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一例多发性面部及髁突骨折病例的保守性多学科治疗

Conservative interdisciplinary treatment of a case with multiple facial and condyle fractures.

作者信息

Lee You-Sun, Yi Yang-Jin, Kim Young-Kyun, Lee Nam-Ki, Larson Brent E

机构信息

Department of Orthodontics, Seoul National University Bundang Hospital, Seongnam, South Korea.

Department of Prosthodontics, Seoul National University Bundang Hospital, Seongnam, South Korea.

出版信息

Dent Traumatol. 2017 Jun;33(3):226-229. doi: 10.1111/edt.12290. Epub 2016 Jun 6.

Abstract

The purpose of this case report is to describe an interdisciplinary approach for a 51-year-old male who underwent multiple facial fractures including bilateral condyle fractures. The patient underwent emergency surgery, which included open reduction of the maxilla and mandibular symphysis and closed reduction of the bilateral condyle fractures. Although the patient recovered a comfortable range of mouth opening and alleviation of the temporomandibular joint (TMJ) symptoms after surgery, he suffered from a large anterior-posterior discrepancy due to less stability on the condyle-fossa relationships and from open bite with contacts only on both second molars and right second premolars. In this case, first, to increase the occlusal contact, comprehensive orthodontic treatment was completed. Second, occlusal equilibration was selectively performed to relieve the interferences and establish a stable range of mandibular movement without any changes in the vertical dimension. Third, both the upper central incisors and left lateral incisor were minimally restored with splinted and single zirconia crowns, which had modified lingual contours to provide adequate anterior guidance permitting the anterior-posterior discrepancy of the posterior teeth during protrusion. This conservative interdisciplinary treatment, including open and closed reduction, orthodontic treatment, occlusal adjustment, and minimal prosthetic restorations, resulted in a stable mandibular position and recovery of mastication function.

摘要

本病例报告的目的是描述一种针对一名51岁男性的多学科治疗方法,该男性遭受了多处面部骨折,包括双侧髁突骨折。患者接受了急诊手术,包括上颌骨和下颌骨联合处的切开复位以及双侧髁突骨折的闭合复位。尽管患者术后恢复了舒适的开口范围并缓解了颞下颌关节(TMJ)症状,但由于髁突-关节窝关系稳定性较差,他存在较大的前后牙合差异,并且出现了开牙合,仅双侧第二磨牙和右侧第二前磨牙有接触。在本病例中,首先,为增加牙合接触,完成了全面的正畸治疗。其次,选择性地进行了牙合平衡,以消除干扰并建立稳定的下颌运动范围,而垂直维度无任何变化。第三,对上颌中切牙和左侧侧切牙进行了最小限度的修复,采用了夹板式和单颗氧化锆冠,这些冠对舌侧外形进行了修改,以提供足够的前导,允许在向前突出时后牙存在前后牙合差异。这种保守的多学科治疗,包括切开复位和闭合复位、正畸治疗、牙合调整以及最小限度的修复性修复,使下颌位置稳定,咀嚼功能得以恢复。

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