髁突解剖复位侧向螺钉技术治疗髁突矢状骨折

目的:探讨应用暂留螺钉解剖复位、侧向拉力螺钉和定位螺钉固定技术治疗下颌髁突矢状骨折的方法及疗效.方法:4例5侧下颌髁突矢状骨折采用耳屏前切口,暂留螺钉作为支点,行翼外肌-髁突解剖复位,侧向拉力螺钉联合定位螺钉固定技术坚强内固定骨折,术后行临床和影像学评价,平均追踪12个月.结果:全部病例治疗效果满意,下颌运动和咬合关系恢复良好,影像学检查提示骨折复位良好,髁突形态无异常.结论:暂留螺钉解剖复位、侧向拉力螺钉和定位螺钉固定技术治疗下颌髁突矢状骨折是一种简单、有效、经济、省时、微创的治疗方法.     

髁突矢状骨折的复位与螺钉固定

目的 探讨髁突矢状骨折手术复位与螺钉固定的技巧与疗效.方法 对21例(23侧)髁突矢状骨折患者采用手术治疗,术中在髁突复位后进行螺钉(长螺钉、拉力螺钉)固定.术后早期开始下颌运动训练,术后半年内定期随访.结果 所有患者术后疗效满意,伴有下颌骨骨折的3例术后出现轻微的咬合紊乱,进行1周颌间牵引后咬合关系基本恢复正常.CT检查显示髁突复位固定理想.术后开口度基本正常,下颌运动和功能满意.结论 依据髁突矢状骨折的类型选择复位及螺钉固定,可以达到稳定的复位固定目的 .     

拉力螺钉内固定治疗髁突矢状骨折23例临床报告

目的：探讨拉力螺钉内固定治疗髁突矢状骨折的临床应用效果。方法：对23例髁突矢状骨折病例的临床资料进行分析,23例均采用拉力螺钉内固定术式,对比手术前后张口度,骨折片复位情况等。结果：23例中19例达到解剖复位,3例功能复位,1例为陈旧性骨折取出骨折碎片。结论：拉力螺钉内固定治疗髁状突矢骨折具有较好的临床效果。     

口腔颌面部创伤

20051925 椎动脉损伤的诊断与治疗；20051926 钛板骨内固定系统在颌骨骨折中的应用研究；20051927侧向拉力螺钉技术治疗髁突囊内矢状骨折；20051928 髁状突纵形骨折及殆夹板治疗时对翼外肌影响的光镜和电镜观察；20051929 158例髁突骨折回顾分析；20051930 6种咬合负载情况下下颌体骨折坚强内固定的三维有限元分析……     

侧向长钛钉皮质固定在髁突骨折中的应用

目的：探讨侧向长钛钉皮质固定技术治疗髁突矢状骨折的临床疗效。方法：5例（7侧）髁突矢状骨折解剖复位后，用2根侧向长钛钉进行固定，术后6-12个月进行临床和影像学复查。结果：5例（7侧）病例的髁突外形良好．钛钉无松动、脱落，下颌运动和功能满意，开口度3.5-4．0cm，少数伴有关节区疼痛或弹响。结论：侧向长钛钉皮质固定治疗髁突矢状骨折疗效确切，操作简单，并发症少。     

小“S”形深部拉钩在下颌骨髁突矢状骨折复位固定中的应用

25例(30侧)下颌骨髁突囊内矢状骨折患者,均采用小"S"形深部拉钩辅助下复位,用侧壁拉力螺钉行坚固内固定,全部治愈。应用小"S"形深部拉钩可缩短手术时间,复位效果好,可有效避免深部组织损伤,值得推广。     

拉力螺钉内固定治疗髁状突骨折的临床应用

目的 对拉力螺钉内固定治疗髁减突骨折的效果进行评价。方法 对6例6侧状突骨折施行了骨折复位拉力螺钉内固定术，术后观察6－9个月。结果 6例伤口Ⅰ期愈合，1例延迟愈合，5例（7侧）均无关节区疼痛、面部不对称且咬合关系良好。结论 拉力螺钉复位内固定治疗髁突骨折可以及时恢复髁状突解剖形态、生理功能，方法简便可行。     

下颌骨髁突骨折轴向拉力螺钉复位固定的应用研究

目的　评估髁突骨折轴向拉力螺钉复位技术的临床可行性及治疗效果。方法　6例成人颞下颌关节囊外移位性髁突骨折患者接受了轴向拉力螺钉外科复位手术,其中男性5例,女性1例,平均年龄32岁,术后追踪平均7个月(3～13个月)。结果　6例伤口均I期愈合,术后3个月,临床检查无关节区疼痛不适及面部不对称,咬合关系良好,最大开口度除1例外均大于40mm,全部患者对手术效果满意。结论　轴向拉力螺钉复位固定技术对于固定髁突骨折、恢复髁突的生理功能,防止相应并发症是行之有效的     

