翼外肌的解剖,功能与功能紊乱

翼外肌与颞颌关节关系密切，其功能状态可影响颞颌关节的结构和功能。对翼外肌的解剖，功能及功能紊乱，在多数学者认为，翼外肌分为上，下两头，上头纤维附着于关节盘和关节盘和关节囊，部分纤维附着于髁突，下头纤维则附着于髁突颈部；翼外肌上头具有闭口肌的特性，而下头则属开口肌，上下头共同发挥稳定关节盘等结构，协同关节运动的作用；翼外肌功能紊乱可导致关节结构和功能紊乱，其中翼外肌上头功能紊乱是关节盘前移位的重要原     

翼外肌与颞颌关节盘

对于翼外肌与颞颌关节盘的关系,在学者中存在一些不同的观点:①认为翼外肌上头的上份纤维附着于关节盘和关节囊,并主要附着于其中份,翼外肌上头的下份纤维与翼外肌下头一起附着于髁状突颈部;②认为翼外肌上头不附着于关节盘;③认为翼外肌上头直接附着于关节盘和髁状突;④认为翼外肌上头仅附着于颞颌关节盘和关节囊的前缘。为何有这不同观点     

翼外肌的解剖、功能与功能紊乱

翼外肌与颞颌关节关系密切,其功能状态可影响颞颌关节的结构和功能。对翼外肌的解剖、功能及功能紊乱,目前大多数学者认为,翼外肌分为上、下两头,上头纤维附着于关节盘和关节囊,部分纤维附着于髁突,下头纤维则附着于髁突颈部;翼外肌上头具有闭口肌的特性,而下头则属开口肌,上下头共同发挥稳定关节盘等结构,协同关节运动的作用;翼外肌功能紊乱可导致关节结构和功能紊乱,其中翼外肌上头功能紊乱是关节盘前移位的重要原因之一。     

翼外肌的附面——眼颌关节的解剖学研究

翼外肌上头是仅附着于关节盘,还是大部分附着于关节盘,少数肌纤维附着于髁状突。或是大部分附着于髁状突,少数肌纤维附着于关节盘,目前尚存在争论。为此,作者对10具尸颅的20侧颞下颌关节及其周围组织进行了连续切片的组织学观察,结果显示:翼外肌上头与下头在颞颌关节前方融合并在关节的内侧形成强大的肌肉壁。在关节盘前带的外1/3处,未见翼外肌附着;在关节盘前带的中1/3处,翼外肌纤维行经关节盘的下方,附着于髁状突颈部的关节翼肌窝上部;仅于     

翼外肌上头与颞颌关节的形态学联系及其意义

作者通过垂直于髁状突横轴的颞下颌关节连续矢状组织切片，观察了３０侧成人翼外肌上头与颞下颌关节的解剖联系。结果：翼外肌上头主要附丽于髁状突。仅见不到半数的关节盘（４６．６７％）有少量肌纤维附丽，且附丽范围限于关节盘的内侧１／６段。作者据此对Ｂｅｌｌ关于颞下颌关节功能运动的生物机械学机制的解剖学基础提出了质疑，对翼外肌上头功能亢进引起关节盘前移位的观点作了商榷，对翼外肌上头的生物机械学机制作了新的解释．     

翼外肌对可复性颞下颌关节盘前移位的作用机制

目的 分析可复性关节盘移位中翼外肌作用下颞下颌关节的应力分布情况。方法 利用已建立的可复性关节盘前移位颞下颌关节数字化仿真模型,在单纯翼外肌加载下进行生物力学分析。结果 关节盘应力集中于关节盘中间带偏外侧区域;髁突及关节窝应力主要集中于与关节盘相接触的功能面。在颞下颌关节盘的位移分布中,从关节盘前带至关节盘中间带,位移趋势逐渐增大,关节盘中间带与关节盘后带之间出现位移撕裂带,从关节盘中间带至关节盘双板区位移逐渐递减;而颞下颌关节整体位移最大值出现在关节囊前份的翼外肌上头附着区。结论 在可复性关节盘前移位中翼外肌可导致关节盘中间带偏外侧区域的应力集中,可能导致此区域关节盘变薄、穿孔甚至撕裂。     

