24例髁突骨折经下颌后进路行坚强内固定的疗效观察

目的:介绍发生于髁突颈和髁颈以下髁突骨折用小型钛板经下颌后进路行解剖复位、坚强内固定术的方法和经验。方法:发生于髁突颈和髁颈以下骨折24例30侧,经下颌后进路以小型钛板行坚强内固定术。术后3～6个月后复查并评价疗效,复查内容包括:张口度、张口型、咬合关系、X线表现、面神经损伤情况。结果:张口度较术前明显增大,张口型偏移明显改善,错牙合3例,面神经下颌缘支损伤2例。X线检查:髁突骨折复位良好,髁突无移位。结论:下颌后进路是一种治疗髁突颈和髁颈以下骨折的有效方法。     

髁颈及髁颈下骨折术后非骨源性咬合关系紊乱因素探讨

目的 总结髁颈及髁颈下骨折解剖复位、坚强内固定术后影响咬合关系的非骨源性因素。方法 分析23例髁颈及髁颈下骨折经解剖复位、小型接骨板坚强内固定术后出现咬合紊乱的原因，并提出相应的处理措施。结果 23例术后咬合紊乱者均经曲面断层片及瓦氏位片复查，未发现小型接骨板变形、断裂以及骨折片再移位，但伴其他并发症(一过性面瘫2例；一过性下颌缘支损伤3例；感染2例；关节区疼痛2例；关节弹响及杂音1例)。结论 髁颈及髁颈下骨折虽经解剖复位、小型接骨板坚强内固定，且术后并无导致咬合紊乱的骨源性因素，仍有发生咬合紊乱的可能性。其原因为肌源性和关节源性。这时，不需再次手术复位，只需颌间弹性牵引及功能锻炼，个别情况下调He治疗即可恢复正常咬合关系。     

Transoral miniplate osteosynthesis of condylar neck fractures.

OBJECTIVE: In a retrospective study, we reviewed a series of 55 consecutive patients with 57 fractures of the condylar neck that were treated with transoral miniplate osteosynthesis. STUDY DESIGN: Forty-one patients were included in a clinical follow-up study; the median length of study was 26.5 months (minimum, 7 months; maximum, 79 months). In a radiographic study, the positions of the condyle before open reduction, after open reduction, and more than 6 months postoperatively were evaluated in 3 radiographic planes. A statistical analysis was performed to determine factors that lead to secondary instability of the reduced condyle and to correlate the actual position of the condyle with clinical parameters collected in follow-up examinations. RESULTS: At the time of the follow-up examination, the median measurement of the mandibular openings was 48.3 +/- 8.0 mm (minimum, 32 mm; maximum, 66 mm). A deviation of 2 mm to the operated side when opening was observed in 7 patients. The median range of laterotrusion was 10.0 mm to the fracture side and 9. 0 mm to the opposite side. In 7 patients, radiographic follow-up more than 6 months postoperatively revealed a medial tilt of the proximal fragment of 15 to 40 degrees despite a good immediate postoperative position of the condyle. This may be attributed to bone resorption in the fracture gap, together with a bending instability observed when titanium miniplates with a thickness of 0. 9 mm were used. The position of the condyle at the follow-up examination did not correlate with clinical parameters. CONCLUSIONS: Transoral approach miniplate osteosynthesis of dislocated condylar neck fractures is indicated when visible scars in the head and neck region, which are encountered with other fixation techniques, must be avoided.     

Open reduction without fixation of dislocated condylar process fractures: Long-term clinical and radiologic analysis

Purpose: This study evaluates the long-term results of open reduction without fixation for displaced fractures of the condylar process.Patients and Methods: Clinical and radiologic examinations were performed on 27 patients with 29 operated joints an average of 6.7 years postoperatively. The postoperative result was evaluated on the basis of occlusal and joint function, as well as radiographic assessment of condylar changes.Results: Clinically, satisfactory results were achieved. Radiologically, despite correct intraoperative alignment of the fractured segments, a slight medial deviation of the condylar process was found on the posteroanterior radiograph. However, in only two cases was a 20-degree deviation observed. On final follow-up, 48% of the cases had a normal condylar configuration radiologically, and in the remaining cases, normal function was established even though there were condylar changes. Fully exposed and devascularized condylor processes generally showed more severe changes than those in which partial vascularization was maintained.Conclusion: The surgical management described enables a satisfactory outcome to be achieved with dislocated condylar process fractures.     

