髁突高位切除術(shù)治療髁突肥大的臨床和影像學(xué)研究及病例報(bào)告
發(fā)布時(shí)間：2018-07-28 09:19
【摘要】：髁突肥大(condylar hyperplasia, CH),亦被稱為單頜肥大(hemimandibular hyperplasia, HH)、單頜伸長(zhǎng)(hemimandibular elongation,HE)、偏面肥大、上頜發(fā)育不良、Sturge-Weber綜合征等,是臨床上較少見(jiàn)的一種疾病。由Robert Adams于1836首次發(fā)現(xiàn)并記錄這一疾病。髁突肥大是指下頜骨髁突非腫瘤性過(guò)度生長(zhǎng)而產(chǎn)生的一種畸形,包括髁突形態(tài)及大小上的改變。髁突肥大能造成嚴(yán)重的錯(cuò)黯及面部非對(duì)稱畸形是患者就診的主要原因,并且在下頜骨不對(duì)稱畸形中,其發(fā)病比例相當(dāng)高。 本次研究的目的即通過(guò)對(duì)接受髁突高位切除患者術(shù)后隨訪研究,系統(tǒng)闡述術(shù)前、術(shù)后面部軟/硬組織偏頜指數(shù)的測(cè)量,評(píng)估兩者對(duì)面型偏斜改善的作用的關(guān)聯(lián)。并比較口內(nèi)入路與口外入路的髁突高位切除術(shù)術(shù)后髁突改建效果及面型偏斜改善程度,以及該術(shù)式對(duì)顳下頜關(guān)節(jié)功能的影響。進(jìn)一步加深對(duì)這類疾病的認(rèn)識(shí),將有助于制定合理的診療計(jì)劃和預(yù)后判斷。 實(shí)驗(yàn)一髁突高位切除術(shù)后面部軟/硬組織相關(guān)性研究 目的：對(duì)髁突高位切除術(shù)患者的術(shù)前、術(shù)后面部軟/硬組織偏頜指數(shù)測(cè)量,觀察軟/硬組織偏斜改善的關(guān)聯(lián)。 方法：研究對(duì)象為本院顳下頜關(guān)節(jié)外科就診的髁突肥大患者。觀測(cè)術(shù)前及術(shù)后隨訪時(shí),軟組織耳屏前點(diǎn)、下頜角點(diǎn)(Go’)、頦點(diǎn)(Me‘)與面中線和Go'-Me',及硬組織髁突外側(cè)點(diǎn)(Co1)、下頜角點(diǎn)(Go)、頦點(diǎn)(Me)和Go-Me的距離。計(jì)算得出對(duì)應(yīng)偏頜指數(shù)(AI)。組內(nèi)配對(duì)t檢驗(yàn)及組間Pearson相關(guān)性檢驗(yàn)。 結(jié)果：組內(nèi)配對(duì)t檢驗(yàn)。經(jīng)耳屏前點(diǎn)與經(jīng)髁突外側(cè)點(diǎn)偏頜指數(shù)(AI)相關(guān)系數(shù)r=0.933,下頜角(AI)r=0.984,下頜骨體(AI)r=0.997,頦點(diǎn)偏移r=0.997,下頜升支(AI)r=0.645,僅耳屏前點(diǎn)(AI)P0.01。 結(jié)論：1)單純的髁突高位切除術(shù)可有效的改善偏頜畸形；2)經(jīng)長(zhǎng)期隨訪,面部軟組織偏斜的矯正與硬組織的矯正之間有較高的相關(guān)性；3)面部軟/硬組織下頜升支偏斜的改善不完全等效。 實(shí)驗(yàn)二髁突高位切除術(shù)對(duì)顳-下頜關(guān)節(jié)功能的影響 目的：探討髁突高位切除術(shù)對(duì)髁突肥大患者顳下頜關(guān)節(jié)功能的影響。 方法：評(píng)估14例髁突肥大患者術(shù)前、隨訪時(shí)檢查包括下頜運(yùn)動(dòng)、關(guān)節(jié)雜音、關(guān)節(jié)區(qū)觸診及頭頸部肌肉的觸診。根據(jù)Fricton顳下頜關(guān)節(jié)功能紊亂指數(shù)(CMI)進(jìn)行評(píng)分,評(píng)價(jià)該術(shù)式對(duì)患者顳下頜關(guān)節(jié)功能影響。 結(jié)果：隨訪時(shí)TMJ功能障礙指數(shù)(DI)由0.15±0.092降至0.031±0.028,t=5.182,P0.05。肌肉壓痛點(diǎn)指數(shù)(PI)由0.069±0.091降至0.019±0.032,t=2.920,P0.05.顳下頜關(guān)節(jié)紊亂指數(shù)(CMI)由0.11±0.089降至0.025±0.022,t=4.459,P0.05。 結(jié)論：髁突高位切除術(shù)可有效改善髁突肥大導(dǎo)致的顳下頜關(guān)節(jié)功能紊亂。 實(shí)驗(yàn)三口內(nèi)/口外入路髁突高位切除術(shù)術(shù)后髁突改建的研究 目的：評(píng)估髁突肥大患者在接受口內(nèi)和口外入路髁突高位切除術(shù)后,面部不對(duì)稱畸形及髁突表面改建的差異性。方法：經(jīng)診斷確診髁突肥大患者24例(左側(cè)：右側(cè)=14：10),主訴為面部不對(duì)稱性及咬合干擾。所有患者均接受在患側(cè)的單側(cè)髁突高位切除術(shù)(11例口外入路,13例口內(nèi)入路),平均隨訪間期為11.7個(gè)月。