摘要：

目的：回顾分析颞下颌关节骨性强直伴颌面部异位骨化的发病原因、临床表现及诊治方法。方法：回顾性分析2017-04就诊于遵义医科大学附属口腔医院的1例右侧颞下颌关节骨性强直伴颌面部广泛异位骨化的病例资料，并结合文献复习分析其发病原因，总结其特征临床表现、诊断及治疗原则。结果：根据临床表现及影像学检查结果，该患者被确诊为右颞下颌关节骨性强直伴颌面部异位骨化，无明确外伤史。采用“右关节成形术+牵张成骨+异位骨化部分切除术”治疗，术后张口度恢复正常，面型稍有改善。出院时主动张口约2.0 cm，被动张口可达3.0 cm。嘱患者使用开口器积极张口训练并同期进行下颌骨牵张成骨，但患者配合度较差。患者于术后4个月再次出现进行性张口受限，颌面部异位骨化增多；于术后5个月取出牵张器，同时行关节强直松解术，术中可被动张口2.5 cm；但术后再次出现进行性张口受限，颌面部异位骨化继续增多，患者放弃治疗。结论：颞下颌关节骨性强直伴颌面部广泛异位骨化在临床上较为罕见，可能的病因有外伤、遗传等。依据影像学检查可明确诊断，治疗以手术为主。如何在行关节成形的同时治疗颌面部的广泛异位骨化是临床上的难题。

关键词: 颞下颌关节强直, 异位骨化, 锥形束CT

Abstract:

Objective: To retrospective analyze the etiology, clinical feature and diagnosis and treatment of temporomandibular ankylosis with maxillofacial heterotopic ossification. Methods: Clinic data of a case of right temporomandibular joint ankylosis with extensive heterotopic ossification in the maxillofacial region, in the stomatological hospital affiliated to Zunyi Medical University in April 2017, was reported and retrospective analyzed with literatures review. Results: Without a clear history of trauma, the patient was diagnosed with the right temporomandibular joint ankylosis and heterotopic ossification of the maxillofacial region according to CBCT imaging. An surgery including right arthroplasty, distraction osteogenesis, heterotopic ossification, were performed to increase mouth opening and improve the facial contour. Traction osteogenesis was performed post-operation, but the patient didn't follow the doctor's advice well. 4 months later, progressive limited mouth of opening happened and the maxillofacial region of heterotopic ossification extended. 5 months later, the distractor and ankylotic bone was removed by the second operation with a passive opening distance of 2.5 cm. But after the second operation, progressive restricted mouth opening happened again, and heterotopic ossification region of the maxillofacial continued to extend, and the patient gave up any treatment. Conclusion: Temporomandibular joint ankylosis with extensive heterotopic ossification of maxillofacial region is rare in clinic, and it may be caused by trauma or genetics and so on. Based on imaging examination, it's not difficult to make a diagnosis, and surgical excision and joint reconstructioni are the main method of treatments. The most difficult point is how to treat the extensive heterotopic ossification of the maxillofacial region after the arthroplasty.

Key words: temporomandibular joint ankylosis, heterotopic ossification, cone beam CT

中图分类号: 

• R782