自体喙突移植重建髁突对儿童颞下颌关节强直患者下颌骨生长的远期影响

doi:10.7518/hxkq.2020.01.005

摘要/Abstract

摘要：

目的儿童期下颌骨髁突受损通常导致错颌畸形和面部生长不协调。本研究目的是评价自体喙突移植重建下颌骨髁突对儿童颞下颌关节强直患者面部生长发育的远期影响。方法追踪评估2008年1月1日至2016年12月31日期间收治于四川大学华西口腔医院正颌及关节外科的10名单侧颞下颌关节强直的儿童患者,其中包括3名男性和7名女性,于5~12岁期间接受了关节间隙成形术、同侧喙突移植髁突重建术和带蒂颞筋膜瓣置入术。术后追踪3~8年,平均4.9年。术后拍摄曲面断层X线片,测定患侧下颌体长度和下颌支高度的生长量并与健侧相比较。结果所有患者术后恢复良好,追踪结束时10名患者的最大开口度为32~41 mm,平均35.6 mm。自体喙突移植重建髁突解除强直后下颌支高度和下颌体长度均继续生长,但是依然存在生长不足的现象。与初始数据（术后）相比,患侧下颌支高度（随访结束）增加了25.3%（P<0.05）,患侧下颌体长度增加了26.1%（P<0.05）。对比患侧与健侧的下颌骨生长率,患侧下颌支高度增长量与健侧相比少47.1%（P<0.05）,患侧下颌体长度的增长量与健侧相比少27.2% （P<0.05）。结论自体喙突移植重建下颌骨髁突治疗儿童颞下颌关节强直后,患侧下颌骨可继续生长,但依然会存在生长不足的现象。在颞下颌关节强直治疗完成后,相比于健侧,患侧的生长率是减小的。

关键词: 颞下颌关节, 关节强直, 儿童, 喙突移植, 下颌骨生长

Abstract:

Objective Mandibular condyle injury usually results in malocclusion and disharmony of facial growth in growing children. This study aimed to evaluate the long-term effects of autogenous coronoid grafts on the facial growth of children with unilateral temporomandibular joint (TMJ) ankylosis who underwent mandibular condyle reconstruction. Methods Ten growing patients with unilateral bony TMJ ankylosis admitted in West China Hospital of Stomatology, Sichuan University between January 1st, 2008 and December 31st, 2016 were followed up and evaluated. These patients include three males and seven females with ages ranging from 5 years to 12 years at the time of surgery. Each patient underwent gap arthroplasty, condyle reconstruction with ipsilateral coronoid, and interposition of the pedicled temporalis fascial flap in a single operation. The postoperative follow-up ranged from 3 years to 8 years with an average of 4.9 years. Postoperative panoramic radiographs determined the growth of the mandibular height and length on the affected side and compared it with those of the healthy side. Results All patients recovered uneventfully after surgery. At the end of follow-up period, the maximal mouth opening ranged from 32 mm to 41 mm with an average of 35.6 mm. Mandibular height and length continued to grow after the successful treatment of ankylosis using autogenous coronoid grafts for condyle reconstruction. However, growth deficit still existed. The final ramus height and mandibular length of the affected side at the end of follow-up increased by 25.3% (P<0.05) and 26.1% (P<0.05), respectively, compared with the initial values measured immediately after surgery. Growth rates of ramus height and mandibular length of the affected side were 47.1% and 27.2% lower (P<0.05) than those of the healthy side, respectively. Conclusion Mandibular height and length continued to grow after the successful treatment of ankylosis by using autogenous coronoid grafts for condyle reconstruction. However, growth deficit still existed. The growth rate of the affected mandible was reduced compared with that of the undisturbed side even after treatment of ankylosis.

Key words: temporomandibular joint, ankylosis, children, coronoid process, mandible growth

中图分类号:

R782.6⁺1

阚召俊,苏成利,李运峰. 自体喙突移植重建髁突对儿童颞下颌关节强直患者下颌骨生长的远期影响[J]. 华西口腔医学杂志, 2020, 38(1): 23-29.

Kan Zhaojun,Su Chengli,Li Yunfeng. Long-term effects of autogenous coronoid grafts on the facial growth of children with unilateral temporomandibular joint ankylosis and reconstructed mandibular condyle[J]. West China Journal of Stomatology, 2020, 38(1): 23-29.