翼外肌上头与颞颌关节的形态学联系及其意义

作者通过垂于髁状突横轴的颞下颌关节连结矢庆组织切片，观察了３０侧成人翼外肌人头与颞下颌关节的解剖联系。结果：翼外肌上头主要附丽于髁状突，仅见不到半数的关节盘有少量肌纤维附丽，且附丽范围限于关节盘的内侧１／６段。作者据此对Ｂｅｌｌ关于颞下颌关节功能运动的生物机械学机制的解剖学基础提出了质疑对翼外肌上头功能亢进引起关节盘前移位的观点作了商榷，对翼外面上头的生物机械学机制作了新的解释。     

翼外肌上头附着的形态测定分析

对与颞颌关节有关疾病和关节盘前脱位的解释,翼外肌特别是其上头,一直是许多研究的焦点。虽然认为其属真正的关节肌肉,对其上头附着的认识仍有分歧。本研究目的即为记录翼外肌上头的长度,并对其附着于关节盘、髁状突肌纤维的数量予以量化分析。 材料和方法 尸体40具,男25,女15。只使用一侧关节。其中6例不符要求被剔除。翼外肌上头既附着于关节盘又附着于髁状突的标本26例,其中22例肌肉附着的横断面用来进行形态测定分析。由颞下嵴肌     

颞下颌关节盘前区的解剖学与组织学观察

为探索颞下颌关节盘前区在颞下颌关节紊乱综合征发病中的作用,作者利用47侧老年尸体颞下颌关节斜矢状面组织学切片,观察盘前区的解剖结构,并比较在盘位改变、骨质改变时盘前区的组织学变化.观察表明:①关节盘前区包括关节盘纤维向前延伸的部分、下颌前附着、颞前附着、盘前方附着间的疏松组织及与关节盘关系密切的翼外肌;②关节盘前区的这些组织确实存在可引起关节症状及加重关节退行性变的改变;③关节盘前移及盘穿孔的标本翼外肌上头就业性的发生率明显增高.因此,盘前区无论结构上还是功能上均对颞下颌关节有重要意义.     

关节盘无移位的症状性颞下颌关节的核磁共振研究

目的：本研究的目的是应用核磁共振成像（MRI）诊断颞下颌关节紊乱病（TMD），讨论在关节盘位置正常的TMD关节中的核磁共振影像发现，并探讨这些影像发现与临床症状间的关系。方法：本研究对2000－2002年期间在芬兰欧鲁大学牙学院颌面外科就诊的78名TMD患中，经MRI发现为关节盘位置正常的68侧关节作了影像及临床症状的对比分析。结果：在此68侧关节MRI中，发现了髁突运动异常：过度运动（61.8%）及运动受限（2.9%）；发现了怀疑为翼外肌上头和／或下头的肥大、萎缩及挛缩等病理改变（58.9%）。在关节盘形态方面，未发现明显的关节盘畸形，但发现了关节盘整体变厚的病理影像表现（22.1%），还到涉及关节囊上腔、下腔和／或双板区的炎性渗出（35.3%）。髁突过度运动及翼外肌病理改变与症状组有显性关系。结论：本研究的结果提示，髁突过度运动及可能发生的翼外肌病理改变，在引起关节盘位置正常的颞下颌关节的临床TMD症状中，扮有十分重要的角色。     

