下颌升支部取骨移植治疗复发性颞颌关节强直

OSTEAL AUTO-TRANSPLANTATION FROM THE ASGENDING RAMUS USING IN TMJ-ARTHROPLASTY OF THE RECURRENCTED ANKYLOSIS

采用面部双切口,直视下行下颌升支“L”形截骨,骨块倒置再植,以下颌角部替代髁状突,治疗复发性颞颌关节强直10例,其中双侧性强直一例。经术后6月～2年的随访观察,张口度≥3cm,无一例复发。X线检查,倒置再植后的“L”形骨块生长愈合良好,形态满意。本术式具有就近取材,高位关节成形的优点,益于恢复下颌骨有效杠杆作用和力偶作用。个别病人同期或Ⅱ期作块状羟基磷灰石陶瓷种植颏部增高,使面部外形得以改善。

With L-form osteotomy of the ascending ramus 10 cases of recurrented TMJ-ankylosis have been performed arthroplasty with inverted replantation of the posterior segment. The advantages of this operative method: 1. reconstruction of the new TMJ with point to surface contact; 2. maintenance of the height of the ascending ramus; 3. rehabilitation of the TMJ-functions: 4, increase of the safety during the osteotomy and the stability of the os- teosynthesis. 8 cases were followed-up postoperatively more than 2 years, the maximum incisal opening of the all patients were>3.0cm. There was no recrudescence. Radiologic examination revealed satisfactory appearance and excenllentunion between the replanted segment and the rest of ramus. The details of the technique are described and discussed. An immediate or secondary mental augmentation is recommended.