图/表 9

表 1

图 1

图 2

表 2

表 3

图 3

图 4

图 5

图 6

参考文献 33

[1]	Movahed R, Mercuri LG . Management of temporomandibular joint ankylosis[J]. Oral Maxillofac Surg Clin North Am, 2015,27(1):27-35.
[2]	Al-Moraissi EA, El-Sharkawy TM, Mounair RM , et al. A systematic review and meta-analysis of the clinical outcomes for various surgical modalities in the management of temporomandibular joint ankylosis[J]. Int J Oral Maxillofac Surg, 2015,44(4):470-482.
[3]	焦子先, 张善勇 . 肋骨肋软骨移植在颞下颌关节重建中的应用进展[J]. 中国口腔颌面外科杂志, 2014,12(4):373-377.
	Jiao ZX, Zhang SY . Research progress of costochondral graft in temporomandibular joint reconstruction[J]. China J Oral Maxillofac Surg, 2014,12(4):373-377.
[4]	刘尧, 祝颂松, 李继华 , 等. 自体喙突移植再造髁突关节成形术的疗效评估[J]. 实用口腔医学杂志, 2009,25(5):668-671.
	Liu Y, Zhu SS, Li JH , et al. The clinic evaluation of condylar reconstruction by using autogenous coronoid process in arthroplasty[J]. J Pract Stomatol, 2009,25(5):668-671.
[5]	祝颂松, 胡静 . 牵张成骨在颞下颌关节强直及其继发畸形矫治中的应用[J]. 口腔疾病防治, 2016,24(1):6-10.
	Zhu SS, Hu J . The application of distraction osteogenesis in the temporomandibular joint ankylosis and secondary dentofacial deformities[J]. J Prev Treat Stomatol Dis, 2016,24(1):6-10.
[6]	Parmar BS, Garg B, Mehta RD , et al. Ramus condyle unit reconstruction using vertical ramus osteotomy in temporomandibular joint ankylosis[J]. J Maxillofac Oral Surg, 2015,14(3):630-636.
[7]	Liu Y, Khadka A, Li J , et al. Sliding reconstruction of the condyle using posterior border of mandibular ramus in patients with temporomandibular joint ankylosis[J]. Int J Oral Maxillofac Surg, 2011,40(11):1238-1245.
[8]	Neelakandan RS, Raja AV, Krishnan AM . Total alloplastic temporomandibular joint reconstruction for management of TMJ ankylosis[J]. J Maxillofac Oral Surg, 2014,13(4):575-582.
[9]	Sharma H, Chowdhury S, Navaneetham A , et al. Costochondral graft as interpositional material for TMJ ankylosis in children: a clinical study[J]. J Maxillofac Oral Surg, 2015,14(3):565-572.
[10]	Verma A, Yadav S, Singh V . Overgrowth of costochondral graft in temporomandibular joint ankylosis: an unusual case[J]. Natl J Maxillofac Surg, 2011,2(2):172-174.
[11]	Guyuron B, Lasa CI Jr . Unpredictable growth pattern of costochondral graft[J]. Plast Reconstr Surg, 1992, 90(5): 880-886 887-889.
[12]	Siavosh S, Ali M . Overgrowth of a costochondral graft in a case of temporomandibular joint ankylosis[J]. J Craniofac Surg, 2007,18(6):1488-1491.
[13]	Baek RM, Song YT . Overgrowth of a costochondral graft in reconstruction of the temporomandibular joint[J]. Scand J Plast Reconstr Surg Hand Surg, 2006,40(3):179-185.
[14]	Lata J, Kapila BK . Overgrowth of a costochondral graft in temporomandibular joint reconstructive surgery: an uncommon complication[J]. Quintessence Int, 2000,31(6):412-414.
[15]	Perrott DH, Umeda H, Kaban LB . Costochondral graft construction/reconstruction of the ramus/condyle unit: long-term follow-up[J]. Int J Oral Maxillofac Surg, 1994,23(6 Pt 1):321-328.
[16]	Medra AM . Follow up of mandibular costochondral grafts after release of ankylosis of the temporomandibular joints[J]. Br J Oral Maxillofac Surg, 2005,43(2):118-122.
[17]	赵界云, 何冬梅 . 颞下颌关节强直治疗进展[J]. 中国实用口腔科杂志, 2016,9(12):751-755.
	Zhao JY, He DM . Treatment progress of temporomandibular joint ankylosis[J]. Chin J Pract Stomatol, 2016,9(12):751-755.
