Cascone Piero, Marra Marcozzi Marco, Ramieri Valerio, Bosco Giulio, Vellone Valentino, Spallaccia Fabrizio
Department of Odontostomatologic and Maxillofacial Sciences, Sapienza Università di Roma, Rome, Italy.
J Craniofac Surg. 2017 Oct;28(7):1742-1745. doi: 10.1097/SCS.0000000000003914.
Best treatment for paediatric patients with mandibular condylar fractures is still debated, and many approaches have been proposed. Closed treatment is the most used, but there is evidence showing long-term problems in patients with dislocated fractures. On the other hand, there are concerns on surgical treatment with open reduction internal fixation, particularly on the implanted hardware during growth. The aim of this study is to evaluate the long-term outcomes of paediatric patients treated surgically with external fixation. A total of 21 paediatric patients were treated. Diagnostic procedures included clinical and radiographic examinations. Of those 21 patients, 16 presented monocondylar fractures, 5 bicondylar fractures. They were treated surgically with open reduction and external fixation. Patients showed good recovery in maximal mouth opening, maximal lateral excursion and in vertical height of ramus, and all returned to preinjury occlusion. No patient presented permanent facial nerve palsy, and none referred pain or stiffness in the operated area. Minimal scars were visible. Just 1 patient referred clicking in the operated temporo-mandibular joint. Surgical approach using external fixation could be considered an option for treatment of mandibular condylar fractures in paediatric patient. Vertical height recovery, early mobilization, and good occlusion can be achieved, minimizing the risk of facial asymmetry.
小儿下颌髁突骨折的最佳治疗方法仍存在争议，并且已经提出了许多治疗方法。闭合治疗是最常用的方法，但有证据表明，骨折脱位的患者存在长期问题。另一方面，对于切开复位内固定的手术治疗存在担忧，尤其是在生长过程中植入的硬件方面。本研究的目的是评估接受外固定手术治疗的小儿患者的长期疗效。共有21名小儿患者接受了治疗。诊断程序包括临床和影像学检查。在这21名患者中，16例为单髁突骨折，5例为双髁突骨折。他们接受了切开复位和外固定手术治疗。患者在最大张口度、最大侧向运动度和升支垂直高度方面恢复良好，并且全部恢复到受伤前的咬合关系。没有患者出现永久性面神经麻痹，也没有患者诉说手术区域疼痛或僵硬。可见最小的疤痕。只有1名患者诉说手术侧颞下颌关节有弹响。使用外固定的手术方法可被视为小儿患者下颌髁突骨折治疗的一种选择。可以实现垂直高度恢复、早期活动以及良好的咬合关系，将面部不对称的风险降至最低。
