Mehra Pushkar, Murad Haitham
Department of Dentistry and Oral and Maxillofacial Surgery, Boston Medical Center, Boston University School of Dental Medicine, Boston, MA 02118, USA.
J Oral Maxillofac Surg. 2008 Nov;66(11):2254-60. doi: 10.1016/j.joms.2008.06.024.
To compare treatment outcomes between rigid extraoral fixation and semirigid intraoral fixation for the management of isolated mandibular angle fractures, and to develop a protocol for successfully managing these fractures in an indigent population.
This study involved a retrospective analysis of mandibular angle fracture patients treated at Boston Medical Center from 1999 to 2006. All patients were treated by a single attending surgeon, with oral and maxillofacial surgery residents. Data were collected by a review of pertinent inpatient and outpatient clinic records, and radiographic and laboratory results. The criteria for inclusion into the study comprised: 1) patients with isolated unilateral or bilateral mandibular angle fractures; 2) surgical treatment provided within 7 days of injury via 1 of the 2 following techniques: a) open reduction and internal fixation via an intraoral approach (single monocortical miniplate), or b) open reduction and internal fixation (ORIF) via an extraoral approach (inferior border plate with at least 2 holes on either side of the fracture line and bicortical screws); 3) the presence of decayed, partially bony, or full bony impacted third molars requiring removal at time of surgery; 4) the use of postsurgical maxillomandibular fixation (MMF) for 1 week (extraoral rigid-fixation cases) and 2 weeks (intraoral semirigid-fixation cases) and 5) a 1-week duration of postsurgical oral antibiotic therapy.
The patient sample ranged in age from 17 to 55 years, with an average age of 24.8 years. The average follow-up was 12.3 weeks (range, 8 to 64 weeks). In total, 98 fractures were treated with intraoral miniplate fixation, whereas 65 fractures underwent rigid fixation using an extraoral approach. The presence or absence of bone gaps in radiographs immediately after surgery had no correlation with surgical success. None of the patients in either group required further surgical intervention in the operating room. Patients with postsurgical infections were successfully managed with localized intraoral incision and drainage, and oral antibiotic therapy.
Isolated mandibular angle fractures can be effectively treated in an indigent population with either intraoral monocortical fixation or extraoral bicortical fixation techniques. Use of a standard protocol involving early surgical management with limited periosteal reflection, concomitant removal of third molars, and short-term maxillomandibular fixation ensures predictable success with a low incidence of complications.
比较坚固性口外固定与半坚固性口内固定治疗孤立性下颌角骨折的疗效，并制定一套针对贫困人群成功治疗此类骨折的方案。
本研究对1999年至2006年在波士顿医疗中心接受治疗的下颌角骨折患者进行回顾性分析。所有患者均由同一位主治外科医生及口腔颌面外科住院医师进行治疗。通过查阅相关住院和门诊病历记录以及影像学和实验室检查结果收集数据。纳入本研究的标准包括：1）孤立性单侧或双侧下颌角骨折患者；2）受伤后7天内通过以下两种技术之一进行手术治疗：a）经口内入路切开复位内固定（单皮质微型钢板），或b）经口外入路切开复位内固定（骨折线两侧至少有2个孔的下颌下缘钢板及双皮质螺钉）；3）存在龋坏、部分骨阻生或完全骨阻生的第三磨牙，需在手术时拔除；4）术后颌间固定（MMF）：口外坚固固定病例为1周，口内半坚固固定病例为2周；5）术后口服抗生素治疗1周。
患者年龄范围为17至55岁，平均年龄24.8岁。平均随访时间为12.3周（范围8至64周）。总共98例骨折采用口内微型钢板固定治疗，而65例骨折采用口外入路坚固固定。术后即刻X线片上有无骨间隙与手术成功与否无关。两组患者均无需在手术室进行进一步手术干预。术后感染患者通过局部口内切开引流及口服抗生素治疗成功治愈。
在贫困人群中，孤立性下颌角骨折采用口内单皮质固定或口外双皮质固定技术均可有效治疗。采用包括早期手术治疗、有限的骨膜剥离、同时拔除第三磨牙以及短期颌间固定的标准方案，可确保取得可预测的成功效果且并发症发生率低。