Discal attachments of the human temporomandibular joint

BACKGROUND: Despite its clinical significance, the anatomy of the human temporomandibular joint (TMJ) and its relationship to the lateral pterygoid muscle remains poorly described and often misrepresented in standard texts. The aim of this study was to describe how the anterior and posterior attachments of the TMJ disc vary between lateral, central and medial regions of the joint. METHODS: Ten left TMJs were removed en bloc from cadavers and serial sections were made at 3-4mm intervals. Observations were made to ascertain the anterior and posterior attachments of the disc and the joint structures were traced from standardized photographs. RESULTS: Laterally, the capsule and lateral discal ligament merged prior to their attachment at the condylar pole. Medially, muscle fibres, capsule and the disc converged on the medial pole of the condyle. There was no evidence that fibres of the upper head of the lateral pterygoid muscle inserted directly into the disc. The upper head inserted into the condyle either directly at the pterygoid fovea or via a central tendon or indirectly via the capsule. Posteriorly, the superior part of the posterior attachment of the disc attached to the cartilaginous meatus and tympanic part of the temporal bone. The inferior part of the posterior attachment of the disc attached to the posterior surface of the condyle. In four joints, this attachment was folded beneath the posterior band of the disc, creating a wedge-shaped flap that ran medio-laterally. CONCLUSION: This study is in broad agreement with other anatomical TMJ studies but there are two main points of difference. Firstly, a true muscle insertion of the superior head of the lateral pterygoid muscle to the disc was not observed. Secondly, a wedge-shaped flap of retrodiscal tissue was identified between the condyle and the disc.     

Variations of the attachment of the superior head of human lateral pterygoid muscle

IntroductionThe superior head of the lateral pterygoid muscle (LPM), is closely related to the temporomandibular joint (TMJ) and plays a role in the aetiology of temporomandibular disorders. Increased activity of this muscle has been implicated in the anterior displacement of the TMJ disc. However, there is uncertainty about the manner of the LPM attachment to the disc–condyle complex.AimThe aim of this study was to investigate the exact anatomy of the attachment of the superior head of the LPM (SLPM) to the disc–condyle complex of the TMJ.Material and methodsThirty-six TMJs were examined – both sides of 18 Greek cadavers (eight males and 10 females, mean age 79.6 years). Examination of the attachment of the SLPM was undertaken viewed under the dissecting microscope.ResultsVariation in the attachment of the SLPM was categorized into three types: in type I, the SLPM inserted into the condyle and the disc–capsule complex (55.5%). In type II, the SLPM only inserted into the condyle (27.8%). In type III, the SLPM inserted purely into the disc–capsule complex (16.7%).ConclusionsThis study demonstrates that there are three different attachment types of the SLPM to the disc–condyle complex. The type III variation could be involved in the TMJ pathology. The knowledge of the variations of the SLPM attachment could be useful for precise surgical and pharmaceutical approaches.     

Evaluating the correlation between the lateral pterygoid muscle attachment type and internal derangement of the temporomandibular joint with an emphasis on MR imaging findings

ObjectivesDisc displacement is accepted as one of major findings in temporomandibular disorders. Correlation between lateral pterygoid muscle (LPM) attachment type to the disc–condyle complex and TMJ dysfunction has rarely been discussed and still not clarified. The purpose of this study was to assess the prevalence LPM attachment type to the disc–condyle complex, and to investigate whether these attachment types are linked to MR imaging findings of ID and TMJ dysfunction in a Turkish population.Study designNinety-eight TMJs in 49 patients (32 males, 17 females, mean age = 36 years) with one of either: TMJ clicking, TMJ locking, restricted movement of the jaw, or pain in the TMJ region, were included. According to the clinical findings and data obtained from MRI examinations, TMJs dysfunctions were classified. LPM attachments to the condyle–disc complex were categorized into three different types. Correlation between TMJ dysfunction and LPM attachments to the condyle–disc complex was evaluated.ResultsOf 98 TMJs in 49 patients (32 males, 17 females, mean age = 36 years), 47 TMJ’s (%48) were evaluated as normal, 35 (%35.7) had a disc displacement with reduction and 16 (%16.3) TMJ had a disc displacement without reduction. Arthritis was seen in 49 TMJ’s (%50). LPM attachments to the condyle–disc complex were as follows: Type I (29.6%), Type II (40.8%), and Type III (29.6%). There was no statistically significant difference between the type of muscle attachment and the presence or absence of disc displacement (p = 0.481), disc degeneration (p = 0.752), articular surface degeneration (p = 0.117).ConclusionsThere was no statistically significant correlation between the LPM attachment types and TMJ abnormalities.     

