Compound splint for comminuted mandibular fracture

Maintenance of an adequate airway, control of bleeding, and neurologic evaluation should take precedence over treatment of facial injuries. Comminuted mandibular fractures are rare and require the use of complex splints. Severe lacerations and bone displacement accompany comminuted mandibular fractures. Extraoral facial splints constructed from donor facial moulages can be used along with intraoral splints for these patients. Preaccident photographs and radiographs are excellent aids to help realign the fractured segments. The use of an extraoral "donor" splint in conjunction with an intraoral splint to stabilize comminuted mandibular fracture helps to eliminate unnecessary gross removal of mandibular bone.     

应用正畸保持器片牙弓夹板治疗颌骨骨折的疗效评价

目的:探讨应用正畸保持器片牙弓夹板治疗颌骨骨折的临床效果。方法:对12例颌骨骨折患者应用正畸保持器片牙弓夹板固定合并颌间弹性牵引治疗,恢复咬合关系后第2周,停止颌间牵引,第4周拆除牙弓夹板,术后1、2、6个月时复查咬合关系,X线检查骨折愈合情况。结果:所有患者咬合关系恢复理想,X线检查显示骨折断端对位良好,骨折愈合良好,患者无不适感。结论:正畸保持器片牙弓夹板具有骨折对位准确、固位稳固、骨折愈合快、美观卫生、配戴舒适、费用低廉、操作简便等优点,适用于单发性、多发性、移位不明显的颌骨骨折。     

Multiple and comminuted mandibular fractures: treatment outlines in adverse medical conditions in Iraq

This study was conducted to evaluate prospectively the simple and more reliable methods in the treatment of multiple and comminuted mandibular fractures in hospitals with limited facilities and a high influx rate of trauma patients such as ours in Baghdad. One hundred patients with multiple and comminuted mandibular fractures of different severities were included in this study. Fifty-four patients were with comminuted and 46 were with multiple mandibular fractures. Eighty-eight patients had isolated mandibular fractures, and 12 had other associated facial bones fractures. Seventy-two patients were treated solely with maxillomandibular fixation. Thirteen patients were treated with different methods of internal fixation; the remainder was treated conservatively, functionally, or with different combinations of closed and open reduction methods. There was a statistically significant difference (P < 0.05) for fractures healing in relation to the type, severity, and etiology of the fracture. Eighty-four patients had fractures healed to bony union, 4 ended with nonunited fractures, and 10 patients had bone loss. Four patients developed infection, thus the infection rate was 4% for all, and 2.17% and 5.56% for patients with multiple and comminuted fractures, respectively. Seventeen patients required further surgeries for facial recontouring. The results of this study underscore the efficacy of closed reduction for treating multiple and comminuted mandibular fractures in terms of its simplicity, the availability of materials and instruments, and the favorable outcomes.     

微型钛板在内固定治疗下颌骨粉碎性骨折中的应用:21例临床分析

目的 研究微型钛板内固定术在治疗下颌骨粉碎性骨折中的应用价值。方法 选择2017年3月—2018年2月沈阳市口腔医院收治的下颌骨粉碎性骨折患者21例。所有患者均给予微型钛板坚固内固定,分别在患者下颌骨下缘、上缘、外皮质中部进行固定。观察术后骨折愈合情况及不良反应发生情况。结果 术后3个月内,所有患者均达到骨性愈合,平均时长为（1.53±0.36）个月。21例患者中,6例（28.57%）出现轻微咬合不正,1例（4.76%）发生局部感染,未出现微型钛板断裂、持续疼痛、开口受限、牙损伤、面神经损伤及骨不连患者。结论 微型钛板内固定术适用于无骨缺损的下颌骨粉碎性骨折患者,具有术后骨折愈合良好、时间短、不良反应少的优点。     

75例下颌骨粉碎性骨折的治疗效果评价

目的:提出一种针对下颌骨粉碎性骨折的分类方法,并尝试将其用于临床评价.方法:回顾75例下颌骨粉碎性骨折患者,按照下颌骨是否伴有节段性骨缺损、下颌骨形态、下颌骨的粉碎程度、可否恢复稳定的咬合关系对其进行分类.按照严重程度,进行保守治疗或使用小型钛板、钛网或重建板进行手术.其中,44例按照分类及治疗策略进行治疗(实验组),...     

