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。     

数字孪生辅助调整颌位流程的临床新技术和应用效果研究

目的 介绍一种衍生自数字孪生的颌位调整新技术,并评价其辅助临床治疗颞下颌关节紊乱病（TMD的效果。方法 纳入2022年6月至2023年5月于四川大学华西口腔医院颞下颌关节科就诊的TMD患者74例,收集患者的初诊计算机断层扫描（CT）和双侧颞下颌关节磁共振成像（MRI）数据。根据MRI数据进行评估将148个关节分为正常盘-髁关系组（正常组）、可复性盘移位（DDWR）组以及不可复性盘移位（DDWoR）组,用CT数据重建患者口颌系统三维模型并构建个性化参考系进行颌位调整,将调整后的咬合关系输出打印为咬合导板,患者佩戴后行MRI复查。测量不同组别调整颌位前后患者髁突及关节盘的移位量和方向以及髁突与关节盘的夹角,评估其与髁突移位的相关性。结果 在正常组中,关节盘沿X轴和Z轴分别向后、下移动（-0.60±0.62）、（0.51±0.71） mm;在DDWR组中,关节盘沿X轴和Z轴分别向后、上移动（-1.33±1.38）、（-0.09±1.31） mm;在DDWoR组中,关节盘沿X轴和Z轴分别向前、下移动（0.49±1.76）、（1.35±1.76） mm。在3组中,患者的髁突与关节盘的夹角在调整颌...     

髁突在关节窝中的位置及其在临床诊断治疗中的意义

临床治疗中,特别是髁突外伤骨折、正颌手术、修复咬合重建、正畸治疗以及在颞下颌关节紊乱病的诊断和治疗中,要考虑髁突在关节窝中的位置变化。本文通过文献回顾,结合我们的研究成果,讨论髁突在关节窝中的正常生理位置及其在颞下颌关节紊乱病特别是关节盘移位的诊断和治疗中的意义。目前多项研究认为,健康成年人髁突平均位置为基本中性,但存在较大变异;髁突后移可能是关节盘前移位的危险因素,关节盘前移位也可导致髁突后移;在关节盘移位的牙合垫治疗中,髁突在牙合垫戴入后显著向前、下移位,可有效改善盘突关系;稳定牙合垫使髁突前下移位不明显,改善盘突关系的效果有限。此外,再定位牙合垫使髁突前下移位还可促进髁突骨质的改建。     

145例颞下颌关节紊乱病患者的磁共振影像分析

目的 研究145例颞下颌关节紊乱病（TMD）患者的磁共振（MRI）影像学表现,为临床治疗提供依据。方法 利用MRI对145例TMD患者的290侧关节完成开闭口斜矢状位、闭口斜冠状位T1/T2加权成像,观察盘突关系,髁突骨质改变,关节腔积液,关节盘形态改变等情况,并进行分类统计。结果 MRI检查结果显示：37.2%患者双侧TMD病变,71%患者伴有不可复关节盘前移位,10.3%患者伴有可复性关节盘前移位,6.9%患者伴有髁突骨质改变,4.8%患者伴关节腔积液,52.4%患者伴关节盘明显变形。结论 TMD患者中以关节盘不可复性前移位最为常见,提示正常盘突关系的重要性。MRI可以为临床医师提供可靠的影像学诊断依据。     

颞下颌关节盘前移位关节间隙改变的X线研究

目的测量颞下颌关节盘前移位患者与健康成人许勒位片上的关节间隙,分析髁突在关节窝中的位置,探讨髁突后移位在关节盘前移位临床诊断中的价值。方法选择120例（120侧）关节盘前移位患者和30例健康成人,拍摄许勒位片,使用AutoCAD计算机软件,采用2种线距测量方法（张震康法和Kamelchuk法）在许勒位片上测量关节间隙,并计算ln（P/A）值,比较关节盘前移位患者与健康成人（对照组）关节间隙的差异。结果2种测量方法的测量结果均显示：关节盘前移位组的关节上间隙和后间隙均小于对照组,其差异有统计学意义（P<0.05）,而关节前间隙与对照组的差异无统计学意义（P>0.05）;关节盘前移位组ln（P/A）值均小于对照组相应ln（P/A）值,其差异有统计学意义（P<0.05）。结论许勒位片上显示的颞下颌关节髁突后移位在一定程度上提示有关节盘前移位的存在;但正常髁突位置也存在变异,单纯的许勒位片尚不能作为关节盘前移位的确切诊断依据。     

