使用顳肌瓣施行中置性關節成型術治療顳顎關節骨性粘連－病例報告

顳顎關節粘連會使張口受限和咬合功能受損，在口腔衛生維護及治療牙疾上也會發生障礙，並進一步影響到周邊組織，造成嚴重的後遺症。現今顳顎關節粘連的治療以外科手術療法為主，關節成形術有間隙關節成形術，中置式關節成形術、自體肋骨軟骨移植關節成形術及關節贋復物置入術等。本病例爲21歲女性，由於張口受限而至本院求診，初期診斷爲顳顎關節骨關節炎暨內部紊亂。經咬合科以咬合板及藥物治療後仍未見改善，即轉至口腔顎面外科治療，最後由骨關節炎演變爲顳顎關節骨性粘連(TMJ bony ankylosis)。經由外科手術以顳肌瓣進行中置性關節成型術(Interpositional arthroplasty)，開口度由術前之0.8公分改善至4.5公分。手術後追蹤2年無明顯併發症，並維持良好的咬合功能，本病例患者由骨關節炎導致骨性粘連，其年齡與疾病演進過程較爲罕見。本文的目的是提出骨關節炎可能的演變結果以及利用顳肌瓣進行中置性關節成術的原因。本文並將探討顳顎關節粘連之病源、手術治療方式及中置物質材料的選擇。

關鍵字

顳顎關節粘連；中置式關節成型術；顳肌瓣；骨關節炎

並列摘要

Ankylosis of the temporomandibular joint (TMJ) causes limitation in mouth opening, with resultant problems in mastication, digestion, speech, facial appearance, psychological stress and oral hygiene maintains. Surgery plays a crucial role in the management of TMJ ankylosis. The surgical treatmentinclude gap arthroplasty, interpositional arthroplasty, and joint reconstruction with autogenous or alloplastic materials. A 21-year-old female patient came to our department with the complaint of limited mouth opening. At first, she went to occlusion department for treatment, medication and occlusion splint treatment was given, spontaneous pain was happened and the mouth opening limitation was progress. Then she was referred to oral and maxillofacial surgery for further evaluation. Osteoarthritis induced TMJ bony ankylosis was diagnosed. Interpositional arthroplasty with temporalis muscle were carried out under general anesthesia. The results of this surgery were encouraging, while the mouth opening improves from 0.8cm to 4.5cm, the left TMJ pain was found when maximum mouth opening after operation but improved now. No. significant complication was noted after operation. The etiology, the surgery protocol and the choice of interpositional materials are discussed.

並列關鍵字

TMJ ankylosis ； Interpositional arthroplasty ； Temporalis muscle flap ； Osteoarthritis

國際替代計量

使用顳肌瓣施行中置性關節成型術治療顳顎關節骨性粘連－病例報告

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