idiopathic condylar resorption

特发性髁突吸收
  • 文章类型: Journal Article
    由于有争议的发现,颞下颌关节(TMJ)骨破坏对骨矿物质密度(BMD)的影响尚不清楚。此外,以前没有研究探讨特发性髁突吸收(ICR)与身体成分之间的关系.本研究旨在探讨ICR与BMD或体成分之间的关系。
    在2018年7月至2022年8月之间,由经验丰富的牙医评估并诊断为颞下颌关节紊乱病(TMD)的患者被转诊到我们的中心。他们在接受磁共振成像(MRI)检查时被招募,完全BMD和身体组成。根据MRI发现,将患者进一步分为有或没有ICR的TMD组。采用单因素方差分析比较两组的BMD和身体成分变量。
    总共,67例患者纳入分析,其中42个被归类为具有ICR的TMD,25个被归类为没有ICR的TMD。ICR患者的瘦体重百分比和脂肪质量百分比明显较高;较低的android/gynoid脂肪比,与无ICR的内脏脂肪组织面积比较(P<0.05)。此外,与无ICR的受试者相比,30岁以上有ICR的患者Z评分较低(P=0.017).
    患有ICR的TMD患者表现出与身体成分的关系,并影响瘦肉和脂肪量的分布,尤其是android/gynoid脂肪比。病理生理机制尚不清楚。进一步的研究,以调查牙齿结合,错牙合和饮食习惯对理解ICR的关联很重要,BMD和身体成分。
    UNASSIGNED: The impact of temporomandibular joint (TMJ) osseous destruction on bone mineral density (BMD) remains unclear due to controversial findings. Besides, no previous study has explored the relationship between idiopathic condylar resorption (ICR) and body composition. This study aimed to investigate the relationship between ICR and BMD or body composition.
    UNASSIGNED: Between July 2018 and August 2022, patients evaluated by an experienced dentist and diagnosed with temporomandibular disorders (TMDs) were referred to our center. They were recruited while they received the magnetic resonance image (MRI) examination, BMD and body composition completely. Patients were further categorized into TMDs with or without ICR groups according to MRI findings. One-way analysis of variance was used to compare the variables of BMD and body composition in the two groups.
    UNASSIGNED: In total, 67 patients were included in the analysis, with 42 categorized as TMDs with ICR and 25 as TMDs without ICR. Patients with ICR had a significantly higher lean mass percentage and lower fat mass percentage; lower android/gynoid fat ratio, and visceral adipose tissue area than those without ICR (P < 0.05). Besides, patients above age 30 with ICR had lower Z scores (P = 0.017) compared with subjects without ICR.
    UNASSIGNED: TMDs patients with ICR show a relationship with body composition and affect the lean and fat mass distribution, especially android/gynoid fat ratio. The pathophysiological mechanism remains unclear. Further researches to investigate teeth binding, malocclusion and dietary habits are important to understand the association of ICR, BMD and body composition.
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  • 文章类型: Journal Article
    颞下颌关节(TMJ)是一个笼罩在神秘中的复杂滑膜关节,因为许多TMJ疾病的病因尚未解决。特发性/进行性髁突吸收(ICR/PCR)是一种这样的TMJ疾病,其特征是下颌髁突肿块逐渐恶化,导致严重的下颌后移症,通常伴随着下颌骨的顺时针旋转和前部开放咬合。由于ICR/PCR的病因尚不清楚,尚未确定明确的预防或管理方案。迄今为止,各种有症状的非手术,外科,和救助管理方案已经制定和报告。为了了解ICR/PCR管理选项的现状,本文概述了目前文献中报道的减轻其TMJ症状和改善下颌功能和形式的选择。
    The temporomandibular joint (TMJ) is a complex synovial joint shrouded in mystery, as the etiology of many TMJ disorders are unsolved. Idiopathic/progressive condylar resorption (ICR/PCR) is one such TMJ disorder characterized by a gradually deteriorating mandibular condylar mass, resulting in severe mandibular retrognathia, which often accompanied by clockwise rotation of mandible and an anterior open bite. Since the etiology of the ICR/PCR remains unclear, no definitive prevention or management options have been established. To date, various symptomatic non-surgical, surgical, and salvage management options have been developed and reported. To understand the current status of the ICR/PCR management options, this article provides an overview of the options presently reported in the literature to reduce its TMJ symptoms and improve mandibular function and form.
