Department of Maxillofacial Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.
Department of Maxillofacial Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
ANZ J Surg. 2024 Apr;94(4):597-603. doi: 10.1111/ans.18705. Epub 2023 Sep 24.
Mandibular fractures are common facial fractures, and contemporary management of mandibular condylar fractures is controversial. The purpose of this study was to compare the outcomes of patients who sustained a mandibular condylar fracture between 2016 and 2020, who were managed by either open or closed techniques. The outcomes of this study were: post-operative facial nerve function, occlusion, and maximal mouth opening.
This study is a retrospective multicentre cohort study which assessed clinical records for 246 patients with mandibular condyle fractures in three hospitals in Perth, Western Australia. The primary outcome measure was changes in post-operative facial nerve function.
One hundred and thirty-two patients underwent open reduction and internal fixation (ORIF), and 114 patients had closed management. The overall rate of temporary facial nerve injury following ORIF was 3.28%. The overall rate of permanent facial nerve injury was 0.82%. Sialocoele occurred in 2.46% of all patients who underwent ORIF. 6.14% of patients had persisting malocclusion across both groups. There was a statistically significant association between the degree of fragment shortening and facial nerve injury (P = 0.0063), with more facial nerve changes in the group with 5 mm or greater of fragment shortening.
There is still significant debate over the management of mandibular condylar injuries. This study demonstrates a similar rate of temporary and permanent facial nerve injury as previously described, as well as a similar rate of sialocoele occurrence. Further prospective studies may provide clarity about important characteristics that will help guide decision making for mandibular condylar fractures.
下颌骨骨折是常见的面部骨折，而当代对下颌骨髁突骨折的处理存在争议。本研究的目的是比较 2016 年至 2020 年间接受开放式或闭合式治疗的下颌骨髁突骨折患者的治疗结果。本研究的结果包括术后面神经功能、咬合和最大张口度。
这是一项回顾性多中心队列研究，评估了西澳大利亚珀斯的 3 家医院的 246 例下颌骨髁突骨折患者的临床记录。主要的观察指标是术后面神经功能的变化。
132 例患者接受了开放式复位内固定（ORIF），114 例患者接受了闭合式治疗。ORIF 后暂时性面神经损伤的总发生率为 3.28%。永久性面神经损伤的总发生率为 0.82%。ORIF 术后涎漏的总发生率为 2.46%。两组中有 6.14%的患者存在持续的咬合不正。在髁突骨折片段缩短 5mm 或以上的患者中，面神经损伤的程度与面神经损伤之间存在统计学显著关联（P=0.0063）。
对于下颌骨髁突损伤的处理仍然存在很大的争议。本研究显示，暂时性和永久性面神经损伤的发生率与先前报道的相似，涎漏的发生率也相似。进一步的前瞻性研究可能会明确有助于指导下颌骨髁突骨折决策的重要特征。
