中国口腔颌面外科杂志

中国口腔颌面外科杂志 ›› 2022, Vol. 20 ›› Issue (6): 554-559.doi: 10.19438/j.cjoms.2022.06.006

• 论著 • 上一篇    下一篇

23例颞下颌关节手术联合面部除皱术临床疗效分析

李莉玫1, 朱耀旻1, 王昱萌1, 戴娟2, 张丹迪2, 梁潇1   

  1. 1.深圳市口腔医院 颌面外科医学中心,广东 深圳 51800;
    2.深圳大学总医院 口腔科,广东 深圳 518000
  • 收稿日期:2022-04-25 修回日期:2022-07-06 出版日期:2022-11-20 发布日期:2022-11-20
  • 通讯作者: 朱耀旻,E-mail：zymin555@hotmail.com
  • 作者简介:李莉玫（1987-）,女,硕士,主治医师,E-mail：shinelee123@hotmail.com
  • 基金资助:
    深圳市科技计划（JCYJ20200109114006014）; 深圳大学总医院科技人才助推基金（SUGH2018QD049）

Clinical effects of the combination of rhytidectomy and temporomandibular joint surgery on 23 patients with internal derangement of the temporomandibular joint and aging faces

LEE Mui-lee1, ZHU Yao-min1, WANG Yu-meng1, DAI Juan2, ZHANG Dan-di2, LIANG Xiao1   

  1. 1. Medical Center for Maxillofacial Surgery, Shenzhen Stomatology Hospital. Shenzhen 518000;
    2. Department of Stomatology, Shenzhen University General Hospital. Shenzhen 518000, Guangdong Province, China
  • Received:2022-04-25 Revised:2022-07-06 Online:2022-11-20 Published:2022-11-20

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摘要： 目的 探讨颞下颌关节手术联合面部除皱术治疗颞下颌关节内紊乱（TMJ ID）Ⅳ-Ⅴ期伴面部皮肤松弛的临床效果。方法 选择23例TMJ ID Ⅳ-Ⅴ期需手术治疗、伴面部皮肤松弛中老年女性患者,均由同一名外科医师进行颞下颌关节盘复位手术同期面部除皱术。收集术前及术后6个月疼痛VAS评分、最大开口度（MMO）,CBCT及MRI图像,术后伤口愈合、瘢痕情况、并发症以及面部提升改善满意度等信息。采用SPSS 21.0软件包对数据进行统计学分析。结果 23例患者术前疼痛VAS评分平均为6.13分,术后6个月降至0.52分（P<0.05）;术前MMO平均为2.21 cm,术后6个月升高至3.33 cm（P<0.05）。术后创口愈合良好,耳前瘢痕不明显,无明显血肿、颞区皮肤麻木、感染、脱发及严重面神经损伤等并发症发生。术后6个月MRI显示,关节盘稳定复位;CBCT检查显示髁突骨质无继续破坏吸收,其中8例出现髁突骨质修复改变。患者软组织下垂及皮肤松弛明显改善。医师、患者和第三方的面部提升年轻化平均满意度为95.52%、97.34%和97.04%。结论 对于TMJ ID Ⅳ-Ⅴ需手术治疗伴面部皮肤松弛患者,TMJ手术和除皱术切口一致,两者相结合是一种有效的治疗方法,可在改善TMJ ID症状和髁突骨质的同时,改善患者面部皮肤松弛、下垂衰老状态,值得临床推广。

关键词: 颞下颌关节内紊乱, 颞下颌关节盘复位术, 除皱术

Abstract: PURPOSE: To investigate the clinical effects of the combination of rhytidectomy and temporomandibular joint (TMJ) disc repositioning surgery in internal derangement (ID) stage IV-V and facial aging patients. METHODS: Twenty-three middle-aged and elderly female patients with bilateral TMJ ID IV-V requiring surgical treatment and facial skin relaxation were enrolled in this study. All patients underwent TMJ surgery and facial rhytidectomy by the same surgeon. Preoperative and 6-month postoperative pain visual analog score(VAS), maximum mouth opening (MMO), CBCT and MRI imaging, postoperative wound healing, scar condition, complications, postoperative facial lift improvement and satisfaction were collected. SPSS 21.0 software package was used for statistical analysis. RESULTS: The VAS score of 23 patients was 6.13 points before operation, and decreased to 0.52 points 6 months after operation(P<0.05). The average MMO was 2.21 cm before operation and increased to 3.33 cm 6 months after operation(P<0.05). The wound healed well after operation, the scar before ear was not obvious, and there was no obvious complications such as hematoma, temporal skin numbness, infection, hair loss and severe facial nerve injury. Six months after operation, MRI showed that the position of TMJ disc had been stably restored above the condyle. CBCT showed that the anchoring screws were in place, and there was no destruction and absorption of condylar bone. Among them, 8 cases showed repair changes of condylar bone. Facial photos showed that the patient's soft tissue sagging and skin relaxation improved significantly. The average satisfaction of doctors, patients and third parties with younger facial appearance was 95.52%, 97.34% and 97.04%. CONCLUSIONS: For middle-aged and elderly female patients with TMJ ID IV-V who need surgical treatment and facial skin relaxation, due to the same incision of TMJ surgery and rhytidectomy,the combination of the two surgeries is an effective treatment method. It can improve the symptoms of TMJ disorder and reverse the destruction of condylar bone, improve the aging state of facial skin relaxation and soft tissue sagging, which is worthy of clinical promotion.

Key words: Temporomandibular joint internal derangement, Disc reduction of temporomandibular joint, Rhytidectomy

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