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  • 文章类型: Journal Article
    背景:当前正颌手术的高标准要求既要有效又要美观的手术解决方案。我们的方法提供了一种增强稳定性的方法,吸引力,与倒L型截骨术相比,在大多数正颌情况下,神经保护能力得到改善。方法:提供一系列案例来说明HSSO的应用和结果,一种优化的方法,结合了经口倒L型截骨术的优势,具有特定的增强功能和增加的多功能性,与BSSO相似的可及性和曝光率。结果:HSSO作为一种完全经口的技术,展示了下颌骨进行显著逆时针旋转的能力,消除了套管针或皮肤切口的需要。当在动态相对牙弓上进行HSSO与三件式LeFort1截骨术时,我们发现术后稳定性很高。与倒L方法相比,我们假设HSSO在稳定性方面具有优势,由于下颌骨近端和远端段的节段重叠增加。与传统的矢状分裂方法相比,该方法旨在增强下牙槽神经的安全性。此外,在特发性con突吸收的某些情况下,HSSO是全关节置换的替代方法,可有效纠正下颌不对称性,同时保持下颌美观。这是通过操纵下颌角实现的,拉姆高度,和下边界,而不会在软组织中造成台阶畸形。结论:HSSO的结果突出了其提供可预测、功能,和美观的结果,为更传统的正颌技术提供了可行的替代方案。
    Background: The current high standards in orthognathic surgery demand surgical solutions that are both ⁠ functionally ⁠ effective and aesthetically pleasing. Our approach offers one for enhanced stability, attractiveness, and nerve protection ⁠ with improved accessibility ⁠ in the majority of orthognathic scenarios ⁠ compared to an inverted L osteotomy. Methods: A case series is presented to illustrate the application and outcomes of HSSO, an optimised approach that combines the advantages of a transoral inverted L osteotomy with specific enhancements and increased versatility, ⁠ with accessibility and exposure similar to a BSSO. Results: HSSO as a completely transoral technique, demonstrate the ability to perform significant counterclockwise rotations of the mandible, eliminating the need for trocars or skin incisions. We experinced high postoperative stability when HSSO was performed in conjunction with a three-piece LeFort 1 osteotomy on a dynamic opposing arch. In comparison to an inverted L approach, we postulated that HSSO offers advantages in stability, due to the increased segmental overlap of the proximal and distal segments of the mandible. This approach is designed to enhance the safety of the inferior alveolar nerve compared to traditional sagittal split methods. Furthermore, HSSO represents an alternative to total joint replacement in select cases of idiopathic condylar resorption and is effective for correcting mandibular asymmetries while maintaining jawline aesthetics. This is achieved through the manipulation of the mandibular angle, ramus height, and inferior border without creating a step deformity in the soft tissue. Conclusions: The outcomes of HSSO highlight its capacity to deliver predictable, functional, and aesthetically pleasing results, offering a viable alternative to more traditional orthognathic techniques.
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  • 文章类型: Journal Article
    目的:特发性髁突吸收(ICR),也被称为进行性髁再吸收,知之甚少,特别是青少年患者。因此,本范围审查旨在总结有关患病率的现有文献,病因学,发病机制,诊断过程,关于青少年个体ICR的治疗和/或任何结果。
    方法:此范围审查遵循了系统审查和荟萃分析(PRISMA)指南的首选报告项目及其范围审查(PRISMA-ScR)的扩展,以及乔安娜·布里格斯研究所的研究。搜索策略的定义是为每个源采用核心搜索结构,搜索是在MEDLINE上进行的,EMBASE,科克伦图书馆,WebofScience,Scopus和谷歌学者。重复删除后,两名独立审稿人筛选了摘要,其次是完整的文章,达到纳入研究的定义。进行了数据收集,提取的数据以表格形式组织,以及与本次审查目标一致的主要发现的叙述性总结。
    结果:本综述包括6项观察性研究。三项研究集中在体征和症状上,一个关于患病率和体征和症状,一个关于治疗,一个关于疾病的发病机理。
    结论:这项范围审查显示,有关患病率的已发表研究不足,病因学,早期诊断,青少年ICR的发病机制和治疗。
    OBJECTIVE: Idiopathic condylar resorption (ICR), also known as progressive condylar resorption, is poorly understood, particularly in adolescent patients. Therefore, this scoping review aims to summarize the available literature on the prevalence, aetiology, pathogenesis, diagnostic process, treatment and/or any outcome regarding ICR in adolescent individuals.
