Maurer Michael, Klaes Tabea, Meier Johannes K, Gottsauner Josef Maximilian, Taxis Jürgen, Schuderer Johannes, Reichert Torsten E, Ettl Tobias
Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany.
Dent Traumatol. 2023 Dec;39(6):586-596. doi: 10.1111/edt.12871. Epub 2023 Jul 23.
BACKGROUND/AIM: Mandibular condylar fractures represent 25%-35% of all mandibular fractures. Despite profound research, there is still a controverse debate about treating these fractures conservatively or by open reduction and internal fixation (ORIF). The aim of this study is to analyse the outcome after open and closed treatment of extracapsular mandibular condyle fractures regarding general characteristics, post-treatment malocclusion, facial nerve palsy (FNP), maximum mouth opening (MMO) and parotid complications.
A retrospective cohort of 377 fractures (350 open, 27 closed treatment) was reviewed by reference to clinical and radiological pre- and postoperative documentation. Follow-up period was 12 months. Pearsons' chi-square-test, correlations, Kruskal-Wallis test and t-test were carried out for statistical analysis.
The dominant type of fracture was type II in Spiessl and Schroll classification (50.1%). In the open treated fractures, the most common approach was retromandibular transparotid (91.7%). Post-treatment malocclusion occurred in 18.0% and was significantly increased in bilateral fractures (p = .039), in luxation fractures (p = .016) and in patients with full dentition (p = .004). After open reduction and internal fixation (ORIF), temporary FNP was documented in 7.1% whereas a permanent paresis occurred in 1.7%. FNP was significantly associated with high fractures (p = .001), comminution (p = .028) and increased duration of surgery (p = .040). Parotid complications were significantly associated with revision surgery (p = .009). Post-treatment reduction of MMO mainly occurred in female patients (p < .001) as well as in patients with bilateral fractures (p < .001), high fractures (p = .030) and concomitant mandibular (p = .001) and midfacial fractures (p = .009).
Malocclusion seems to be the most frequent long-term complication after open reduction and osteosynthesis of extracapsular mandibular condyle fractures. We suggest ORIF by a transparotid approach to be an appropriate treatment with a low complication rate regarding especially FNP for extracapsular fractures of the mandibular condyle.
背景/目的：下颌髁突骨折占所有下颌骨骨折的25%-35%。尽管进行了深入研究，但对于这些骨折采用保守治疗还是切开复位内固定（ORIF）仍存在争议。本研究的目的是分析下颌髁突囊外骨折切开和闭合治疗后的结果，包括一般特征、治疗后错牙合、面神经麻痹（FNP）、最大开口度（MMO）和腮腺并发症。
通过参考临床和影像学术前及术后记录，回顾了377例骨折（350例切开治疗，27例闭合治疗）的回顾性队列。随访期为12个月。进行Pearson卡方检验、相关性分析、Kruskal-Wallis检验和t检验进行统计分析。
在Spiessl和Schroll分类中，主要骨折类型为II型（50.1%）。在切开治疗的骨折中，最常见的入路是下颌后入路经腮腺（91.7%）。治疗后错牙合发生率为18.0%，在双侧骨折（p = 0.039）、脱位骨折（p = 0.016）和全口牙列患者（p = 0.004）中显著增加。切开复位内固定（ORIF）后，临时FNP记录为7.1%，而永久性麻痹发生率为1.7%。FNP与高位骨折（p = 0.001）、粉碎性骨折（p = 0.028）和手术时间延长（p = 0.040）显著相关。腮腺并发症与翻修手术显著相关（p = 0.009）。治疗后MMO降低主要发生在女性患者（p < 0.001）以及双侧骨折患者（p < 0.001）、高位骨折患者（p = 0.030）以及伴有下颌骨（p = 0.001）和面中部骨折（p = 0.009）的患者中。
错牙合似乎是下颌髁突囊外骨折切开复位内固定术后最常见的长期并发症。我们建议经腮腺入路的ORIF是一种合适的治疗方法，对于下颌髁突囊外骨折，尤其是FNP的并发症发生率较低。
