Yoshida Kazuya
Department of Oral and Maxillofacial Surgery, National Hospital Organization, Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan.
J Clin Med. 2023 May 31;12(11):3781. doi: 10.3390/jcm12113781.
The superior dislocation of the condyle into the cranium occasionally requires invasive procedures due to the absence of a timely diagnosis. This review analyzed the available clinical data to provide information on treatment decisions. The reports were assessed using electronic medical databases from inception to 31 October 2022. A total of 116 cases from 104 studies were assessed; among the patients, 60% and 87.5% of the affected women and men required open reduction, respectively. The ratio of closed to open procedures within 7 days after injury was maintained; however, closed reduction decreased over time, and all cases required open reduction after 22 days. Eighty percent of the patients with a total intrusion of the condyle required open reduction, whereas the frequency for both procedures was comparable in the remaining patients. Open reduction was significantly more frequently performed for men ( = 0.026, odds ratio; 4.959, 95% confidence interval; 1.208-20.365) and less frequently performed in cases with partial intrusion ( = 0.011; odds ratio: 0.186; 95% confidence interval: 0.051-0.684); the frequency varied according to the time until treatment ( = 0.027, odds ratio; 1.124, 95% confidence interval; 1.013-1.246). Appropriate diagnostic imaging and prompt diagnosis are indispensable for minimally invasive treatment of this condition.
由于未能及时诊断,髁突向上脱位进入颅骨的情况偶尔需要采取侵入性手术。本综述分析了现有的临床数据,以提供治疗决策方面的信息。使用电子医学数据库对从数据库建立到2022年10月31日的报告进行评估。共评估了来自104项研究的116例病例;在这些患者中,分别有60%的受影响女性和87.5%的受影响男性需要切开复位。受伤后7天内闭合手术与切开手术的比例保持不变;然而,随着时间的推移,闭合复位的比例下降,所有病例在22天后都需要切开复位。髁突完全嵌入的患者中有80%需要切开复位,而其余患者中两种手术的频率相当。男性进行切开复位的频率显著更高(P = 0.026,优势比;4.959,95%置信区间;1.208 - 20.365),部分嵌入的病例中进行切开复位的频率较低(P = 0.011;优势比:0.186;95%置信区间:0.051 - 0.684);频率根据治疗前的时间而有所不同(P = 0.027,优势比;1.124,95%置信区间;1.013 - 1.246)。对于这种情况的微创治疗,适当的诊断成像和及时诊断是必不可少的。