口內法顳顎關節成形術

現今對於顳顎關節粘連的治療仍然是以手術為主：包括間隙成型術以及各種不同材料的中置式關節成型術。切線位置有耳前，耳道周圍，耳後和顎下。這些方法的可能副作用或後遺症有：顏面神經時或永久性麻痺，形成涎囊腫，出血多，以及造成疤痕等等。本文提出經由口內切線來完成顳顎關節粘連的關節成形術，可適用於間隙或中置式關節成形術。方法是在頰棚作切線，翻開軟組織，將喙狀突切斷，撥到內側，然後在髁頸的高度進行關節成形術。最後將喙狀突用鋼絲固定回去，再將傷口縫合。本法的優點為臉部或耳朵周圍無疤痕，不易及顏面神經底耳顳神經，不形成唾液瘻管，以及在粘範圍大或是需要切斷喙狀突的病例時，則本法比口外法容易完成。本法缺點是手術視野較小，需要幾次操作才能熟悉。

關鍵字

顳顎關節粘連；關節成形術；口內法

並列摘要

Surgery is the primary treatment for temporomandibular joint ankylosis. The surgical treatments include gap arthroplasty and interpositional arthroplasty. Various surgical approaches to TMJ include pre-auricular, perimeatal, endaural, post-auricular, and submandibular incisions. The possible adverse effects or reported complications are temporary or permanent facial nerve paralysis, sialocele, hemorrhage, scarring etc. We performed an arthroplasty with an intraoral approach for temporomandibular joint ankylosis. The intraoral incision was placed over the buccal shelf and then reflction of the soft tissue off the mandibular armus was performed. Coronoidectomy was performed and the arthroplasty was accomplished at the level of the condylar neck. Finally the coronoid process was fixed with stainless steel wire and the wound closed. The advantages of this intraoral approach are an excellent cosmetic appearance without a facial scar, lower risk of injury to the facial nerve or auriculotemoporal nere and no salivary fistula formation. Arthroplyasty is easier to perform with an intraoral approach in cases of extensive ankylosis or cases requiring coronoidectomy. The disadvantages are poor access, limited surgical fields and more required practical experience with this procedure.

並列關鍵字

TMJ ankylosis ； Arthroplasty ； Intraoral approach

國際替代計量

口內法顳顎關節成形術

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