From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine; and Rush Medical College of Rush University.
Plast Reconstr Surg. 2021 Feb 1;147(2):443-452. doi: 10.1097/PRS.0000000000007527.
The purpose of this study was to examine injury patterns in pediatric mandibular condylar fractures and to propose and evaluate the validity of an institutional treatment algorithm for such fractures.
A retrospective chart review was conducted on pediatric patients who presented to the authors' institution with isolated mandibular condylar fractures between 1990 and 2016. Patients were categorized by dentition, and information regarding demographics, injury characteristics, management, and complications was compiled.
Forty-three patients with 50 mandibular condylar fractures were identified. Twelve patients (27.9 percent) had deciduous dentition, 15 (34.9 percent) had mixed dentition, and 16 (37.2 percent) had permanent dentition. The most common fracture pattern in all groups was diacapitular [n = 30 (60 percent)]; however, older groups showed higher rates of condylar base fractures and bilateral fractures (p = 0.029 and p = 0.011, respectively). Thirty-one patients (72.1 percent) were treated with nonoperative management, 10 (23.2 percent) with closed treatment and mandibulomaxillary fixation, and two (4.7 percent) with open treatment and mandibulomaxillary fixation; nonoperative treatment was more common in younger patients (p = 0.008). Management for 10 patients (23.2 percent) was nonadherent to the treatment algorithm. Eight patients had complications (18.6 percent). Common complications included temporomandibular joint ankylosis (n = 2) and malocclusion (n = 2). Although complications were seen in all groups, adherence to the algorithm was associated with an 81.8 percent reduction in odds of complications (p = 0.032).
Nonoperative management has a low complication rate in deciduous children. Children with permanent/mixed dentition may undergo closed treatment and mandibulomaxillary fixation if they have malocclusion/contralateral open bite, significant condylar dislocation, and ramus height loss greater than 2 mm.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
本研究旨在探讨儿童下颌骨髁突骨折的损伤模式，并提出并评估一种机构治疗此类骨折的有效性。
对 1990 年至 2016 年间因孤立性下颌骨髁突骨折到作者机构就诊的小儿患者进行回顾性病历分析。根据牙列对患者进行分类，并收集人口统计学、损伤特征、治疗和并发症信息。
共确定 43 例 50 例下颌骨髁突骨折患者。12 例（27.9%）为乳牙列，15 例（34.9%）为混合牙列，16 例（37.2%）为恒牙列。所有组中最常见的骨折类型为双髁突骨折[n = 30（60%）]；然而，年龄较大的组显示出更高的髁突基底部骨折和双侧骨折发生率（p = 0.029 和 p = 0.011）。31 例（72.1%）采用非手术治疗，10 例（23.2%）采用闭合治疗和颌骨固定，2 例（4.7%）采用开放式治疗和颌骨固定；年龄较小的患者更常采用非手术治疗（p = 0.008）。10 例（23.2%）患者的治疗方法不符合治疗方案。8 例患者出现并发症（18.6%）。常见并发症包括颞下颌关节强直（n = 2）和咬合不正（n = 2）。尽管所有组均出现并发症，但遵守算法可使并发症的几率降低 81.8%（p = 0.032）。
非手术治疗在乳牙期儿童中的并发症发生率较低。恒牙/混合牙列儿童如果存在咬合不正/对侧开颌、髁突明显脱位和支抗高度损失大于 2 毫米，可采用闭合治疗和颌骨固定。
临床问题/证据水平：治疗性，III 级。
