四例罕见颞下颌关节盘骨化的临床回顾性分析

Retrospective analysis of 4 rare cases of temporomandibular joint disc ossification

目的总结颞下颌关节盘骨化的临床表现和治疗方法,以期为临床提供参考。方法对2006年1月至2018年1月深圳市第二人民医院口腔颌面外科收治的4例颞下颌关节盘骨化患者(其中男性2例,女性2例,年龄20~55岁,平均35.5岁)进行回顾性分析,4例颞下颌关节盘骨化均在颞下颌关节手术术中发现,对2例行骨化部分切除+关节盘复位锚固术,2例行关节盘摘除+颞肌筋膜瓣置换术。通过对比手术前后患者开口度、开口时关节区疼痛视觉量表(visual analogue scale,VAS)得分以及MRI影像学指标,分析颞下颌关节盘骨化的病因、临床表现并评价手术效果。结果4例患者颞下颌关节盘前移位的病史均较长(平均11.5年),临床以开口疼痛、开口受限为主要症状。术前开口度为(32.1±6.1)mm,开口时关节区疼痛VAS得分为(7.3±0.4)分;MRI示所有患侧均为关节盘不可复性前移位,髁突骨质磨损。术中可见关节盘骨化变黄,质地硬,失去原有弹性。病理检查示关节盘软骨骨化为骨样组织,镜下可见散在的骨细胞,骨细胞周围为红染的骨基质,有骨小梁形成。术后1年患者疼痛症状明显好转,VAS得分为(1.7±0.2)分,开口度改善至(38.5±2.2)mm;MRI示关节盘恢复至正常位置,髁突骨质有改建。结论关节盘长期前移位可发生骨化现象。根据骨化的程度和范围,可行骨化部分切除+关节盘复位锚固术或关节盘摘除+颞肌筋膜瓣置换术,临床治疗效果满意。

Objective To summarize the clinical manifestation and treatment of temporomandibular joint (TMJ) disc ossification,providing reference for clinical diagnosis and treatment of TMJ disc ossification.Methods From January 2006 to January 2018,4 patients with TMJ disc ossification (2 males and 2 females,aged 20-55 years with an average age of 35.5 years) which were admitted to the Department of Oral and Maxillofacial Surgery,Shenzhen Second People′s Hospital were analyzed retrospectively.Ossification of TMJ disc was found in 4 cases during TMJ surgery.Two cases underwent partial ossification resection plus disc reduction and anchorage,and two cases underwent discectomy plus temporalis myofascial flap replacement.The causes,clinical manifestations and surgical effects of TMJ disc ossification were analyzed by comparing the maximal interincisal opening,visual analogue scale (VAS) score and MRI imaging indexes before and after operation.Results The history of anterior disc displacement of TMJ in 4 patients was long (average 11.5 years).In clinic,TMJ disc ossification was characterized by TMJ pain and limitation of mouth opening.The maximal interincisal opening was (32.1±6.1) mm and the VAS score was (7.3±0.4) before operation.MRI showed that the displaced discs of the affected sides were displaced and the condyle bones were worn.During the operation,ossification of TMJ discs was found yellow and hard,and the original elasticity was lost.Pathologic findings showed that the TMJ disc cartilage were ossified to osteoid tissue.Under the microscope,bone cells scattered around the bone cells and red trabecular bone were seen,and there were bone trabecula formed.In a follow-up of one year,TMJ pain was significantly decreased [VAS:(1.7±0.2)],and the maximal interincisal opening was (38.5±2.2) mm.MRI showed that the TMJ disc returned to normal position,and the sign of repairing and reconstruction of condyle bone could be found.Conclusions Long term displacement of TMJ disc may cause ossification with pain and limitation of interincisal opening.According to the degree and extent of ossification,partial ossification plus disc reduction and anchorage or discectomy plus temporalis myofascial flap replacement is feasible,and the clinical effects are satisfactory.