Infection after rigid internal fixation of mandibular fractures: a clinical and radiologic study

Of 214 patients with mandibular fractures treated following the AO/ASIF principle of rigid fixation, 13 patients (6.1%) developed postoperative infection. The yearly percentage decreased remarkably during the study period. When rigid fixation became a routine method, the infection rate was as low as the corresponding figure for cases treated with nonstable techniques and maxillomandibular fixation (MMF). All but one of the infected fractures were in the angular region of the mandible. Teeth had been extracted from the fracture line in 9 of the 10 dentulous patients. It was concluded that erroneous techniques had been used in almost all infected cases, because compression could not be achieved when there was an irregular fracture line, an atrophic edentulous mandible, or inadequate stability due to removal of a tooth in the line of fracture. In five patients, successful reoperation was performed using a reconstruction plate. Detailed radiologic examination was useful in assessment of infection and in follow-up.     

Long-term results after childhood condylar fractures. A computer-tomographic study

A computer-tomographic study of the remodelling process of the TMJ was made of 12 patients who had suffered condylar fractures during their growth period. The most interesting results were exhibited by patients with low fractures of the condyle and medial luxation of the small fragment. The remodelled condyles consisted of 2 parts, a medial part, probably the remainder of the small fragment and a lateral part, probably callus formation. In some patients a flattening of the fossa characterized by thickening of the roof was clearly observed. The case presentation additionally included one patient with post-traumatic ankylosis and one patient presenting a bifid condyle.     

Retromandibular approach for reduction and fixation of mandibular condylar fractures: A clinical experience

This study evaluated the efficiency and safety of a retromandibular approach to reduce and fix displaced condylar fractures. The study group included 31 patients who had undergone surgery for 35 condylar fractures (8 bilateral, 23 unilateral). Consultants and residents had performed the procedure. Inclusion criteria were: patient's choice for open reduction and fixation; displaced unilateral condylar fractures with occlusal derangement; bilateral condylar fractures with anterior open bite. Restriction of lateral movement towards the unaffected side was observed preoperatively in all cases taken up. There was a difference in the lateral movements towards the fractured side (mean 7.2) and unaffected side (mean 4.2) during the first postoperative review. Functional occlusion identical to the preoperative occlusion and good reduction of the condyles was noted in all cases. Facial nerve was encountered in 6 cases (17%) intraoperatively. There was one case (3%) of temporary facial nerve weakness, which resolved within 2 weeks. There was no permanent facial nerve damage in any patient. The retromandibular-transparotid approach seems to be a safe and efficient method for reduction and internal fixation of condylar fractures with little or no risk to the branches of facial nerve.     

Transoral 2.0-mm miniplate fixation of mandibular fractures plus 2 weeks' maxillomandibular fixation: a prospective study.

PURPOSE: We conducted a study to assess the efficacy of intraoral treatment of mandibular fractures using a 2.0-mm miniplate and 2 weeks of maxillomandibular fixation (MMF). PATIENTS AND METHODS: Forty-four mandible fractures in 31 patients with a mean of 15 days of MMF were included in this study. A 2.0-mm miniplate was adapted along Champy's lines of ideal osteosynthesis and secured with four 8.0-mm monocortical screws. All patients were followed for at least 8 weeks after surgery. The incidences of bone or soft tissue infections, wound dehiscence, nonunion, malunion, malocclusion, plate fractures, and iatrogenic neurosensory deficits were prospectively evaluated. RESULTS: Primary bone healing was achieved in 100% of cases. No soft or hard tissue infection, malocclusion, malunion, nonunion, dental injuries, plate fracture, or iatrogenic nerve injuries were observed. Two (4.52%) minor complications-intraoral wound dehiscences-were noted. CONCLUSIONS: The use of a single 2.0-mm miniplate adapted along Champy's line of ideal osteosynthesis and stabilized with 4 monocortical screws plus 2 weeks of MMF was a viable treatment modality for mandibular fractures.     

