Arya Varun, Chigurupati Radhika
Resident, Department of Oral and Maxillofacial Surgery, Boston University, School of Dental Medicine and Boston Medical Center, Boston, MA.
Associate Professor, Department of Oral and Maxillofacial Surgery, Boston University, School of Dental Medicine and Boston Medical Center, Boston, MA.
J Oral Maxillofac Surg. 2016 Mar;74(3):569-81. doi: 10.1016/j.joms.2015.09.033. Epub 2015 Oct 26.
Traumatic injuries of the mandible resulting in intrusion of the condyle into the middle cranial fossa are rare and treatment is often based on anecdotal experience. The objective of this study was to develop an algorithm for the management of condylar intrusion injuries by identifying factors that influenced the treatment decision of closed versus open reduction of the condyle.
This study was a systematic review of the literature on intracranial intrusion injuries of the mandibular condyle. A thorough search of the PubMed and Cochrane databases and individual maxillofacial and craniofacial journal databases was conducted using the Medical Subject Heading terms condylar impaction, condylar dislocation, condylar intrusion, and middle cranial fossa and condyle without date and language restriction. Quantitative data on the patient's age, gender, etiology of injury, and time from injury to diagnosis were analyzed using descriptive statistics. The authors studied how the predictor variables of age, etiology, time from injury to diagnosis, and associated neurologic injuries influenced the outcome variable of closed versus open reduction of the condyle.
Forty-eight of the 62 retrieved case reports, case series, and review articles were published in the English-language literature from 1963 to 2015. Data on 51 patients with these injuries showed that 38 (75%) were female and younger than 30 years. The most common etiology of injury was motor vehicular accidents, occurring in 25 of 51 patients (49%). The mean time from injury to diagnosis was 31.2 days (0 to 106.4 days). Forty of the 51 patients (78%) were diagnosed within the first 2 weeks of injury. A good proportion of patients underwent open reduction (63%) and 18 of the 51 of patients (35%) underwent closed reduction.
Predictor variables that influenced the treatment decision of open versus closed reduction were age of the patient, etiology of injury, and time from injury to diagnosis. Based on the present results, younger patients (0 to 15 yr old), patients who sustain condylar intrusion injuries from bicycle accidents, and those diagnosed within the first 2 weeks of injury are more likely to benefit from closed reduction. The treatment algorithm emphasizes the importance of assessment of associated neurologic injuries and an interdisciplinary approach for the management of these injuries.
下颌骨创伤性损伤导致髁突突入中颅窝的情况较为罕见，治疗往往基于经验。本研究的目的是通过确定影响髁突闭合复位与切开复位治疗决策的因素，制定一种髁突突入性损伤的管理算法。
本研究是对下颌骨髁突颅内突入性损伤文献的系统综述。使用医学主题词“髁突撞击、髁突脱位、髁突突入、中颅窝和髁突”对PubMed和Cochrane数据库以及各个颌面和颅面期刊数据库进行了全面检索，无日期和语言限制。使用描述性统计分析患者年龄﹑性别﹑损伤病因以及从受伤到诊断的时间等定量数据。作者研究了年龄、病因、从受伤到诊断的时间以及相关神经损伤这些预测变量如何影响髁突闭合复位与切开复位的结果变量。
在检索到的62篇病例报告、病例系列和综述文章中，有48篇发表于1963年至2015年的英文文献。51例此类损伤患者的数据显示，38例（75%）为30岁以下女性。最常见的损伤病因是机动车事故，51例患者中有25例（49%）发生。从受伤到诊断的平均时间为31.2天（0至106.4天）。51例患者中有40例（78%）在受伤后的前2周内得到诊断。相当一部分患者接受了切开复位（63%），51例患者中有18例（35%）接受了闭合复位。
影响切开复位与闭合复位治疗决策的预测变量为患者年龄、损伤病因以及从受伤到诊断的时间。根据目前的结果，年轻患者（0至15岁）、因自行车事故导致髁突突入性损伤的患者以及在受伤后前2周内得到诊断的患者更有可能从闭合复位中获益。该治疗算法强调了评估相关神经损伤的重要性以及对这些损伤进行多学科管理的方法。
