Bu Lingtong, Zhang Yuxing, Wei Xiang, Xu Qingyu, Jiao Zixian, Yang Chi
Department of Oral and Maxillofacial Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, No. 639 Zhizaoju Road, Shanghai, 200011, China.
Department of Oral Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China.
Sci Rep. 2025 May 13;15(1):16638. doi: 10.1038/s41598-025-01866-7.
To reveal morphological changes in musculoskeletal apparatus after conservative treatment of condylar head fracture (CHF) by clinical examinations, condylar and masticatory muscle reconstruction, to guide the clinical therapeutic strategy. Patients with unilateral CHF and treated conservatively during November 2015 to January 2020 were enrolled and followed up for 2 years. Clinical assessments (mouth open, mandible deviation and occlusal relationship), and CT reconstruction (condyle, ramus height, masseter and lateral pterygoid) immediately and 2 years after fracture were compared with the unfractured side as control group. Mixed-effect analysis and two-way ANOVA were manipulated and P ≤ 0.05 was defined as significant. 26 patients were involved. The average of maximum mouth opening increased from 12.6 ± 5.40 mm to 27.8 ± 8.60 mm. Significant musculoskeletal resorption with an average condyle volume decrease of 241.86 mm3 (P = 0.0029), ramus height decrease of 1.87 mm (P = 0.0004), masseter volume decrease of 3,447.3 mm3 (P < 0.0001), and lateral pterygoid volume decrease of 1203.05 mm3 (P = 0.0049) occurred. No significant changes occurred to the unfractured sides. Conservative treatment of CHF displayed significant musculoskeletal resorption. Clinical assessments showed less optimal improvements. Surgeons should be aware of these trends and take full consideration before applying nonsurgical treatment.
通过临床检查、髁突和咀嚼肌重建来揭示髁突头部骨折（CHF）保守治疗后肌肉骨骼系统的形态变化，以指导临床治疗策略。纳入2015年11月至2020年1月期间接受保守治疗的单侧CHF患者，并进行2年随访。将骨折后即刻及2年时的临床评估（张口度、下颌偏斜和咬合关系）以及CT重建（髁突、升支高度、咬肌和翼外肌）与未骨折侧作为对照组进行比较。采用混合效应分析和双向方差分析，P≤0.05定义为有统计学意义。共纳入26例患者。最大张口度平均值从12.6±5.40mm增加到27.8±8.60mm。出现了明显的肌肉骨骼吸收，髁突平均体积减少241.86mm³（P = 0.0029），升支高度减少1.87mm（P = 0.0004），咬肌体积减少3447.3mm³（P < 0.0001），翼外肌体积减少1203.05mm³（P = 0.0049）。未骨折侧未出现明显变化。CHF的保守治疗显示出明显的肌肉骨骼吸收。临床评估显示改善效果欠佳。外科医生在应用非手术治疗前应了解这些趋势并充分考虑。