臨床及放射學(xué)檢查確診,包括顳下頜關(guān)節(jié)功能檢查,面部對(duì)稱評(píng)估,下頜升支長(zhǎng)度測(cè)量及顳頜關(guān)節(jié)面的改建。 結(jié)果：口內(nèi)入路及口外入路術(shù)后,患者最大張口度、關(guān)節(jié)彈響及疼痛均無(wú)顯著性差異�？谕饨M患側(cè)下頜術(shù)前升支長(zhǎng)度平均為7.09±0.61cm,術(shù)后為6.63±0.60cm�？趦�(nèi)組術(shù)前為6.83±0.55cm,術(shù)后測(cè)的6.48±0.54cm。隨訪時(shí),口外/口內(nèi)分別為6.59±0.61cm和6.50±00.49cm�？谕饨M平均總下頜骨體偏斜指數(shù)(AI)為2.81±1.63,下頜升支AI為3.34±1.88。隨訪時(shí)測(cè)得1.89±1.75及2.17±1.11。在口內(nèi)組均總下頜骨體偏斜指數(shù)(AI)為3.43±1.98,下頜升支A13.73±1.82,隨訪時(shí)分別為2.27±1.91,1.92±1.48。兩組之間無(wú)顯著性差異。 結(jié)論：在防止單側(cè)髁突肥大導(dǎo)致的面部不對(duì)稱畸形進(jìn)展以及下頜升支的伸長(zhǎng)方面,口內(nèi)入路的髁突高位切除術(shù)與口外入路武明顯差異。同時(shí),患側(cè)髁突改建的效果經(jīng)長(zhǎng)期隨訪也是較明顯的。
[Abstract]:Condylar hyperplasia (CH), also known as hemimandibular hyperplasia (HH), single maxillary elongation (hemimandibular elongation, HE), partial hypertrophy, maxillary dysplasia, Sturge-Weber syndrome, is a rare disease in clinical. The first discovery and recording of this disease by Robert Adams in 1836. Condyle fertilizer It refers to a malformation caused by the non tumor growth of the mandibular condyle, including the shape and size of the condyle. The condyle hypertrophy can cause serious malocclusion and facial asymmetrical deformity as the main cause of the patient's treatment, and the incidence of the disease is quite high in the asymmetry of the mandible.
The purpose of this study is to systematically elaborate the relationship between the facial soft / hard tissue deflecting index and the correlation of the effect of the facial deviation improvement before and after the operation, and compare the condyle reconstruction effect and face type deviation after the intraoral and extraoral approach to the condyle resection. The degree of improvement, as well as the effect of the operation on the function of the temporomandibular joint, and further deepening the understanding of these diseases, will help to establish a reasonable diagnosis and treatment plan and a prognostic judgement.
Correlation between soft tissue and hard tissue after high condylar resection in rabbits
Objective: To observe the correlation between soft / hard tissue partial maxillofacial index and the improvement of soft / hard tissue deviation.