锥形束CT颞下颌关节上腔造影在诊断关节盘病变中的应用

目的探讨颞下颌关节（TMJ）骨关节病中关节盘前移位、穿孔及髁突骨质改变类型的关系。 方法选择中山大学附属口腔医院颞下颌关节专科就诊的96例骨关节病患者共145侧TMJ行锥形束CT（CBCT）关节造影检查,分为关节盘穿孔组和非穿孔组,两组病例以CBCT按照关节盘移位及髁突骨质改变类型进行分类比较,应用SPSS 18.0对关节盘穿孔与关节盘移位类型进行Pearson χ²独立性检验,两组间骨质分型构成比进行χ²检验。 结果所有关节发生关节盘前移位,其中123侧为不可复性盘前移位、22侧为可复性盘前移位。86侧TMJ发生关节盘穿孔,59侧关节造影未检出穿孔。关节盘是否发生穿孔与关节盘前移位类型存在相关性（χ²= 6.866,P= 0.015）,关节盘穿孔组不可复性盘前移位发生率（91.86%）高于非关节盘穿孔组（76.3%）。 结论TMJ骨关节病患者均存在不同程度的关节盘移位,关节盘移位类型与关节盘穿孔相关,髁突骨质改变类型与关节盘是否穿孔无明显相关性。     

肌位咬合板治疗颞下颌关节可复性盘前移位的疗效

可复性盘前移位是指关节盘在闭口位时处于前移位状态,当开口及下颌滑动时,关节盘恢复其与髁突的正常结构关系.其症状以关节区开闭口弹响为主,可伴有疼痛、开口型异常等,临床首选保守性治疗方法,其中咬合板治疗是一种常用的治疗手段.笔者对30 例可复性盘前移位患者采用肌位咬合板进行治疗,取得较好的临床疗效.     

Activator矫治安氏Ⅱ类错(牙合)前后髁突和关节盘位置改变的MRI研究

目的分析Activator功能矫治对髁突、关节盘的位置及盘髁关系的影响。方法选择20个AngleⅡ1错[牙合]患者,在斜矢状位闭口MRI影像上测量Activator功能矫治前后髁突和关节盘位置的改变。结果在无症状AngleⅡ1错[牙合]中有40％出现关节盘前移位,功能矫治前后其髁突和关节盘位置没有明显改变。结论Activator治疗不会改变髁突在关节窝中的位置,不会引起正常位置的关节盘前移位,也不会使已经存在的盘前移位复位。     

急性和慢性不可复性盘前移位临床对比研究

目的　探讨颞下颌关节紊乱病不可复性盘前移位急性和慢性分类对临床诊断、治疗和预后的指导意义。方法　分析连续接诊的 10 0例不可复性盘前移位病例 (急性 4 5例、慢性 5 5例 ) ,比较两组之间临床主诉、开口度、颞下颌关节功能、髁突和关节盘的影像学改变。结果　急性不可复性盘前移位主诉开口受限 ,下颌运动功能严重障碍 ,大部分病例髁突骨质正常 ,关节盘形态良好 ;慢性不可复性盘前移位主诉多为开口痛和 (或 )咀嚼痛 ,下颌运动受限 ,部分病例伴有咀嚼肌疼痛 ,相当一部分病例髁突骨质吸收破坏 ,关节盘变形、变性 ,关节盘附着松弛、撕裂 ,甚至关节盘穿孔。结论　对急性不可复性盘前移位应早期采取积极的治疗 ,恢复良好的盘 突关系 ,阻止关节盘和髁突的进一步损伤。     

兔颞下颌关节盘前移位的X线研究

目的　通过影像学检查了解颞下颌关节盘前移位的病理变化过程,证实关节盘前移位与退行性改变之间的关系。方法　在手术组动物一侧关节区显露颞骨颧突根部,用丝线垂直穿过关节盘前带的延伸部并拉缝线向前并固定,使颞下颌关节盘前移位。手术对照组的手术步骤与手术组相同,但不缝合关节盘前带的延伸部,也不将关节盘位向前方。正常对照组5只,手术组和手术对照组动物术后1、2、4、8、10、12和16周分别处死。拍摄关节X线片,观察38只兔颞下颌关节X线表现。将兔左、右关节区锯成组织块,肉眼观察兔关节盘的位置。结果　手术组关节盘位置与形态均发生了改变,13侧为部分关节盘前移位,完全性关节盘前移位为11侧,关节盘穿孔为9侧。部分关节盘前移位出现关节间隙狭窄或消失,髁状突骨密度增高。完全性关节盘前移位与关节盘穿孔表现为髁状突骨质增生、破坏及肥大,关节结节磨平以及硬化。结论　颞下颌关节盘前移位可导致关节骨质改变。完全性关节盘前移位和关节盘穿孔与骨关节病的关系密切。     

