髁突高位切除术治疗髁突肥大的临床和影像学研究及病例报告
发布时间：2018-07-28 09:19
【摘要】：髁突肥大(condylar hyperplasia, CH),亦被称为单颌肥大(hemimandibular hyperplasia, HH)、单颌伸长(hemimandibular elongation,HE)、偏面肥大、上颌发育不良、Sturge-Weber综合征等,是临床上较少见的一种疾病。由Robert Adams于1836首次发现并记录这一疾病。髁突肥大是指下颌骨髁突非肿瘤性过度生长而产生的一种畸形,包括髁突形态及大小上的改变。髁突肥大能造成严重的错黯及面部非对称畸形是患者就诊的主要原因,并且在下颌骨不对称畸形中,其发病比例相当高。 本次研究的目的即通过对接受髁突高位切除患者术后随访研究,系统阐述术前、术后面部软/硬组织偏颌指数的测量,评估两者对面型偏斜改善的作用的关联。并比较口内入路与口外入路的髁突高位切除术术后髁突改建效果及面型偏斜改善程度,以及该术式对颞下颌关节功能的影响。进一步加深对这类疾病的认识,将有助于制定合理的诊疗计划和预后判断。 实验一髁突高位切除术后面部软/硬组织相关性研究 目的：对髁突高位切除术患者的术前、术后面部软/硬组织偏颌指数测量,观察软/硬组织偏斜改善的关联。 方法：研究对象为本院颞下颌关节外科就诊的髁突肥大患者。观测术前及术后随访时,软组织耳屏前点、下颌角点(Go’)、颏点(Me‘)与面中线和Go'-Me',及硬组织髁突外侧点(Co1)、下颌角点(Go)、颏点(Me)和Go-Me的距离。计算得出对应偏颌指数(AI)。组内配对t检验及组间Pearson相关性检验。 结果：组内配对t检验。经耳屏前点与经髁突外侧点偏颌指数(AI)相关系数r=0.933,下颌角(AI)r=0.984,下颌骨体(AI)r=0.997,颏点偏移r=0.997,下颌升支(AI)r=0.645,仅耳屏前点(AI)P0.01。 结论：1)单纯的髁突高位切除术可有效的改善偏颌畸形；2)经长期随访,面部软组织偏斜的矫正与硬组织的矫正之间有较高的相关性；3)面部软/硬组织下颌升支偏斜的改善不完全等效。 实验二髁突高位切除术对颞-下颌关节功能的影响 目的：探讨髁突高位切除术对髁突肥大患者颞下颌关节功能的影响。 方法：评估14例髁突肥大患者术前、随访时检查包括下颌运动、关节杂音、关节区触诊及头颈部肌肉的触诊。根据Fricton颞下颌关节功能紊乱指数(CMI)进行评分,评价该术式对患者颞下颌关节功能影响。 结果：随访时TMJ功能障碍指数(DI)由0.15±0.092降至0.031±0.028,t=5.182,P0.05。肌肉压痛点指数(PI)由0.069±0.091降至0.019±0.032,t=2.920,P0.05.颞下颌关节紊乱指数(CMI)由0.11±0.089降至0.025±0.022,t=4.459,P0.05。 结论：髁突高位切除术可有效改善髁突肥大导致的颞下颌关节功能紊乱。 实验三口内/口外入路髁突高位切除术术后髁突改建的研究 目的：评估髁突肥大患者在接受口内和口外入路髁突高位切除术后,面部不对称畸形及髁突表面改建的差异性。方法：经诊断确诊髁突肥大患者24例(左侧：右侧=14：10),主诉为面部不对称性及咬合干扰。所有患者均接受在患侧的单侧髁突高位切除术(11例口外入路,13例口内入路),平均随访间期为11.7个月。临床及放射学检查确诊,包括颞下颌关节功能检查,面部对称评估,下颌升支长度测量及颞颌关节面的改建。 结果：口内入路及口外入路术后,患者最大张口度、关节弹响及疼痛均无显著性差异。口外组患侧下颌术前升支长度平均为7.09±0.61cm,术后为6.63±0.60cm。口内组术前为6.83±0.55cm,术后测的6.48±0.54cm。随访时,口外/口内分别为6.59±0.61cm和6.50±00.49cm。口外组平均总下颌骨体偏斜指数(AI)为2.81±1.63,下颌升支AI为3.34±1.88。随访时测得1.89±1.75及2.17±1.11。在口内组均总下颌骨体偏斜指数(AI)为3.43±1.98,下颌升支A13.73±1.82,随访时分别为2.27±1.91,1.92±1.48。两组之间无显着性差异。 结论：在防止单侧髁突肥大导致的面部不对称畸形进展以及下颌升支的伸长方面,口内入路的髁突高位切除术与口外入路武明显差异。同时,患侧髁突改建的效果经长期随访也是较明显的。
[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.
【学位授予单位】：武汉大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：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.
【学位授予单位】：武汉大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R782.2
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