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。     

儿童颌面部骨折治疗的临床研究

目的：分析评价儿童颌面部骨折的病因、治疗方法及效果,探讨骨折与儿童性别、年龄的联系,为临床个性化治疗及提高治疗效果提供参考。方法：回顾性研究71例颌面部骨折儿童的临床资料,统计分析其年龄、性别、致病因素和骨折部位,随访测量患者面型、张口度及咬合关系。结果：随访期8年。患者年龄为2～12岁(平均年龄5．7岁),男女比例2．4：1,跌伤为首要致病原因,3～8岁年龄段发病较多。骨折好发部位以下颌骨居首,下颌骨骨折中颏部骨折最多见。治疗方面,上颌骨骨折仅2例行手术治疗,78％的髁状突骨折行保守治疗,髁状突以外的下颌骨体骨折75％行手术处理。远期疗效基本令人满意。结论：跌伤是本地区儿童颌面部骨折的主要病因,在12岁以下7～8岁为高发病期,下颌骨为高发部位,儿童颌面部骨折需坚持个性化治疗,保守治疗为首选治疗方法。     

526例下颌骨髁状突骨折临床病例回顾性研究

目的:探讨下颌骨髁状突骨折的发生特点。方法:通过对526例髁状突骨折病案资料的调查,对髁状突骨折的发生年龄、性别、致伤原因、骨折类型、合併伤、治疗及后遗症进行分析?峁?髁状突骨折好发于20~30岁;男性多于女性,交通事故伤(47.97%)为主要致伤原因;髁状突骨折60.59%发生在髁颈部;49.62%合并颏部骨折;儿童髁状突骨折69.85%采用保守治疗,高位(囊内)骨折69.52%摘除骨折断端;3.23%继发关节强直。结论:髁状突骨折好发于髁颈部,髁状突矢状骨折及髁颈部骨折伴骨折断端和关节盘移位严重的骨折处理不当易发生关节强直。     

髁状突骨折开放性和闭合性治疗的比较

下颌骨骨折是颌面部最常见的骨折,其中25％～35％有髁状突骨折。长期以来,对髁状突骨折的处理在临床上有较大争议。一般认为,对儿童髁状突骨折患者应以保守治疗为主,对成人则根据情况选择保守或手术治疗。本文作者选择部分诊断相同的髁状突骨折病例,分别采用保守治疗和手术治疗,并进行长时间随访,比较二者的预后,为临床上选择治疗方案提供参考。     

下颌骨髁状突骨折保守治疗与手术治疗对颞颌关节功能及形态的影响

下颌骨髁状突骨折保守治疗与手术治疗对颞颌关节功能及形态的影响李令超综述东耀峻张国志审校下颌骨髁状突骨折是指从下颌乙状切迹水平向后至下颌升支后缘以上任何部位的骨折，往往伴有近中骨段移位［１］。关于髁状突骨折，国外文献报道占下颌骨骨折的２１．５％～３６．...     

下颌骨髁状突骨折179例临床分析

目的探讨髁状突骨折的临床特点和治疗方法。方法分析对比1990—2010年179例髁状突骨折患者致伤原因、治疗方法及疗效等临床资料。结果交通事故致伤92例(占51.4%),髁状突颈部骨折76例(占42.3%)。123例患者经保守治疗,56例患者经不同进路的内固定手术治疗。在治疗方法的选择上,青少年组保守治疗比率较成年患者高(P<0.01),不同骨折部位治疗方法有差异(P<0.01),其中髁状突头部骨折保守治疗率最高(92.06%),合并其他部位骨折手术治疗比率较不合并其他部位骨折高(P<0.01)。治疗后大多获得良好的咬合关系,双侧髁状突骨折初期张口受限率显著增高(P<0.01),通过功能锻炼1年后张口度均恢复达3.0 cm以上。结论交通事故是首要的致伤原因,颈部为髁状突骨折最好发部位。青少年主要采取保守治疗,合并其他部位骨折多选择手术治疗,手术治疗对骨折端移位角度大于30°,下颌升支垂直高度降低超过5 mm,保守治疗后张口受限小于2 cm的患者很重要。     

