨锯定量准确,截骨速度较快。
Objective：Temporomandibular Joint Replacement with artifical condyle using the intraoral vertical osteotomy, to avoid the facial incision.Method： five patients with condylar osteoosteochondroma underwent this operation. the mandibular ramus was osteotomy vertically with a quantitation saw. The posterior border bone block of mandibular ramus was taken out of the mouth, under direct vision, condylar osteochondroma is resected. Artifical condyle and the posterior border bone block of mandibular ramus were reunion with two or three titanium screw. The reunion bone was implanted and reposited in the mouth incision. The malocclusion and asymmetry are corrected Result： secured fixation of artifical condyle was achieved in all patients without facial nerve and major auricular nerve damage, without salivary fistula. The range of mouth opening was 25mm-35mm. 3-D CT show the artifical condyle was in the glenoid fossa. An intraoral approach avoids large facial scars, facial nerve injury, and allows visualization of the occlusion during the procedure. Conclusion： As the patient is paying more and more attention on out appearance, The transoral approach proved to be a reliable surgical approach for temporomandibular joint replacement with artifical condyle, the risk of facial nerve damage can be reduced and without extensive visible scars.
出处
《临床口腔医学杂志》
2007年第2期95-97,共3页
Journal of Clinical Stomatology
基金
国家自然科学基金(30471902)
首都医学发展科研基金项目(20023091)
