目的:探讨颞下颌关节锚固术耳缘小切口手术入路对于颞下颌关节中晚期结构紊乱的治疗效果以及对术后面神经功能影响.方法:选择2015年3月至2016年6月就诊于白求恩国际和平医院颞下颌关节门诊患者87例(94侧)关节,所有患者经临床及MRI检查,符合Wilkes-Bronstein分期中Ⅲ-Ⅴ期诊断,除外关节盘置换病例,所有患者均接受颞下颌关节开放性锚固手术,并于术后24h、l周、1个月、3个月、6个月进行面神经功能评价,术后1个月、3个月、6个月进行临床症状及MRI评价.按耳缘切口颞浅动脉后手术入路,翻开皮瓣,显露或不显露颞浅血管束,在血管束后方,切至颞深筋膜,钝分离至骨性外耳道外侧缘.向前牵拉开颞浅血管束,于颞中静脉后方之颧弓根部,切开至骨膜,翻起组织瓣,向前下方分离至关节结节前下方,并显露关节囊.结果:84例(91侧)关节术后24h面神经功能均无障碍,3例患者面神经出现轻度颞支损伤症状,术后1个月均好转,随访至术后半年,面神经功能良好,84例患者临床症状均消失,MRI显示恢复正常盘突关系.结论:耳缘小切口颞浅动脉后手术入路对于颞下颌关节中晚期结构紊乱的治疗效果肯定,能有效避免术中对于面神经牵拉、挤压等损害,但是仅限于囊内病变的治疗,由于暴露范围局限,视野较小,对于颞下颌关节囊外病变及关节区肿瘤、骨折等疾病仍需耳颞切口进行治疗.%Objective:To investigate the effect of surgical approach for the treatment of temporomandibular joint internal derangement with small incision.Methods:From March 2015 to June 2016,87 patients (94 sides) were selected in this study.All patients were diagnosed clinically with MRI according to Wilkes-Bronstein stage Ⅲ-Ⅴ,except for case of disc replacement.Informed consent from all the patients was obtained for the surgery of the temporomandibular joint.The facial nerve function was evaluated at 24 hours,first week,first month,third month and six months after operation.The clinical symptoms and MRJ performance were evaluated at first month,third month and six month.Tragus incision after superficial temporal artery approach was used First,the skin flap was opened,and the superficial temporal blood vessels was revealed.behind the vessels,it was cut down to the temporal foscia.blunt separation to the lateral bony external auditory canal,pull forward the temporal blood vessels,from the zygomatic arch root that after temporal veins,cut the periosteum,flip the tissue flap seprated to the before of joint nodules and revealed the joint capsule.Results:84 patients (91 sides) were free of facial nerve dysfunction after operation 24 hours,3 patients were nerve dysfunction for two grade.after six months follow up after operation,both the facial nerve function and the clinical symptoms were satisfied.MRI showed the formal disc position.Conclusions:The posterior approach of the superficial temporal artery of the small incision might be effective for the treatment of the temporomandibular joint disorder.It can effectively avoid the injury of traction and extrusion of the facial nerve during operation,but this approach was only applied to the treatment of intracapsular disease because of limited exposure.For the extracapsular disease,joint tumors,fractures and other diseases,the incision from ear and temporal is still needed.
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