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中华口腔医学研究杂志(电子版) ›› 2024, Vol. 18 ›› Issue (03) : 169 -174. doi: 10.3877/cma.j.issn.1674-1366.2024.03.005

论著

冠突过长患者的临床表现及磁共振影像学分析
陈海香1, 王元银2, 蒋盼3,()   
  1. 1. 中国科学技术大学附属第一医院口腔医学中心,合肥 230001;安徽医科大学口腔医学院,安徽医科大学附属口腔医院,安徽省口腔疾病研究重点实验室,合肥 230032
    2. 安徽医科大学口腔医学院,安徽医科大学附属口腔医院,安徽省口腔疾病研究重点实验室,合肥 230032
    3. 中国科学技术大学附属第一医院口腔医学中心,合肥 230001
  • 收稿日期:2024-04-01 出版日期:2024-06-01
  • 通信作者: 蒋盼

Clinical and magnetic resonance imaging imaging analysis of hyperplasia of the coronoid process

Haixiang Chen1, Yuanyin Wang2, Pan Jiang3,()   

  1. 1. Department of Stomatology, The First Affiliated Hospital of University of Science and Technology of China, Hefei 230001, China; College & Hospital of Stomatology, Anhui Medical University, Key Lab. of Oral Diseases Research of Anhui Province, Hefei 230032, China
    2. College & Hospital of Stomatology, Anhui Medical University, Key Lab. of Oral Diseases Research of Anhui Province, Hefei 230032, China
    3. Department of Stomatology, The First Affiliated Hospital of University of Science and Technology of China, Hefei 230001, China
  • Received:2024-04-01 Published:2024-06-01
  • Corresponding author: Pan Jiang
  • Supported by:
    Joint Fund for Medical Artificial Intelligence of The First Affiliated Hospital of USTC(MAI2022Q016)
引用本文:

陈海香, 王元银, 蒋盼. 冠突过长患者的临床表现及磁共振影像学分析[J/OL]. 中华口腔医学研究杂志(电子版), 2024, 18(03): 169-174.

Haixiang Chen, Yuanyin Wang, Pan Jiang. Clinical and magnetic resonance imaging imaging analysis of hyperplasia of the coronoid process[J/OL]. Chinese Journal of Stomatological Research(Electronic Edition), 2024, 18(03): 169-174.

目的

分析2例成年冠突过长患者的临床及磁共振成像(MRI)影像学表现。

方法

回顾性分析经临床确诊的2例冠突过长患者(冠突过长组)与71例颞下颌关节紊乱疾病患者的100侧正常关节MRI资料(正常对照组)。所有患者均接受3.0T MRI设备的颞下颌关节检查,利用pyradiomics软件处理得到肌肉纹理参数,采用Mann-Whitney U检验并进行组间比较。

结果

2例冠突过长患者均表现出低角宽面型的特征,张口度分别为20及22 mm,被动张口度无改善,张口型正常,双侧关节区无弹响或疼痛。口内检查为前牙内倾型深覆,后牙磨耗。MRI表现为颞肌及咬肌的体积增大,关节盘髁关系正常,关节盘变性,髁突骨质光滑连续。冠突过长组的颞肌及咬肌的能源、总能量、灰度不均匀性、网格体积和体素体积等参数均显著高于正常对照组(P<0.05)。然而,冠突过长组翼外肌在这些参数上与正常对照组相比差异无统计学意义(P>0.05)。

结论

2例成年冠突过长患者MRI影像学表现为颞肌及咬肌体积增大,对于了解冠突过长的发病机制具有重要意义。

Objective

Our objective was to conduct a comprehensive analysis of the clinical symptoms and magnetic resonance imaging (MRI) findings in two adult patients with hyperplasia of the coronoid process (CPH) .

Methods

A retrospective study was conducted, analyzing two patients clinically diagnosed with an elongated coronoid process (CPH group) , along with MRI data from 100 normal joints of 71 patients diagnosed with temporomandibular joint disorders (control group) . All participants underwent temporomandibular joint examination using a 3.0T MRI device. The obtained images were post-processed using pyradiomics software to extract muscle texture feature parameters, and a comparative analysis using the Mann-Whitney U test was performed between the two groups.

Results

Both patients with an elongated coronoid process exhibited traits of a low-angle, wide face type, with mouth opening degrees of 20 mm and 22 mm, respectively, and no improvement in passive mouth opening. The pattern of mouth opening remained normal, with no clicking or pain in the joint area. Intraoral examination revealed an endoclination deep bite of the anterior teeth and wear on the posterior teeth. MRI results showed an increase in the volume of the temporal and masseter muscles, with a normal disc-condyle relationship, but degenerative changes in the articular disc and a smooth and continuous surface of the condylar bone. In the elongated coronoid process group, the energy, total energy, gray-level non-uniformity, grid volume and voxel volume of the temporal and masseter muscles were significantly higher than those in the control group (P<0.05) . However, these parameters for the external pterygoid muscle showed no statistically significant difference compared to the control group (P>0.05) .

