儿童髁突囊内骨折外脱位合并颏部骨折的治疗：附1例报告

儿童髁突囊内骨折常见,若治疗不当会引起后遗症。本文报告1例儿童双侧髁突骨折外上脱位伴颏部骨折,外院颏部骨折固定术后咬合紊乱。重新手术,颏部骨折复位固定,恢复牙弓宽度,关闭舌侧裂隙。手法复位双侧外脱位的髁突,使其进入关节窝内。采用改良牙弓夹板进行颌间结扎牵引,改善咬合关系。术后随访显示,髁突位于关节窝内、双侧髁突和关节窝均愈合改建,咬合关系良好。该病例提示,儿童双侧髁突囊内骨折外上脱位伴颏部骨折治疗的关键在于恢复牙弓宽度,纠正外脱位的髁突。     

28例颏部骨折合并髁突囊内骨折伴脱位的疗效分析

目的 探讨下颌骨颏部骨折合并髁突囊内骨折伴脱位的治疗方法,并比较髁突骨折不同处理方法对治疗效果的影响。方法 2008—2013年间收治28例、44侧颏部骨折合并髁突囊内骨折患者,22侧髁突囊内骨折采用手术治疗,手术中注意保护翼外肌的附着;其余22侧采取保守治疗,术前或术中取模,术后配戴颌垫并配合弹性牵引及开口训练。应用SPSS17.0软件包对治疗结果进行Wilcoxon秩和检验。结果 手术治疗组髁突骨折22侧,术后髁突位置基本回复到关节窝内17侧,其牙弓宽度及咬合关系基本恢复,术后髁突仍然脱出关节窝5侧;保守治疗组22侧,术后髁突成功回复到关节窝内4侧,其余18侧脱出关节窝,其面下1/3仍有不同程度增宽。手术治疗组疗效评分显著优于保守治疗组（P<0.01）。结论 对颏部骨折合并髁突囊内骨折伴脱位患者,应在保持翼外肌良好附着的前提下,对脱位的髁突骨折进行复位和固定,这样有利于脱位的髁突恢复到正常的生理位置,维持下颌骨的正常宽度。     

下颌骨髁状突游离回植术治疗髁状突骨折(附5例报告)

髁状突骨折并不少见。其治疗方法多有争议。我们从１９８３～１９９７年治疗髁状突骨折共２３例,其中采用保守治疗者７例,手术治疗者１６例,后者包括骨折复位内固定１１例,髁状突摘除术２例（其中１例髁状突进入颅中凹）,髁状突游离回植术５例。鉴于髁突游离回植术少...     

陈旧性脱位性髁突骨折的手术治疗

目的 总结陈旧性脱位性髁突骨折的手术治疗经验。方法 经患侧绕下颌角切口,将２２例脱位髁突游离再植,通过Ｘ线对比观察、咬合关系恢复程度、张口度及张口型改善等指标进行评价。结果 １９例咬合关系恢复正常,１９例髁突复位良好,关节间隙均匀,骨皮质光滑、连续。平均张口度由２８．９ｍｍ增至３９．２ｍｍ;均有明显改善（Ｐ〈０．０１）。结论 髁突游离再植有利于结构和功能的恢复,是治疗陈旧性脱位性髁突骨折的有效方法。     

下颌骨髁突颅内脱位的研究进展

下颌骨髁突前脱位较为常见,而颅内脱位(上脱位)却非常少见.迄今为止,关于髁突颅内脱位,国内文献鲜有报道;而Pubmed所报道的此类患者仅仅数十例.虽然此类疾病较为罕见,其治疗却十分具有挑战性.本研究回顾以往文献,对髁突颅内脱位的发病机制、临床表现、诊断和治疗做一简要综述,为临床诊治提供参考.     

髁突骨折55例治疗体会

目的:探讨髁突骨折的治疗方法。方法:回顾性分析55例髁突骨折患者的资料,其中非手术治疗(保守治疗)40人,手术治疗15人,经随访1～5年,观察髁突骨折后成角和恢复情况与远期临床疗效的关系。结果:行保守和手术治疗者的平均髁突骨折移位角度分别为27°和56°,平均年龄分别为23岁和36岁。结论:根据髁突骨折移位角度和年龄来选择保守治疗或手术治疗,其远期效果较好。     