Physiological effects of anterior repositioning splint on temporomandibular joint disc displacement: a quantitative analysis

Anterior repositioning splints (ARS) are used primarily for the management of temporomandibular joint (TMJ) anterior disc displacement with reduction (ADDwR). However, the exact physiological effects of ARS are still unclear. This study investigated the short and long‐term effects of ARS on disc and condyle angles/positions by metric analysis. Twenty‐two subjects diagnosed with ADDwR were recruited. Maxillary full‐coverage ARS were fabricated, and MRI of TMJs was obtained before splint treatment, immediate post‐insertion and 6 months after splint treatment. Disc–condyle relationship was determined by disc–condyle angle measurement. Disc and condyle positions were described as X‐Y coordinates with the summit of glenoid fossa as the origin of the coordinates. Thirty‐two TMJs were classified as ADDwR and 12 were normal. Upon ARS insertion, all TMJs with ADDwR got normal disc–condyle relationships. The condyles moved significantly forward and downward, while the discs moved significantly backward and upward. MRI at 6 months after treatment (without ARS insertion) indicated that only 40·6% (13/32) of the joints were maintained in the normal disc–condyle relationship. The majority of condyles returned to their pre‐treatment positions, while the discs generally moved anteriorly again. The use of ARS resulted in forward and downward condyle movement, and a concurrent backward movement of the disc resulting in ideal spatial disc–condyle relationship. The stability of this relationship, however, could not be maintained in the majority of TMJs upon ARS removal. Findings explain the good short‐term clinical outcomes with ARS and their relatively lower efficacy in the long term.     

Clinical protocol for managing acute disc displacement without reduction: a magnetic resonance imaging evaluation

This study investigated the efficacy of a sequential combination of arthrocentesis, mandibular manipulation, and anterior repositioning splint (ARS) in the management of acute temporomandibular joint (TMJ) disc displacement without reduction (DDwoR). Twenty-one consecutive patients diagnosed with acute DDwoR by Diagnostic Criteria for Temporomandibular Disorders and magnetic resonance imaging (MRI) were recruited and managed with this method. Clinical and MRI data were obtained before and at 1 week after treatment. The disc–condyle relationship was determined by disc–condyle angle measurement. Condyle/disc positions were described as x–y coordinates with the summit of the articular fossa as the coordinate origin. Statistical analyses including independent/paired samples t-tests were conducted; significance was set at P < 0.05. Clinical success was observed in 95.2% of patients (20/21) with 22 joints affected by acute DDwoR. After combined treatment and ARS insertion, TMJs with DDwoR showed (a) normal disc–condyle relationships with substantial forward and downward condyle movement and significant disc reduction in closed position, and (b) discs with an intermediate zone located between the condylar head and articular eminence in open position. The combined approach was highly effective in ‘unlocking’ acute TMJ DDwoR and achieving spatial full disc reduction and a normal disc–condyle relationship. The duration of acute DDwoR appears to be critical for success.     

Evaluation of temporomandibular joint in patients with hemifacial microsomia.

OBJECTIVE: The purpose of this study was to elucidate positional relationships between temporomandibular joint (TMJ) components, including the articular discs, using magnetic resonance imaging (MRI) in patients with hemifacial microsomia (HFM). SUBJECTS AND METHODS: Twenty TMJs in 10 patients with HFM were examined at closed- and open-mouth positions using an MRI scanner. The condyle-fossa and disc-condyle relationships, disc configuration at the closed-mouth position, and the reduction of the disc at the open-mouth position were evaluated. RESULTS: On the unaffected side, the condyle-fossa and disc-condyle relationships appeared fairly normal at the closed mouth position. The disc-condyle relationship at the open-mouth position was also normal. The TMJ disc showed normal biconcave configurations at both closed- and open-mouth positions. On the affected side, there was considerable variation in the state of the TMJ. At the closed-mouth position, 5 of the 10 patients revealed fairly normal disc-condyle relationships, one patient showed anterior displacement of the disc, and four patients had no disc. Two patients appeared biconcave, three patients appeared biplanar, and one patient was hemiconvex. At the open-mouth position, the condyle and disc moved in harmony in five patients with normal disc-condyle relationships, but the disc was reduced in a patients with anterior disc displacement. The degree of the TMJ disc dysplasia did not necessarily correspond with the degree of mandibular dysplasia. CONCLUSIONS: The present study contributes to an improved understanding of TMJ pathology in patients with HFM. The results suggest that, in HFM patients, the examination of the TMJ using MRI is helpful for determining treatment procedures in mandibular distraction osteogenesis.     

