Hwang Kun, Park Jun Ho, Lee Hyun Jeong
Department of Plastic Surgery, Inha University Hospital, 7-206 Singheung-dong, Jung-gu, Incheon, 400-711, Korea.
J Craniofac Surg. 2005 Jan;16(1):113-6. doi: 10.1097/00001665-200501000-00021.
The aim of this report is to present three cases of high condylar fracture treated with vertical ramus osteotomy, miniplate fixation of fractured condylar neck, and free grafting. The authors also introduce a simple and easy postoperative exercise regimen. A submandibular incision is made and the ascending ramus divided between the sigmoid notch and the angle of the mandible. After the fragment is removed, the dislocated head of the condyle is readily visible and can be retrieved. The reconstructed osteotomized ramus and condylar head can now be reinserted through the wound and plated. Intermaxillary fixation with arch bar is used. The length of the fixation period is about 14 days after surgery. At the end of this period, the bracket is applied to maxillary incisors, the occlusion becomes stable and reproducible, and then aggressive jaw-opening exercise begins. On postoperative day 21, elastics are applied 24 hours a day. They are placed lightly during the daytime to assist guiding protrusion of the mandible. The patient is instructed to protrude the mandible and to open the mouth simultaneously. The exercise is modified to lateral movement. After the bracket is removed on postoperative day 28, the patient exercises the chin laterally without any guiding elastic fixation for approximately 1 week. This regimen can be widely used in ostectomy-osteosynthesis cases.
本报告旨在介绍三例采用垂直升支截骨术、髁突颈部微型钢板固定及游离植骨治疗的高位髁突骨折病例。作者还介绍了一种简单易行的术后锻炼方案。做下颌下切口，在乙状切迹与下颌角之间切断升支。取出骨折块后，脱位的髁突头部很容易看到并可找回。现在可将重建的截骨升支和髁突头部通过伤口重新插入并进行钢板固定。采用牙弓夹板进行颌间固定。固定期约为术后14天。在此期间结束时，在上颌切牙上安装托槽，咬合变得稳定且可重复，然后开始积极的张口锻炼。术后第21天，每天24小时使用弹力牵引。白天轻轻放置以协助引导下颌前伸。指导患者同时前伸下颌并张口。锻炼改为侧向运动。术后第28天取下托槽后，患者在无任何引导性弹力固定的情况下进行约1周的下颌侧向锻炼。该方案可广泛应用于截骨-骨固定病例。
