West Griffin Harold, Griggs Jason Alan, Chandran Ravi, Precheur Harry Vincent, Buchanan William, Caloss Ron
Resident, Department of Oral-Maxillofacial Surgery and Pathology, University of Mississippi Medical Center, Jackson, MS.
Professor, Department of Biomedical Materials Science, University of Mississippi Medical Center, Jackson, MS.
J Oral Maxillofac Surg. 2014 Jan;72(1):112-20. doi: 10.1016/j.joms.2013.08.001. Epub 2013 Sep 25.
The purpose of this prospective randomized study was to assess whether uncomplicated mandible fractures could be treated successfully in an open or closed fashion using maxillomandibular fixation (MMF) screws.
This was a prospective institutional review board-approved study involving 20 adult patients who presented to the university emergency department or oral and maxillofacial surgical clinic with uncomplicated mandible fractures. Patients who met the exclusion criteria consented to enter the study in the open reduction internal fixation (ORIF) or the closed (MMF) study group. Six to 8 MMF screws were used to obtain intermaxillary fixation (IMF) in the 2 groups. Screw failure was documented. All screws were removed at 5 to 6 weeks postoperatively. Insertional torque (IT) was measured at time of screw placement to assess primary stability. Clinical and photographic documentation was performed to assess fracture healing, occlusion, and gingival health. Ten-centimeter visual analog scales were used to assess patient-centered outcomes. Cone-beam computed tomography was performed to assess the long-term effects on the periodontium and roots. A cost comparison was performed to determine whether the use of screws was cost effective compared with arch bars.
Fifteen men and 5 women (mean age, 25.2 yr) entered the study. All patients displayed adequate fracture healing based on clinical examination. All patients had acceptable occlusion at 5 to 6 weeks postoperatively. Total screw failure was 27 of 106 screws (25.5%). Forty percent of screws placed in the MMF group failed compared with only 6% in the ORIF group. Gingival health scores were favorable. Factors that had a significant effect on screw failure included a lower IT (P = .002), use in closed (MMF) treatment (P < .001), and use in the posterior jaw (P = .012). Minimal pain was associated with the MMF screws and pre-existing occlusion was re-established based on patients' subjective responses. The MMF group reported a statistically significant lower quality of life (P < .001) compared with the ORIF group. There was only 1 screw site that had a facial cortical bone defect noted at 6-month follow-up CBCT examination. There were no discernible long-term root defects. Cost analysis showed that the use of MMF screws saved around $600 per patient in operating room usage cost alone compared with the estimated use of arch bars.
Uncomplicated mandible fractures were successfully treated using MMF screws in open and closed treatments. However, the utility in closed treatment was decreased because of significant screw failure and patient noncompliance. The screws were well tolerated by the patients. There was minimal long-term damage to the periodontium and dental roots. The cost of screws was more than offset by time savings.
本前瞻性随机研究的目的是评估使用颌间固定（MMF）螺钉，以开放或闭合方式能否成功治疗单纯性下颌骨骨折。
这是一项经机构审查委员会批准的前瞻性研究，纳入了20例因单纯性下颌骨骨折就诊于大学急诊科或口腔颌面外科诊所的成年患者。符合排除标准的患者同意进入切开复位内固定（ORIF）组或闭合（MMF）组进行研究。两组均使用6至8枚MMF螺钉进行颌间固定（IMF）。记录螺钉失败情况。术后5至6周取出所有螺钉。在螺钉置入时测量插入扭矩（IT）以评估初始稳定性。进行临床和照片记录以评估骨折愈合、咬合及牙龈健康情况。使用10厘米视觉模拟量表评估以患者为中心的结局。进行锥形束计算机断层扫描以评估对牙周组织和牙根的长期影响。进行成本比较以确定与牙弓夹板相比，使用螺钉是否具有成本效益。
15名男性和5名女性（平均年龄25.2岁）进入研究。根据临床检查，所有患者骨折均愈合良好。所有患者术后5至6周咬合均良好。106枚螺钉中共有27枚（25.5%）出现完全失败。MMF组置入的螺钉有40%失败，而ORIF组仅为6%。牙龈健康评分良好。对螺钉失败有显著影响的因素包括较低的IT（P = .002）、用于闭合（MMF）治疗（P < .001）以及用于下颌后牙区（P = .012）。MMF螺钉引起的疼痛极小，根据患者主观反应，原有咬合得以重建。与ORIF组相比，MMF组报告的生活质量在统计学上显著较低（P < .001）。在6个月随访的锥形束计算机断层扫描检查中，仅发现1个螺钉部位存在面部皮质骨缺损。未发现明显的长期牙根缺损。成本分析表明，与估计使用牙弓夹板相比，仅手术室使用成本方面，使用MMF螺钉每位患者可节省约600美元。
单纯性下颌骨骨折在开放和闭合治疗中使用MMF螺钉均成功得到治疗。然而，由于螺钉显著失败和患者依从性差，其在闭合治疗中的效用降低。患者对螺钉耐受性良好。对牙周组织和牙根的长期损害极小。螺钉节省的时间成本超过了其费用。