髁状突骨折手术治疗的体会

目的 探讨手术治疗髁状突骨折的适应证.方法 回顾性分析17例髁状突骨折手术治疗的病例,其中囊内(高位)骨折2例,颈部(中位)骨折11例和基部(低位)骨折4例.7例采用耳屏前切口复位内固定, 8例采用颌下切口解剖复位内固定术, 2例因骨折片向内侧移位成角,采用耳屏前、颌下联合切口,使骨折的髁突复位固定.结果 10例术后恢复正常开口度,咬合关系是正中牙合,咀嚼有力,X线片示髁状突外形及位置正常; 7例术后开口度、咀嚼功能稍差,咬合关系基本呈正中牙合, X线片示髁状突外形及位置基本正常.结论 对于错位愈合形成错牙合的陈旧性骨折者,升支有效距离变短的低位骨折、保守治疗效果不佳者,骨折的髁状突移位成角且角度大于45°者应积极采取手术治疗.     

小钛板坚强内固定治疗陈旧性髁状突骨折

目的　观察陈旧性髁状突骨折手术切开复位固定的疗效。方法　对 2 1例保守治疗失败、6例延误治疗的陈旧性髁状突骨折 ,采取耳前切口切开复位小钛板坚强内固定治疗。结果　经过治疗的 2 7例陈旧性髁状突骨折 ,创口均甲级愈合 ,张口度恢复 ,咬合关系改善 ,钛板无松动、移位和排异反应 ,无颞下颌关节强直发生。结论　小钛板坚强内固定是治疗陈旧性髁状突骨折的可靠方法 ,对髁状突明显移位或脱位的骨折宜及早实行手术切开复位固定。     

青少年髁状突骨折保守治疗的X线追踪观察

青少年正处在骨骼发育旺盛期,骨折修复能力很强,保守治疗下颌骨髁状突骨折仍被大多数作者采用。许多文献报道保守治疗髁状突骨折常有咀嚼功能损伤、面部两侧不对称、颞下颌关节强直等并发症的发生。本文作者通过对青少年髁状突骨折保守治疗患者的X线片追踪观察,来了解年龄、骨折类型对骨折愈合的影响。     

髁状突矢状骨折1例报告

髁状突矢状骨折１例报告山东省文登市口腔医院邢树林，吕昊，徐东武临床上常见髁状突颈部骨折，而对髁状突矢状骨折较为少见。１９９４年６月，我科收治１例陈旧性左髁状突矢状劈开骨折、右下颌骨粉碎性骨折病人。现报告如下：病人于××，男，４０岁，住院号９４０６１２...     

下颌髁状突骨折治疗的临床研究

目的 :探讨髁状突骨折的治疗方法选择及其疗效。方法 :对我科收治的 6 8例髁状突骨折 ,38例无移位或轻度移位者行保守治疗 ,30例中度或重度移位、脱位、粉碎性或陈旧性骨折行手术治疗。结果 :保守组随访 34例 ,31例获得满意效果 ,7例出现颞颌关节紊乱症 ,1例关节强直 ;手术组随访 2 8例 ,2 6例面形与关节功能正常 ,5例出现关节紊乱症。结论 :无移位或轻度移位宜采用保守治疗 ,中度或重度移位、脱位、粉碎性或陈旧性骨折并影响颌运动者须采用手术治疗     

Surgical treatment of the fractured and dislocated condylar process of the mandible

Most fractures of the mandible can be managed conservatively. This report is a retrospective evaluation of the clinical and radiological results in 17 patients with 21 dislocated fractures submitted to open reduction and fixation, employing steel wires and maxillomandibular fixation. Follow-up ranged from 7 to 55 months, (mean 29.5). Functional assessment showed good opening movements (mean 41.9 mm). There were no cases of ankylosis, pain, or paralysis of the facial nerve. Radiological assessment was normal when the lateral pterygoid muscle was maintained adherent to the fractured proximal segment. Radiological signs of bone resorption occurred when the fractured segment was detached from the lateral pterygoid muscle. In our opinion, dislocated condylar process fractures can be managed surgically and with steel wire ligatures and maxillomandibular fixation. Whenever possible, the lateral pterygoid muscle should be inserted into the fractured proximal segment, i.e. as an osteomuscular flap.     