肌位牙合板对颅颌功能紊乱者髁突位置及盘突关系异常影响的研究

目的　研究颅颌功能紊乱（ Ｃ Ｍ Ｄ） 者牙尖交错位（ Ｉ Ｃ Ｐ） 的髁位及戴入肌位牙合板后的改变, 对戴入肌位牙合板后颞颌关节（ Ｔ Ｍ Ｊ） 弹响消失者, 观察盘突关系的变化。方法　对１０２ 例 Ｃ Ｍ Ｄ 者在 Ｉ Ｃ Ｐ 及戴入肌位牙合板后咬合接触时, 在断层深度不变的情况, 分别进行双侧 Ｔ Ｍ Ｊ侧位中层摄影, 对其中９ 例戴板后弹响立即消失者行戴板前、即刻戴入牙合板后及治疗后, Ｔ Ｍ Ｊ上腔造影的断层摄影。结果　１０２ 例 Ｃ Ｍ Ｄ 者 Ｉ Ｃ Ｐ 时, 髁突一侧后位或双侧后位４３ 例, 中位４６ 例, 一中一前６ 例, 双侧前位７ 例。戴入牙合板后, 后位者３０ 例双侧居中, 中位者３６ 例前下移,而髁位异常在戴板后持不变者５ 例。９ 例盘突关系异常者, 戴入牙合板后全部恢复正常, 但３ ～６ 月后去板, 仅１ 例盘突关系正常,８ 例仍异常。结论　肌位牙合板可使后位的髁突居中, 居中者前下调位并纠正不对称的髁位, 而对盘突关系异常的调整作用有限。     

Variability of disk position in asymptomatic volunteers and patients with internal derangements of the TMJ

This study determined the variability of temporomandibular joint (TMJ) disk position in medial, central, and lateral aspects of the joint using magnetic resonance imaging (MRI). Subjects had clinical evidence of reciprocal TMJ clicking (N = 123) or restricted mandibular motion (N = 52). Eighty-nine asymptomatic volunteers provided a control group. Disk position was quantified on MRI by measuring the angle formed by a line through the middle of the condyle and perpendicular to the Frankfort plane and a line through the same midpoint of the condyle and tangential to the posterior-most aspect of the disk. The disk position in asymptomatic TMJs varied considerably with a tendency toward farther anterior placement in more lateral images. In 47 TMJs from a total of 52 TMJs (90%), restricted mobility was associated with anterior disk displacement (ADD) without reduction. The disk position demonstrated a mean displacement of 77 degrees without significant differences at the medial and lateral aspects of the condyle. One hundred TMJs from a total of 123 TMJs (81%) with reciprocal clicking demonstrated ADD with reduction. Tomograms revealed larger lateral displacements or rotational displacements in these joints, whereas medial images frequently showed similar ranges of disk positions as compared with asymptomatic TMJs. The results suggest that disk positions of up to +15 degrees on medial tomograms and +30 degrees on lateral tomograms should be regarded as normal variations. Furthermore, multisection analysis of all parasagittal images improved the separation between disk displacement and asymptomatic TMJs.     

颞下颌关节的3T磁共振高分辨扫描方法研究

目的：探索3T磁共振对颞下颌关节（TMJ）的成像方法与序列特点,并优化扫描参数。方法：采用Siemens3.0TTrio磁共振扫描机,8通道相控阵头线圈,对25例双侧TMJ分别行张口位、闭口位扫描。其中正常志愿者15例,TMD10例。结果：所有被检查者均一次扫描成功,分别取T1WI,T2WI,PWI以及T2WI,T1WI 3D容积成像,扫描方位以髁突为中心,分别做平行于髁突长轴的斜冠状位,垂直于髁突长轴的斜矢状位扫描,正常志愿者的双侧TMJ在优化后的扫描序列中充分而完整显示关节盘、关节间隙、关节窝、关节盘随张闭口改变而位置变化情况,关节周围软组织与骨组织亦充分清楚显示。10例TMD均完全显示出关节盘移位情况,与临床症状一致。结论：3T磁共振扫描机成像速度快,视野内成像矩阵高,解剖细节显示充分,组织分辨力高,对于TMJ等小关节的结构异常与细微病变的显示充分,是其它医学检查设备无法比拟的。     

下颌稳定型(牙合)垫治疗可复性盘前移位的临床评价

目的 探讨下颌稳定型(牙合)垫治疗颞下颌关节可复性盘前移位的疗效.方法 对32例(34侧)关节盘可复性前移位患者,采用下颌稳定型(牙合)垫治疗,疗程为3个月,采用Fricton指数及疼痛量化表来评价治疗效果.结果 统计学分析表明治疗前后的差异有统计学意义(P＜0.05),Fricton颞下颌关节指数(CMI)从治疗前的...     

