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目的:应用保留颞下颌关节盘的手术方法治疗外伤性颞下颌关节强直,达到恢复颞下颌关节结构、改善面部外形和防止术后复发的目的。方法:对36例外伤所致Ⅱ型和Ⅲ型颞下颌关节强直病例进行手术,男16例,女20例,年龄5～54岁,病程1～16a,最大开口度0～1.5cm。新的手术方法是凿开关节窝与髁突之间的骨性融合,凿除前内侧移位的髁突骨折碎片,将残余的关节盘向外牵拉、复位,与外侧关节囊缝合,同时将髁突与关节窝磨改光滑。结果:36例病例中,21例术后随访1～7a,保留关节盘手术的病例均无复发,术后平均开口度为3.37cm。1例11岁患儿术后面部畸形得到改善。结论:保留颞下颌关节盘正常结构在防止外伤性颞下颌关节强直手术后复发以及生长发育期患者面部畸形中具有重要作用。
OBJECTIVE: To treat the ankylosis of temporomandibular joint with the method of preserving the temporomandibular joint disc, and to achieve the purpose of restoring the structure of the temporomandibular joint, improving facial contour and preventing postoperative recurrence. Methods Thirty - six patients with type Ⅱ and type Ⅲ temporomandibular joint ankylosis were treated by trauma. There were 16 males and 20 females, aged 5 to 54 years. The course of disease ranged from 1 to 16a and the maximal opening was from 0 to 1.5 cm. The new surgical method is to heal the fossa between the junction fossa and the condyles, to excise the condyle fractures before the medial displacement, to pull the residual disc outwards, and to suture the lateral joint capsule The condyle and joint fossa change smooth. Results: Of the 36 cases, 21 cases were followed up for 1 to 7 years. No recurrence was found in the cases of arthroplasty. The average postoperative opening was 3.37 cm. A case of 11-year-old children with facial deformity improved. CONCLUSION: Retaining the normal structure of temporomandibular joint disc plays an important role in preventing recurrence of traumatic TMJ ankylosis and facial deformity in patients with growth and development.