2018-08-012024-05-17https://scholars.lib.ntu.edu.tw/handle/123456789/687687顳顎關節連接下顎骨與頭顱骨，在咀嚼、發音、與呼吸功能上扮演著重要的角色。顳顎關節髁頭的顳顎關節盤，於開口運動時與關節隆凸呈現移動，而關節盤是維持顳顎關節功能的先決條件。牙科門診常見顳顎關節障礙，包括關節噪音、開口程度受限、開口路徑偏移、閉口卡住或困難、以及下顎運動過程中伴隨疼痛等。其中部分患者會發生關節髁頭重塑，在動態磁振造影上可以發現髁頭於前方斜面磨凹處，正好就是與前移關節盤對磨之處。由此推論，可能因不當受力之故導致髁頭磨損。本研究團隊之前研究已證實，髁頭磨損比較嚴重的病例，多為無法復位的關節盤前移的病患，其骨密度亦降低。這些患者多會進入”不明原因下顎髁頭吸收”。 下顎髁頭吸收的原因雖然可能與上述髁頭的磨損有關，但是病因學與病變演進的過程機制依然不明。此一疾病確切病因與解決方法，仍然嚴重困擾著醫界。患者最終仍須接受矯正或是正顎手術的治療。但這類病人接受正顎手術之後，術後再度發生變化的機會很高。因此有些口腔外科醫師會建議病人施行人工顳顎關節的置換，當然手術技術的難度與病患承受的痛苦也大大的提高。這也反映出臨床上處理這些關節髁頭嚴重磨損的病人及其咬合改變之後遺症的棘手之處。 討論致病機制必須要回答以下幾個重點：如果患者其顳顎關節髁頭的吸收是次發於關節盤前移所造成的髁頭磨合調整，有哪些宿主因素造成這些髁頭的重塑較為明顯？髁頭吸收導致前牙開咬的機轉為何? 從另一角度，由於肌肉的收縮導致僵硬及開咬，或因為髁頭磨損而造成高度變短，或長期的關節發炎造成顳顎關節周圍關節囊或韌帶的收縮，或微循環及輕度組織發炎的因素，顳顎關節的不正常機械/物理性質等等因素，和病患的性別、體脂比例及骨質密度均有相關性，非常複雜，而且最基本的機制仍不清楚。因此，本研究計畫朝向其最基礎的制病機轉，作深入探討；期待能標的出明確的病理機制，以新進的磁振造影、骨質密度、超音波技術及合併體瘦素的檢驗，進一步分析上述各個相關因素或病變，來了解顏面的顳顎關節及肌肉結締組織的微循環、微結構或物理性質的改變，造成初步病兆之後的自我調整及適應機制，來瞭解並幫助如何改進其治療方式，對於顳顎關節及不明原因下顎髁頭磨損吸收等疾病，作基礎及策略性的探討。The temporomandibular (TM) joint, which connects the lower jaw and the cranium, plays important roles in mastication, speaking, respiration, and communication. Intercondylar disc has translation in relation to condylar articular eminence. The clinical symptoms of the TM joint disorders include noises, mouth opening limitation, jaw movement path deviation, mouth closing difficulty or locking, and pain during jaw movements, etc. This joint also plays an important component of oral-facial function/morphology and synchronizes with adjacent muscular structure such as masseter muscle. TM joint and masseter muscle are responsible for force transmission and elastic energy utilization in biting, chewing; and will reflect to body nutrition intake and general status. That would be no doubt influence the facial geometry. The most severe problems of TM joint usually came to idiopathic condylar resorption (ICR). Most of them do need orthodontic therapy. However, fail or recurrence after orthodontic therapy of ICR patients was extremely high. Alternative therapeutic approach by surgery or joint replacement are only recommended by limited population. According to our previous research, the TM joint with disc displacement /without reduction would be subsequently followed by condylar resorption. However, the causal relationship, disease duration or mechanism remained unclear. The patients with ICR would suffer from open-bite, malocclusion, mouth opening limitation, jaw movement path deviation, joint pain and facial asymmetry, etc. On the other hand, severity of joint contracture, altered microcirculation /inflammation of synovium or muscle, abnormal mechanical properties of the TM joint, stiffness or dysfunction of masseter muscle, and their correlation with body mass index (BMI) and bone mineral density (BMD) in the diseased groups are still unclear. This project intends to inspire fundamental mechanism research, which is very much needed in this area, to target the specific underlying patho-mechanism. By using technologies to investigate tissue microcirculation /inflammation and mechanical properties, as well as functional tests and newly developed MR and ultrasound approach, this research project could investigate and have more understanding about how different entities or roles that would affect the adaptation process and may be integrated into the current therapy and optimize precise treatments. These will have an emerging significant impact on biomechanics, tissue characteristics and oral- facial input of idiopathic condylar resorption (ICR) of TM joint problems.顳顎關節不明原因下顎髁頭吸收咀嚼肌齒科矯正術咬合不全骨質密度磁振造影超音波彈力係數微循環temporomandibular jointidiopathic condylar resorptionmasticationmasseter muscleorthodonticsmal-occlusionbone mineral densitymagnetic resonanceultrasoundelastographymicrocirculation