Lim Hye-Youn, Jung Tae-Young, Park Sang-Jun
Department of Oral and Maxillofacial Surgery, Inje University Busan Paik Hospital, Busan, Korea.
J Korean Assoc Oral Maxillofac Surg. 2017 Feb;43(1):37-41. doi: 10.5125/jkaoms.2017.43.1.37. Epub 2017 Feb 20.
The aim of this study was to evaluate the implication of third molars in postoperative complications of mandibular angle fracture with open reduction and internal fixation (ORIF).
Data were collected on patients who presented with mandibular angle fracture at our Department of Oral and Maxillofacial Surgery between January 2011 and December 2015. Of the 63 total patients who underwent ORIF and perioperative intermaxillary fixation (IMF) with an arch bar, 49 patients were identified as having third molars in the fracture line and were followed up with until plate removal. The complications of postoperative infection, postoperative nerve injury, bone healing, and changes in occlusion and temporomandibular joint were evaluated and analyzed using statistical methods.
In total, 49 patients had third molars in the fracture line and underwent ORIF surgery and perioperative IMF with an arch bar. The third molar in the fracture line was retained during ORIF in 39 patients. Several patients complained of nerve injury, temporomandibular disorder (TMD), change of occlusion, and postoperative infection around the retained third molar. The third molars were removed during ORIF surgery in 10 patients. Some of these patients complained of nerve injury, but no other complications, such as TMD, change in occlusion, or postoperative infection, were observed. There was no delayed union or nonunion in either of the groups. No statistically significant difference was found between the non-extraction group and the retained teeth group regarding complications after ORIF.
If the third molar is partially impacted or completely nonfunctional, likely to be involved in pathologic conditions later in life, or possible to remove with the plate simultaneously, extraction of the third molar in the fracture line should be considered during ORIF surgery of the mandible angle fracture.
本研究旨在评估下颌角骨折切开复位内固定术（ORIF）后第三磨牙对术后并发症的影响。
收集2011年1月至2015年12月在我院口腔颌面外科就诊的下颌角骨折患者的数据。在总共63例行ORIF及术中使用牙弓夹板进行颌间固定（IMF）的患者中，49例患者骨折线处存在第三磨牙，并随访至钢板取出。采用统计学方法对术后感染、术后神经损伤、骨愈合、咬合及颞下颌关节变化等并发症进行评估与分析。
共有49例患者骨折线处存在第三磨牙，接受了ORIF手术及术中牙弓夹板IMF。39例患者在ORIF手术中保留了骨折线处的第三磨牙。部分患者抱怨保留的第三磨牙周围出现神经损伤、颞下颌关节紊乱（TMD）、咬合改变及术后感染。10例患者在ORIF手术中拔除了第三磨牙。其中部分患者抱怨存在神经损伤，但未观察到其他并发症，如TMD、咬合改变或术后感染。两组均未出现延迟愈合或不愈合。ORIF术后并发症在未拔牙组和保留牙组之间未发现统计学上的显著差异。
如果第三磨牙部分阻生或完全无功能，可能在日后引发病理状况，或可与钢板同时取出，则在下颌角骨折ORIF手术中应考虑拔除骨折线处的第三磨牙。