    METHODS: This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and its extension for scoping reviews (PRISMA-ScR), as well as Joanna Briggs Institute studies. The search strategy was defined adopting a core search structure for each source, and the search was performed on MEDLINE, EMBASE, Cochrane Library, Web of Science, Scopus and Google Scholar. After duplicate removal, two independent reviewers screened abstracts, followed by complete articles, to achieve the definition of included studies. Data collection was performed, and the extracted data were organized in tabular form, along with a narrative summary of main findings that aligns with the objective of this review.
    RESULTS: Six observational studies were included in this review. Three studies focused on signs and symptoms, one on prevalence and signs and symptoms, one on treatment and one on disease pathogenesis.
    CONCLUSIONS: This scoping review revealed inadequate published research regarding prevalence, aetiology, early diagnosis, pathogenesis and treatment of ICR in adolescents.
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  • 文章类型: Journal Article
    小儿颞下颌关节(TMJ)疾病代表了广泛的先天性和获得性诊断。牙面畸形,包括面部不对称,逆行,和错牙合,普遍发展。与成人TMJ条件相比,疼痛和关节盘病理较少见。准确的诊断在计划和预测中至关重要。几个具体的考虑适用于骨骼矫正的准备,包括与疾病进展和生长轨迹相关的时机,对校正后稳定性的期望,重建技术,因为它适用于预期的耐久性和未来修订的需要,闭塞的管理,并需要辅助程序来优化校正。本文回顾了常见的情况和治疗注意事项。
    Pediatric temporomandibular joint (TMJ) disorders represent a broad range of congenital and acquired diagnoses. Dentofacial deformities, including facial asymmetry, retrognathism, and malocclusion, commonly develop. Compared with adult TMJ conditions, pain and articular disc pathology are less common. Accurate diagnosis is paramount in planning and prognostication. Several specific considerations apply in preparation for skeletal correction, including timing in relation to disease progression and growth trajectory, expectation for postcorrection stability, reconstructive technique as it applies to expected durability and need for future revision, management of occlusion, and need for ancillary procedures to optimize correction. This article reviews common conditions and treatment considerations.
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  • 文章类型: Journal Article
    在这篇图片评论中,导言段强调了某些解剖学方面对颞下颌关节(TMJ)最佳成像的重要性。全面讨论和说明了最常见的病理:内部紊乱(ID)和骨关节炎(OA)。不太常见的情况:儿童和青少年的ID和OA样变化,特发性髁突吸收,炎性关节炎,和幼年特发性关节炎进行了简要讨论。包括有关年轻患者的鉴别诊断的简短段落,然后简要评论了TMJ中偶尔可能发生的扩张性病变。
    In this pictorial review, an introductory paragraph emphasizes the significance of some anatomical aspects for optimal imaging of the temporomandibular joint (TMJ). The most frequent pathologies: internal derangement (ID) and osteoarthritis (OA) are comprehensively discussed and illustrated. Less common conditions: ID and OA-like changes in children and adolescents, idiopathic condylar resorption, inflammatory arthritis, and juvenile idiopathic arthritis are briefly discussed. A short paragraph on differential diagnostics in young patients is included followed by a brief comment on expansile lesions that occasionally may occur in the TMJ.
