下颌髁突囊外骨折的治疗:377例回顾性分析。

IF 2.3 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE
Dental Traumatology Pub Date : 2023-12-01 Epub Date: 2023-07-23 DOI:10.1111/edt.12871
Michael Maurer, Tabea Klaes, Johannes K Meier, Josef Maximilian Gottsauner, Jürgen Taxis, Johannes Schuderer, Torsten E Reichert, Tobias Ettl
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引用次数: 1

摘要

背景/目的:下颌骨髁突骨折占所有下颌骨骨折的25%-35%。尽管有深入的研究,但对于保守治疗或切开复位内固定(ORIF)治疗这些骨折仍存在争议。本研究的目的是分析开放和封闭治疗下颌髁突囊外骨折的一般特征、治疗后错颌合、面神经麻痹(FNP)、最大开口(MMO)和腮腺并发症的结果。方法:对377例骨折(开放治疗350例,封闭治疗27例)的临床及术后影像学资料进行回顾性分析。随访期12个月。采用pearson卡方检验、相关性检验、Kruskal-Wallis检验和t检验进行统计分析。结果:Spiessl和Schroll分型以II型为主(50.1%);在开放治疗的骨折中,最常见的入路是下颌后经骨瘤(91.7%)。治疗后错牙合发生率为18.0%,双侧骨折(p = 0.039)、脱位骨折(p = 0.016)和全牙列患者(p = 0.004)的错牙合发生率显著增加。在切开复位内固定(ORIF)后,有7.1%的人出现暂时性FNP,而1.7%的人出现永久性瘫瘫。FNP与高骨折(p = 0.001)、粉碎(p = 0.028)和手术时间延长(p = 0.040)显著相关。腮腺并发症与翻修手术显著相关(p = 0.009)。结论:下颌髁突囊外骨折切开复位植骨后最常见的长期并发症是错牙合。我们建议经椎体入路的ORIF是一种并发症发生率低的合适治疗方法,特别是对于下颌髁囊外骨折的FNP。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Treatment of extracapsular fractures of the mandibular condylar process: A retrospective evaluation of 377 cases.

Background/aim: Mandibular condylar fractures represent 25%-35% of all mandibular fractures. Despite profound research, there is still a controverse debate about treating these fractures conservatively or by open reduction and internal fixation (ORIF). The aim of this study is to analyse the outcome after open and closed treatment of extracapsular mandibular condyle fractures regarding general characteristics, post-treatment malocclusion, facial nerve palsy (FNP), maximum mouth opening (MMO) and parotid complications.

Methods: A retrospective cohort of 377 fractures (350 open, 27 closed treatment) was reviewed by reference to clinical and radiological pre- and postoperative documentation. Follow-up period was 12 months. Pearsons' chi-square-test, correlations, Kruskal-Wallis test and t-test were carried out for statistical analysis.

Results: The dominant type of fracture was type II in Spiessl and Schroll classification (50.1%). In the open treated fractures, the most common approach was retromandibular transparotid (91.7%). Post-treatment malocclusion occurred in 18.0% and was significantly increased in bilateral fractures (p = .039), in luxation fractures (p = .016) and in patients with full dentition (p = .004). After open reduction and internal fixation (ORIF), temporary FNP was documented in 7.1% whereas a permanent paresis occurred in 1.7%. FNP was significantly associated with high fractures (p = .001), comminution (p = .028) and increased duration of surgery (p = .040). Parotid complications were significantly associated with revision surgery (p = .009). Post-treatment reduction of MMO mainly occurred in female patients (p < .001) as well as in patients with bilateral fractures (p < .001), high fractures (p = .030) and concomitant mandibular (p = .001) and midfacial fractures (p = .009).

Conclusion: Malocclusion seems to be the most frequent long-term complication after open reduction and osteosynthesis of extracapsular mandibular condyle fractures. We suggest ORIF by a transparotid approach to be an appropriate treatment with a low complication rate regarding especially FNP for extracapsular fractures of the mandibular condyle.

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来源期刊
Dental Traumatology
Dental Traumatology 医学-牙科与口腔外科
CiteScore
6.40
自引率
32.00%
发文量
85
审稿时长
6-12 weeks
期刊介绍: Dental Traumatology is an international journal that aims to convey scientific and clinical progress in all areas related to adult and pediatric dental traumatology. This includes the following topics: - Epidemiology, Social Aspects, Education, Diagnostics - Esthetics / Prosthetics/ Restorative - Evidence Based Traumatology & Study Design - Oral & Maxillofacial Surgery/Transplant/Implant - Pediatrics and Orthodontics - Prevention and Sports Dentistry - Endodontics and Periodontal Aspects The journal"s aim is to promote communication among clinicians, educators, researchers, and others interested in the field of dental traumatology.
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