颞下颌关节腱鞘囊肿和滑膜囊肿的诊断与治疗

摘要/Abstract

摘要： 目的：回顾性分析颞下颌关节腱鞘囊肿和滑膜囊肿的临床特点及治疗预后，为早期临床诊断和治疗提供参考。方法：收集1998年5月至2013年8月间在北京大学口腔医学院颞下颌关节病及口颌面痛诊治中心、口腔颌面外科就诊并进行治疗，最终诊断为颞下颌关节腱鞘囊肿和滑膜囊肿的患者9例，就其临床表现、影像学特点、诊断与鉴别诊断、治疗和随访情况进行总结和讨论。结果：9例患者中，男性3例，女性6例，年龄33~62岁，中位年龄39岁；病程2周至3年，中位值4个月。行普通X线检查者7例，CT检查者8例，MRI检查者6例，B超检查1例。最终诊断为腱鞘囊肿者7例，滑膜囊肿2例。腱鞘囊肿主要表现为耳前区或关节区的包块或膨隆，无明显症状或局部仅有酸胀不适感，偶然有痛；而滑膜囊肿则表现为耳前区肿痛、开口受限等，可伴咬合紊乱。行手术切除8例，关节穿刺冲洗治疗1例。随访时间3个月至9年，其中1例复发，其余8例无复发。结论：MRI检查对颞下颌关节腱鞘囊肿和滑膜囊肿的诊断和治疗有重要价值。手术切除治疗具有较好的治疗效果，但经关节腔穿刺冲洗治疗滑膜囊肿同样获得了良好的治疗效果，有待于更多病例治疗经验的积累。

关键词: 颞下颌关节, 腱鞘囊肿, 滑膜囊肿

Abstract: Objective：To give a reference for the early diagnosis and treatment of the cysts arising from the temporomandibular joint. Methods: Nine patients finally diagnosed as temporomandibular joint cysts at the Peking University Hospital of Stomatology from May 1998 to August 2013 were selected and reviewed. Their clinical manifestations, imaging features, diagnoses and differential diagnoses, treatments and followups were summarized and discussed. Results: In the 9 patients, 3 were males and 6 females. Their ages ranged from 33 to 62 years with a median age of 39 years; the course of the disease ranged from 2 weeks to 3 years with a median of 4 months. The image examinations were performed with conventional X-ray examinations in 7 cases, CT scans in 8 cases, MRI in 6 cases and ultrasound in one case. Of the 9 cases, 7 were finally diagnosed as ganglion cyst and 2 as synovial cyst. Ganglion cysts mainly presented as the mass of preauricular area or joint area, with no obvious symptoms or only local discomfort, occasionally with pain. The synovial cysts manifested as the painful swelling of preauricular area and limited mouthopening, accompanying with occlusal disorders. The treatments included surgical resection in 8 cases, repeated arthrocenteses and lavages in one case. The follow-ups were from 3 months to 9 years, one case with recurrence, and the remaining eight cases without recurrence. Conclusion: MRI examinations are very helpful in the early diagnosis and treatment planning of temporomandibular joint cysts. Surgical resection can have good results. Repeated arthrocenteses and lavages also have a good result, which may be an alternative choice for synovial cyst, but more accumulation of clinical experience is further needed.

Key words: Temporomandibular joint, Ganglion cyst, Synovial cyst

孟娟红，郭传瑸，马绪臣. 颞下颌关节腱鞘囊肿和滑膜囊肿的诊断与治疗[J]. 北京大学学报（医学版）, 2014, 46(1): 43-47.

MENG Juan-hong, GUO Chuan-bin, MA Xu-chen. Diagnosis and treatment of the ganglion cysts and synovial cysts arising from the temporomandibular joints[J]. Journal of Peking University(Health Sciences), 2014, 46(1): 43-47.

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