骨性安氏Ⅲ类错[牙合]伴偏颌及与颞下颌关节紊乱病的关联研究进展

Research progress on the structural features,treatments,and association with temporomandibular disorder in patients with skeletal classⅢmalocclusion with mandibular deviation

骨性安氏Ⅲ类错[牙合]畸形伴偏颌会导致颅骨、下颌骨、上颌骨的旋转和移位,并常伴有口颌面部软组织的不对称改变,影响美观和功能,其常用治疗手段(正畸和正颌手术)存在美学效果的局限性,正确评估形态改变对治疗方案的选择意义重大。骨性安氏Ⅲ类错[牙合]伴偏颌与颞下颌关节形态、功能变化及颞下颌关节紊乱病(temporomandibular disorder,TMD)的发生相关,但因果关系尚存争议。本文就骨性安氏Ⅲ类错[牙合]畸形伴偏颌患者的病因、软硬组织的改变、治疗手段以及其与TMD的关联进行综述。目前研究结果表明,偏颌是一种病因不明确,涉及到颅底、上颌骨、下颌骨形态变化、软组织形态变化、咬合改变以及颌骨旋转移位的复杂疾病,对颞下颌关节及下颌功能运动也会产生影响。偏颌患者中常见骨性安氏Ⅲ类错[牙合]畸形,需要早期治疗;其治疗手段多样,正确评估导致面部不对称的软硬组织形态变化是治疗的前提。正畸⁃正颌联合治疗(必要时合并软组织的修整)是治疗骨性安氏Ⅲ类错[牙合]伴偏颌的有效手段。此外,偏颌与TMD之间也有紧密的联系,设计治疗方案时需要充分考虑。

Skeletal angle classⅢmalocclusion with mandibular deviation involves the rotation and translation of the cranial base,maxilla,mandible,and soft tissue.It compromises the patients’appearance and stomatognathic func⁃tion.The treatment outcome is not satisfactory,and correct evaluation is of great significance.The causal relationship between skeletal ClassⅢwith mandibular deviation and TMD remains controversial.This review focuses on the struc⁃tural alterations of hard and soft tissue,the etiology,the choice of treatment methods,and the association with TMD in patients with skeletal classⅢmalocclusion with mandibular deviation.The results show that mandibular deviation is a complex disease with unclear etiology.It involves morphological changes,rotation and displacement of the cranial base,maxilla and mandible,morphological changes of the soft tissue,and occlusal changes,which also compromise the temporomandibular joint and mandibular function.Skeletal ClassⅢmalocclusion is common in patients with mandibular deviation.Early treatment is needed;however,the treatment methods vary.The correct evaluation of the morphological changes of soft and hard tissues leading to facial asymmetry is the premise of treatment.Orthodontic and orthognathic treatment(combined with soft tissue repair when necessary)is an effective method for the treatment of skeletal classⅢmalocclusion with mandibular deviation.In addition,there is a close relationship between mandibular deviation and TMD,which needs to be fully considered in the design of treatment.