口腔疾病防治 ›› 2018, Vol. 26 ›› Issue (1): 48–51.doi: 10.12016/j.issn.2096-1456.2018.01.009

• 防治实践 • 上一篇    下一篇

颞下颌关节盘钙化病例报告暨文献回顾

宋娟1(), 龙星2(), 邓末宏2()   

  1. 1. 佛山市口腔医院口腔特诊科,广东 佛山(528000)
    2. 武汉大学口腔医院第二口腔颌面外科,湖北 武汉(430079
  • 收稿日期:2017-03-28 修回日期:2017-06-30 发布日期:2018-08-31
  • 作者简介:

    【作者简介】 宋娟,副主任医师,硕士, Email: 364782489@qq.com

  • 基金资助:
    国家自然科学基金(81470761)

Temporomandibular joint disc calcification: case report and literature review

Juan SONG1(), Xing LONG2(), Mohong DENG2()   

  1. 1. Special Clinical Department, Foshan Stomatological Hospital, Foshan 528000, China
    2. Department of Oral Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, China
  • Received:2017-03-28 Revised:2017-06-30 Published:2018-08-31

摘要:

目的 分析颞下颌关节盘钙化的临床特点及影像学表现,以期对该疾病的临床诊断提供帮助。方法 分析总结近10年在武汉大学口腔医院接受手术治疗并明确诊断为颞下颌关节盘钙化的患者2例,对患者的临床表现、X线影像及组织病理学资料,结合文献进行回顾性分析。结果 患者的临床症状为关节区疼痛、开口受限,患侧后牙开颌,X线检查可见关节窝内钙化物存在。手术中发现颞下颌关节盘大穿孔,残余的关节盘硬化。病理检查可见大量致密的成熟胶原纤维增生,胶原纤维中可见钙盐沉着;可见软骨细胞增生,大量细胞外基质形成并钙化。结论 颞下颌关节盘钙化的诊断需结合临床表现、X线及组织学检查,临床需与颞下颌关节髁突骨瘤、滑膜软骨瘤病等相鉴别。

关键词: 颞下颌关节, 关节盘, 钙化, X线检查, 病理检查

Abstract:

Objective To analysis the clinical and image features of temporomandibular joint (TMJ) disc calcification. Methods The patients diagnosed with TMJ disc calcification treated in School and Hospital of Stomatology, Wuhan University in the latest 10 years were collected, clinical symptom and images of these cases were analyzed, and the published literatures of TMJ disc calcification were reviewed. Results Total 2 cases of TMJ disc calcification with complete clinical data were analyzed. The symptom included mouth opening limitation, TMJ pain, open bite of the affected side molar. Calcified body were found through X-ray examination. Joint disc perforation were found during the surgery. The discs showed calcified features. Collagen hyperplasia, cartilage cells generation and calcification were found in the disc through pathological examination. Conclusion The diagnosis of TMJ disc calcification should be combined the symptom, image features and the surgery, it should be differentiated with TMJ osteoma and synovial membrane chondromasis.

Key words: Temporomandibular joint, Joint disc, Calcification, X-ray examination, Pathological examination

中图分类号: 

  • R782.6

图1

病例1影像学、病理学检查及手术切除标本 a:矢状面见髁突前、上、后可见高密度物质,髁突骨皮质可见被压迫吸收; b:横断面见髁突前高密度影像,髁突前内骨皮质压迫性吸收; c:手术标本病理学检查显示局部软骨细胞增生(A)、大量成熟胶原纤维增生(B)、细胞外基质钙化(C) HE × 40; d:手术切除的软骨样组织块标本。"

图2

病例2影像学及病理学检查 a:横断面见右侧髁突前钙化物; b:关节盘穿孔; c:组织内局部钙化 HE × 40; d:双侧后牙开颌。"

[1] Koyama J, Ito J, Hayashi T, et al.Synovial chondromatosis in the temporomandibular joint complicated by displacement and calcification of the articular disk: report of two cases[J]. AJNR Am J Neuroradiol, 2001, 22(6): 1203-1206.
[2] Marchetti C, Bernasconi G, Reguzzoni M.Presence of calcified tissue in the human temporomandibular joint disc[J]. Arch Oral Biol, 1998, 42(10/11): 755-760.
[3] Dimitroulis G.Tumoral calcinosis of the articular disc of the temporomandibular joint: a rare entity[J]. J Oral Maxillofac Surg, 2004, 62(12): 1551-1553.
[4] Shibuya T, Kino K, Kitamura Y, et al.Synovial osteochondromatosis accompanying an ossified articular disk in the temporomandibular joint: a case report[J]. J Oral Pathol Med, 2003, 32(7): 441-442.
[5] Yang C, Qiu WL.Bilateral discal tumoral calcinosis of the temporomandibular joint[J]. J Oral Maxillofac Surg, 2002, 60(3): 315-318.
[6] Jibiki M, Shimoda S, Nakagawa Y, et al.Calcifications of the disc of the temporomandibular joint[J]. J Oral Pathol Med, 1999, 28(9): 413-419.
[7] Embree MC, Iwaoka GM, Kong D, et al.Soft tissue ossification and condylar cartilage degeneration following TMJ disc perforation in a rabbit pilot study[J]. Osteoarthritis and Cartilage, 2015, 23(4): 629-639.
[8] Kelly DJ, Jacobs CR.The role of mechanical signals in regulating chondrogenesis and osteogenesis of mesenchymal stem cells[J]. Birth Defects Res C Embryo Today, 2010, 90(1): 75-85.
[9] 郑有华, 张志光, 曾融生, 等. 颞下颌关节肿瘤及瘤样病变致颜面部畸形的手术治疗[J]. 口腔疾病防治, 2016, 24(10): 567-573.
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