Conservative treatment of unilateral condylar fractures in children: a long-term clinical and radiologic follow-up of 55 patients

The purpose of this prospectively designed study was the long-term clinical and radiological evaluation of conservatively treated unilateral condylar fractures in children. Fifty-five children aged between 2 1/2 and 9 3/4 years, presenting with a singular unilateral fracture of the mandibular condyle, were treated in a nonsurgical-functional way using an intraoral myofunctional appliance. In the follow-up period, patients were investigated by standardized clinical examination and by evaluation of panoramic radiographs taken immediately post-traumatically, after 6, 12, 24, 48 and 72 weeks, and then yearly through the period of growth. With a satisfactory clinical course in all patients, there was no instance of functional disturbance or mandibular asymmetry after the respective follow-up periods. The radiographs showed a fairly good shape of the condyle (no or only slight condylar deformity) in the 47 patients of the 2-6 year age group. In the eight patients of the 7-10 year age group presenting with a class II or III condylar fracture, healing was characterized by incomplete condylar regeneration, resulting in a moderate condylar deformity in two cases, a definite reduction in condylar neck height in two cases, and a hypertrophic condylar deformity in four cases. The positive results of this study confirm the concept of a nonsurgical-functional approach in children presenting with various types of unilateral fractures of the mandibular condyle. Condylar remodeling was the mode of fracture healing in instances of displaced and dislocated condylar fractures.     

Resorbable poly-L-lactide plates and screws for the treatment of mandibular condylar process fractures: a clinical and radiologic follow-up study.

PURPOSE: The purpose of this study was to determine whether a resorbable poly-l-lactide (PLLA) miniplate system could be used to treat mandibular condylar process fracture. PATIENTS AND METHODS: Fourteen patients (12 males, 2 females, aged 23.1 +/- 5.7 years) who had mandibular condylar process fractures treated with PLLA implants were recalled for follow-up clinical and radiologic examinations at 3 years. RESULTS: Mouth opening recovered to more than 35 mm and occlusion was stable in all patients. There was no facial asymmetry 3 months postoperatively. Two patients had mild chronic postoperative tenderness at the implantation site; however, there was no wound infection. All fractured mandibular condyles showed anatomic good reduction and long-term stability with the use of resorbable miniplates and screws. Bone healing was satisfactory in all patients, and there was no evidence of abnormal resorption of the condylar process. The screw holes remained evident after 3 years. Screw holes in 2 patients showed enlargement on radiographic examination. CONCLUSION: The PLLA miniplate system provides reliable stability when used for the fixation of mandibular condylar process fractures.     

158 例髁突骨折回顾分析

目的:探讨髁突骨折的临床特点及治疗。方法:收集1999～2003年入院的158例髁突骨折患者的病历资料并进行回顾分析。结果:158例骨折中,交通事故伤71例,跌伤41例,其他原因46例。手术治疗133例(177侧关节),保守治疗25例(32侧关节)。135侧采用固定的关节中,71侧采用夹板,41侧采用钢丝,其他材料23侧。41侧关节仅行骨折片摘除。59例患者病历中有明确的保留翼外肌或复位关节盘记录。结论:交通事故是髁突骨折的主要原因,手术治疗仍是主要手段,手术中生理解剖复位的观点正逐渐被接受。     

Further development of titanium miniplate fixation for mandibular fractures. Experience gained and questions raised from a prospective clinical pilot study with 2.0 mm fixation plates.

Miniplate systems are often used instead of more rigid systems for the treatment of mandibular fractures. While the most stable fixation method for all mandibular fractures is the 2.7 mm plate, most fracture sites and types are eminently suitable for miniplate fixation via an intraoral approach. However, the relatively low stability of the miniplate systems compared with rigid plate systems limits the indications for their use in mandibular fracture treatment, especially when immediate postoperative function is desired. A more rigid miniplate which provides increased stability was studied. The results of a preliminary study and a clinical trial of a 2.0 mm titanium miniplate system are presented in this paper. The therapeutic consequences of the lesser stability afforded by small plate systems are discussed. Indications for miniplate fixation without additional immobilization are reviewed.     

