可吸收螺钉微创治疗髁突矢状骨折的实验研究

目的：通过动物实验,为临床髁突矢状骨折（SFMC）探索一种微创的手术治疗方法。方法：6只成年绵羊双侧髁突制备成SFMC模型,右侧采用牵引螺钉辅助复位,可吸收螺钉内固定手术治疗,左侧为对照组,采用保守治疗,12周后通过影像学检查和解剖学观察、测量,比较2组颞下颌关节（TMJ）的形态变化,并进行统计学分析。结果：实验组TMJ形态基本正常,TMJ形态改变的放射学评分显著低于对照组,对照组TMJ形态明显异常。结论：动物实验显示,牵引螺钉辅助复位,可吸收螺钉内固定治疗,是一种微创的SFMc手术治疗方法,应用于临床尚需进一步深入研究。     

绵羊下颌髁突矢状骨折手术和保守治疗的临床和放射学评价

目的：评价下颌髁突矢状骨折（sagittal fracture of mandibular condyle,SFMC）手术和保守治疗的疗效。方法：8只被制备成右侧SFMC的绵羊,被随机分成2组,每组4只,组1保守治疗,组2手术治疗。临床和放射学检查评价治疗效果。结果：与术前相比,实验结束时,保守治疗组最大开口度、前伸和左侧向运动度显著减少,手术治疗组下颌的运动度无显著性变化。平均放射学评分,手术治疗组显著低于保守治疗组。结论：对于SFMC,在恢复颞颌关节功能和形态方面,手术治疗优于保守治疗。     

咬合与髁状突形态的对称性间的相关关系解剖学

目的：探讨髁状突形态对称性与咬合对称性的关系及其意义。方法：观察32具颅骨的咬合关系,并根据是否存在产生不对称的非轴向咬合力的咬合关系而将其分为咬合对称组（17例）、咬合轻度不对称组（6例）和咬合明显不对称组（9例）,其中主要包括以下几种咬合;①第三磨牙伸长;②因后牙缺失久未修复而导致的邻牙倾斜、对颌牙伸长的继发性错He;③后牙反He或锁He。髁状突形态对称性也分为对称（12例0、轻度不对称（15例）和明显不对称（5例）,并用游标卡尺（精度0．02mm)测量其内外径和前后径。结果：①咬合对称程度与双侧髁状突对称程度有密切关系,即咬合对称者,双侧髁状突对称的比例比较高,咬合不对称者,其髁状突也多不对称;②髁状突大小的差异,主要表现为内外径的差异,可能系样本的问题,前后径差异未达到统计学显著水平;③咬合正常者,双侧髁状突形态不仅基本对称,而且其12侧髁状突的形态也基本一致。结论：咬合对称性与双侧髁状突形态对称性存在一定的相关关系,髁状突不对称的显著表现是内外径明显差异。此特点可能是咬俣异常易导致颞下颌关节紊乱症的解剖学基础。     

Temporomandibular joint prosthesis as treatment option for mandibular condyle fractures: a systematic review and meta-analysis

The aim of this study was to perform a systematic review of the literature on the temporomandibular joint (TMJ) prosthesis as a treatment option after mandibular condyle fracture. Three databases were searched (PubMed, Embase, Cochrane Library) and 2670 unique papers were identified. A total of 337 studies were included (121 case reports, 89 case series, and 127 cohort/clinical studies). In total 14,396 patients and 21,560 prostheses were described. Of the 127 cohort or clinical studies, 100 (79%) reported inclusion criteria, 54 (43%) reported exclusion criteria, and 96 (76%) reported the inclusion period. The base population from which patients were recruited was reported in 57 studies (45%). The reason for TMJ prosthesis implantation was reported for 4177 patients (29.0%). A history of condylar fracture was present in 83 patients (2.0%); a history of mandibular trauma was present in 580 patients (13.9%). The meta-analysis showed a pooled prevalence of condylar fracture of 1.6% (95% confidence interval 0.9–2.4%) and a pooled prevalence of trauma or condylar fracture of 11.3% (95% confidence interval 7.1–16.0%). Heterogeneity was highly significant (P < 0.001). The TMJ prosthesis appears to be reserved for patients with persistent pain, bony or fibrous ankylosis, or osteomyelitis after primary closed or open treatment of fractures of the mandibular condyle.     

The effect of methotrexate on the bone healing of mandibular condylar process fracture: An experimental study in rats

BackgroundMethotrexate (MTX) is an anti-metabolite used in rheumatology and oncology. High doses are indicated for oncological treatment, whereas low doses are indicated for chronic inflammatory diseases. This study evaluated the effect of two MTX treatment schedules on the bone healing of the temporomandibular joint fracture in rats.MethodsSeventy-five adult male Wistar rats were used to generate an experimental unilateral medially rotated condylar fracture model that allows an evaluation of bone healing and the articular structures. The animals were subdivided into three groups that each received one of the following treatments intraperitoneally: saline (1 mL/week), low-dose MTX (3 mg/kg/week) and high-dose MTX (30 mg/kg). The histological study comprised fracture site and temporomandibular joint evaluations and bone neoformation was evaluated by histomorphometric analysis. A biochemical parameter of bone formation was also assessed.ResultsWhen compared with saline, high-dose MTX delayed bone fracture repairs. In this latter group, after 90 days, the histological analysis revealed atrophy of the fibrocartilage and the presence of fibrous tissue in the joint space. The histomorphometric analysis revealed diminished bone neoformation. The alkaline phosphatase levels also decreased after MTX treatment.ConclusionIt was concluded that high-dose MTX impaired mandibular condyle repair and induced degenerative articular changes.     