Surgical versus conservative treatment of unilateral condylar process fractures: clinical and radiographic evaluation of 80 patients.

Treatment results of 26 surgically and 54 conservatively treated unilateral condylar process fractures were investigated by standardized clinical examination and by evaluation of computer-simulated graphic presentations of posteroanterior (PA) radiographs of the mandible. The radiographic evaluation compared the relation of actual reduction of the condylar process fractures with ideally reduced fractures produced on the computer. Using clinical parameters (maximal mouth opening, deviation, protrusion), no statistical differences between surgically and conservatively treated fractures were found. However, the radiographic examinations showed a statistically better position of the surgically reduced condylar process fractures.     

Evaluation of surgical treatment in mandibular condyle fractures

AimIn the past, fractures of the mandibular condylar process were, as a rule, treated conservatively. At the Department of Maxillofacial and Oral Surgery of the University Medical Centre Ljubljana, Slovenia, our doctrine was changed in 2002 on the basis of preliminary results and reports in the literature, and these fractures were started to be treated surgically by open reduction and internal fixation with miniplates and screws, which led to good results and a shorter rehabilitation period. The goal of this study was to determine the safety and efficiency of surgical treatment, as well as to compare long-term results of surgical and conservative treatment, as objectively as possible.Patients and methodsTwo groups of patients, which had all sustained a unilateral, extra-articular mandibular condyle fracture, were compared. In the test group, there were 42 surgically treated patients, and in the control group, 20 conservatively treated patients. Clinical parameters and X-ray images were assessed in both groups and compared by the two tailed Student t test, and in case of attributive variables by the χ² test. Within the surgically treated group, postoperative and intraoperative complications were noted: temporary facial nerve palsy, development of a parotid salivary fistula, disturbance of auricle sensibility due to injury of the greater auricular nerve, miniplate fracture, as well as intraoperative bleeding, postoperative haematoma formation, infection, reoperation due to fragment malposition and other complications. Postoperative scars were also assessed.ResultsStatistically significant differences between the surgically and conservatively treated patients were found when comparing clinical parameters as well as X-ray images, the results being better in the surgically treated group. Complications of surgical treatment were also noted, the most important among them temporary paresis of facial nerve branches, which occurred in 10 patients (24%). Plate fractures occurred in five patients (12%), in four of them miniplates of sizes less than 2.0 mm were used. There were no cases of significant intraoperative bleeding, two cases (5%) required drainage of postoperative haematomas, and one patient (2%) experienced a mild postoperative infection, which was easily controlled with amoxicillin with clavulanic acid. The scar was hidden best if a facelift incision was used, and a hypertrophic scar developed in only one patient (2%).ConclusionResults of surgical treatment of condylar process fractures are superior to the results of conservative treatment, and the procedure is safe with the transparotid surgical approach and adequate surgical technique.     

Condylar Segment Removal in the Management of Diacapitular Mandibular Fractures

Introduction

Contemporary opinion strongly concurs that isolated intracapsular fractures, in almost every instance, should be treated solely with physical therapy. Based on the premise that although these fractures can result in significant anatomic/radiologic changes in the appearance of the condyle itself, most patients with these fractures recover very well if adequately rehabilitated. However, in our study four cases of high condylar head (diacapitular) fractures were managed by surgically removing the fractured condylar head as it was obstructing mandibular function.

Materials and Methods

The retrospective analytical study was carried out at the Division of Oral & Maxillofacial Surgery, Department of Dental Surgery, INHS Kalyani, Vishakhapatnam from Jul 2008 to Aug 2010. Patients who were clinically and radiologically diagnosed with high condylar head/neck fracture who did not respond to conservative management of active mouth opening exercises even after 2–3 weeks of physiotherapy and continued to have no improvement in mouth opening although the occlusion was stable were included in this study. The fractured condylar head was surgically removed and function restored.