翼外肌-髁突解剖复位内固定治疗髁突颈骨折60例的临床分析

目的 探讨髁突颈部骨折时进行髁突-翼外肌解剖复位坚强内固定的适应证、手术方法 及术后效果。方法 对髁突颈部骨折出现髁头脱位突破关节囊、髁突和髁突颈下骨折移位成角大于30°~45°、下颌支垂直高度降低超过4~5 mm的骨折患者,采用耳屏前绕耳轮脚向上后耳颅沟切口,行翼外肌-髁突肌解剖复位坚强内固定方法 治疗。术后1、3、6个月复诊,检查面型、开口度、开口型、牙合关系、咀嚼力、面神经功能,三维CT重建上下颌骨,根据临床和影像学进行评价。结果 术后1月,所有患者面型对称、牙合关系好、开口度均较术前增大;无骨折移位、患侧咀嚼力减弱、8例额纹变浅。3月后,所有病例面型对称、开口度≥3.5 cm、开口型无偏斜、骨折一期愈合、髁突表面未见骨质吸收、面神经瘫痪症状恢复、双侧咬合力对称。6月后观察所有项目同术后3月。结论 髁突骨折经耳屏前后上绕耳轮脚切口,能较好的保护颞下颌关节区相关血管神经;对髁突颈部骨折行翼外肌-髁突解剖结构开放性复位内固定,是一种恢复解剖形态和关节功能的有效方法 ,在术后3月内可判定其效果。     

保守治疗髁突横断骨折：附17例报告

本文对３例（５例）髁突脱位性横断骨折、１４例（２３例）髁突非脱位横断骨折患者，分别采用髁突外牵引复位和单纯Ｈｅ间弹性牵引固定两种保守治疗方法，治疗的１７例患者均痊愈。作者认为，治疗成功的关键是：①脱位髁突复位至关节窝内，断端接触、临床愈合；②放置上下颌带钩牙弓夹板，Ｈｅ间弹性牵引恢复原始咬合关系；③早期功能锻炼，制动时间以２０天左右为宜。     

正畸辅助儿童髁突囊内骨折外脱位伴下颌后缩的闭合性治疗

目的 ：尝试正畸辅助闭合性治疗儿童髁突囊内骨折外脱位伴颏部骨折及下颌后缩,并观察其短期治疗效果。方法 ：1例9岁儿童外伤后15 d就诊,临床及影像学检查诊断为颏部骨折,双侧髁突囊内骨折外脱位,伴下牙弓增宽、下颌后缩。取模设计模型外科,制作Herbst矫治器。全麻下手法复位双侧髁突并缩窄下牙弓,同时戴入矫治器前移下颌。结果 ：配戴1个月后去除矫治器,随访6个月后患者咬合关系正常,下颌运动无碍,锥形束CT（CBCT）显示双侧髁突愈合改建良好,颏部骨折对位愈合。结论 ：借助Herbst矫治器的辅助,可闭合性治疗儿童髁突骨折外脱位伴颏部骨折及下颌后缩,短期随访获得了良好的咬合关系、髁突形态及下颌功能。     

髁突骨折28例治疗体会

目的:应用微型钛板内固定法治疗髁突骨折,观察其治疗效果。方法:!18例骨折采用耳屏前切口,10例选择自后下颌下切口,微型钛板坚强内固定。结果:28例患者,26例伤口一期愈合,2例延期愈合。张口度3月复查28～30mm,咬合关系良好。结论:!微钛板坚强内固定能精确复位,短期内可行使下颌功能,减轻了患者痛苦,是一种值得推广的良好方法。     

外伤致下颌骨髁突颅内移位：病例报告及文献复习

下颌骨髁突颈部结构薄弱,受外力作用时容易折断,从而通过缓冲创伤能量,避免颅中窝及颅脑等重要解剖部位受到损伤,可视为人体的一种自我保护机制。本文报告1例较为少见的髁突颅内移位外伤病例,髁突在未发生骨折的情况下向上移位,突破颅中窝底进入颅内,并结合相关文献,就其发生机制、临床表现、诊断及治疗进行讨论。     

Management of superolateral dislocation of the mandibular condyle: A retrospective study of 10 cases

IntroductionSuperolateral dislocation of the mandibular condyle (SDMC) is rarely described. The best treatment for superolateral dislocation of the fractured mandibular condyle (SDMC) is debated. This study investigated selection of the timing and techniques used in treating these fractures.Patients and methodsA retrospective clinical study was conducted on clinical data from 10 SDMC patients. Maximum mouth opening and occlusal relationships were compared following treatment using different techniques.ResultsThe 10 patients were followed for 6–25 months. Patients who had dislocation for less than 1 week had condylar reduction and rigid internal fixation of the fractures.Mandibular sagittal split ramus osteotomy and articular reduction and fixation were performed in seven cases. Postoperative mouth opening and occlusal relationships were satisfactory in all patients with the exception of one case with mouth opening of only 27 mm.ConclusionsFor all patients with superolateral dislocation, our first approach was to reduce the bone stump through surgery. When the dislocated joint had become adherent to the surrounding tissues and ankylosis developed, mandibular sagittal split ramus osteotomy was performed with good results.     

