Landes Constantin A, Day Kai, Glasl Bettina, Ludwig Björn, Sader Robert, Kovács Adorján F
Oral-, Maxillofacial and Plastic-Facial Surgery, Frankfurt University Medical Center, Frankfurt, Germany.
J Oral Maxillofac Surg. 2008 Jun;66(6):1184-93. doi: 10.1016/j.joms.2007.06.667.
The purpose of the study was to evaluate open reposition and internal fixation of displaced or dislocated child mandibular condyle fractures, and closed treatment of nondisplaced, nondislocated fractures of the condyle with long-term follow-up outcomes.
Twenty-four patients less than 14 years of age were included from 2000 to 2005. Classes II to V after Spiessl and Schroll, eg, displaced or dislocated fractures were surgically treated; Class I and VI nondisplaced, nondislocated fractures were treated closed. At yearly intervals, facial symmetry, pain, nerve function, bone repositioning, scarring, and reossification were evaluated. Incisal opening, protrusion, laterotrusion and sonographic condylar translation were measured in mm.
Nineteen (79%) patients presented for follow-up: Class I, 8; Class II, 3; Class III, 0; Class IV, 2; Class V, 5; and Class VI, 1. After 1 year, 11 patients (58%) presented for follow-up; after 2 years, 4 (21%) patients, and after 5 years, 4 (21%) patients presented for follow-up. The reasons for not presenting for follow-up given by the parents upon telephone interview were no symptoms and absent motivation. All patients exhibited sufficient opening; 1 Class IV patient had insufficient translation; 3 patients had opening deflection; 2 patients' partial facial nerve paresis subsided after 1 year; in 2 cases broken osteosyntheses were removed. Vertical and horizontal condyle support was successfully reconstructed; considerable bone resorption occurred in Class V; failure rate was 4 (17%). Of 5 Class V, 3 were failures (60%).
The evaluated treatment rationale attained 83% treatment success; Class V should be repositioned with careful mobilization to not risk impaired perfusion and considerable remodeling. Patient number is limited; a negative bias for follow-up can be supposed, eg, symptom-free patients avoided a follow-up interview. Prospectively small, rigid, mainly intraosseous and hopefully resorbable osteofixation should be assessed.
本研究旨在评估移位或脱位儿童下颌髁突骨折的切开复位内固定术，以及非移位、非脱位髁突骨折的保守治疗，并进行长期随访观察其疗效。
选取2000年至2005年间年龄小于14岁的24例患者。按照Spiessl和Schroll分类法的II至V类骨折，如移位或脱位骨折采用手术治疗；I类和VI类非移位、非脱位骨折采用保守治疗。每年对患者的面部对称性、疼痛、神经功能、骨复位情况、瘢痕形成及再骨化情况进行评估。测量切牙开口度、前突度、侧方运动度及超声检查的髁突移位情况，单位为毫米。
19例（79%）患者接受了随访：I类8例；II类3例；III类0例；IV类2例；V类5例；VI类1例。1年后，11例（58%）患者接受随访；2年后，4例（21%）患者接受随访；5年后，4例（21%）患者接受随访。电话随访时家长给出的未接受随访的原因是无症状且缺乏积极性。所有患者均有足够的开口度；1例IV类患者移位不足；3例患者开口偏斜；2例患者的部分面神经麻痹在1年后恢复；2例患者取出了断裂的内固定物。垂直和水平方向的髁突支持得以成功重建；V类患者出现了明显的骨质吸收；失败率为4例（17%）。在5例V类患者中，3例失败（60%）。
所评估的治疗原则取得了83%的治疗成功率；对于V类骨折，应谨慎移动进行复位，以免有灌注受损和明显重塑的风险。患者数量有限；可以推测存在随访的负性偏倚，例如无症状患者避免了随访面谈。应前瞻性地评估小型、坚固、主要为骨内固定且有望可吸收的内固定物。
