- 期刊
以微創顳顎關節內視鏡復位縫合手術治療顳顎關節盤移位─病例報告
Arthroscopic Discopexy in Repositioning of the Temporomandibular Disc Displacement-A Case Report
摘要
顳顎關節盤移位是造成顳顎關節内部紊亂主要的原因，目前對於顳顎關節盤移位的原因仍不明確，主要認為可能原因為顳顎關節外傷、張口過大、附著肌肉韌帶鬆弛等。導致張口受限、關節產生彈響聲與張口疼痛等臨床症狀。文獻回顧上，大約九成的病患可藉由保守治療（例如：咬合板、藥物與物理治療等）獲得良好的改善，但仍有一成病患對保守治療無效，可能須藉由微創顳顎關節內視鏡或是開放性顳顎關節手術來做進一步的治療。由於開放性手術術後併發症較大，近年來，持續有學者提出微創顳顎關節内視鏡手術來治療等相關研究報告，簡單的操作可以做檢查與沖洗，改善發炎環境與臨床症狀，進階上，也可以做關節盤復位縫合，屬於可重複手術。本篇提出一名32歲女性病患，因長期右側顳顎關節疼痛與張口受限至本科治療，術前安排核磁共振影像檢查，顯示右側顳顎關節盤不可回復之前内側移位合併關節髁頭輕度退化性變化，為Wilkes分類第四期。在接受保守治療無效後，安排微創顳顎關節内視鏡檢查與治療，鏡檢顯示關節盤移位合併盤後區發炎，以微創顳顎關節内視鏡復位縫合手術，於前隱窩處做關節盤前鬆解與復位，改善關節盤位置，再由外耳道做關節盤縫合。術後病患恢復良好，張口疼痛與開口度皆獲得改善，術後核磁共振影像檢查顯示關節盤復位，故提出此方式作為臨床參考。
並列摘要
Numerous studies have demonstrated that the most common type of internal derangement of the tempomandibular joint (TMJ) is anterior disc displacement. Local factors including joint trauma, grinding or clenching of the teeth can lead to TMJ internal derangement but its origin and consequences, however, are still controversial and inconclusive. Evidence-based literature reviews showed most of patients with TMDs would be improved with conservative and noninvasive therapies, such as patients' education, self-care, physical therapy, and splint devices. Only 5%-10% of those patients in whom conservative therapy was ineffective and refractory, indicated for further invasive therapy. As reported arthroscopy has played an important role in surgical treatment for intra-articular TMDs. It was involved not only in lysis, lavage and arthrocentesis, but also in suturing and reposition of displaced disc. We presented a 32-year-old lady who sought help because of pain and opening mouth limitation in the right TMJ. The preoperative magnetic resonance imaging showed the right TMJ disc anterior displacement without reduction and condyle degenerative change as Wilkes classification IV. She underwent the minimally invasive TMJ endoscopy for exploration and treatment after failure of the conservative therapy. Arthroscopic examination showed articular disc anterior displacement and the retrodiscal synovitis. After anterior releasing of displaced articular disc to backward over the condyle, the disc was repositioned and sutured to the auricular cartilage via the external auditory canal (EAC). The patients recovered well and the pain and opening of the mouth were improved. Also, the post-operative sagittal PD-weighted MRI showed the disc was repositioned. It is highly recommended that arthroscopic disc reposition with suturing technique via EAC is an effective technique for treatment of articular disc displacement.