正颌外科患者术前的颞下颌关节功能评价

TEMPOROMANDIBULAR JOINT DISORDERS(TMD) IN ORTHOGNATHIC SURGERY PREOPERATIVE PATIENTS

目的 了解正颌患者颞下颌关节 (TMJ)的功能状况 ,探讨牙颌面畸形与颞下颌关节之间的关系。方法正颌外科发育性牙颌面畸形 12 3例患者 ,平均年龄 2 3.8岁 ,男性 45例 ,女性 78例。颞下颌关节功能的检查方法采取问诊与检查相结合 ,颞下颌关节功能记分采取 Helkim o指数记分方法。结果 (1)牙颌面畸形患者颞下颌关节紊乱病 (TMD)各种症状发生率明显高于对照组人群。(2 )男性患者弹响症状发生率高于女性 ,而女性患者关节触诊疼发生率高。(3) 16～ 2 5岁患者张口受限发生率较高 ,但大多数为轻度张口受限。(4 )不对称畸形 (下颌前突偏斜 )者弹响症状发生率较高 ,而且相应偏斜侧最大侧向移动度小。而下颌后缩组开口度明显小于其他各组 ,提示其关节功能受损较严重。结论 牙颌面畸形患者的颞下颌关节功能不同于正常人 。

Objective To evaluate the function of temporomandibular joint(TMJ) of patients with diverse maxillo mandibular defromities, investigate TMD related to a maxillo mandibular deformity. Methods The Helkimo index was used to analyze the anamnestic(Ai) and clinical(Di) data of 123 preoperative cases with severe maxillo mandibular deformities. Results 1. The incidence of symptom of TMD in the patient group with diverse severe dentofacial deformities was higher than the control group. The most frequent symptom was clicking or other joint sounds. Pain originating from muscle or TMJ and limiation of jaw movement were the next two commonest symptoms. The incidence of signs of TMD in the patient group was not found to be different from the controls. 2. Clicking or other joint sounds were reported more often in female patients than male. In contrast with it the palpation tenderness from the TMJ was found more often in male. The incidence of limitation of jaw movement was higher in younger patients than older, but most mild. The symptom of TMJ sounds was significantly correlated with asymmetry deformity. The lateral movement mobility of the asymmetry patients was reduced in the deviation side. The more impaired mandibular mobility of the patients with mandibular retrusion suggested that their TMDs were severe. Conclusion The temporomandibular joint function of patients with severe maxillofacial deformities is different from that of normal peole. Mandibular asymmetry and retrusion deformities are associated with temporomandibular joint disorders.