长螺钉在下颌骨髁突斜形骨折内固定中的应用研究

目的:探讨长螺钉在下颌骨髁突骨折内固定中的应用,对其疗效进行初步评价。方法:对29例髁突高位斜形骨折患者经耳前途径行髁突解剖复位长螺钉内固定。测量术前、术后高度正常侧与降低侧下颌升支长度差值的变化(双侧髁突骨折时至少一侧为矢状骨折,该侧升支高度正常者才纳入研究),骨折段前后向及内外侧向的夹角,对结果进行统计分析及随访观察。结果:患者术后愈合良好,X线测量显示:术前患侧升支缩短高度平均6.6mm,术后为2.3mm,升支高度有显著性恢复;术前前后向平均夹角为47.7°,术后为9.8°,术前内外向平均夹角为60°,术后为16.9°,两组均有显著性改善。13例随访患者主观满意(随访时间为3～23个月,平均9个月),平均开口度为39mm,开口型正常,前伸、侧向运动幅度均大于5mm,无功能障碍。除2例双侧髁突骨折患者的髁突中度吸收外,其余均恢复良好。结论:长螺钉可用于髁突斜形骨折开放复位的内固定,特别是累及囊内的高位骨折,但其长期效果有待进一步随访观察。     

髁突游离回植术治疗移位髁突骨折的初步分析

目的:分析髁突游离回植术治疗重度移位髁突骨折的适应证、固定方法及疗效。方法:对43例、56侧严重移位的髁突骨折进行了移位角度、移位程度及翼外肌附丽情况测量,43例均施行髁突游离回植术,固定方法分别为钢丝骨间固定、小型钛板固定及横向拉力螺钉固定;观察时间6个月;采取临床标准(切口感染、开口度、咬合关系、中线偏移、面神经损伤、咀嚼疼痛等情况)和影像学检查评价治疗成功率、分析疗效,研究所选固定方法的优缺点。结果:髁突游离回植治疗重度移位的髁突骨折成功率高达98.2%;固定方法以小型钛板固定及横向拉力螺钉固定更加可靠、简捷,术后移位小,咬合关系好。56侧中仅有2侧有轻微的面神经损伤,2例咬合轻度错位。结论:髁突游离回植术治疗重度移位髁突骨折成功率高,疗效较佳,适用于有严重移位的髁突骨折。     

Use of a temporary screw for alignment and fixation of sagittal mandibular condylar fractures with lateral screws

This study introduced and evaluated the clinical application of a temporary and lateral screw technique for open reduction and internal rigid fixation of sagittal mandibular condylar fractures. A preauricular approach was used to expose the fracture. A temporary screw was used to assist in the anatomical reduction, and a lateral lag screw in combination with a lateral position screw was used for internal rigid fixation. Six adult patients with sagittal condylar fractures and more than 5 mm condylar height shortening were treated. The treatment outcomes were followed up clinically and radiographically for 8–27 months (mean 18 months) postoperatively. There were no complications associated with the operation. All patients recovered favorably with good occlusion, normal movement of the mandible, correct repositioning and rigid fixation of the fragment of the fracture and a good condyle shape on radiographs. The temporary and lateral screw technique is a simple, effective, fast, and minimally invasive surgical treatment for adult sagittal condylar fractures.     

下凳骨髁突骨折轴向拉力螺钉复位固定的应用研究

目的 评估髁突骨折轴向拉力钉复位技术的临床可行性及治疗效果。方法 ６例成人颞下凳关节囊外移位性髁突骨折患者接受了轴向拉力螺钉外科复位手术,其中男性５例,女性１例,平均年龄３２岁,术后追踪平均７个月（３～１３个月）。结果 ６例伤口均Ⅰ期愈合,术后３个月,临床检查无关节区疼痛不适及面部不对称,咬合关系良好,最大开口度除１例外均大于４０ｍｍ,全部患者对手术效果满意。结论 轴向拉力螺钉复位固定技术对于固定     

A comparative evaluation of osteosynthesis with lag screws, miniplates, or Kirschner wires for mandibular condylar process fractures.

PURPOSE: This study compared the clinical and radiologic outcomes of open treatment of mandibular condylar process fractures using lag screws, miniplates, or Kirschner wires. PATIENTS AND METHODS: Open reduction and internal fixation was performed for severely displaced or dislocated mandibular condylar process fractures in 23 patients (26 fractures) using Eckelt lag screws, in 10 patients (10 fractures) using Kirschner wires, and in 21 patients (22 fractures) using miniplates. Clinical and radiologic evaluations were made 6 months postoperatively and at final follow-up (mean, 18.4 months; range, 7 to 106 months). Radiologic evaluation included accuracy of reduction of the fractured condylar processes and changes in ramus height. RESULTS: Most fractured condylar processes (approximately 90%) were repositioned precisely in all groups. A shortening of the ramus of more than 5 mm was observed significantly more frequently (P <.05) in the miniplate group than in the lag screw group at 6 months. The condyles were severely resorbed in 2 or 3 patients in each group. All of these patients were associated with malunion, and partial bone resorption of the condyles was seen during the first 6 months. The relation between reduction or screw position and bone healing in patients treated with lag screws indicated that correct reduction and screw insertion allowed normal bone healing. The patients in all groups showed satisfactory clinical results. No significant intergroup differences were noted in maximum mouth opening and laterotrusion. However, deviation during mouth opening was significantly greater (P <.05) in cases treated with miniplates than with lag screws. CONCLUSION: Lag screw osteosynthesis may be more advantageous for restoration of ramus height than miniplates or Kirschner wires.     

