口腔颌面外科学（中山大学）15颞下颌关节病课件.ppt

Treatment principle Intra-articular ankylosis: TMJ arthroplasty 1 Timing: age of operation 2 Position of osteoectomy 3 Management of raw surface 4 Space remaining and interpose 5 Treatment of secondary micrognathia Extra-articular ankylosis Local : Scar excision + skin graft Extensive : Scar excision + flap Prognosis Recurrent rate: 10-55% Factors related to recurrent 1 Age 2 Amount shape of osteoecotmy 3 Interpose 4 Periosteum: 5 Post-operative training 6 Severity operation technic obstructive sleep apnea syndrome (OSAS) Sleeping apnea 10s + Respiratory Disturbance Index(RDI) 5/hour or one night (7h) apnea hypopnea 30 times Pathogenesis - Airway stricture and obstruction Soft tissue Hard tissue - Central regulation factor Symptoms Snoring Excessive daytime sleepness, EDS Abnormal behavior caused by sleep apnea Other symptoms caused by SaPO2 Diagnosis Airway obstruction: yes or no Position of obstruction Severity of obstruction Complication CL History Clinical examination -General examination -Respiratory digestive tract -Crainioral maxillofacial region X-ray: cephalometric (static) SNB mandible SNA maxilla ANB mandible maxilla PNS-P Soft palate length PAS Post Airway Space MP-H Position of Hyoid SPD Soft Palate thickness Polysomnograph, PSG (dynamic) Sleeping monitoring Frequency and classification of apnea Change of SaPO2 Respiratory Disturbance Index(RDI) Nasopharyngeal endoscope Treatment General Treatment -Diet -Quit smoking etc Nonsurgical treatment -Nasal Continuous Positive Airway Pressure n-CPAP -Othodontic treatment -Medication Surgical Treatment – relieve airway obstruction -Tonsiloectomy -Nasal cavity operation -Lingoplasty -uvulopalatopharyngoplasty, UPPP -Tracheotomy -Orthognathic surgery: mandible advancement, chinplasty -Distraction Osseogens