Superolateral dislocation of an intact mandibular condyle into the temporal fossa: case report and literature review

Temporomandibular joint dislocation refers to the dislodgement of mandibular condyle from the glenoid fossa. Anterior and anteromedial dislocations of the mandibular condyle are frequently reported in the literature, but superolateral dislocation is a rare presentation. This report outlines a case of superolateral dislocation of an intact mandibular condyle that occurred in conjunction with an ipsilateral mandibular parasymphysis fracture. A review of the clinical features of superolateral dislocation of the mandibular condyle and the possible techniques of its reduction ranging from the most conservative means to extensive surgical interventions is presented.     

Features and management of intracranial mandibular condyle dislocation after trauma

Background:

Dislocation of the mandibular condyle into the middle cranial fossa is rare in clinics. It often occurs when the mouth is open wide during the injury. It causes restriction of mandibular motion, lower facial asymmetry, pain in the temporomandibular joint (TMJ), etc.

Objective:

To introduce the features of intracranial mandibular condyle dislocation and discuss the management to this kind of trauma.

Major findings:

In this paper, the authors present two cases, describing the diagnosis, surgical management, and 1-year follow-up evaluation. The results of the authors' treatment to intracranial mandibular condyle dislocation were satisfactory and stable, and no surgical complications were detected.

Conculsion:

Advanced imaging studies are mandatory for exact diagnosis and successful treatment of intracranial mandibular condyle dislocation, and individualized management is recommended.     

Superolateral Dislocation of the Mandibular Condyle: A Series of Seven Cases

Introduction

Anterior and anteromedial dislocations of the mandibular condyle are seen frequently in mandibular fractures. Less frequent are dislocations of the condylar head in the lateral, medial and posterior direction whereas superior dislocation into the middle cranial fossa is rare. We report a series of seven cases encountered over the years, which, incidentally, is the largest case series reported till date with lateral and superolateral dislocation of the condyle after a traumatic injury.

Materials and method

In all cases but one, the condyle was reduced by manual manipulation with the patient in general anaesthesia. In all cases but one there was simultaneous fracture in the mandibular symphyseal region. The associated fractures were reduced and fixed with bone plates and screws.

Results

Patients were generally free from any long term complications of injury or surgery except for facial nerve paresis of a transient nature in one case.

Conclusion

To our knowledge, this clinical series presents the first reported case of superolateral dislocation which required open reduction. The etiology and mechanism of dislocation has been discussed along with a brief review of the literature.

Electronic supplementary material

The online version of this article (doi:10.1007/s12663-015-0770-9) contains supplementary material, which is available to authorized users.     

Superolateral Dislocation of the Mandibular Condyle Not Associated With Fracture: A Case Report

Background  

Superolateral dislocation is rarely encountered in clinical practice. It is usually associated with fracture of the contralateral mandibular body or zygoma. The occurance of type II superolateral dislocation of the condyle without associated fracture is very rare and only a few cases are reported in literature.     

髁突矢状骨折的影像学特征及临床分析

目的 探索髁突矢状骨折的影像学特征及临床特点。方法 对14例（15侧）下颌骨髁突矢状骨折患者的临床表现、常规X线、二维CT和三维CT图像进行分析,并对治疗效果随访。结果 14例15侧约占下颌骨髁突骨折的31．25％（15／48）,髁突前斜面纵裂处常位于髁突外1／3与中1／3交界处,在髁突后斜面,纵裂常位于髁突中1／3处。随访3－29个月;14例咬合关系均正常。结论 下颌骨髁突矢状骨折主要发生于髁突翼外肌凹所在部位,有效的治疗可获良好的治疗效果;二维CT和三维CT对诊断髁突矢状骨折有重要意义。     

Chondrosarcoma of the mandibular condyle: Report of a case

A rare case of chondrosarcoma of the mandibular condyle is reported. CT and MRI were available in the diagnosis of chondrosarcoma, but plain radiograms were nearly non-contributory. Microscopically, the malignant chondroid tissue and malignant chondrocytes were observed.     

髁突骨样骨瘤1例报告

髁突较少发生肿瘤,髁突骨样骨瘤鲜见报道.作者报告1例髁突骨样骨瘤,对其临床表现、X线及病理特点进行总结,确定瘤巢是诊断骨样骨瘤的关键,确诊需要病理诊断.