Methods: the subjects were the patients with condylar hypertrophy in the temporomandibular joint surgery in our hospital. Before and after the follow-up, the soft tissue preview point, the mandibular angle point (Go '), the chin point (Me) and the midline line and Go'-Me', the hard tissue condylar lateral point (Co1), the mandibular angle (Go), the mental point (Me) and the Go-Me distance were calculated, and the corresponding mandibular index (AI) was calculated. Intra-group paired t test and inter-group Pearson correlation test.
Results: in group t test, the correlation coefficient between the anterior point and the lateral point of the condyle was r=0.933, the mandibular angle (AI) r=0.984, the mandibular body (AI) r=0.997, the chin point migration r=0.997, the mandibular ramus (AI) r=0.645, and only the anterior (AI) P0.01..
Conclusions: 1) simple mandibular condyle resection can effectively improve the deformity of the mandible; 2) after long-term follow-up, there is a high correlation between the correction of facial soft tissue deflection and the correction of hard tissue; 3) the improvement of the ramus ramus of the facial soft / hard tissue is not completely equivalent.
Effect of high condylar resection on temporomandibular joint function in experiment two
Objective: To investigate the effect of high condylar resection on temporomandibular joint function in patients with condylar hypertrophy.
Methods: 14 patients with condylar hypertrophy were evaluated before the operation, including mandibular movement, joint murmur, palpation in the joint area and palpation of the head and neck muscles. According to the Fricton temporomandibular joint dysfunction index (CMI), the effect of the operation on temporomandibular joint energy was evaluated.
Results: the TMJ dysfunction index (DI) decreased from 0.15 + 0.092 to 0.031 + 0.028, t=5.182, P0.05. muscle tenderness point index (PI) decreased from 0.069 + 0.091 to 0.019 + 0.032, t=2.920, and P0.05. temporomandibular joint disorder index (CMI) decreased from 0.11 + 0.089 to 0.025 + 0.022, t= 4.459, P0.05..
Conclusion: high condylar resection can effectively improve the temporomandibular joint dysfunction caused by condylar hypertrophy.
Study of condylar reconstruction after three condylar high excision via oral / extraoral approach
Objective: To evaluate the differences in facial asymmetry and condylar surface remodeling after condylar resection in patients with condylar hypertrophy. Methods: 24 cases of condylar hypertrophy (left side: right =14:10) were diagnosed by diagnosis. The main complaint was facial asymmetry and occlusal interference. All patients accepted the unilateral side of the affected side. High position resection of condylar process (11 out of mouth approach and 13 intraoral approach) with an average follow-up interval of 11.7 months. Clinical and radiological examinations were confirmed, including TMJ function examination, facial symmetry assessment, mandibular ramus length measurement and reconstruction of temporomandibular joint surface.
Results: there was no significant difference in maximum mouth opening, joint elastic response and pain after oral and extraoral approach. The length of the ascending branch of the lateral mandible was 7.09 + 0.61cm before operation and 6.83 + 0.55cm before operation in 6.63 + 0.60cm. after operation, and 6.59 + 0.61cm and 6.50 in the outside of mouth / mouth respectively. The average total mandibular deviation index (AI) in the + 00.49cm. group was 2.81 + 1.63 and the mandibular ramus AI was 3.34 + 1.88. follow-up. The total mandibular body deflection index (AI) was 3.43 + 1.98 and the mandibular ramus was A13.73 + 1.82. There was no significant difference between the 2.27 + 1.91,1.92 + two groups at the follow-up.
Conclusion: in preventing the progress of asymmetric deformity of the face and the extension of the ramus of the mandibular ramus, the high position of the condyle in the intraoral approach is significantly different from that of the external oral administration.
【學(xué)位授予單位】：武漢大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R782.2
[Abstract]:Condylar hyperplasia (CH), also known as hemimandibular hyperplasia (HH), single maxillary elongation (hemimandibular elongation, HE), partial hypertrophy, maxillary dysplasia, Sturge-Weber syndrome, is a rare disease in clinical. The first discovery and recording of this disease by Robert Adams in 1836. Condyle fertilizer It refers to a malformation caused by the non tumor growth of the mandibular condyle, including the shape and size of the condyle. The condyle hypertrophy can cause serious malocclusion and facial asymmetrical deformity as the main cause of the patient's treatment, and the incidence of the disease is quite high in the asymmetry of the mandible.
