From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., U.K.B., S.E.M.), Division of Plastic Surgery (A.J.N.), and Department of Surgery (D.M.S.), University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, The George Washington Hospital, Washington, DC (N.T.); School of Dental Medicine, University of Pennsylvania, Philadelphia, Pa (M.D.L.); and Department of Diagnostic Radiology, University of Miami Leonard Miller School of Medicine and Jackson Memorial Hospital & Ryder Trauma Center, Miami, Fla (F.M.).
Radiographics. 2016 Sep-Oct;36(5):1539-64. doi: 10.1148/rg.2016150218.
After the nasal bones, the mandible is the second most common site of facial fractures, and mandibular fractures frequently require open reduction. In the trauma injury setting, multidetector computed tomography (CT) has become the cornerstone imaging modality for determining the most appropriate treatment management, fixation method, and surgical approach. Multidetector CT is also used to assess the adequacy of the reduction and evaluate potential complications in the postoperative period. For successful restoration of the mandible's form and function, as well as management of posttraumatic and postoperative complications, reconstructive surgeons are required to have a detailed understanding of mandibular biomechanics, occlusion, and anatomy. To provide added value in the diagnosis, treatment planning, and follow-up of mandibular fractures, radiologists should be aware of these concepts. Knowledge of the techniques commonly used to achieve occlusal and anatomic reduction and of the rationale behind the range of available treatment options for different injury patterns-from isolated and nondisplaced fractures to multisite and comminuted fractures-also is essential. This article focuses on the use of multidetector CT for pre- and postoperative evaluation of mandibular fractures and outlines fundamental concepts of diagnosis and management-beginning with an explanation of common fracture patterns and their biomechanical underpinnings, and followed by a review of the common postoperative appearances of these fractures after semirigid and rigid fixation procedures. Specific considerations regarding fractures in different regions of the tooth-bearing and non-tooth-bearing mandible and the unique issues pertaining to the edentulous atrophic mandible are reviewed, and key features that distinguish major from minor complications are described. (©)RSNA, 2016.
在鼻骨之后，下颌骨是面部骨折的第二常见部位，下颌骨骨折常需行切开复位。在创伤损伤情况下，多层螺旋 CT 已成为确定最合适的治疗管理、固定方法和手术入路的基石成像方式。多层螺旋 CT 还用于评估复位的充分性，并评估术后潜在并发症。为了成功恢复下颌骨的形态和功能，并管理创伤后和术后并发症，重建外科医生需要详细了解下颌骨的生物力学、咬合和解剖结构。为了在诊断、治疗计划和下颌骨骨折的随访中提供附加价值，放射科医生应该了解这些概念。了解实现咬合和解剖复位的常用技术，以及针对不同损伤模式（从孤立的无移位骨折到多部位和粉碎性骨折）的各种治疗选择的基本原理也很重要。本文重点介绍多层螺旋 CT 在术前和术后评估下颌骨骨折中的应用，并概述诊断和治疗的基本概念，首先解释常见的骨折模式及其生物力学基础，然后复习这些骨折在半刚性和刚性固定手术后的常见术后表现。本文还回顾了有牙和无牙下颌骨不同区域骨折的具体注意事项，以及无牙萎缩下颌骨特有的问题，并描述了区分主要和次要并发症的关键特征。（©）RSNA，2016 年。
