颞下颌关节髁突囊样变的锥形束CT影像特点

doi:10.7518/hxkq.2018.05.007

摘要/Abstract

摘要：

目的利用口腔颌面锥形束CT观察髁突囊样变的影像学表现,探讨囊样变的影像特点并加以分类。方法收集颞下颌关节锥形束CT影像学表现有囊样变的194例患者,观察并记录囊样变的部位、大小、数量、边缘骨白线、周围骨小梁结构、髁突整体骨质情况。根据髁突整体骨质情况,将髁突囊样变分为Ⅰ型和Ⅱ型,比较其发生的部位、数量、边缘骨白线以及周围骨小梁结构情况。结果 194例患者的198侧关节发现囊样变表现,94例位于左侧关节,96例位于右侧关节,4例位于双侧关节。50.0%（99侧）的囊样变位于髁突前外侧皮质骨下方;囊样变直径最小1.2 mm,最大13.5 mm,平均（3.4±1.5）mm;75.3%（149侧）为单发囊样变;62.6%（124侧）存在完整的骨白线包绕;80.8%（160侧）周围骨小梁结构有骨质硬化。66.7%（132侧）囊样变髁突表现有晚期骨关节病征象,5.1%（10侧）囊样变髁突表现有早期骨关节病征象,28.3%（56侧）髁突除囊样变外无其他明显骨质改变。Ⅰ型和Ⅱ型髁突囊样变在发生部位、数量和周围骨小梁结构方面存在差异,Ⅰ型髁突囊样变较多发和骨质硬化,Ⅱ型髁突囊样变发生于髁突内部或髁突颈部较多。结论 Ⅰ型和Ⅱ型髁突囊样变在发生部位、数量和周围骨小梁结构存在不同,这可能与其病因及形成机制不同有关。

关键词: 颞下颌关节, 髁突, 囊样变, 放射学特征, 锥形束CT

Abstract:

Objective To analyze the radiological characteristics and classifications of the cyst-like lesion of condyle in temporomandibular joint (TMJ) by cone beam computed tomography (CBCT). Methods The study was conducted retros-pectively on TMJ images from 194 patients who underwent CBCT examinations. Location, size, amount, surrounding bone trabecula, cortical bone white line of cyst-like lesion, and the overall condition of the condylar bone were evaluated. According to the overall condition of the condylar bone, the cyst-like lesion of condyle were divided into typesⅠand Ⅱ. The location, size, amount, surrounding bone trabecula, and cortical bone white line of the two types of cyst-like lesions were compared. Results In 198 condylars of 194 patients, cyst-like lesions were detected in the left side of 94 patients, in the right of 96 patients, and in both sides of 4 patients. The size of lesions ranged from 1.2 mm to 13.5 mm, with an average size of (3.4±1.5) mm. Half of the cyst-like lesions were located underneath the anterior lateral cortical bony layer (99 condylars, 50.0%). Most cyst-like lesions were solitary (149 condylars, 75.3%), while 62.6% (124 condylars) were surrounded by continuous bony white lines. Bone sclerosis could be observed in 160 condylars (80.8%). A total of 132 condyles (66.7%) were accompanied by changes in late-stage osteoarthrosis, while the others were only accompanied by early-stage osteoarthrosis (10 osteoarthrosis, 5.1%) or showed no evidence of osteoarthrosis (56 osteoarthrosis, 28.3%). Statistical difference were observed in the location, amount, and surrounding bone trabecula of the two types of cyst-like lesions. TypeⅠcyst-like lesions had more frequent and bone sclerosis than type Ⅱ, whereas type Ⅱ cyst-like lesions occurred more on condylar internal or condyle neck than typeⅠ. Conclusion The pathogenesis and mechanism of the two types of cyst-like lesions may be different from each other.

Key words: temporomandibular joint, condyle, cyst-like lesion, radiological characteristics, cone beam computed tomography

中图分类号:

R782.6

李澍,雷杰,傅开元. 颞下颌关节髁突囊样变的锥形束CT影像特点[J]. 华西口腔医学杂志, 2018, 36(5): 498-502.

Shu Li,Jie Lei,Kaiyuan Fu. Radiological characteristics of the cyst-like lesion of condyle in temporomandibular joint by cone beam computed tomography[J]. West China Journal of Stomatology, 2018, 36(5): 498-502.

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囊样变	发生部位
囊样变	前外侧	前内侧	后外侧	后内侧	内部或颈部
Ⅰ型	72/54.5	39/29.5	10/7.6	8/6.1	3/2.3
Ⅱ型	27/40.9	16/24.2	5/7.6	4/6.1	14/21.2

囊样变	数目		边缘骨白线			周围骨小梁结构
囊样变	单发	多发	完整	部分	无	有骨质硬化	无骨质硬化
Ⅰ型	88/66.7	44/33.3*	78/59.1	53/40.2	1/0.8	128/97.0	4/3.0^#
Ⅱ型	61/92.4	5/7.6%*	46/69.7	18/27.3	2/3.0	32/48.5	34/51.5^#