颧骨颧弓联合下颌角整形术对颞颌关节髁状突的影响

Effect of zygoma combined with mandibular angel plastic surgery on temporomandibular joint condyle

目的 观察颧骨颧弓联合下颌角整形术后颞颌关节髁状突位置的变化。方法随机选取颧骨颧弓肥大合并下颌角肥大者59例，筛除牙周病、颞颌关节痛及偏颌等。均采用双侧颧骨颧弓缩窄术＋下颌角下颌缘切除＋下颌体部外侧骨皮质劈除术。于术前、术后10d、术后6个月分别做螺旋CT检查并进行三维重建，用图像分析软件进行三维CT测量，测得颞颌关节矢状面上相应角度（0°，60°，120°，180°）上的线距离。其中以0°（EE’间距）和60。（AA’间距）表示关节前间隙情况，以60°（AA’间距）和120°（PP’间距）表示关节上间隙情况；以120°（PP’间距）和180°（SS’间距）表示关节后间隙情况。结果颧骨颧弓联合下颌角整形术后O°及60°上间距变化趋势相同，术后10d稍增大，但术前、术后10d、术后6个月差异无统计学意义（P〉0．05）；120°及180°上间距变化趋势相同，术后10d增大，术前与术后10d差异有统计学意义（P〈0．05），但术前与术后6个月差异无统计学意义（P〉0．05）。结论颧骨颧弓联合下颌角整形术后短期内颞颌关节上间隙及关节后间隙发生了改变，间隙减小，可能说明颞颌关节具有代偿能力，短期的改变能够恢复正常。

Objective To observe the temporomandibular joint spaces changes after the plastic surgery of combined zygoma with mandibular angel. Methods We randomly selected 59 patients with prominent zygoma and mandibular angle, screening periodontal disease, TMJ pain and partial jaw. Bilateral zygomatic arch coarctation, jaw edge of the mandibular angle ostectomy and the mandibular body outer panel split were used. All patients accepted CT scan and three-dimensional reconstruction before operation, 10 days after operation and 6 months after operation, and then image analysis softwares were used to measure the line distance of corresponding angle （0°, 60°, 120°, and 180°）at the TMJ sagittal plane. The 0° （EE ＇pitch） and 60° （AA＇pitch） represented for pre-space, the 60° and 120° （PPrpitch） was upper-space, the 120° and 180° （SS＇pitch） was posterior-space. Results 0° and 60° had the same change trend, which slightly increased at 10 days after operation. The difference before operation and 10 days, 6 months after operation were not statistically significant （P〉 0.05）; 120° and 180° had the same change trend, which increased at 10 days after operation. The difference between before operation and 10 days after operation was statistically significant （P〈 0.05）, but the difference between before operation and 6 months after operation was not statistically significant （P〈0.05）. Conclusions In the short term after plastic surgery of zygoma combined with mandibular angel, the TMJ upper and posterior spaces are changed, and the interspace reduced. This may indicate that the TMJ has compensatory ability, and short-term changes can return to normal.