Comparison of the clinical outcomes of patients having sounds in the temporomandibular joint with skeletal mandibular deformities treated by vertico-sagittal ramus osteotomy or vertical ramus osteotomy

OBJECTIVE: This article describes the effects of the intraoral vertico-sagittal ramus osteotomy (IVSRO) procedure on the jaw of patients with temporomandibular joint (TMJ) disorders. STUDY DESIGN: IVSRO was performed on 15 patients (30 sides) who had mandibular protrusion or asymmetry with TMJ dysfunction. IVRO was performed on another 15 patients (30 sides). All of the 30 patients had sounds in the TMJ uni- or bilaterally. The relative positions of the condyle and disc and the range of motion of the condyles were determined by magnetic resonance imaging (MRI) before and 12 months after the operations. RESULTS: Sounds such as clicking improved in 92% (24/26) of the joints in the IVSRO group, and in 83% (20/24) of the joints in the IVRO group 12 months after the operation. The positional relationship between the condyle and disc on the MR images improved in 82% (9/11) of the joints with reduction of the anterior disc displacement; in 60% (3/5) of the joints without reduction of the anterior disc displacement in the IVSRO group; in 75% (9/12) of the joints with reduction of the anterior disc displacement; and in 40% (2/5) of the joints without reduction of the anterior disc displacement in the IVRO group. Immediately after the operation, the condyle was displaced anterio-inferiorly in all joints in both groups, but gradually returned to close to the preoperative position. There were no significant differences between the 2 groups regarding the extent of shift of the condylar head at 2 weeks and 12 months after the operation. CONCLUSION: The clinical outcomes of the IVSRO procedure are similar to those of the IVRO procedure. Therefore, IVSRO may be a suitable procedure for patients having TMJ dysfunction with skeletal mandibular deformities, particularly when an IVRO is unsuitable.     

降钙素基因相关肽阳性神经纤维在鼠颞下颌关节中的分布

目的　观察鼠颞下颌关节中降钙素基因相关肽阳性神经纤维的分布特征。方法　将鼠颞下颌关节取出 ,脱钙脱水后恒冷切片 ,以ABC法漂染后进行镜检及半定量分析。结果　除关节盘中心区外 ,颞下颌关节各部位的软组织均有丰富的降钙素基因相关肽阳性纤维 ,主要沿血管尤其是动脉周围分布 ,密度为 :前部盘周附着和关节囊 (45 4 6± 72 8)mm2 、后部 (30 2 7± 43 4)mm2 、外侧 (2 40 2± 2 3 6 )mm2 、内侧 (2 2 9 6± 2 5 0 )mm2 、盘外周区 (2 0 2 4± 35 2 )mm2 。结论　降钙素基因相关肽阳性纤维广泛分布于颞下颌关节中 ,是感觉神经的一部分 ,其密度以关节前部盘周附着及关节囊中最高     

安氏Ⅱ~1错儿童颞下颌关节结构变化与Helkimo指数分析

目的研究安氏Ⅱ1错儿童颞下颌关节(TMJ)髁突移位、关节盘移位等结构变化与临床症状、体征的特点及两者间的关系。方法120例尚未接受正畸治疗的安氏Ⅱ1错患者,进行TMJ的磁共振成像(MRI)检查后测定TMJ中髁突及关节盘位置,同时以Helkimo指数评价TMJ临床表现与功能状况;采用秩和检验(rank sum test)对临床功能检查结果与髁突移位与否、关节盘移位与否进行分析比较。结果120例患者中髁突前位为61例,发病率达50.8%;盘前位为40例,发病率达33.3%。主诉症状指数Ai100%为0,且大部分无临床功能障碍(髁突前位患者中67.2%,盘前位患者中70.0%Di=0)。秩和检验结果表明TMJ临床表现、功能状况在正常组、髁突移位组、关节盘移位组间分布差别无统计学意义。结论安氏Ⅱ1错儿童TMJ存在罹患颞下颌关节紊乱(TMD)风险但临床表现轻微多属无症状期。MRI能为TMD的早期诊断提供可靠依据。     