Conclusions

The MRI imaging of two adult patients with an elongated coronoid process showed an increased volume of the temporal and masseter muscles. This finding was significant for understanding the pathogenic mechanism of CPH.

图1 颞下颌关节磁共振成像(MRI)影像中咬肌、颞肌及翼外肌的标注及肌肉三维重建模型 A:在MRI上勾画颞肌、咬肌、翼外肌的感兴趣区(ROI);B:三维重建图像,其中红色为颞肌、绿色为咬肌、蓝色为翼外肌。
图2 口腔全景曲面体层片显示双侧冠突过长 Cd:髁突的尖端;Cor:冠状突的尖端;Go:下颌角点;Cd-Go:Cd和Go点之间的距离;Cor-Go:Cor和Go点之间的距离;Cor-Go/Cd-Go:高于1.15时诊断为冠突过长。
图3 冠突过长患者及正常对照组的关节磁共振成像(MRI)表现 A:冠突过长组变性关节盘MRI影像;B:正常对照组关节盘MRI影像;C:冠突过长组颞肌MRI影像;D:正常对照组颞肌MRI影像。A、B图中红色箭头所指为关节盘,C、D图中红色区域为颞肌。
表1 颞肌、咬肌和翼外肌纹理参数Mann-Whitney U秩和检验结果( ± s
[1]
Parmentier GILNys MVerstraete L,et al. A systematic review of treatment and outcomes in patients with mandibular coronoid process hyperplasia[J]. J Korean Assoc Oral Maxillofac Surg202248(3):133-148. DOI:10.5125/jkaoms.2022.48.3.133.
[2]
Mulder CHKalaykova SIGortzak RA. Coronoid process hyperplasia:A systematic review of the literature from 1995[J]. Int J Oral Maxillofac Surg201241(12):1483-1489. DOI:10.1016/j.ijom.2012.03.029.
[3]
Costa YMPorporatti ALStuginski-Barbosa J,et al. Coronoid process hyperplasia:An unusual cause of mandibular hypomobility[J]. Braz Dent J201223(3):252-255. DOI:10.1590/s0103-64402012000300012.
[4]
Goh YCTan CCLim D. Coronoid hyperplasia:A review[J]. J Stomatol Oral Maxillofac Surg2020121(4):397-403. DOI:10.1016/j.jormas.2019.12.019.
[5]
Chakranarayan AJeyaraj P. Coronoid hyperplasia in chronic progressive trismus[J]. Med Hypotheses201177(5):863-868. DOI:10.1016/j.mehy.2011.07.058.
[6]
Erdem SErdem S. Investigation of coronoid process hyperplasia using Levandoski analysis on panoramic radiographs[J]. World J Radiol202214(5):107-113. DOI:10.4329/wjr.v14.i5.107.
[7]
Leonardi RCaltabiano MLo ML,et al. Bilateral hyperplasia of the mandibular coronoid processes in patients with nevoid basal cell carcinoma syndrome:An undescribed sign[J]. Am J Med Genet2002110(4):400-403. DOI:10.1002/ajmg.10432.
[8]
Bayar GRAkcam TGulses A,et al. An excessive coronoid hyperplasia with suspected traumatic etiology resulting in mandibular hypomobility[J]. Cranio201230(2):144-149. DOI:10.1179/crn.2012.021.
[9]
Romano MPorcellini GRossi D,et al. Bilateral coronoid hyperplasia:A report of six cases[J]. J Biol Regul Homeost Agents201731(2 Suppl 1):139-145.
[10]
Kim SMLee JHKim HJ,et al. Mouth opening limitation caused by coronoid hyperplasia:A report of four cases[J]. J Korean Assoc Oral Maxillofac Surg201440(6):301-307. DOI:10.5125/jkaoms.2014.40.6.301.
[11]
张艳艳,刘飞,沈颉飞,等.双侧冠突过长导致开口受限2例[J].华西口腔医学杂志202240(4):476-482. DOI:10.7518/hxkq.2022.04.016.
[12]
廖文婷,何一青,孙佳栋,等.冠突过长:一种伪装成颞下颌关节疾病的罕见病[J/OL].中华口腔医学研究杂志(电子版)202115(1):1-5. DOI:10.3877/cma.j.issn.1674-1366.2021.01.001.
[13]
Colquhoun ACathro IKumara R,et al. Bilateral coronoid hyperplasia in two brothers[J]. Dentomaxillofac Radiol200231(2):142-146. DOI:10.1038/sj.dmfr.4600672.
[14]
Galie MConsorti GTieghi R,et al. Early surgical treatment in unilateral coronoid hyperplasia and facial asymmetry[J]. J Craniofac Surg201021(1):129-133. DOI:10.1097/SCS.0b013e3181c46a30.
[15]
