Maxillofacial Plastic and Reconstructive Surgery

  • 제27권4호
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  • Pages.372-380
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  • 2005
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  • 2288-8101(pISSN)
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  • 2288-8586(eISSN)
대한악안면성형재건외과학회 (Korean Association of Maxillofacial Plastic and Reconstructive Surgeons)
권호 표지

하악골 과두 골절의 관혈적 정복술과 비관혈적 정복술의 예후에 관한 후향적 연구

RETROSPECTIVE STUDY FOR PROGNOSIS AFTER OPEN AND CLOSED REDUCTION OF THE MANDIBULAR CONDYLE FRACTURES

  • 김병수 (단국대학교 치과대학 구강악안면외과학교실) ;
  • 이재훈 (단국대학교 치과대학 구강악안면외과학교실) ;
  • 김철환 (단국대학교 치과대학 구강악안면외과학교실)
  • Kim, Byoung-Soo (Dept. of Oral & Maxillofacial Surgery, School of Dentistry, Dankook University) ;
  • Lee, Jae-Hoon (Dept. of Oral & Maxillofacial Surgery, School of Dentistry, Dankook University) ;
  • Kim, Chul-Hwan (Dept. of Oral & Maxillofacial Surgery, School of Dentistry, Dankook University)
  • 발행 : 2005.07.30
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초록

Condylar process of mandible, has the specialized anatomic structure compared with any other body structure, acts directly in connection with mastication and speech and so on. In general, mandibular condyle fractures have been managed by two methods as open and closed reduction. But, there are no reasonable consensus about the proper management of this injury. This study was designed for analysis of the prognosis of two methods of treatment, open and closed reduction, with positional change of fractured condyle and complications within 6 months post-intermaxillary fixation period. We conducted a retrospective analysis of 154 patients whose unilateral mandibular condyle fractures were treated by open or closed reduction in our department. The horizontal, sagittal, and coronal change of the condyle was examined using modified Towne's and panoramic radiographs before intermaxillary fixation(IMF), immediately after IMF, and at 6 months after IMF. Patients, whose mandibular condyle fractures were treated by closed reduction, had significantly shorter ramus height on the side of injury(P<0.05). But, fractured condylar fragments were displaced insignificantly with aspect to sagittal and coronal plane(P>0.05). The level of the fracture influenced the ramus length and the degree of coronal change in the closed reduction group(P<0.05). There was no significant correlation among the level of the fracture, treatment methods and complications(P>0.05). From the results obtained in this study, fractured mandibular condyles, were treated by closed reduction, had a tendency that continuous condylar displacement was occurred with aspect to horozontal and coronal plane in treatment period including intermaxillary fixation. And then there was a correlation between the level of the fracture and the position change in close reduction group statistically. These result suggested that care must be taken in basing treatment decisions on the degree of displacement of the condyle and in treating the mandibular condyle fractures for a long time.

