Department of Plastic & Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD.
Department of Plastic & Oral Surgery, Boston Children's Hospital, Boston, MA.
J Craniofac Surg. 2020 Oct;31(7):1946-1950. doi: 10.1097/SCS.0000000000006892.
Mandible angle fractures can result in significant, long-term morbidity in children. However, management of this particular mandibular fracture type is not well-characterized in the pediatric population. This study investigated isolated mandibular angle fractures in the pediatric patients.
This was a 30-year retrospective, longitudinal cohort study of pediatric patients presenting to a single institution with mandibular angle fractures. Patient data were abstracted from electronic medical records. Subgroup analyses were completed by dentition stage.
Seventeen patients met inclusion criteria, of whom 6 (35.3%) had deciduous, 4 (23.5%) had mixed, and 7 (41.2%) had permanent dentition. Deciduous/mixed dentition patients with mobile, displaced fractures underwent ORIF, whereas those with nondisplaced fractures underwent treatment with soft diet. Among permanent dentition patients, most patients (71.4%) underwent ORIF regardless of fracture severity. The post-ORIF complication rate was 55.6%; no complications were reported after soft diet or closed treatment (Fischer exact: P = 0.05). The most common post-ORIF complication was alveolar nerve paresthesia (17.6%) and post-ORIF complication rates did not vary by age (deciduous: 16.7%, mixed: 25.0%, permanent: 42.9%, Fischer exact: P = 0.80). ORIF patients who received a single upper border miniplate had a lower complication rate (42.9%) than other plating methods (upper and lower miniplates-100%). Fracture severity was predictive of post-ORIF complications (odds ratio: 2.23, 95% confidence interval: 2.22-2.24, P < 0.0001).
Isolated mandible angle fractures were relatively rare in children, and treatment requirements varied by injury severity and dentition stage. Although isolated angle fractures had substantial associated morbidity, this fracture pattern did not result in notable growth limitations/deformity.
下颌角骨折可导致儿童长期出现严重的并发症。然而，儿童下颌角骨折类型的治疗方法尚未得到很好的描述。本研究调查了儿童孤立性下颌角骨折。
这是一项对单家医疗机构就诊的儿童下颌角骨折患者进行的 30 年回顾性、纵向队列研究。从电子病历中提取患者数据。通过牙列阶段进行亚组分析。
17 名患者符合纳入标准，其中 6 名（35.3%）为乳牙，4 名（23.5%）为混合牙，7 名（41.2%）为恒牙。有移位的活动性骨折的乳牙/混合牙患者接受切开复位内固定术，无移位的骨折患者接受软食治疗。在恒牙患者中，大多数患者（71.4%）无论骨折严重程度如何，均接受切开复位内固定术。切开复位内固定术后的并发症发生率为 55.6%；软食或闭合治疗后无并发症（Fisher 精确检验：P=0.05）。最常见的切开复位内固定术后并发症是牙槽神经感觉异常（17.6%），且切开复位内固定术后并发症发生率与年龄无关（乳牙：16.7%，混合牙：25.0%，恒牙：42.9%，Fisher 精确检验：P=0.80）。接受单个上缘微型钢板固定的切开复位内固定术患者的并发症发生率较低（42.9%），低于其他接骨板固定方法（上、下微型钢板-100%，Fisher 精确检验：P=0.80）。骨折严重程度是切开复位内固定术后并发症的预测因素（比值比：2.23，95%置信区间：2.22-2.24，P<0.0001）。
孤立性下颌角骨折在儿童中相对少见，治疗需求因损伤严重程度和牙列阶段而异。尽管孤立性角骨折有相当大的相关发病率，但这种骨折模式不会导致明显的生长受限/畸形。