导板外科应用于下颌骨粉碎性骨折精准复位

目的　探讨应用数字化导板辅助重建钛板精准复位及固定下颌骨粉碎性骨折的方法及效果。方法：选取本院2016年1月～2017年12月收治10例下颌骨粉碎性骨折患者作为研究对象,所有患者术前应用数字化外科技术设计手术导板并行3D打印,术中手术导板辅助重建钛板精准复位及固定下颌骨粉碎性骨折,术后行图像融合及临床评价。结果：所用患者均一期愈合,图像融合显示与术前虚拟设计偏差度＜2mm,咬合关系恢复及骨折复位愈合情况良好,张口度未见异常。结论：数字化导板辅助下颌骨粉碎性骨折复位及固定,缩短了手术时间,能精准复位及固定下颌骨粉碎性骨折,临床应用效果确定。     

钛板内固定与颌间固定治疗下颌骨骨折59例疗效分析

目的：探讨小型钛板坚强内固定与颌间固定治疗下颌骨骨折的临床效果。方法：59例下颌骨骨折患者随机分为2组，一组采用颌间弹性牵引加小型钛板内固定术(30例)，另一组采用上、下牙弓夹板固定加颌间弹性牵引术(29例)，治疗后对临床效果进行评价。结果：2组术后在感染发生率、骨愈合率方面疗效基本相同：在咬合关系、张口度的恢复及体重改变方面存在明显差异。结论：小型钛板坚强内固定对下颌骨骨折治疗效果肯定，在咬合关系及张口度恢复方面优于颌间固定术。     

腮腺前缘咬肌入路固定髁状突中低位骨折

目的：探讨腮腺前缘咬肌表面面神经间入路复位固定下颌骨髁突中低位骨折的方法。方法：37例43侧髁突中低位骨折患者随机分为两组,A组：16例19侧耳前切口穿腮腺入路复位固定骨折;B组：21例24侧髁状突中低位骨折患者采用绕下颌角皮肤切口,腮腺前缘、咬肌表面面神经间入路,直视下复位固定骨折。对两组的临床疗效进行比较。结果：B组术后第2d咬合关系恢复情况,涎瘘发生情况及术后1月下颌运动时关节局部牵拉不适感等方面均优于A组,差异有统计学意义（P＜0．05）;面神经功能障碍、术后CT三维重建骨折断端对位及术后1月患者主观满意度等方面差异无统计学意义（P＞0．05）。结论：腮腺前缘、咬肌表面面神经间入路可获得较为理想的术野,直视下保护面神经、复位固定骨折,不需分离腮腺,发生涎瘘和面神经损伤的危险性大大降低,并能用于下颌支粉碎性骨折等较为复杂的骨折的治疗,是安全有效的手术路径之一。     

The use of resorbable plates in association with dental arch stabilization in the treatment of mandibular fractures in children

PurposeThe purpose of this study was to investigate the effect of resorbable plate fixation in association with dental arch stabilization in the treatment of displaced mandibular fractures in children.Patients and methodsThirteen children (5 girls and 8 boys, age range 2 years 5 months to 12 years 2 months) with displaced mandibular fractures were included in this case series. Open reduction by intraoral approach was performed on these patients, and the fractures were fixed using resorbable plates and monocortical screws placed at the lower border of the mandible. At the same time, an arch bar or orthodontic wire splint was anchored using stainless steel wires or resin on the teeth to stabilize the whole mandibular dental arch. Postoperatively, follow-up was undertaken to evaluate the fracture healing, mandible movement, and mandible growth.ResultsPostoperatively, all patients achieved uneventful healing; premorbid occlusion restoration and wound healing were achieved, along with unimpaired function and normal growth and development of the mandible. Complications such as damage to tooth buds, infection, malunion, and nonunion were not encountered in these patients.ConclusionResorbable plates use in association with dental arch stabilization can provide good stabilization for mandibular fractures and is a promising approach for the treatment of displaced mandibular fractures in children.     

超高分子量聚D、L乳酸小型接骨板在下颌骨骨折治疗中的应用

目的:评价国产超高分子量聚D、L乳酸小夹板螺钉内固定系统在下颌骨骨折内固定中的疗效。方法:根据随机数字表法,将57例下颌骨单纯线性骨折分为2组,分别行PDLLA小夹板骨折内固定及小型钛板骨折内同定,术后行颌间牵引固定0-14d,观察伤口愈合、骨折段复位及咬合关系恢复等情况。结果:31例PDLLA小夹板骨折内固定患者,术后伤口无感染,未发现非特异性炎症;术后骨折段的稳定性好,骨折愈合正常,除4例出现轻度咬合关系紊乱外,其余患者咬合关系恢复良好,与小型钛板内固定疗效相似(X2检验,p>0.05)。结论:在下颌骨单纯线性骨折治疗中,PDLLA小夹板螺钉是一种可选择的骨折内固定材料,优点是不需要二次手术取出。     

颌面部骨折坚强内固定术85例临床分析

目的:评估和总结坚强内固定术治疗颌面部骨折的临床疗效.方法:对85例颌面部骨折患者进行坚强内固定治疗,术后定期复诊,根据外形、咬合关系、开口度的恢复及X线片检查骨折愈合情况确定临床效果.结果:85例中84例软组织创口一期愈合(98.82％)；1例创口感染,治疗后愈合.除1例颧骨粉碎性骨折外形欠佳外,其余84例外形、咬合...     

