耳屏后切口颞下颌关节盘复位固定术手术入路及效果评价

Evaluation of short-term effect of posterior tragus approach for the treatment of TMJ anterior disc displacement

目的 探讨耳屏后小切口手术入路对颞下颌关节盘复位固定术术式的治疗效果以及对术后面神经功能影响。方法 选择符合条件的颞下颌关节盘不可复性前移位患者5例(5侧关节),依据Wilkes-Bronstein分期,纳入Ⅲ-Ⅴ期患者,采用耳屏后切口行颞下颌关节盘复位固定术,并于术后24 h、1周、1个月、3个月进行面神经功能评价,术后1个月、3个月进行临床症状及MRI评价。结果 术中术区视野显露充分,4例(4侧)关节术后24 h面神经功能均无障碍,1例患者面神经出现轻度颞支损伤症状,术后1个月好转,随访至术后3个月,面神经功能良好,5例患者临床症状均消失。与术前张口度和疼痛VAS相比,术后1、3个月张口度及疼痛VAS评分,均有明显得到改善,且达到显著性差异(P <0.05),而且术后MRI显示恢复正常盘突关系。结论 耳屏后小切口手术入路对于颞下颌关节盘不可复性前移位的治疗效果肯定。术中暴露关节区充分,具有切口隐蔽美观、手术创伤小、面神经受损程度轻等优点,可作为颞下颌关节手术的入路之一。

Objective To investigate the effect of surgical approach for the treatment of temporomandibular joint anterior disc displacement with posterior tragus incision.Methods Five patients(5 joints)were selected in this study.All patients were diagnosed as stageⅢ-Ⅴof TMJ internal derangement according to Wilkes-Bronstein staging system.All patients underwent open surgery for TMJ disc repositioning and fixation using the posterior tragus incision with vascular-guided mutilayer approach.The facial nerve function was evaluated at 24 hours,first week,first month and third month after operation.The clinical symptoms and MRI performance were evaluated at first month and third month.Results Good surgical field exposure was obtained.Four patients(4 sides)had no obstacle in facial nerve function 24 hours after operation.One patient had mild symptoms of temporal branch injury of facial nerve,which improved one month after operation.Three months after operation,the facial nerve function was good,the clinical symptoms of five patients disappeared.Compared with the preoperative mouth opening degree and pain VAS,the mouth opening degree and pain VAS score were significantly improved at 1 and 3 months after operation(P<0.05),and the postoperative MRI showed that the normal disc process relationship was restored.Conclusions The posterior approach is feasible for the treatment of the temporomandibular joint disorder,which has the advantages of concealed incision,small surgical trauma and light damage of facial nerve.It can be used as one of the approaches for temporomandibular joint surgery.