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  • 文章类型: Journal Article
    在正畸患者特发性髁突吸收的治疗中,颞下颌关节紊乱的症状和下颌位置不稳定引起的不断变化的咬合,使正畸医生难以确定确定的正畸诊断和治疗计划。因此,这些患者的颞下颌关节(TMJ)结构需要在主动移动牙齿之前通过夹板治疗来稳定,以识别和保持真实的下颌位置。对于一些特发性髁突吸收患者,正颌手术可导致下颌骨易损髁的进一步吸收;因此,应考虑在关节稳定后进行有效的正畸伪装治疗。在正畸伪装治疗期间,TMJ结构上的不利载荷,这可能会改变髁突的位置,应该避免,和TMJ友好的力学必须应用。
    In the treatment of orthodontic patients with idiopathic condylar resorption, symptoms of temporomandibular joint disorders and constantly changing occlusions caused by an instability of mandibular position make it difficult for orthodontists to confirm definitive orthodontic diagnosis and treatment plans. Therefore, these patients\' temporomandibular joint (TMJ) structures need to be stabilized with splint therapy before active tooth movement to identify and maintain the true mandibular position. For some idiopathic condylar resorption patients, orthognathic surgery can cause further resorption on the vulnerable condyles of the mandible; thus, effective orthodontic camouflage treatment after joint stabilization should be considered. During the orthodontic camouflage treatment, adverse loads on the TMJ structures, which could change the position of condyles, should be avoided, and TMJ-friendly mechanics must be applied.
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  • 文章类型: Journal Article
    在这项研究中,我们旨在描述特发性髁突吸收(ICR)患者颞下颌关节(TMJ)髁突变形和颅面颌骨形态变化的三维分析。我们还将那些与健康且年龄和性别相匹配的对照组进行比较。进行了锥形束计算机断层扫描(CBCT)和头颅X射线照相(X射线),并分析了颅面测量,髁突宽度,长度,高度,使用ProPlanCMF™3.0软件(Materialise)三维进行髁突轴角变化。根据本研究结果,ICR患者的颅面下颌测量值与对照组显着不同,并且在ICR患者中可以看到下颌骨的显着变化。ICR组中较小的髁宽度和高度的结果反映了与未受影响的髁相比,髁的尺寸较小。此外,左右矢状髁角(p=0.001和p=0.003),分别,和轴向髁角(p=0.01和p=0.02),分别,两组间有显著差异。总之,在ICR患者中,髁的垂直发育随着髁的宽度和高度测量的减少而减少,观察到研究组之间颅面颌骨形态和髁突角度的差异。
    In this study we aim to describe the three-dimensional analysis of condylar deformation of the temporomandibular joint (TMJ) and morphological changes of the craniofacial jaw in patients with idiopathic condylar resorption (ICR). We also compare those with a control group that is healthy and matched for age and gender. Cone-beam computed tomography (CBCT) and cephalometric radiograph (X-ray) were conducted and analysis of craniofacial measurement, condylar width, length, height, and condylar axial angle changes were done three-dimensionally using ProPlan CMF™ 3.0 software (Materialise). The craniofacial jaw measurements of the ICR patients were significantly different than the control group and the significant changes in the mandible can be seen in ICR patients according to the results of this study. The results of smaller condylar width and height in the ICR group reflect the smaller size of the condyle compared with an unaffected condyle. Also, both right and left sagittal condylar angles (p = 0.001 and p = 0.003), respectively, and axial condylar angles (p = 0.01 and p = 0.02), respectively, displayed significant differences between the two groups. In conclusion, the vertical development of the condyle decreased along with reduced measurements in the width and height of the condyle in ICR patients, and differences in the morphology of the craniofacial jaw and condylar angles were observed between study groups.
