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目的:探讨应用定量截骨锯行口腔入路髁突骨软骨瘤切除人工颞下颌关节置换术。方法:采用口内下颌骨矢状截骨手术入路,用定量截骨锯下颌骨升支后缘垂直截骨,将升支后缘骨块和髁突及骨软骨瘤游离取出,体外直视下病变髁突及骨软骨瘤切除后,人工颞下颌关节与升支后缘骨块固定,再从口腔原切口回植,颞下颌关节重建。5例5侧采用本方法治疗,配合术中术后调牙合或矫治器矫治,调整咬合关系。结果:术后6月、12月、24月复查,全部患者开口范围25mm～35mm,平均30.3mm,1例有早接触,下切牙中线过矫正1mm。另1例张口约25mm,轻度受限。3名患者6月复查主诉张口时人工关节侧有异常声响,无疼痛。12月复查时,异常响声基本消失,无主诉关节疼痛与弹响症状。全部患者无面神经、耳大神经损伤,无涎瘘,面颈皮肤无手术疤痕。结论:髁突骨软骨瘤造成面下1/3歪斜畸形,口腔入路具有无外部疤痕优势,且不会损伤面神经。定量截骨锯定量准确,截骨速度较快。
Objective: To investigate the surgical technique of artificial temporomandibular joint replacement by oral cavity osteotomies with oral osteotomies with quantitative osteotomy. Methods: The sagittal osteotomy for oral mandibular intramedullary osteotomy was performed. With the quantitative osteotomy sawing the vertical osteotomy of the posterior margin of the ascending ramus of the jaw, the trabecular bone, condyle and osteochondroma were aspirated freely under direct vision After the condyles and osteochondroma were removed, the artificial temporomandibular joint and the posterior margin of the ascending branch were fixed, and then replanted from the original oral incision. The temporomandibular joint was reconstructed. 5 cases of 5 sides using this method of treatment, with intraoperative occlusal adjustment or appliance correction, adjust the occlusal relationship. Results: The patients were reviewed at 6 months, 12 months and 24 months after operation. The opening range of all the patients was 25mm ~ 35mm with an average of 30.3mm. One case had early contact and the lower incisor had an overcorrection of 1mm. Another case of mouth about 25mm, slightly limited. 3 patients review the main complaint in June when the mouth of artificial joints have abnormal sound, no pain. December review, the basic sound disappeared, no complaints of joint pain and snapping symptoms. All patients without facial nerve, auricular nerve injury, no salivary fistula, no surgical scars face and neck skin. CONCLUSION: Condylar osteochondroma causes 1/3 inferior face crooked deformity. Oral approach has the advantage of no external scar and will not damage the facial nerve. Quantitative quantitative quantitative bone cutting saw, osteotomy faster.