保存翼外肌附着的颞下颌关节肋骨-肋软骨移植重建术效果评价

Effect of modified costochondral graft in temporomandibular joint reconstruction with lateral pterygoid muscle preservation technique

目的 :探索一种保存翼外肌功能的颞下颌关节重建术式。方法:对3例因严重颞下颌关节骨关节病行肋骨-肋软骨移植重建颞下颌关节的患者,采用髁突截骨下降的方法保存翼外肌附着,避免传统颞下颌关节置换术术中切断翼外肌对翼外肌功能所造成的损害。通过术后1年连续随访,从影像学结果与临床效果两方面评估该方法的稳定性与有效性。结果:术后影像学检查证实,下降的髁突头与外侧移植的肋骨-肋软骨均贴合良好,无明显移位,肋骨-肋软骨与髁突头之间骨皮质连续,愈合良好;患侧翼外肌与髁突头附着紧密,肌束走行正常,未见明显肿胀、变形。术后连续1年的随访表明,采用保存翼外肌附着术式的患者,在开口度、前伸及侧方运动程度和饮食功能方面均恢复良好,且随着随访期的延长,下颌运动范围逐步增大。结论:保留翼外肌附着的颞下颌关节重建术在术后下颌运动的恢复方面优于传统的颞下颌关节肋骨-肋软骨移植重建术。

PURPOSE： To explore a modified temporomandibular joint reconstruction which can preserve the maximum function of lateral pterygoid muscle. METHODS： In 3 cases with severe temporomandibular joint osteoarthrosis who received temporomandibular joint reconstruction with costochondral graft, we kept the integrity of condyle and lateral pterygoid muscle attachment and move them downwards to preserve the muscle function. Consecutive follow-ups, both radiographic and clinical, were carried out to evaluate its effectivity and reliability. RESULTS： Postoperative CT scan showed a satisfactory bone healing and almost normal lateral pterygoid muscle patterns. The one-year follow-up of 3 case series showed a desirable recovery of mouth opening, mandible movement range and diet quality. CONCLUSIONS：Lateral pterygoid muscle preservation technique showed an inspiring result of postoperative mouth opening recovery and improving range of lateral mandibular movement.