Minimally-invasive open reduction of intracapsular condylar fractures with preoperative simulation using computer-aided design

Reduction of intracapsular condylar fractures is difficult, so we have based our technique on preoperative simulation using computer-aided design (CAD), which has proved useful in other surgical specialties. We have treated 11 patients with intracapsular condylar fractures. Before the operation the procedure was shown on the computer using a three-dimensional simulation system. The relation between the stump and the fragment of the condyle, and assessment of the position and the size of the screw, were made preoperatively to obtain a perfect fit. The displaced fragment was reduced by elevators, and fixed with a bicortical screw through a minimised preauricular incision under general anaesthesia. The fragments and the location of the screws were similar on the preoperative simulation and on the postoperative computed tomographic (CT) scan. The reduction and fixation of the fracture showed a perfect fit on the same view in the preoperative CAD simulation in the Mimics 10.01 software and postoperatively. Postoperative clinical examinations showed good occlusion and satisfactory mouth opening. Two patients had temporary paralysis of the occipitofrontalis muscle that recovered within 3 months. All patients regained normal mandibular movements and had short and invisible scars at 6 months’ follow up. The technique of CAD simulation could help to improve the accuracy during open treatment for intracapsular condylar fractures.     

Minimally invasive fracture treatment with cannulated lag screws in intracapsular fractures of the condyle.

PURPOSE: We examined the use of cannulated lag screw osteosynthesis for the treatment of fractures of the mandibular condylar head in providing a high-quality durable fixation, while at the same time reducing the trauma necessary for an open approach to the fracture site. PATIENTS AND METHODS: A preauricular approach was used for exposure, reduction, and osteosynthesis in 5 cases of type B condylar fractures. A cannulated screw system was used that allowed optimum placement of the self-cutting cannulated lag screw following insertion of a guiding wire and using clinical control to ensure its correct position. The joints were submitted to functional exercises immediately following surgery and postoperative radiologic, axiographic, and clinical follow-ups were performed. RESULTS: Radiologic follow-up revealed correct reduction and fixation in all 5 cases. Axiographic and clinical follow-up showed an initial limitation, but normal mobility of the condyles was achieved within 3 months postoperatively, with a maximum mouth opening of 41.2 +/- 9.4 mm after 6 months. There were no occlusal disturbances, no trismus, no lateral deviations of the mandible, and no nerve lesions. Intraoperatively, the method applied shortened the time necessary for and simplified the procedure of reduction and osteosynthesis. CONCLUSION: By using a cannulated lag screw, it was shown that the major factor in the extent of the trauma relating to surgical access was the reduction of the fracture fragments. The method ensured stable fixation of the fracture with a minimum of osteosynthesis material, while reducing the operative time. In combination with intraoperative imaging techniques it can also successfully be applied to other fractures in maxillofacial surgery.     

Retrieval of the displaced condylar fragment with a screw: simple method of reduction and stabilisation of high and intracapsular condylar fractures

We acknowledge the difficulties that arise when attempting to reduce and stabilise some condylar fractures, particularly those that are high or intracapsular. This paper highlights retrieval of the proximal fragment with a screw, and its benefit for reduction and stabilisation of the fractured condylar head before fixation. Eight patients with condylar fractures were treated at two centres, Morriston Hospital, Swansea, South Wales, and the General Hospital St. Jan, Brugge, Belgium between 1998 and 2007. The proximal fragment was retrieved by insertion of a screw in all cases. Three patients had unilateral, and five had bilateral high or intracapsular fractures. In all cases postoperative scans showed excellent anatomical repositioning and fixation of the condylar fragments. Postoperative follow-up showed good, stable occlusion, excellent mouth opening, and no facial nerve weakness even for a temporary period. Once the screw is in position the operator can gain precise control of the reduction, and the ease of manipulation reduces operating time considerably. The technique provides an excellent solution to the difficult task of reduction and stabilisation of the displaced fragment in condylar fractures, particularly in high fractures, and can be extended to other areas of maxillofacial trauma and corrective bone surgery.     

Fractures of the condylar process

Fractures of the mandibular condyle are frequently seen. There is no consensus on the most appropriate treatment modality. Closed reduction with help of arch bars and guiding elastics is in most cases sufficient. Open reduction and fixation with a plate osteosynthesis or a specially designed lag screw is occasionally performed. Intracapsular fractures of the condylar head are only operated in case of severely reduced mobility, or ankylosis. Fractures of the mandibular condyle normally heal uneventfully. Complications mostly occur in bilateral condylar neck fractures, or intracapsular fractures.