Crestal bone resorption 5 years after implant loading: clinical and radiologic results with a 2-stage implant system

PURPOSE: The aim of the present study was to assess crestal bone resorption 5 years after loading by conducting a clinical and radiographic evaluation of 112 Frialit-2 implants consecutively placed in 51 patients from January 1994 through June 1994. MATERIALS AND METHODS: All implants were placed in the same private-practice clinic by the same surgeon. Clinical assessment included plaque score monitoring, bleeding on probing, probing depth, type of occlusion, and prosthetic adaptation. Intraoral radiographs were taken and compared using suitable software to accurately measure peri-implant bone resorption. RESULTS: The survival rate of the implants was 100%. Plaque was present on 47 (42%) implants. Bleeding on probing was detectable at 17 implants (15.5%). Probing depth was > 5 mm for 5 implants (4.5%). Crestal bone resorption was > 3 mm for 32 implants (28.6%); the average observed crestal bone resorption was 2.17+/-1.6 mm. DISCUSSION: The survival rate of the implants may be the result of the relatively short functional period as well as the strict and frequent clinical evaluations associated with oral hygiene procedures during the supportive periodontal therapy. CONCLUSION: The results suggest that with strict plaque control, and provided that the patient follows a regular program of supportive therapy, crestal bone resorption around a 2-stage implant system may be limited.     

The role of a posteriorly inclined condylar neck in condylar resorption after orthognathic surgery.

Recently, it has been reported that a posteriorly inclined condylar neck is associated with condylar resorption following orthognathic surgery, although its role in resorption remains unknown. By cephalometric screening of 240 patients with Angle Class II occlusion 2 years after orthognathic surgery, 11 patients with postoperative condylar resorption were identified. The preoperative posterior inclination of the condylar neck and the surgical risk factors mentioned in the literature, particularly surgically induced counterclockwise rotation of the mandibular proximal segment were evaluated. In all 11 cases, the condylar neck was clearly inclined posteriorly. Counterclockwise rotation of the proximal segment was also observed in all cases, and it amounted to 6.7 degrees (2.5-12 degrees) on average. The contributing role of a posteriorly inclined condylar neck in connection with surgical mandibular movement in postoperative condylar resorption is discussed.     

Evaluation of condylar position in anterior mandibular fractures using 3 dimensional miniplate osteosynthesis versus conventional miniplates: Randomized clinical trial

To compare clinically and radiographically between the 3-D plates and the conventional two Champy's miniplates in the treatment of anterior mandibular fractures.It is a randomized clinical and radiographic comparative study between 2 equal groups of patients with isolated anterior mandibular fractures. Open reduction and internal rigid fixation was accomplished in the study group using 3D miniplates fixation while in the control group using the two Champy's miniplates.The 3D miniplate osteosynthesis consumed less operative time than the two miniplates osteosynthesis. Independent t-test revealed that the difference between the 2 groups was 8.4 ± 3.11 min. This difference was statistically significant (p=0.012).Occlusion was slightly disturbed in two patients in the study group in comparison to three patients in the control group. The difference between the 2 groups was not statistically significant (p=0.62).None of the cases of both groups showed mobility between the reduced and fixed fractured segments, immediately post-operatively and at the end of follow-up intervals.The 3D miniplate osteosynthesis (study group) recorded less intercondylar distance than two miniplates osteosynthesis (control group) immediately post-operatively and after 3 months. Independent t-test revealed that the difference between the 2 groups was not statistically significant, immediately postoperative (p=0.322) and after 3 months (p=0.263).Pre-operatively to 3 months postoperatively, the 3D miniplate osteosynthesis (study group) recorded a lower median percent increase in the intercondylar distance than the two miniplates osteosynthesis (control group). The difference between the 2 groups was not statistically significant (p=0.917).Regarding the intercondylar angle, the3D miniplate osteosynthesis (study group) recorded higher intercondylar angle than the two miniplates osteosynthesis (control group) immediately post-operative (p=0.333) and after 3 months (p=0.255). Independent t-test revealed that the difference between the 2 groups was not statistically significant.The 3-Dimensional strut miniplates should be considered an alternative for internal rigid fixation of anterior mandibular fractures for their ease of adaptation and insertion, while providing the advantage of reduced operative time compared to the conventional two Champy's miniplates.     

