| Part one: Etiology and X-ray study of temporomandibular joint ankylosisObjective To study the correlation between temporomandibular joint ankylosis and trauma and infection of TMJ, and incidence characteristic of ankylosis of TMJ.Methods A retrospective study of 155 medical records of temporomandibular joint ankylosis inpatients during 1988-2003. The incidence and etiology of TMJ ankylosis inpatients were reviewed and analyzed, and the course of making a diagnosis and giving treatment of TMJ trauma and infection was studied. The X-ray datam of 66 inpatients were readed and studied.Results There was a great deal of increase of TMJ ankylosis inpatients from 1999. The composing ratio of traumatic TMJ ankylosis had been increased from percent 49.4 (40/81) to percent 71.6 (53/74) during 1999-2003 comparing 1988-1997. Percent 83 (44/53) patients of traumatic TMJ ankylosis were not made a diagnosis and gived treatment in time when they were wounded in TMJ, and 15 cases infectivity TMJ ankylosis were not made a diagnosis and treatment to TMJ infection in time. Condylar fractured segment that belongs to high level fracture was found in 45 traumatic TMJ ankylosis's X-ray, which was ankylosed to the anteromedial aspect of the condyle stump, and that could not be found in other 8 traumatic TMJ ankylosis. A bony fusion of the condyle, sigmoid notch, and coronoid process to the glenoid fossa was found in 8 cases infectivity TMJ ankylosis's X-ray, however, the lower density interspase in the bony fusion was found in 5 cases.Conclusion In recent years, the traumatic TMJ ankylosis inpatients became more and more. TMJ ankylosis was result of delay of the diagnosis and treatment to the TMJ trauma and infection. The TMJ architecture of traumatic ankylosis were not totally replaced by a bonyfusion, but TMJ architecture of infectivity ankylosis were. The high level condyle fracture is tendency to TMJ ankylosis.key words Temporomandibular joint; Ankylosis; Etiology; Condylar fracturePart two: Surgery treatement of temporomandibular joint ankylosisObjective To evaluate the effect of TMJ arthroplasty between modified and traditional methods by follow-up and prognosis factors.Methods A clinical retrospective evaluation of 78 patients treated for temporomandibular joint ankylosis during 1997-2002. Arthroplasty of retaining disc was used to traumatic TMJ ankylosis with remains disc. There were two methods of osteotomy in gap arthroplasty and arthroplasty of retaining disc. The follow-up examination to mouth opening of these patients was done. The change of mouth opening as follow-up was acted as guideline of evaluating operation effect. Independent-samples t test and rank sum test were applied. The Chi-Square test was applied to evaluate prognosis factors, such as operation age, ankylosis degree, and number of operation times.Results 54 patients were followed up after operation average 3.19 years. The Kruskal Wallis test showed statistical difference between the four kinds of operation methods (P=0.002), but there was no difference between traditional and modified osteotomy in arthroplasty of retaining disc by two independent-samples T test (P=0.238). There was not statistical difference on recurrence rate in different age and number times of operation by Chi-Square test (P=0.907, P=0.455) , but there was great statistical difference between two kinds of degree of TMJ ankylosis (P=0.001) .Conclusion The effect of arthroplasty of retaining disc was better than traditional arthroplasty, the same even as the condylar was reserved. There was not correlation between recurrent rate of TMJ ankylosis and age, number times of operation, but there was correlation in ankylosis degree. |
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