张口位MRI动态研究在诊断颞下颌关节盘前移位中的应用

目的：探讨颞下颌关节张口位磁共振动态成像在颞下颌关节盘前移位中的诊断价值。方法：对30例有颞下颌关节疼痛或弹响MRI患者60侧颞下颌关节行常规MRI静态扫描,并用快速自旋回波扫描获得开口度为0．5cm的图像,依次进行到患者达到最大开口位。然后采用模拟动态观察。分别由两名专科医师对动态扫描和常规静态扫描时关节盘移位进行诊断,并比较诊断结果。结果：静态MRI检查中关节盘可复性前移位21侧,关节盘不可复性前移位18侧,关节盘侧向移位2例,位置正常19例。动态MRI检查中关节盘可复性前移位23侧,关节盘不可复性前移位19侧,位置正常18例。结论：张口位动态MRI联合静态MRI观察对髁突、关节盘运动功能的评价非常重要,对区别可复性与不可复性关节盘前移位具有重要作用。     

下颌三维定位技术指导下稳定型殆垫治疗颞颌关节紊乱病的疗效分析

目的：探讨超声三维下颌定位技术指导下修正性调磨的骀垫对TMD的临床疗效。方法：本研究从北京口腔医院颞颌关节门诊2003年3月～2008年12月就诊的患者选用40例（男12例女28例）颞颌关节病并有关节绞锁的患者，超声三维下颌定位仪中的髁突运动中心电子位置分析（electronicpositionanalysis，EPA）检测指导下进行修正性调磨骀垫治疗后，比较治疗前后下颌运动程度如张口度、关节绞锁运动、弹响和下颌运动疼痛的变化情况。结果：本研究发现超声三维下颌定位技术指导下修正性调磨的殆垫治疗后，下颌运动明显改善，张口运动及被动最大张口度治疗前后均有显著性差异；绞锁运动症状明显改善。并有统计学差异。结论：超声三维下颌定位技术指导下修正性调磨的黯垫治疗TMD，能够改善TMD症状，在治疗绞锁运动方面有显著疗效。     

Disc-condyle Relationships during Class II Treatment with the Functional Mandibular Advancer (FMA)

OBJECTIVE: The objective of this study was to verify the effects of treatment to correct Class II malocclusion with the Functional Mandibular Advancer (FMA) on the relative positions of the articular disc and mandibular condyle. In particular, we aimed to find out whether the disc-condyle relationship changed between baseline and post-treatment, in temporomandibular joints initially exhibiting a physiological relationship and alternatively, in temporomandibular joints initially presenting anterior displacement of the articular disc. PATIENTS AND METHODS: Treatment progress in 15 patients was monitored at defined points in time by manual structural analysis (MSA) and magnetic resonance (MR) imaging. The disc-condyle relationship was assessed by examining the parasagittal MR images made up of three slices each (lateral, central, medial) taken in habitual intercuspation and maximum-open mouth position. The MR images were metrically analyzed to determine the sagittal positional relationship of the articular disc and mandibular condyle using two methods on the central slices of the images taken in closed-mouth position. MSA was used in particular to determine the disc-condyle relationships and to metrically record the extent of active movement of the mandible during mouth opening, protrusion, laterotrusion, and retrusion. RESULTS: Comparison of baseline and post-treatment findings revealed that none of the joints exhibited a treatment-induced deterioration in the disc-condyle relationship, while the relationship improved in five joints. After categorization of the joints according to groups according to disc position, metric analysis of the MR images showed significantly-improved post-treatment disc positions in the joints that had initially exhibited anterior disc displacement. Post-treatment findings for maximum-open mouth position, protrusion, and laterotrusion corresponded to the baseline values recorded before bite-jumping, and the extent of maximum active retrusion increased significantly. CONCLUSIONS: Functional jaw orthopedics for correction of skeletal Class II with the rigid fixed FMA leads to side-effects reflected in the disc-condyle relationship in the temporomandibular joints: no adverse effects were observed in joints presenting an initial physiological disc-condyle relationship, whereas the disc position may improve in joints with initial partial or total anterior disc displacement. In comparison with the baseline findings, we observed no post-treatment restriction in the extent of maximum mouth opening, protrusion, and left and right laterotrusion. Maximum active retrusion increased due to the treatment. MR imaging and MSA only partly cover the same aspects of temporomandibular joint diagnostics.