颞肌筋膜瓣联合冠突移植治疗颞下颌关节强直

Application of temporalis myofascial flap combined with coronoid process graft in the treatment of temporomandibular joint ankylosis

目的:应用带蒂颞肌筋膜瓣联合冠突移植治疗颞下颌关节真性强直,评价其重建颞下颌关节的效果。方法:对6例颞下颌关节真性强直患者切除病变区骨质,形成骨间隙,采用带蒂颞肌筋膜瓣转移充填骨间隙和冠突切取植入构造新的“髁突”,重建颞下颌关节。手术后常规随访,评价其疗效。结果:全部病例术后随访4～28个月,开口度3.1～3.8cm,平均开口度3.5cm,效果满意。结论:带蒂颞肌筋膜瓣联合冠突移植治疗颞下颌关节真性强直具有多方面优势,是防止颞下颌关节术后复发的有效手术治疗方法。

PURPOSE： To determine the efficacy of interpositional temporalis myofascial flap and coronoid process graft in the treatment of temporomandibular joint ankylosis. METHODS： A retrospective clinical study of 6 cases of TMJ ankylosis surgically treated was performed. Our operative protocol for TMJ ankylosis entailed resection of ankylotic mass, arthroplasty, interpositional tissue transfer to the TMJ with temporalis superficial fascial flap and autogenous coronoid process graft for lengthening the ramus, and early postoperative initial exercise. Clinical examination, radiographs, and photographs were used postsurgically to evaluate the grafts, condylar function, and facial appearance. RESULTS： Very satisfactory postsurgical results were obtained in terms of function of the TMJ and aesthetics during the follow-up period of 4 to 28 months. The postoperative mean maximal incisal opening was 35 mm, ranged from 31 to 38 mm. CONCLUSION： The temporalis superficial facial flap combined with coronoid process are autogenous grafts that have the advantages of close proximity to the TMJ, minimal surgical morbidity, and successful clinical results. It was found to be a valuable option for TMJ ankylosis reconstruction.