The evaluation of temporomandibular joint disc position in TMJ disorders using MRI

The purpose of this study was to correlate disc position and the type of disc displacement, intra-capsular effusion and degenerative changes of the condyle as demonstrated in MRI studies. In this study, 126 temporomandibular joints (TMJs) of 63 patients with TMJ disorders were investigated using clinical examination and MRI. One hundred and twelve TMJs were found to have internal derangement as disc displacement. The angle between the posterior margin of the disc and the vertical line drawn through the centre of the condyle was measured on MRI for each TMJ. The positions of the discs were normal, 0 degrees-10 degrees, in 11.11%; slightly displaced, 11 degrees-30 degrees, in 37.30%; mildly displaced 31 degrees-50 degrees, in 15.08%; moderately displaced, 51 degrees-80 degrees, in 7.14% of the TMJs with anterior displacement with reduction (ADDR). The disc position was severely displaced anteriorly, as over 80 degrees, in all TMJs with anterior disc displacement without reduction (ADD), constituting 27.78% of all cases. We found that the smaller the degree of disc displacement the milder the internal derangement and that the intra-capsular effusion was more frequently associated with TMJ with ADDR. The degenerative condylar changes were more severe with an increased degree of anterior disc displacement.     

颞下颌关节盘前移位患者关节骨形态与矢状向关节盘位置的关系

目的　利用磁共振成像（MRI）技术和锥形束CT（CBCT）分析颞下颌关节盘前移位患者矢状向关节盘位置与关节骨形态的关系。方法　对97例患者的178个颞下颌关节（TMJ）进行回顾性分析，根据矢状向MRI上关节盘的位置分成4组，即对照组（关节盘无移位）、轻度组（关节盘轻度前移位）、中度组（关节盘中度前移位）和重度组（关节盘重度前移位）。然后利用Mimics 20软件基于CBCT数据进行TMJ的相关形态学参数测量，包括髁突线性尺寸（宽度、长度和高度）、髁突体积和表面积，关节窝的深度和长度，关节结节倾斜角，关节前、上、后间隙等，并对各组矢状髁突位置进行评估。使用方差分析、非参数检验和卡方检验等比较关节形态及位置参数的组间差异，采用相关性分析探索矢状关节盘位置与关节测量参数之间的相关性。结果　髁突的线性尺寸、关节窝深度、关节倾斜角、关节间隙和矢状髁突位置分布在4组间差异有统计学意义，而关节窝长度在4组间差异没有统计学意义；相关性分析显示：髁突的线性尺寸、髁突的体积及表面积、关节窝的深度、关节结节倾斜角和关节上间隙与关节盘矢状位置之间存在显著负相关，而关节后间隙与矢状关节盘位置之间存在显著正相关。结论　TMJ骨形态与不同矢状关节盘位置之间存在相关性，应警惕临床看到的关节骨形态的退行性改变可能是患者存在关节盘前移位的标志。     

The anatomic relationship of the insertion of the superior lateral pterygoid muscle to the articular disc in the temporomandibular joint of human cadavers

Confusion has existed as to whether the major insertion of the superior lateral pterygoid muscle is into the articular disc or the condyle. Five human cadaver joints were studied under the dissecting microscope. This allowed superior lateral pterygoid fibres to be selectively placed under tension to determine their point of insertion and to examine the integrity of the anterior joint capsule. All superior lateral pterygoid fibres gained either direct or indirect insertion to the condyle. A classification for the variation in insertion is suggested. The fibres of the anterior joint capsule extended from the anterior rim of the condyle to the roof of the infratemporal fossa but under the foot of the disc they blended with and became indistinguishable from disc fibres.