颞下颌关节腱鞘囊肿和滑膜囊肿的诊断与治疗

发布时间：2018-11-03 17:29

【摘要】：目的:回顾性分析颞下颌关节腱鞘囊肿和滑膜囊肿的临床特点及治疗预后,为早期临床诊断和治疗提供参考。方法:收集1998年5月至2013年8月间在北京大学口腔医学院颞下颌关节病及口颌面痛诊治中心、口腔颌面外科就诊并进行治疗,最终诊断为颞下颌关节腱鞘囊肿和滑膜囊肿的患者9例,就其临床表现、影像学特点、诊断与鉴别诊断、治疗和随访情况进行总结和讨论。结果:9例患者中,男性3例,女性6例,年龄33~62岁,中位年龄39岁;病程2周至3年,中位值4个月。行普通X线检查者7例,CT检查者8例,MRI检查者6例,B超检查1例。最终诊断为腱鞘囊肿者7例,滑膜囊肿2例。腱鞘囊肿主要表现为耳前区或关节区的包块或膨隆,无明显症状或局部仅有酸胀不适感,偶然有痛;而滑膜囊肿则表现为耳前区肿痛、开口受限等,可伴咬合紊乱。行手术切除8例,关节穿刺冲洗治疗1例。随访时间3个月至9年,其中1例复发,其余8例无复发。结论:MRI检查对颞下颌关节腱鞘囊肿和滑膜囊肿的诊断和治疗有重要价值。手术切除治疗具有较好的治疗效果,但经关节腔穿刺冲洗治疗滑膜囊肿同样获得了良好的治疗效果,有待于更多病例治疗经验的积累。
[Abstract]:Objective: to retrospectively analyze the clinical features and prognosis of temporomandibular joint tendon sheath cyst and synovial cyst in order to provide reference for early clinical diagnosis and treatment. Methods: from May 1998 to August 2013, we collected and treated the patients with temporomandibular arthropathy (TMJ) and maxillofacial pain (OMG) in the Center of Temporomandibular Arthropathy (TMJ), Peking University School of Stomatology. Nine cases of temporomandibular joint tendon sheath cyst and synovial cyst were diagnosed. The clinical manifestations, imaging features, diagnosis and differential diagnosis, treatment and follow-up were summarized and discussed. Results: of the 9 patients, 3 were male and 6 were female, aged 3362 years, with a median age of 39 years, and the course of disease ranged from 2 weeks to 3 years with a median value of 4 months. Routine X-ray examination was performed in 7 cases, CT in 8 cases, MRI in 6 cases and B-ultrasound in 1 case. Finally, 7 cases were diagnosed as aponeurotic cyst and 2 cases as synovial cyst. The main manifestations of tendon sheath cyst are anterior ear area or articular mass or bulge, no obvious symptoms or local acid-distention discomfort, occasional pain, while synovial cyst is characterized by anterior ear swelling and pain, limited opening, etc, and may be accompanied by occlusion disorder. Surgical excision was performed in 8 cases and joint puncture and irrigation in 1 case. The follow-up time ranged from 3 months to 9 years, of which 1 case recurred and 8 cases did not. Conclusion: MRI is of great value in the diagnosis and treatment of temporomandibular joint tendon sheath cyst and synovial cyst. Surgical excision has a good therapeutic effect, but the treatment of synovial cysts through articular cavity puncture and flushing has also achieved a good therapeutic effect, which needs to be accumulated in more cases.
【作者单位】：北京大学口腔医学院·口腔医院口腔颌面外科;北京大学口腔医学院·口腔医院颞下颌关节病及口颌面痛诊治中心;
【分类号】：R782.6

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