Intermaxillary fixation is not usually necessary to reduce mandibular fractures

We undertook a retrospective study of all isolated mandibular fractures which had required active management over a 1-year period at the Maxillofacial Unit at Newcastle General Hospital. Patients with single or multiple fractures of the mandible were included in the study, if there were other simultaneous fractures of the facial skeleton, those patients were excluded. All case notes and radiographs were reviewed by a single operator. A total of 202 cases of fractured mandible were identified of which 115 fulfilled the selection criteria of: isolated fracture, no previous facial fracture, treatment by open reduction and internal fixation using titanium osteosynthesis miniplates, and all case notes and radiographs available to study. Sixty-six patients had their fractures reduced manually to obtain anatomical reduction without the use of peroperative intermaxillary fixation (IMF). Forty-nine were treated conventionally using peroperative IMF. The two groups were broadly similar in severity and type of fracture, and the method of reduction seemed to be decided by the operator according to their preference. IMF was not used routinely postoperatively. Overall there were significantly fewer occlusal discrepancies in the early postoperative period in those patients treated by anatomical reduction (6/66 compared with 16/49, P = 0.002) but there was no difference in the final outcome of the occlusion between the two methods of reduction. Avoidance of the use of peroperative IMF is more economical in time and cost, is safer for the operator, and more comfortable for the patient. As this technique produces comparable results in the long term with fewer early complications, we conclude that IMF is not usually necessary to reduce fractures confined to the mandibular bone.     

可吸收钉板在上颌骨及全面部骨折中的应用

目的　评价可吸收钉板在上颌骨与全面部骨折中的应用。方法　选择2011年6月至2018年7月在武汉大学口腔医院口腔颌面创伤与颞下颌关节外科接受治疗的涉及上颌骨骨折的患者244例。全面部骨折的纳入标准是同时包含上颌骨骨折、颧骨颧弓眶骨骨折和下颌骨骨折。所有患者均主动要求使用可吸收钉板系统进行内固定。对其人口统计学信息、治疗情况和随访结果进行回顾性分析。结果　244例患者的上颌骨骨折部位全部使用可吸收钉板进行内固定，其中男145例，女99例；年龄6～73岁，平均35岁；上颌骨Le FortⅠ型骨折36例，Le Fort Ⅱ型骨折111例，Le Fort Ⅲ骨折型97例。涉及额骨骨折3例，鼻骨-眶-筛骨（NOE）复合体骨折42例，上颌骨矢状骨折37例，全面部骨折36例。全面部骨折患者中，颧骨颧弓眶骨、上颌骨、下颌骨同时使用可吸收钉板固定的有14例；仅颧骨颧弓眶骨、上颌骨同时使用可吸收钉板固定的有6例；仅颧骨颧弓眶骨使用可吸收钉板固定的有14例；另外2例患者的情况与上述三种分类均不符合。所有患者术前均有面部畸形，且出现咬合紊乱。复位和修复全面部骨折的方法按照“由简单到复杂”进行序列复位固定的原则。术后并发症情况：3例轻度错牙合畸形，1例颧骨部分缺损，1例眼球内陷，4例创伤瘢痕，2例眼睑下睑萎缩，2例颞肌萎缩。结论　灵活应用可吸收钉板进行上颌骨及全面部骨折复位固定具有可行性。软组织问题引起的手术后并发症，包括撕裂和不对称，难以避免。     

可吸收钉板在下颌骨髁突骨折中的应用

目的　回顾性分析可吸收钉板在下颌骨髁突骨折中的应用，探讨其在髁突骨折治疗中的适应证、操作难点及注意事项。 方法　2012年7月至2018年6月，武汉大学口腔医院口腔颌面创伤与颞下颌关节外科应用可吸收钉板固定下颌骨髁突骨折患者82例（共106侧），其中髁突高位矢状骨折46侧，中位髁颈骨折26侧，低位髁颈下骨折34侧。髁头及髁颈骨折复位术均经耳屏前径路；髁颈下骨折复位术中，多数经耳屏前径路及颌下径路。髁突高位矢状骨折复位后以1～2枚可吸收长螺钉固定，髁颈及髁颈下骨折以2块可吸收板固定。术后随访6个月至3年。结果　所有患者术后未诉明显不适，面型基本对称，面部肌肉运动正常，咬合对位良好，开口度恢复，未见明显排斥反应及严重并发症。结论　可吸收钉板可应用于髁突高位矢状骨折、中位髁颈骨折、低位髁颈下骨折的开放复位内固定。应用可吸收钉板固定髁突骨较钛板钛钉复杂，需熟练掌握合适的操作技巧及注意事项。     

The use of vacuum-formed splints for temporary intermaxillary fixation in the management of unilateral condylar fractures.