正畸治疗前后牙根吸收的临床研究

目的 调查正畸治疗前后牙根吸收的临床特征。方法 随机选择至少经过十二个月固定正畸治疗,有清晰可辨的矫治前后全口曲面断层片的病例９６例,用根吸收分级评估法记录每人矫治前后全口牙齿根吸收情况,并统计分析。结果 （１）正畸治疗前８．６％的牙齿存在根吸收,治疗后４１．６％的牙齿有程度不等的根吸收;（２）治疗前的根吸收绝大部分为轻度,治疗后仍以轻度吸收为主,但也有部分中重度吸收;（３）治疗前的根吸收主要在上颌前牙区;治疗后根吸收上下颌没有显著性差异,但前牙明显高于后牙。结论（１）正畸后的根吸收较为常见;（２）大部分正畸过程中的牙根吸收是可接受的;（３）正畸治疗后有一部分牙齿（１．３％）出现重度根吸收,主要分布于上前牙,成为危害患者颜面美观及功能的隐患,应引起足够的重视。     

Plate osteosynthesis of condylar fractures: a retrospective study of 45 patients.

OBJECTIVE: This retrospective study presents the type of osteosynthesis used for the fixation of condylar fractures and the postoperative results and complications observed. METHOD AND MATERIALS: Forty-five patients with fractures of the mandibular condyle underwent open reduction and osteosynthesis with plates and screws. The surgical approach was, in most cases, via a submandibular incision. Stabilization was achieved in the majority of the cases with a 2.0-mm single or double miniplate, but 2.0-mm mini dynamic compression plates were also used. RESULTS: The complications were mainly inadequate reduction, screw loosening, and limitation of mouth opening. No plate fractures or infections were observed. CONCLUSION: The use of a single plate (miniplate or dynamic compression plate) often produces inadequate stability and reduction postoperatively. The placement of two 2.0-mm zygomatic dynamic compression plates demands great tissue dissection and detachment and can lead to limitation of mouth opening. The use of two 2.0-mm miniplates seems to produce better stability and fewer complications.     

Mandibular angle fractures treated with a single miniplate without postoperative maxillomandibular fixation: A retrospective evaluation of 50 patients

Objective: This retrospective study evaluated the use of a single miniplate for the treatment of mandibular angle fractures (MAF).

Methods: Fifty patients with 53 MAF were treated by open reduction and internal fixation with the use of a single miniplate and were analyzed in this study.

Results: Five patients with MAF had postoperative complications that required additional procedures. Three patients had postoperative infection, one patient complained of malocclusion in the first postoperative week, and one patient had miniplate exposure three months after surgery. Every additional procedure was performed in the office under local anesthesia without disruption of the initial fracture treatment. Postoperative maxillomandibular fixation (MMF) was performed in four patients. Treatment of MAF using a single miniplate was effective, with low morbidity and with low rates of postoperative complications. MAF can be treated without MMF, and stability is improved when long miniplates are used.

Conclusions: The use of a single miniplate is therefore encouraged. However, postoperative MMF should be considered with the presence of little contact between bone segments, malocclusion, or extensive tooth loss.     

Clinical comparison between arthrocentesis and conventional conservative treatment with maxillomandibular fixation for unilateral high condylar fractures

This study aimed to compare the effects of arthrocentesis and conventional closed reduction for unilateral mandibular condyle fractures. A total of 30 patients with unilateral condylar fractures were evaluated. Patients with a high condylar fracture and magnetic resonance evidence of joint effusion (JE) were divided into two groups: those treated with intra‐articular irrigation and betamethasone injection (group I) and those given conservative treatment and rigid maxillomandibular fixation (MMF) (group II). All patients were assessed for mandibular range of motion (ROM), protrusive movements, lateral excursion movements on the fractured and non‐fractured sides, pain in the temporomandibular joint and malocclusion, both before and after treatment. There were no significant differences in regard to protrusion, lateral excursion movement and incidence of malocclusion at 12 months after treatment between the groups (P > 0·05). In group I, ROM and joint pain showed good improvement from the early stages of treatment, and those patients had better outcomes as compared to group II for those parameters at 1 and 3 months after injury. The present findings indicate that arthrocentesis may be more effective and provide faster healing than conventional closed reduction.