Department of Dentistry and Oral Surgery, Tokyo Metropolitan Hiroo Hospital.
Division of Oral Surgery, Nihon University School of Medicine, Tokyo, Japan.
J Craniofac Surg. 2023 May 1;34(3):865-869. doi: 10.1097/SCS.0000000000008978. Epub 2022 Aug 29.
Although closed reduction is common for condylar fractures, bone fragments may heal improperly. This study aimed to investigate the healing morphology of unilateral condylar fractures. We retrospectively investigated 70 patients with unilateral condylar fractures. Clinico-statistical analyses were performed on the whole-condylar fracture, closed reduction, and observation/functional therapy groups. Among these patients, 52 patients aged older than 16 years underwent closed reduction. The extent of maximum mouth opening, the incidence of malocclusion, and the relationship between healing morphology and Arbeitsgemeinschaft für Osteosynthesefragen classification or trismus were analyzed in the closed reduction group. There were significant differences in age ( P= 0.008) and sex ( P =0.025) between the closed reduction and observation/functional therapy groups. However, there were no significant differences in trauma etiologies and concomitant fractures between the 2 groups. The average maximum mouth opening extent for unilateral fractures after closed reduction was 42.6±6.1 mm. Only 1 case (2.1%) of post-treatment malocclusion was observed. In all the MacLennan classification of deviation or more, regardless of the classification, upper fractures (head and upper neck) tended to heal through a spherical ( P <0.001) morphology, whereas lower fractures (lower neck and subcondylar) tended to heal through an L-shaped and lateral fusion ( P <0.001). There was no significant difference in the incidence of trismus between the healing morphology of unchanged type and others ( P =0.690). Our results elucidated the etiology, dysfunction, and healing morphology classification of unilateral mandibular condyle fractures treated with closed reduction.
尽管闭合复位常用于治疗髁突骨折，但骨碎片可能愈合不当。本研究旨在探讨单侧髁突骨折的愈合形态。我们回顾性调查了 70 例单侧髁突骨折患者。对整个髁突骨折、闭合复位和观察/功能治疗组进行临床统计学分析。在这些患者中，52 例年龄大于 16 岁的患者接受了闭合复位。在闭合复位组中，分析了最大张口度、错牙合发生率以及愈合形态与 Arbeitsgemeinschaft für Osteosynthesefragen 分类或张口受限的关系。闭合复位组和观察/功能治疗组在年龄（P=0.008）和性别（P=0.025）方面存在显著差异。然而，两组间创伤病因和伴发骨折无显著差异。单侧髁突骨折闭合复位后平均最大张口度为 42.6±6.1mm。仅观察到 1 例（2.1%）治疗后错牙合。在所有 MacLennan 分类的偏差或更严重的情况下，无论分类如何，上髁突（头部和上颈）倾向于通过球形（P<0.001）形态愈合，而下髁突（下颈和髁突下）则倾向于通过 L 形和侧向融合（P<0.001）愈合。愈合形态不变型与其他类型之间的张口受限发生率无显著差异（P=0.690）。我们的结果阐明了经闭合复位治疗的单侧下颌骨髁突骨折的病因、功能障碍和愈合形态分类。
