Chrcanovic Bruno Ramos
Oral Maxillofac Surg. 2012 Sep;16(3):245-55. doi: 10.1007/s10006-012-0344-7. Epub 2012 Jul 28.
The purpose of the study was to review the literature regarding the evolution of current thoughts on management of mandibular condylar fractures (MCFs) in children.
An electronic search in PubMed was undertaken in May 2012. The titles and abstracts from these results were read to identify studies within the selection criteria. Eligibility criteria included studies published in English or German from the last 20 years (from 1992 onwards) reporting clinical series of MCFs in children and adolescents until the age of 18.
The search strategy initially identified 542 studies. The references from 1992 onwards totaled 339 articles. Twenty-seven studies were identified without repetition within the selection criteria. Additional hand-searching yielded two additional papers.
Pediatric MCFs require thoughtful consideration in management to avoid significant growth disturbance. Early treatment is indicated in order to improve the chances for favorable development. Long-term follow-up is required, in order to properly treat late complications that may appear. Coronal computed tomography is helpful in substantiating the correct final diagnosis. Many studies show that conservative treatment (CTR) has satisfactory long-term outcome of jaw function, occlusion, and facial esthetics, despite a high frequency of radiological aberrations. Surgery before puberty should be reserved for exceptional cases such as missile injuries, in cases with extensive dislocation and lack of contact between the fragments, in cases with multiple midfacial fractures, in which the mandible has to serve as a guide to reposition the midfacial bones, and in cases which the dislocation of the fractured stump creates a functional impediment that cannot be resolved by CTR. As the craniofacial skeleton becomes more adult-like in its form at about 12 years of age, the decreased remodeling capacity in the adolescents may occasionally result in abnormally shaped condylar heads or shortened ramus heights that may lead to persistent malocclusion. Thus, the indication of open reduction and internal fixation increases with age.
本研究旨在回顾有关儿童下颌髁突骨折（MCF）治疗的当前思想演变的文献。
2012年5月在PubMed上进行了电子检索。阅读这些结果的标题和摘要，以确定符合选择标准的研究。纳入标准包括过去20年（从1992年起）以英文或德文发表的报告18岁及以下儿童和青少年MCF临床系列的研究。
检索策略最初识别出542项研究。1992年起的参考文献共计339篇文章。在选择标准内确定了27项无重复的研究。额外的手工检索又得到了两篇论文。
儿童MCF的治疗需要深思熟虑，以避免严重的生长紊乱。需要早期治疗以提高良好发育的机会。需要长期随访，以便正确治疗可能出现的晚期并发症。冠状位计算机断层扫描有助于证实正确的最终诊断。许多研究表明，尽管放射学异常的发生率很高，但保守治疗（CTR）在颌骨功能、咬合和面部美学方面具有令人满意的长期效果。青春期前的手术应仅用于特殊情况，如导弹伤、骨折块广泛脱位且无接触、多处面中部骨折（其中下颌骨必须作为重新定位面中部骨骼的导向）以及骨折残端脱位造成功能障碍且CTR无法解决的情况。随着颅面骨骼在大约12岁时形态更接近成人，青少年重塑能力的下降偶尔可能导致髁突头部形状异常或升支高度缩短，进而导致持续性错牙合。因此，切开复位内固定的指征随年龄增加。