We report a simple, effective method of managing displaced unilateral condylar fractures with occlusal disruption using vacuum-formed thermoplastic foil splints with bonded wire cleats. The cleats enable intermaxillary fixation in the form of orthodontic elastics to be used, which guide then maintain the occlusion in centric relation. A case is presented in which this technique was used successfully.     

The Elastic Internal Traction (EIT): an effective method to reduce the displaced facial fractures

Open reduction and rigid fixation are commonly used to treat displaced fractures of the facial skeleton. Manual reduction can be performed by means of forceps or transosseus wires to close the bone fragments. In order to reduce facial fractures, we used a technique, called Elastic Internal Traction (EIT), based on the elastic action of rubber bands stretched between screws placed on both sides of the fracture line. We have used EIT in 104 patients suffering from mandibular fractures, and 40 cases of patients with orbito-maxillary complex fractures out of the 707 patients treated for trauma between July 2000 and August 2002 at our hospital. In our opinion, this technique provides an effective reduction and a stable primary fixation of the bone before the final fixation. It also has the advantage that the surgical field is clear of the assistant's hands and surgical instruments that are usually used to lock the reduction. The resulting operative time is shortened, and the plating of the bone is simplified.     

下颌骨骨折加压固定与钢丝固定的骨愈合组织学研究

采用组织学方法，对新研制的下颌骨小形加压钢板的效果进行实验研究，并与钢丝固定对比。结果发现，加压固定的骨愈合形式与钢丝固定完全不同。加压固定为骨折的直接愈合，没有外骨痂形成，而钢丝固定则为传统的骨折愈合形式，加压固定的骨愈合质量明显高于钢丝固定。     

髁突摘除术治疗粉碎性髁突骨折疗效分析

目的:探讨髁突颈部以上粉碎性骨折行髁突摘除术的可行性及适应证.方法:回顾我院2007年9月-2011年9月间因外伤导致髁突骨折患者61例,其中完全行手术内固定治疗30例,保守治疗15例,髁突颈部以上粉碎性骨折患者16例(18侧)予以髁突摘除术,术后随访5～48个月,观察疗效.结果:16例(18侧)患者中,止血纱布排异反应导致创口愈合不良1例,咬合偏斜1例,开口轻度受限1例,前牙开(牙合)1例,其余患者无明显咬合不适,牙尖窝关系良好,面容基本对称.结论:对于颌面部发育基本完成的患者,其髁突颈部以上粉碎性骨折采取髁突摘除术是可行的治疗方法,术后可能出现咬合偏斜、前牙开(牙合)及开口受限,进一步治疗后可恢复正常.     

Comminuted mandibular fracture in child victim of dog bite

Dog bites represent lesions commonly found in Hospital Emergency Clinic. This type of lesion may cause severe harm to patients, but it rarely affects the underlying bone structure causes facial fracture. This study aims to illustrate a rare clinical case in which a pediatric patient presented a comminuted fracture in the mandible which evolved into a unilateral avulsion of the mandibular condyle, body fractures as well as a mandibular ramus and hemiface that had been deformed, with multiple lacerations and loss of soft-tissue mass. Intermaxillary fixation was performed using the Ivy method, followed by internal rigid fixation using miniplates and screws in attempt to reconstruct the child's mandible. After 2 years of follow-up, a satisfactory esthetics and functional results could be observed.     

Biomechanical study on monocortical osteosynthesis for the fracture of the mandible

In order to compare the rigidity of the fixation and resultant bone healing of monocortical versus bicortical osteosynthesis, biomechanical tests were performed in dogs. Use of a gnathotome made it possible to produce a mandibular fracture with minimal bone defect between fragments. An AO dynamic compression plate and a mini-plate were used for the fixation of each half side of the fractured mandible. The biomechanical tests revealed that bicortical osteosynthesis was superior to monocortical in the rigidity of the fixation. However, the results after removal of the plates, at 14 weeks postoperatively, showed that there was no apparent difference between the 2 sides. Monocortical osteosynthesis is useful in the treatment of mandibular fractures, except for fractures with bone defects, comminuted fragments and laceration of the lateral cortical bone.