以正顎手術治療顳顎關節症候群合併骨性三級異常咬合－病例報告

Surgical-orthodontic Treatment of TMD Combined Skeletal Class Ⅲ Malocclusion-Case Report

羅信義(Hsin-Yi Lo) ； 李盈欣(Ying-Hsin Lee) ； 陳亮如(Lian-Ru Chen) ； 洪明倫(Ming-Lun Hong) ； 李廣華(Kwong-Wa Li) ； 黃穰基(Yong-Kie Wong) ； 劉正芬(Jeng-Fen Liu)

《中華民國齒顎矯正學雜誌》 22卷2期 (2010/06) Pp. 27-36

https://doi.org/10.30036/TJO.201006.0004

摘要

多數研究顯示患者具有顳顎關節疼痛功能不良症候群(temporomandibular joint painful dysfunction syndrome, painful TMD)及骨性異常咬合在接受口內下顎枝垂直截骨術(intraoral vertical ramus osetotomy, IVRO)，手術後TMD症狀確實有獲得緩解，原因可能與手術後髁頭的重新置位，或咬合改善有關。本病例是一名因顳顎關節疼痛前來求診的成年男性，於檢查時發現有張口、咀嚼疼痛及下顎運動時關節彈響的症狀，合併前牙錯咬之骨性三級異常咬合，經診斷評估後決定以齒列矯正合併正顎手術IVRO術式及顎間固定法(intermaxillary fixation, IMF)固定。於術後發現髁頭的重新置位及關節盤復位、咬合改善，因此獲得顳顎關節疼痛緩解及外觀之改善。術後兩年追蹤發現咬合穩定，髁頭因重新置位而產生骨重塑。

關鍵字

顳顎關節症候群 ； 口內下顎枝垂直截骨術 ； 下顎前突

並列摘要

Many researches had been proved that the effect of intraoral vertical ramus osteotomy (IVRO) to relieve the symptoms of painful temporomandibular joint dysfunction syndrome was significant by repositioning of the condyle head anteriorly and inferiorly. The case report is a male patient who sought the dental advice for relief of TMJ pain when chewing and mouth opening at our OPD. The oral examination found clicking sound, disc displacement with reduction, mouth opening and chewing pain, anterior crossbite and class Ⅲ malocclusion with mandibular prognathism. We decided to perform IVRO (modification of intraoral vertical ramus osteotomy) and internmaxillary fixation (IMF) to improve his painful TMD symptoms, skeletal jaw relationship and occlusion. After the operation, the pain was relieved and his facial profile was improved. Two years follow up, the occlusion was stable and condyle head remodeling was found due to anterior and inferior displacement of condyle head.

並列關鍵字

TMD ； intraoral vertical ramus osteotomy ； mandibular prognathism