[18]	Zhang W, Gu B, Hu J . Retrospective comparison of autogenous cosotochondral graft and coronoid process graft in the management of unilateral ankylosis of the temporomandibular joint in adults[J]. Br J Oral Maxillofac Surg, 2014,52(10):928-933.
[19]	Ware WH, Brown SL . Growth centre transplantation to replace mandibular condyles[J]. J Maxillofac Surg, 1981,9(1):50-58.
[20]	Svensson B, Adell R . Costochondral grafts to replace mandibular condyles in juvenile chronic arthritis patients: long-term effects on facial growth[J]. J Craniomaxillofac Surg, 1998,26(5):275-285.
[21]	Amrani S, Anastassov GE, Montazem AH . Mandibular ramus/coronoid process grafts in maxillofacial reconstructive surgery[J]. J Oral Maxillofac Surg, 2010,68(3):641-646.
[22]	Sabhlok S, Waknis PP, Gadre KS . Applications of coronoid process as a bone graft in maxillofacial surgery[J]. J Craniofac Surg, 2014,25(2):577-580.
[23]	洪民 . 喙突移植治疗颞颌关节强直[J]. 中国医学杂志, 1982,62(1):37-39.
	Hong M . Coronoid process grafting in treatment of temporomandibular ankylosis[J]. Natl Med J China, 1982,62(1):37-39.
[24]	邰振星 . 喙突移植术治疗颞下颌关节强直临床和组织病理学观察[J]. 中华口腔医学杂志, 1987,22(2):94-96, 127.
	Tai ZX . Temporomandibular joint reconstruction with coronoid process transplantation in ankylosis[J]. Chin J Stomatol, 1987,22(2):94-96, 127.
[25]	Hu W, Thadani S, Mukul SK , et al. Autogeneous coronoid process as free graft for reconstruction of mandibular condyle in patients with temporomandibular ankylosis[J]. Oral Maxillofac Surg, 2014,18(3):313-323.
[26]	Liu YM, Li JH, Hu J , et al. Autogenous coronoid process pedicled on temporal muscle grafts for reconstruction of the mandible condylar in patients with temporomandibular joint ankylosis[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2010,109(2):203-210.
[27]	Farmand M, Mommaerts M, Teuscher U . Facial growth after treatment of unilateral temporomandibular joint ankylosis in childhood without growth centre transplantation. A serial cephalomorphometric study[J]. J Craniomaxillofac Surg, 1989,17(6):260-270.
[28]	仇玲玲, 杨力, 王邦康 . 利用曲面断层片进行下颌骨测量的研究[J]. 北京口腔医学, 2007,15(6):326-328.
	Qiu LL, Yang L, Wang BK . A study of mandibular measurement by panoramic radiographs[J]. Beijing J Stomatol, 2007,15(6):326-328.
[29]	徐袁瑾, 沈国芳, 唐友盛 . 曲面断层摄影变形失真的初步研究[J]. 临床口腔医学杂志, 2001,17(3):185-188.
	Xu YJ, Shen GF, Tang YS . A preliminary study on distortion of the orthopantomograph[J]. J Clin Stomatol, 2001,17(3):185-188.
[30]	冷斌, 王贻宁, 程勇 , 等. 曲面断层与螺旋CT在牙种植应用中的对比研究[J]. 中华口腔医学杂志, 2002,37(5):339.
	Leng B, Wang YN, Cheng Y , et al. A comparative study of application of orthopantomography and spiral computed tomography in dental implant[J]. Chin J Stomatol, 2002,37(5):339.
[31]	Larheim TA, Svanaes DB . Reproducibility of rotational panoramic radiography: mandibular linear dimensions and angles[J]. Am J Orthod Dentofacial Orthop, 1986,90(1):45-51.
[32]	Moss ML, Salentijn L . The compensatory role of the condylar cartilage in mandibular growth: theoretical and clinical implications[J]. Dtsch Zahn Mund Kieferheilkd Zentralbl Gesamte, 1971,56(1):5-16.
[33]	Sailer HF . Experiences with intra-oral partial resection and simultaneous reconstruction of the mandible in preoperatively non-infected cases[J]. J Maxillofac Surg, 1974,2(4):173-178.

测量数据	下颌支高度	下颌体长度
初始	46.2±6.3	60.5±8.6
最终	57.9±6.7*	76.3±9.2*

测量数据	下颌支高度增长量	下颌体长度增长量
患侧	11.7±3.5	15.8±2.9
健侧	22.1±4.0*	21.7±4.3*