儿童髁突骨折诊断和治疗的现状与展望

儿童下颌骨骨折中,髁突骨折比较常见,占24％-72％^[1]。长期以来,儿童髁突骨折一直受到国内外学者的广泛关注,不仅因为其发病率较高,还因为儿童处于生长期,髁突骨折可能会影响下颌骨的发育和颞下颌关节功能。严重的导致颞下颌关节强直和睡眠呼吸暂停综合征,对患者的面型、咬合和咀嚼功能产生严重影响。     

Evaluation of condylar resorption rates after orthognathic surgery in class II and III dentofacial deformities: A systematic review

The purpose of this study was to perform a systematic review of morphological alterations in the condyles after orthographic surgery involving a sagittal split ramus osteotomy (SSRO), with or without surgery on the maxilla. Searches were performed on three databases and registered in the PROSPERO. The selected studies fulfilled the criteria established by the following PICO model: (1) population: individuals with skeletal dentofacial deformities (class II or III facial patterns), without asymmetry; (2) intervention: orthognathic surgery for mandibular setback using an SSRO, with or without a Le Fort I osteotomy, and fixed with bicortical screws or plates and screws; (3) comparison: orthognathic surgery for mandibular advancement using an SSRO, with or without a Le Fort I osteotomy, and fixed with plates and screws or bicortical screws; and (4) outcome: condylar resorption rate and relapse. Initially, 1,371 articles were identified and 636 articles were screened after elimination of duplicates, and 6 articles were selected for qualitative analysis based on the inclusion and exclusion criteria. Five studies had data regarding the rate of condylar resorption, varying from 0.0% to 4.2%. In conclusion, condylar resorption and relapses were present in a small percentage of patients studied.     

Botulinum Toxin in the Treatment of Muscle Specific Oro-Facial Pain: A Literature Review

Facial pain associated with temporomandibular joint (TMJ) and surrounding structures has been a challenge to clinicians as far as diagnosis and management is concerned. Complexity of anatomical structures within a small area, function of teeth and surrounding periodontal ligament, action of muscles, pathologies, lack of diagnostic investigations, all these complicate specific diagnosis of TMJ disorders. Various classifications have been designed and studied to help diagnose and treat TMJ related disorders, of which the simplest one is pain from TMJ proper and surrounding muscles. Many treatment modalities to treat pain arising from muscles around TMJ like splints, mouth restriction exercises, injection of sclerosing agents etc. have been used with various degrees of success. Botulinum toxin has been shown to be effective in the treatment of oro-facial pain due to muscular disorders and the same is discussed in detail in this review literature.     

三种不同咬合者翼外肌磁共振影像形态比较

目的：探讨两种不同对称咬合－单侧后牙反He和单侧第三磨牙伸长,号正常He者翼外肌磁共振影像形态的特点及规律,并从影像学角度探讨翼外肌上下头的功能。方法：分别具有上述3种咬合的受试者各10名,双侧翼外肌正矢状位MRI成像。结果：3组受试者的翼外肌上下头均表面为在大开口时缩短增粗的收缩影像,在牙尖交错位闭口和紧咬时的舒张影像。不对称咬合组双侧翼外肌在大开口状态下的影像与咬合引导的牙尖交错位偏斜有一定相关关系。结论：翼外肌上下头均在闭口时舒张、大武器时收缩;不对称咬合者双侧翼外肌开口位时的收缩活动明显不对称,且与异常咬合对牙尖交错位的引导有关。     

颞下颌关节侧向咬合位与对刃位薄层塑化断面对照研究

目的:对比分析下颌对刃位、侧向咬合位颞下颌关节的运动解剖形态,为颞下颌关节病变提供解剖依据。方法:将8例新鲜尸头摆置成对刃位5例、下颌侧向咬合位3例,以颞下颌关节为中心,切割成8cm×8cm×10cm的标本块,利用生物塑化技术,制成斜矢状位、斜冠状位、轴位塑化断层标本共16套。下颌侧向咬合位工作侧、非工作侧关节形态改变与对刃位相对照。结果:下颌侧向咬合位工作侧,髁突在关节窝内向后、向上、向外移位,关节盘位置无变化,关节盘双板及后带受压;非工作侧,髁突向下、向前、向内侧移位,关节盘后带位置向下移位,无前移位,关节盘中带外侧位居上下关节面之间,明显受压变薄。结论:关节盘并非随髁突作同步同向运动。关节盘在髁突作滑动运动时发生移位;当转动运动、滑动运动复合出现时,关节盘发生移位;而在关节窝内发生的转动运动,关节盘不发生移位。     

