下颌髁突不明原因吸收的诊治

Condylar Resorption of Unknown Reason: Diagnosis and Treatment

目的探讨下颌髁突不明原因吸收的诊治方法。方法对10例下颌髁突不明原因吸收患者的临床及影像学资料进行回顾性分析。10例下颌髁突不明原因吸收患者中,男性2例,女性8例,年龄19～31岁。患者主要临床表现为前牙开!、后牙早接触和Ⅱ类错!,影像学检查见髁突骨质吸收、高度降低、体积减小、形态不规则,下颌支高度降低,常伴有下颌支及髁突的发育不足;MRI表现为髁突乃至下颌支骨髓腔信号降低呈黑色无信号区。10例患者中4例髁突切除后内窥镜辅助下肋骨-软骨移植重建髁突,2例患者行关节盘复位修补术,4例患者未作治疗。结果4例重建髁突患者术后随访6～18个月,重建的关节形态和功能良好,具有稳定的!关系;2例关节盘复位修补患者术后随访4～6个月,开!无明显加重,但髁突吸收区域亦未见适应性改建。结论髁突不明原因吸收根据临床表现和影像学检查可确诊;肋骨-软骨移植重建髁突是治疗髁突不明原因吸收的有效手术方法。

Objective To discuss the diagnosis and treatment of condylar resorption of unknown reason. Methods The clinical data including the records of history, physical examination, radiography and laboratory of ten patients were studied. Ten patients consisted of 8 females and 2 males（mean age 24.1 years, range 19-31 years） had common clinical features including anterior open bite, posterior oeclusal prematurities and Class Ⅱ malocclusion. Images demonstrated a small and short condyle with abnormal shape, usually accompanied by the developmental insufficiency of the ramus and condyle. The condylar, even the ramus, showed the black marrow signal on MRI images. Four patients were treated by condylar reconstruction with costoehondral graft after condylectomy under the supervision of endescope. Two patients were treated by reduction and repair of disk. Four patients didn＇t accept any treatment. Results Four patients treated by condylar reconstruction with costochondral graft showed structures with the size and shape morphologically similar to normal joint and achieved a stable occlusion after follow-up of 6-18 months. Two patients treated by reduction and repair of disk didn＇t show significant change of open bite and remodeling of condyle after follow-up of 4-6 months. Conclusion The diagnosis of condylar resorption of unknown reason can be achieved based on the physical examination and radiogtaphical images. The condylar reconstruction with costoehondral graft after condylectomy is feasible.