Results

A total of four cases, four males with high condylar head fractures were taken up for removal of the fractured condylar segment. In all cases satisfactory mouth opening was achieved intraoperatively. One case presented with troublesome intraoperative bleed.

Discussion

The decision influencing open reduction and internal fixation versus closed reduction is based on the ability to restore function and esthetics. There are strong recommendations for conservatively managing the so called intracapsular or Neff’s fractures. However, if the fracture segment is small and yet is causing restriction in mouth opening and inability to achieve desired occlusion we recommend removal of the fractured condylar segment. In this procedure the proximal segment is removed surgically and mouth opening is assessed. The occlusal discrepancy if any is managed subsequently using elastic traction on previously placed arch bars.

Conclusion

In our experience in those cases where the mouth opening continues to be restricted even after physiotherapy and a radiologically wedged segment is observed, removal of the fractured condylar segment to achieve mouth opening and subsequently managing the occlusion may prove to be beneficial to the patient.     

Non-surgical management of paediatric and adolescent mandibular condyles: A retrospective review of 49 consecutive cases treated at a tertiary referral centre

IntroductionMandibular fractures account for over 50% of all facial fractures in children, with the majority of these occurring at the condyle. There is currently no consensus on the management of mandibular condyle fractures in the paediatric population. Treatment options range from conservative management, with or without maxillomandibular fixation (MMF) and physiotherapy, to open reduction and internal fixation (ORIF).MethodsThis was a retrospective review of all patients who attended Alder Hey Children's Hospital with fractured condyle(s) between the years 2000 and 2015. All patients were managed non-surgically and included those managed conservatively and/or with MMF. The following variables were recorded: age, sex, mechanism of injury, concomitant mandibular fractures, imaging, SORG classification, complications and follow-up intervals. The following exclusion criteria applied: patients who underwent open reduction internal fixation of their condylar fracture and patients aged 16 years or over.ResultsForty-nine patients (38 male, 11 female) underwent non-surgical management of condylar fractures during the 15-year study period. The mean age at time of injury was 12 years (range 2–15 years).The etiology of fractures comprised mechanical falls (n = 22), assault (n = 14), sport (n = 5), road traffic accident (n = 3), epileptic fit (n = 1), and unknown mechanism (n = 4). The mean length of hospital stay was 3 days, ranging from 0 to 14 days. Thirty-seven patients had a concomitant mandibular fracture and 12 had an isolated unilateral condylar fracture. Follow-up intervals ranged from 1 to 133 weeks, with a median length of 12 weeks. Fifteen patients underwent MMF, while 34 had soft diet and physiotherapy only. Ninety-two per cent of patients had no complications. No patient had failure of treatment requiring a return to theatre and/or ORIF. Occlusion, interincisal distance, asymmetry and TMJ symptoms were examined in 43/49 patients who attended their postoperative appointments. Four patients (8%) had complications in the postoperative period, namely: lateral open bite (n = 2), deviation to the affected side on wide opening (n = 1), and non-specific TMJ dysfunction (n = 1). None of these patients presented with any subjective symptoms and none developed asymmetry or needed any further surgical intervention.ConclusionPaediatric and adolescent mandibular condyle fractures can be safely and predictably managed using conservative methods. In our, albeit small, study cohort all patients were managed conservatively, and all had a satisfactory outcome with no requirement for further operative intervention.     

Fractures of the mandibular condyle: a review of 466 cases. Literature review, reflections on treatment and proposals.

