血管蒂颞筋膜瓣间置治疗广泛骨性粘连的颞颌关节强直

Pedicled temporal fascial flap for the reconstruction of extensive bony ankylosis of the temporo- mandibular joint

为了探讨血管蒂颞筋膜瓣用作颞颌关节强直重建的间置物的效果,于7例广泛颅颌骨性粘连的颞颌关节强直病例,采用乙状切骨方法和该筋膜瓣间置重建颞颌关节。在术后21天开始主动张口练习。经术后1年2个月至3年6个月,平均2年零2个月的随诊,张口度最大为4.0cm,最小3.0cm(5岁患儿),平均3.3cm。手术后张口度逐渐增大,3个月关节活动轻松自如,无张口度回缩病例。认为颞筋膜瓣是关节强直重建的理想间置物,具有充当关节盘结构和隔离颅颌骨性创面预防强直复发的作用。

Interpositional material is of great importance in the reconstruction of the ankylosed temporomandibular joint.A myriad of types of materials and methods has been used for this purpose with controversy remained among authors.Seven patients of temporomandibular joint ankylosis with extensive bony adhesion at the site of the joint were involved in this paper.Treatment included sigmoid- shaped osteotomy and pedicled temporal fascial flap transfer as an interpositional graft.Active jaw opening exercises started 21 days postoperatively.The time of follow-up ranged from 14 to 40 months with an average of 26 months.The patients showed jaw opening ranging from 3 cm(in a 5-year old child)to 4.0 cm with an average of 3.3 cm.No recurrence was found in the patients.It's our opinion that the flap is an ideal material for the reconstruction of the ankylosed temporomandibular joint,and that it can serve as the structure of the meniscus and completely separate the bony surfaces between the cranium and jaw and therefore prevent recurrence of ankylosis.