手法复位配合运动与(牙合)垫治疗急性颞下颌关节盘不可复性前移位的近期疗效评价

目的:探讨手法复位关节盘继以运动与验垫治疗对急性不可复性盘前移位患者的短期疗效;通过MRI评价复位后短期内颞下颌关节盘-髁关系.方法:选取44例患者急性开口受限(病程在2个月以内)且经MRI证实颞下颌关节盘不可复性关节盘前移位的患者(男7侧,女37侧),施予软组织放松技术,随后行手法复位关节盘.复位后指导患者进行为期2周的下颌运动轨迹训练、关节稳定性训练和软管盘复位训练.白天自我维持下颌休息位,夜间配戴硬质热塑再定位(牙合)垫,以保持良好的盘-髁关系.分别在治疗前、后评估患者的最大主动开口度和疼痛视觉类比评分(visual analogue score,VAS)(0～10分),治疗结束后1～3个月内MRI复查盘-髁关系.采用SPSS 17.0软件包对数据进行t检验.结果:经过2周治疗后,患者开口度明显改善,由治疗前的(22.6±6.1) mm增加到(43.9±3.3)mm;疼痛明显缓解,由治疗前的3.6±1.5下降到0.7±0.25.44例患者在治疗结束后平均4.6±4.7周经MRI复查显示,20例(占46％)为正常盘-髁关系;16例(占36％)为可复性关节盘前移位;8例(占18％)仍为不可复性关节盘前移位.结论:关节盘手法复位后继以运动治疗及配戴(牙合)垫.对急性盘前移位患者能够恢复开口度,缓解疼痛,对维持正常盘-髁关系有一定疗效.     

Attitudes of a group of Brazilian orthodontists towards the diagnosis and management of primary headache (migraine): an electronic-based survey

Objectives

The aim of this study was to investigate the knowledge and attitudes of orthodontists in the diagnosis and management of migraine without aura.

Material and Methods

Participants were dentists, recruited among members of the Brazilian Association of Orthodontics and Facial Orthopedics (ABOR). An e-mail was sent to all ABOR members, with a link to a website, especially prepared for this research. Dentists were presented to a report of a fictional patient fulfilling diagnostic criteria for a primary headache disorder, known as migraine without aura. Participants were asked to describe how they would relieve the patient''s pain. Professional procedures were classified as "adequate" or "inadequate" according to the answers given.

Results

161 valid answers were received (18.8% response rate). Of them, 36% of the actions were considered to be "adequate" procedures, while 64% were "inadequate". The results yielded 12 main procedures, based on common characteristics. Eighty-two orthodontists suggested orthodontic treatment with or without orthognathic surgery, and some suggested using stabilization appliances prior to the orthodontic treatment.

Conclusions

The majority of participants proposed inadequate therapies, and 51% suggested orthodontic correction of occlusion, including orthognathic surgery. Educational activities on migraine should also target orthodontists.     

下颌髁突囊内骨折后关节强直的诊断及手术治疗

目的:对下颌髁突囊内骨折后关节强直依据其自身特点进行分类,制定相应的治疗原则,并作初步的疗效评估。方法:2001年7月至2004年10月间收治下颌髁突囊内骨折后关节强直患者19例(23侧),手术时平均年龄12.68岁,术前平均开口度5.74mm,外伤时平均年龄7.32岁。根据骨折线位置,将关节强直分为Ⅰ、Ⅱ、Ⅲ、Ⅳ4型,采用不同手术方法进行治疗。Ⅰ型和Ⅱ型采用保留内侧髁突头和关节盘的外侧关节间隙成形术(LGA),Ⅲ型和Ⅳ型采用骨球及髁突切除和肋骨肋软骨移植关节重建术(CCG)。术后1周、1个月、3个月、6个月、1a、2a和3a进行临床随访,从临床和影像学两方面评估颞下颌关节的改建情况。结果:19例(23侧)中16例(19侧)行LGA手术,3例(4侧)行关节重建术。术后平均随访11.37个月,随访期末平均开口度27.89mm。结论:LGA既解除了关节强直,又保存了关节的功能尤其是生长潜力,应加以推广,但其有一定的适应证;CCG仍然是关节强直治疗中不可或缺的一部分。     

Treatment of Lymphangioma of the Face with Intralesional Bleomycin: Case Discussion and Literature Review

Surgical treatment of lymphangioma of the face is a difficult task to achieve due to close vicinity of the lesion to the facial nerve and possibility of scar tissue formation. Inefficient surgical removals generally will give rise to high recurrence rates because of infiltrative and diffuse extension of the lesion. However, complete cure has been described by non-surgical methods. A 5-year-old girl with extensive lymphangioma of the left cervicofacial area was treated with intralesional bleomycin injection under ultrasonographic guidance. Case discussion and related literature review was presented.