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  • 文章类型: Journal Article
    特发性髁突吸收(ICR),虽然是罕见的事件,与患者严重的有害后遗症有关。迄今为止,病因仍然未知,和治疗策略是非常有争议的。因此,这项研究的目的是通过AWMF(德国科学医学会协会)的德国跨学科指南项目,对基于共识和证据的ICR方法进行分析。经过系统的文献检索,包括56种(最初的97种)出版物,主要是低水平的证据(LoE),两个独立的工作组(口腔颌面外科和跨学科,分别)对包含25项建议的草案进行了投票,该草案采用了标准化的匿名和盲法Delphi程序。虽然投票结果相对均匀,跨学科阶段需要更多的轮数(p<0.001).大多数有争议的建议与初始成像有关(关于CT/CBCT作为当前成像的诊断标准的共识),药物治疗(由于缺乏证据,没有推荐),双镜检查(由于低LoE而无法推荐)和正颌手术的时机(对侵入性TMJ手术后的两阶段程序达成共识,单阶段手术除外,如果与全关节重建相结合)。总的来说,Delphi程序产生了一个跨学科指南,在ICR的诊断和治疗方面提供了迄今为止最好的基于证据和共识的专业知识.
    Idiopathic condylar resorption (ICR), though a rare event, is associated with severe detrimental sequelae for the patient. To date, the etiology remains unknown, and treatment strategies are highly controversial. Therefore, the aim of this study is to present an analysis of the consensus- and evidence-based approach to ICR by a German interdisciplinary guideline project of the AWMF (Association of the Scientific Medical Societies in Germany). Following a systematic literature search, including 56 (out of an initial 97) publications, with a predominantly low level of evidence (LoE), two independent working groups (oral and maxillofacial surgery and interdisciplinary, respectively) voted on a draft comprising 25 recommendations in a standardized anonymized and blinded Delphi procedure. While the results of the votes were relatively homogeneous, the interdisciplinary phase required a significantly higher number of rounds (p < 0.001). Most of the controversial recommendations were related to initial imaging (with consensus on CT/CBCT as the current diagnostic standard for imaging), pharmacotherapy (no recommendation due to lack of evidence), discopexy (no recommendation possible due to low LoE) and timing of orthognathic surgery (with consensus on two-staged procedures after invasive TMJ surgery, except for single-stage procedures if combined with total joint reconstruction). Overall, the Delphi procedure resulted in an interdisciplinary guideline offering the best possible evidence- and consensus-based expertise to date in the diagnosis and treatment of ICR.
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  • 文章类型: English Abstract
    Objective:To investigate the relationship between idiopathic condylar resorption (ICR) and arch width disorder. Methods:Thirty-two patients with ICR and twenty patients without condylar resorption were enrolled according to the same inclusion criteria. They were divided into experimental group and control group. The experimental group was divided into unilateral ICR group and bilateral ICR group according to the affected side of condylar resorption, and then experimental group was divided into subgroups ICR Ⅰ, ICRⅡand ICR Ⅲ according to the degree of condylar resorption. Patients with no condylar resorption were used as a control group. The width of anterior, middle and posterior segments of dental arch on cone beam computed tomography(CBCT) was measured and the two groups of measured values were statistically analyzed. Results:Compared with the control group, the width of maxillary anterior, middle and posterior segments in ICR group was significantly reduced, and the difference was statistically significant(P<0.01). But the width of mandibular segment was not significantly different from that in control group(P>0.05). There was no significant difference in the width of anterior, middle and posterior dental arch between subgroups(P>0.05). Conclusion:Almost all patients with ICR have malocclusion of maxillary and mandibular arch width, but there is no significant correlation between the malocclusion width and the severity of condylar resorption.
    目的:探讨特发性髁突吸收(idiopathic condylar resorption,ICR)与牙弓宽度不调的相关性。 方法:按同一纳入标准收集32例ICR患者(试验组)及20例无髁突吸收患者(对照组)。试验组按髁突吸收累及侧分为单侧ICR组和双侧ICR组;按髁突吸收程度分为ICRⅠ、ICRⅡ、ICRⅢ亚组。无髁突吸收患者作为对照组,测量各组患者锥形束CT片上的牙弓前、中、后段宽度,并对测量值进行统计学分析。 结果:单、双侧ICR组患者上颌前、中、后段宽度与对照组比较均减小,差异有统计学意义(P<0.01)。而下颌宽度与对照组比较差异无统计学意义(P>0.05)。各亚组间牙弓前、中、后宽度比较差异亦无统计学意义(P>0.05)。 结论:ICR患者几乎都存在上下颌牙弓宽度不调,但宽度不调与髁突吸收的严重程度无明显相关性。.
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