INTRODUCTION: The incidence of condylar fractures is high. Condylar fractures can be extracapsular (condylar neck or subcondylar) or intracapsular, undisplaced, deviated, displaced or dislocated. Treatment depends on the age of the patient, the co-existence of other mandibular or maxillary fractures, whether the condylar fracture is unilateral or bilateral, the level and displacement of the fracture, the state of dentition and the dental occlusion, and the surgeon's experience. PURPOSE: This report presents the experience acquired in the treatment of 466 condylar fractures over 7 years, reviews the pertinent literature and proposes guidelines for treatment. MATERIAL AND METHODS: The archives of KAT, General District Hospital between 1995 and 2002 were scrutinized and the condylar fractures were recorded. The aetiology, age, sex, level of fracture, degree of displacement, associated facial fractures, malocclusion, and type of treatment were noted. RESULTS: Four hundred and sixty-six condylar fractures were admitted, the male:female ratio was 3.5:1. Road traffic accidents were the main cause and most fractures were unilateral, displaced, subcondylar, occurred on the left side and were treated conservatively. CONCLUSIONS: Early mobilization is the key in treating condylar fractures. Whilst rigid internal fixation provides stabilization and allows early mobilization, conservative treatment is the treatment of choice for the majority of fractures. Children and intracapsular fractures are treated conservatively with or without maxillo-mandibular fixation. Open reduction is recommended in selected cases to restore the occlusion, in severely displaced and dislocated fractures, in cases of loss of ramus height, and in edentulous patients. It may be considered in those with 'medical problems' where intermaxillary fixation is not recommended.     

Condylar Paths during Protrusion in Edentulous Patients: Analysis with Electronic Axiography

Purpose: The aim of this study was to determine the condylar form, incline, and movement characteristics during protrusive movement in fully edentulous complete denture wearers. The study went on to analyze the occlusal consequences on the setup of artificial posterior teeth and the occlusal grinding phase. Materials and Methods : The study included 60 complete denture wearers (aged 58 to 74 years), who received a new set of complete dentures for this study. The patients did not present signs of muscular or articular pain. Protrusive movements were recorded by a SAM^® electronic axiography system. Results : Condylar paths exhibited fairly specific characteristics in the completely edentulous patients, particularly path forms, which had highly specific patterns. Three condylar path forms were determined: the classic form following a convex curve (41% of cases), a sinusoidal form that flattened out in the first 2 mm before following a convex curve (51%), and a rectilinear path (9%). The mean condylar angles also exhibited specific patterns. The mean started in the first millimeter of protrusive movement, at 32.2°± 14.9°, and then increased in the second millimeter to 40.4°± 11.9°, reaching 44.5°± 9° at 5 mm. Conclusion : During protrusive movement in completely edentulous patients, the condylar path patterns were different than conventionally described patterns. In particular, the sinusoidal form was frequently found, and the incline of the condylar slope was low. These factors need to be taken into account during the final occlusal selective grinding for new sets of complete dentures.     

Changing trends in the management of condylar fractures

Our aim was to evaluate the functional outcomes and complications of mandibular condylar fractures managed surgically and non-surgically. Patients were identified retrospectively from audit data and clinical records from 2005-2018, and functional outcomes were evaluated based on the development of complications at clinical follow up. Patients were categorised into three treatment groups: conservative (management with soft diet, analgesia, and monitoring), closed (management with intermaxillary fixation), and open reduction and internal fixation (ORIF). A total of 358 patients were included with a median age of 33 years (mean 38), and a male:female ratio of 2.7:1. A total of 72 patients (20%) were treated conservatively, 177 (49%) were treated with closed management, and 109 (31%) with ORIF. The ORIF group demonstrated better outcomes than the closed group in terms of reduced protrusive and lateral excursive movements, and temporomandibular joint (TMJ) pain; and in terms of occlusal derangement when compared with the conservative group. The ORIF group had poorer outcomes than both the closed and conservative groups in terms of maximum mouth opening, and temporary facial nerve injury occurred in 5/109 (5%) and condylar resorption in 2/109 (2%) of patients in the ORIF group. There was no incidence of permanent facial nerve injury, Frey syndrome, or paraesthesia of the auricular nerve. The trend that favours ORIF can be justified, as it offers improved functional outcomes in severe or displaced condylar fractures. However, this must be evaluated against the risk of potential surgical complications. Careful case selection is therefore necessary to optimise management of these injuries.