Hu Min, Wang Yanyi, Zhang Lihai, Yao Jun
Department of Oral Maxillofacial Surgery, General Hospital of Chinese PLA, Beijing 100853, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2010 Dec;24(12):1440-3.
To compare the effectiveness of open reduction and conservative treatment for pediatric mandibular condylar fractures and to provide the evidence for the selection of clinical therapy.
The clinical data were retrospectively analyzed from 25 patients with the mandibular condylar fractures between January 1988 and December 2006. Of them, 8 patients (11 fractures) were treated with surgical treatment (surgical group) and 17 patients (22 fractures) with non-surgical treatment (non-surgical group). In surgical group, there were 6 males (9 fractures) and 2 females (2 fractures) with an age range of 8-13 years; fracture was caused by tumbling in 7 cases and by traffic accident in 1 with an interval of 1-6 days between injury and hospitalization; and 5 cases were identified as unilateral condylar fractures (3 complicated by mental fractures) and 3 cases as bilateral condylar fractures complicated by mental fractures. In non-surgical group, there were 12 males (15 fractures) and 5 females (7 fractures) with an age range of 3-12 years; fracture was caused by falling from height in 4 cases, by tumbling in 10, and by traffic accident in 3 with an interval of 1-25 days between injury and hospitalization; and 12 cases were identified as unilateral condylar fractures (3 complicated by mental fractures) and 5 cases as bilateral condylar fractures (1 complicated by mental fracture).
Incision healed by first intention in surgical group, and 25 cases were followed up 1-6 years with an average of 3.5 years. At 12 months after treatment, no temporomandibular joint pain, eating disorder, or limited mandibular movement occurred in 2 groups. No significant difference was observed in opening mouth extent, protrusive and lateral movements between 2 groups at 6 and 12 months (P > 0.05). During centric occlusion, mental point located at the midline with symmetric face figure. Two patients in surgical group and 3 in non-surgical group had slight snap when opening their mouths. Mandible deviation was observed in 3 patients of 2 groups, respectively when gaping. The X-ray films showed healing of fracture and condylar remodeling at 3-6 months. Mandibular ramus were symmetric in cephalometry.
Good effectiveness can be obtained by surgical or non-surgical treatment in pediatric mandibular condylar fractures. Considering the pediatric mandibular condyle having powerful healing and reconstructing potency and avoiding secondary injury on the temporomandibular joint from surgery, non-surgical treatment should be first selected for the pediatric mandibular condylar fractures in patients under 7 years.
比较小儿下颌骨髁突骨折切开复位与保守治疗的疗效，为临床治疗方法的选择提供依据。
回顾性分析1988年1月至2006年12月期间25例下颌骨髁突骨折患儿的临床资料。其中，8例（11处骨折）接受手术治疗（手术组），17例（22处骨折）接受非手术治疗（非手术组）。手术组中，男性6例（9处骨折），女性2例（2处骨折），年龄8～13岁；7例因跌倒致伤，1例因交通事故致伤，伤后至入院时间为1～6天；5例为单侧髁突骨折（3例合并颏部骨折），3例为双侧髁突骨折合并颏部骨折。非手术组中，男性12例（15处骨折），女性5例（7处骨折），年龄3～12岁；4例因高处坠落致伤，10例因跌倒致伤，3例因交通事故致伤，伤后至入院时间为1～25天；12例为单侧髁突骨折（3例合并颏部骨折），5例为双侧髁突骨折（1例合并颏部骨折）。
手术组切口一期愈合，25例均获随访，随访时间1～6年，平均3.5年。治疗后12个月，两组均无颞下颌关节疼痛、进食障碍或下颌运动受限。治疗后6个月和12个月时，两组间开口度、前伸及侧方运动差异无统计学意义（P＞0.05）。正中咬合时，颏点位于中线，面部外形对称。手术组2例、非手术组3例患儿张口时有轻度弹响。两组各有3例患儿张口时出现下颌偏斜。X线片显示骨折在3～6个月愈合，髁突重塑。头颅侧位片显示下颌升支对称。
小儿下颌骨髁突骨折手术治疗与非手术治疗疗效均较好。鉴于小儿下颌骨髁突具有较强的愈合及改建能力，且可避免手术对颞下颌关节造成二次损伤，7岁以下小儿下颌骨髁突骨折应首选非手术治疗。