The purpose of this study is to systematically elaborate the relationship between the facial soft / hard tissue deflecting index and the correlation of the effect of the facial deviation improvement before and after the operation, and compare the condyle reconstruction effect and face type deviation after the intraoral and extraoral approach to the condyle resection. The degree of improvement, as well as the effect of the operation on the function of the temporomandibular joint, and further deepening the understanding of these diseases, will help to establish a reasonable diagnosis and treatment plan and a prognostic judgement.
Correlation between soft tissue and hard tissue after high condylar resection in rabbits
Objective: To observe the correlation between soft / hard tissue partial maxillofacial index and the improvement of soft / hard tissue deviation.
Methods: the subjects were the patients with condylar hypertrophy in the temporomandibular joint surgery in our hospital. Before and after the follow-up, the soft tissue preview point, the mandibular angle point (Go '), the chin point (Me) and the midline line and Go'-Me', the hard tissue condylar lateral point (Co1), the mandibular angle (Go), the mental point (Me) and the Go-Me distance were calculated, and the corresponding mandibular index (AI) was calculated. Intra-group paired t test and inter-group Pearson correlation test.
Results: in group t test, the correlation coefficient between the anterior point and the lateral point of the condyle was r=0.933, the mandibular angle (AI) r=0.984, the mandibular body (AI) r=0.997, the chin point migration r=0.997, the mandibular ramus (AI) r=0.645, and only the anterior (AI) P0.01..
Conclusions: 1) simple mandibular condyle resection can effectively improve the deformity of the mandible; 2) after long-term follow-up, there is a high correlation between the correction of facial soft tissue deflection and the correction of hard tissue; 3) the improvement of the ramus ramus of the facial soft / hard tissue is not completely equivalent.
Effect of high condylar resection on temporomandibular joint function in experiment two
Objective: To investigate the effect of high condylar resection on temporomandibular joint function in patients with condylar hypertrophy.
Methods: 14 patients with condylar hypertrophy were evaluated before the operation, including mandibular movement, joint murmur, palpation in the joint area and palpation of the head and neck muscles. According to the Fricton temporomandibular joint dysfunction index (CMI), the effect of the operation on temporomandibular joint energy was evaluated.
Results: the TMJ dysfunction index (DI) decreased from 0.15 + 0.092 to 0.031 + 0.028, t=5.182, P0.05. muscle tenderness point index (PI) decreased from 0.069 + 0.091 to 0.019 + 0.032, t=2.920, and P0.05. temporomandibular joint disorder index (CMI) decreased from 0.11 + 0.089 to 0.025 + 0.022, t= 4.459, P0.05..
Conclusion: high condylar resection can effectively improve the temporomandibular joint dysfunction caused by condylar hypertrophy.
Study of condylar reconstruction after three condylar high excision via oral / extraoral approach
Objective: To evaluate the differences in facial asymmetry and condylar surface remodeling after condylar resection in patients with condylar hypertrophy. Methods: 24 cases of condylar hypertrophy (left side: right =14:10) were diagnosed by diagnosis. The main complaint was facial asymmetry and occlusal interference. All patients accepted the unilateral side of the affected side. High position resection of condylar process (11 out of mouth approach and 13 intraoral approach) with an average follow-up interval of 11.7 months. Clinical and radiological examinations were confirmed, including TMJ function examination, facial symmetry assessment, mandibular ramus length measurement and reconstruction of temporomandibular joint surface.
Results: there was no significant difference in maximum mouth opening, joint elastic response and pain after oral and extraoral approach. The length of the ascending branch of the lateral mandible was 7.09 + 0.61cm before operation and 6.83 + 0.55cm before operation in 6.63 + 0.60cm. after operation, and 6.59 + 0.61cm and 6.50 in the outside of mouth / mouth respectively. The average total mandibular deviation index (AI) in the + 00.49cm. group was 2.81 + 1.63 and the mandibular ramus AI was 3.34 + 1.88. follow-up. The total mandibular body deflection index (AI) was 3.43 + 1.98 and the mandibular ramus was A13.73 + 1.82. There was no significant difference between the 2.27 + 1.91,1.92 + two groups at the follow-up.
Conclusion: in preventing the progress of asymmetric deformity of the face and the extension of the ramus of the mandibular ramus, the high position of the condyle in the intraoral approach is significantly different from that of the external oral administration.
【學(xué)位授予單位】：武漢大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R782.2
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