关节盘复位术联合正畸治疗颞下颌关节紊乱病伴偏颌患者1例及文献回顾

Disc repositioning surgery combined with orthodontic treatment of patients with temporomandibular disorders and facial asymmetry: a case report and literature review

摘要

目的 探讨关节盘复位术联合正畸治疗颞下颌关节紊乱病伴偏颌患者的临床疗效。方法 报道关节盘复位术联合正畸治疗颞下颌关节紊乱病（temporomandibular disorder，TMD）伴偏颌患者1例。患者术前开口型摇摆、右侧耳前区轻度压痛伴下颌左偏，上下牙弓宽度不匹配，𬌗平面偏斜。先行关节治疗，经耳屏切口行双侧颞下颌关节盘复位固定术重建盘-髁关系，术后佩戴辅助颌垫6个月稳定颌位，正畸采用上颌骨性扩弓器（maxillary skeletal expansion，MSE）结合多曲方丝弓（multiloop edgewise archwire，MEAW）技术，经过16个月的矫治重建咬合。结果 关节盘复位固定术后佩戴𬌗垫治疗半年，患者偏颌畸形改善，疼痛症状消失，锥形束CT检查见双侧颞下颌关节间隙均匀增大，口内下中线右偏，双侧后牙区反𬌗，前牙区、左侧后牙区开𬌗。通过正畸治疗基本匹配上下牙弓宽度，建立双侧尖磨牙中性关系及前牙正常覆𬌗覆盖，下颌位置无明显偏斜。复习相关文献结果表明，上下牙弓宽度不匹配、𬌗平面偏斜等异常咬合关系可引起下颌骨位置适应性偏斜继而诱发或加重TMD，颞下颌关节盘复位固定术配合𬌗垫治疗可有效改善年轻TMD患者的颌面畸形，建立稳定、符合生理功能的盘-髁关系后，需行正畸治疗解除干扰因素重建咬合，术后需长期复查追踪。结论 对于咬合异常导致TMD伴下颌适应性偏斜的患者，通过关节盘复位术联合正畸治疗恢复正常盘-髁关系、消除咬合干扰，可有效改善面型并建立稳定颌位。

Abstract

Objective To investigate the clinical efficacy of disc repositioning surgery combined with orthodontic treatment in patients with temporomandibular disorder and facial asymmetry. Methods One patient who underwent disc repositioning surgery combined with orthodontic treatment for temporomandibular joint disorder and facial asymmetry was reported. Preoperatively, the patient had a skewed shape of the opening, mild pressure pain in the right preauricular region with left mandibular deviation, and a mismatch between the width of the upper and lower dental arches. In the arthrosurgery department, bilateral temporomandibular disc replacement and anchorage were performed through a transauricular incision, and an auxiliary splint was worn to stabilize the jaw position for 6 months. In the orthopedic department, maxillary skeletal expansion was used in combination with the multiloop edgewise archwire technique to reconstruct the occlusion after 16 months of orthodontic treatment. Results The deviation was corrected by wearing an occlusal splint for six months after joint repositioning and anchoring; moreover, the pain symptoms disappeared, and the cone beam CT examination showed that the bilateral temporomandibular joint space was uniformly enlarged, the lower alveolar ridge midline deviated to the right, the posterior regions of the teeth were bilaterally inverted, and the anterior region and the posterior region of the left side were open. The orthodontic treatment matched the width of the upper and lower dental arches and established the cuspal molar neutrality relationship and the normal overjet coverage of the anterior teeth; additionally, the mandibular position was not obviously skewed. A review of the results of the related literature shows that abnormal occlusal relationships, such as mismatched arch width and skewed occlusal plane, can cause adaptive mandibular deviation, which can lead to the occurrence of TMD. Temporomandibular joint disc anchorage with splint treatment can effectively improve maxillofacial deformity in young TMD patients. After the establishment of a stable, physiologically functional disc-condylar relationship, orthodontic treatment is required to remove the interfering factors to rebuild the occlusion, and long-term postoperative review and follow-up are needed. Conclusion In patients with TMD and mandibular accommodative deviation due to occlusal anomalies, establishing a normal disc-condylar relationship and eliminating occlusal interference through disc repositioning surgery combined with orthodontic treatment can effectively improve facial shape and establish a stable jaw position.

关键词

颞下颌关节紊乱病 / 偏颌畸形 / 关节盘复位固定术 / ??垫 / 反?? / 开?? / 上颌骨性扩弓器 / 多曲方丝弓 / 正畸治疗

Key words

temporomandibular disorders / facial asymmetry / disc repositioning and fixation / splint / cross bite / open bite / maxillary skeletal expansion / multiloop edgewise archwire / orthodontic treatment

Author summay

周迎，住院医师，硕士研究生，Email：[e-mail]