FACIAL SKELETON REMODELING DUE TO TEMPOROMANDIBULAR-JOINT DEGENERATION - AN IMAGING STUDY OF 100 PATIENTS
FACIAL SKELETON REMODELING DUE TO TEMPOROMANDIBULAR-JOINT DEGENERATION - AN IMAGING STUDY OF 100 PATIENTS
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DOI：
10.2214/ajr.155.2.2115271
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发表时间：
1990-08-01
影响因子：
5
通讯作者：
OMLIE, MR
中科院分区：
文献类型：
--
作者：
SCHELLHAS, KP;PIPER, MA;OMLIE, MR
选择100例新近获得的、外部可见的下颌畸形患者，既往无下颌关节外骨折病史，进行回顾性分析。所有患者都进行了临床研究，并通过放射学、体层摄影术和高场表面线圈磁共振成像来确定是否有颞颌关节退变以及退变的程度。在每个研究患者的一侧或双侧关节中都发现了颞颌关节退行性变。下颌偏斜多偏向较小的下颌突或病变较多的关节，许多患者主诉或表现为错牙合，通常表现为不稳定或波动的咬合紊乱。三种不同的退行性和适应性骨关节突起--(1)骨关节炎，(2)缺血性坏死，和(3)退行性重塑--累及下颌骨和颞骨，在最常表现为半月板错乱的关节中被识别出来。骨性关节炎和下颌骨髁突和颞骨的缺血性坏死通常与疼痛、机械关节症状和咬合紊乱有关。尽管面部骨骼发生了重塑，但退行性重塑较少与咬合紊乱有关，而且似乎是由区域性骨质疏松引起的。40名患者(52个关节)接受了开放式关节成形术，包括半月板切除或显微手术半月板修复，当时主要的放射学诊断得到确认。手术和病理表现包括半月板移位、关节盘退变、滑膜炎、关节积液、关节软骨侵蚀、软骨愈合/纤维化、软骨肥大、骨硬化、骨赘形成、剥脱性骨软骨炎、局限性或广泛性无血管性坏死，以及下颌骨髁状突质量和垂直尺寸减小。我们得出结论，在牙列完整且无下颌骨骨折的患者中，颞下颌关节退变是后天性面骨改建和咬合不稳定的主要原因。
One hundred patients with recently acquired, externally visible mandibular deformity and no history of previous extraarticular mandible fracture were selected for retrospective analysis. All had been investigated clinically and with radiography, tomography, and high-field surface-coil MR imaging to determine the presence or absence and extent of temporomandibular joint degeneration. Temporomandibular joint degeneration was found in either one or both joints of each patient studied. Chin deviation was always toward the smaller mandibular condyle or more diseased joint, and many patients either complained of or exhibited malocclusion, often manifested by unstable or fluctuating occlusion disturbances. Three radiologically distinct forms of degenerative vs adaptive osteocartilaginous processes-(1) osteoarthritis, (2) avascular necrosis, and (3) regressive remodeling-involving the mandibular condyle and temporal bone were identifed in joints most often exhibiting meniscus derangement. Osteoarthritis and avascular necrosis of the mandibular condyle and temporal bone were generally associated with pain, mechanical joint symptoms, and occlusion disturbances. Regressive remodeling was less frequently associated with occlusion disturbances, despite remodeling of the facial skeleton, and appears to result from regional osteoporosis. Forty patients (52 joints) underwent open arthroplasty procedures, including either meniscectomy or microsurgical meniscus repair, at which time major radiologic diagnoses were confirmed. Surgical and pathologic findings included meniscus displacement, disk degeneration, synovitis, joint effusion, articular cartilage erosion, cartilage healing/fibrosis, cartilage hypertrophy, osseous sclerosis, osteophyte formation, osteochondritis dissecans, localized or extensive avascular necrosis, and decreased mandibular condyle mass and vertical dimension. We conclude that temporomandibular joint degeneration is the principal cause of both acquired facial skeleton remodeling and unstable occlusion in patients with intact dentition and without previous mandible fracture.