Izumi MIsobe MToyama M,et al. Computed tomographic features of bilateral coronoid process hyperplasia with special emphasis on patients without interference between the process and the zygomatic bone[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod200599(1):93-100. DOI:10.1016/j.tripleo.2004.04.013.
[16]
Fernández Ferro MFernández Sanromán JSandoval Gutierrez J,et al. Treatment of bilateral hyperplasia of the coronoid process of the mandible. Presentation of a case and review of the literature[J]. Med Oral Patol Oral Cir Bucal200813(9):E595-E598.
[17]
Farronato MLucchina AGMortellaro C,et al. Bilateral hyperplasia of the coronoid process in pediatric patients:What is the gold standard for treatment?[J]. J Craniofac Surg201930(4):1058-1063. DOI:10.1097/SCS.0000000000004768.
[18]
Pregarz MFugazzola CConsolo U,et al. Computed tomography and magnetic resonance imaging in the management of coronoid process hyperplasia:Review of five cases[J]. Dentomaxillofac Radiol199827(4):215-220. DOI:10.1038/sj/dmfr/4600353.
[19]
Akita KFukino K. The significance and classification of the layered structures of the human masseter and temporalis[J]. Ann Anat2022242:151907. DOI:10.1016/j.aanat.2022.151907.
[20]
Gaudy JFZouaoui ABravetti P,et al. Functional anatomy of the human temporal muscle[J]. Surg Radiol Anat200123(6):389-398. DOI:10.1007/s00276-001-0389-z.
[21]
樊文萍,刘梦琦,邹颖,等.颞下颌关节紊乱病患者翼外肌MRI直方图纹理特征分析[J].中华口腔医学杂志202055(12):963-968. DOI:10.3760/cma.j.cn112144-20200514-00274.
[22]
宋文龙,郭大静,陈倩羽,等.基于MR增强图像肝细胞癌直方图纹理分析[J].放射学实践201934(12):1348-1353. DOI:10.13609/j.cnki.1000-0313.2019.12.014.
[23]
吴晓枫.基于MR增强图像全瘤直方图分析鉴别诊断腮腺Warthin瘤与多形性腺瘤[J].现代医用影像学202231(6):991-994. DOI:10.3969/j.issn.1006-7035.2022.06.001.
[24]
Tharmaseelan HRotkopf LTAyx I,et al. Evaluation of radiomics feature stability in abdominal monoenergetic photon counting CT reconstructions[J]. Sci Rep202212(1):19594. DOI:10.1038/s41598-022-22877-8.
[25]
Suhail PBhattacharjee RSingh A,et al. Radiomics-based evaluation and possible characterization of dynamic contrast enhanced(DCE)perfusion derived different sub-regions of Glioblastoma[J]. Eur J Radiol2023159:110655. DOI:10.1016/j.ejrad.2022.110655.
[26]
Yoda T. Masticatory muscle tendon-aponeurosis hyperplasia accompanied by limited mouth opening[J]. J Korean Assoc Oral Maxillofac Surg201945(4):174-179. DOI:10.5125/jkaoms.2019.45.4.174.
[27]
Elsayed NShimo THarada F,et al. Masticatory muscle tendon-aponeurosis hyperplasia diagnosed as temporomandibular joint disorder:A case report and review of literature[J]. Int J Surg Case Rep202178:120-125. DOI:10.1016/j.ijscr.2020.11.150.
[28]
Omami GMiller CS. Imaging evaluation of the temporomandibular joint[J]. Dent Clin North Am202468(2):357-373. DOI:10.1016/j.cden.2023.10.001.
[29]
Shen YWShih YHFuh LJ,et al. Oral submucous fibrosis:A review on biomarkers,pathogenic mechanisms,and treatments[J]. Int J Mol Sci202021(19):7231. DOI:10.3390/ijms21197231.
[30]
Nishi TMYamashita SHirakawa YN,et al. Proliferative fasciitis/myositis involving the facial muscles including the masseter muscle:A rare cause of trismus[J]. Am J Case Rep201920:1411-1417. DOI:10.12659/AJCR.917193.
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