키워드

참고문헌

  1. Peterson LJ, Lasen P, Miloro M, et al : Principles of oral and maxillofacial surgery. vol I. Philadelphia, J.B. Lippincott Co, 1992, p267-640, p557-586
  2. Upton LG : Management of injuries to the temporomandibular joint region, in Fonseca RJ, Walker RV (eds):Oral and Maxillofacial Trauma. Philadelphia, PA, Saunders, 1991, p418
  3. Dahlstrom L, Kahnberg KE, Lindahl L : 15 years followup on condylar fractures. Int J Oral Maxillofac Surg 18 : 18, 1989 https://doi.org/10.1016/S0901-5027(89)80009-8
  4. Amaratunga NA : A study of condylar fractures in Sri Lankan patients with special reference to the recent views on treatment, healing and sequelae. Br J Oral Maxillofac Surg 25 : 391, 1987 https://doi.org/10.1016/0266-4356(87)90088-X
  5. Lindahl L, Hollender L : Condylar fractures of the mandible II. A radiographic study of remodeling process of temporomandibular joint. Int J Oral Maxillofac Surg 6 : 153, 1977
  6. Martin K, Orestis H : Condylar displacement after sagittal splitting of the mandibular rami. J Maxillofac Surg 8 : 278, 1980 https://doi.org/10.1016/S0301-0503(80)80115-9
  7. Zou ZJ, Wu WT, Sun GX, et al : Remodeling of the TM joint after conservative treatment of condylar fractures. Dentomaxillofac Radiol 16 : 91, 1987 https://doi.org/10.1259/dmfr.1987.0013
  8. Ellis E, Reynolds ST, Park HS : A method to rigidly fix high condylar fractures. Oral Surg Oral Med Oral Pathol 68 : 369, 1989 https://doi.org/10.1016/0030-4220(89)90130-8
  9. Jeter TS, Hackney FL : Open reduction and rigid fixation of subcondylar fractures, in Yaremchuk MJ, Gruss JS, Manson PN(eds): Rigid fixation of the craniomaxillofacial skeleton. Boston, MA, Butterworth-Heinemann, 1992, p209
  10. Krenkel C : Axial 'anchor' screw or 'slanted-screw' plate for osteosynthesis of fractures of the mandibular condyloid process. J Craniomaxillofac Surg 20 : 348, 1993
  11. Mikkonen P, Lindqvist C, Pihakari A, et al : Osteotomyosteo synthesis in displaced condylar fractures. Int J Oral Maxillofac Surg 18 : 267, 1989 https://doi.org/10.1016/S0901-5027(89)80092-X
  12. Takenoshita Y, Ishibashi H, Oka M : Comparison of functional recovery after nonsurgical and surgical treatment of condylar fractures. J Oral Maxillofac Surg 48 : 1191, 1990 https://doi.org/10.1016/0278-2391(90)90535-A
  13. Silvennoinen U, Iizuka T, Oikarinen K, et al : Analysis od possible factors leading problems after nonsurgical treatment of condylar fractures. J Oral Maxillofac Surg 52 : 793, 1994 https://doi.org/10.1016/0278-2391(94)90219-4
  14. Widmark G, Bugenholm T, Karnberg KE, et al : Open reduction of subcondylar fratures: A study of functional rehabilitation. Int J Oral Maxillofac Surg 25 : 107, 1996 https://doi.org/10.1016/S0901-5027(96)80052-X
  15. Santler G, Karcher H, Ruda C, et al : Fractures of the condylar process. J Oral Maxillofac Surg 57 : 392, 1999 https://doi.org/10.1016/S0278-2391(99)90276-8
  16. Palmieri C, Ellis E, Throckmorton G : Mandibular motion after closed and open treatment of unilateral mandibular condylar process fractures. J Oral Maxillofac Surg 57 : 764, 1999 https://doi.org/10.1016/S0278-2391(99)90810-8
  17. Iizuka T, Lindqvist C, Hallikainen D, et al : Severe bone resorption and osteoarthrosis after miniplate fixation of high condylar fractures. A clinical and radiologic study of thirteen patients. Oral Surg Oral Med Oral Pathol 72 : 400, 1991 https://doi.org/10.1016/0030-4220(91)90547-P
  18. Lindhal L : Condylar fractures of the mandible. I. Classification and relation to age, occlusion, and concomitant injuries of teeth and teeth-supporting structures, and fractures of the mandibular body. Int J Oral Surg 6 : 12, 1977a https://doi.org/10.1016/S0300-9785(77)80067-7
  19. Bradley PF : Injuries of the condylar and coronoid process. In: Rowe NL, Williams JL (eds), Maxillofacial injuries. Edinburgh: Churchill Livingstone, 1985, p337-362, p412- 417
  20. Worsaae N, Thorn JJ : Surgical versus nonsurgical treatment of unilateral dislocated low subcondylar fractures: a clinical study of 52 cases. J Oral Maxillofac Surg 52 : 353, 1994 https://doi.org/10.1016/0278-2391(94)90436-7
  21. Zide MF, Kent JN : Indications for open reduction of mandibular condyle fractures. J Oral Maxillofac Surg 41 : 89, 1983 https://doi.org/10.1016/0278-2391(83)90214-8
  22. Ellis E III, Throckmorton G, Palmieri C : Further displacement of condylar process fractures after closed treatment. J Oral Maxillofac Surg 57 : 1307, 1999 https://doi.org/10.1016/S0278-2391(99)90867-4
  23. Ellis E III, Throckmorton G : Facial asymmetry after closed and open treatment of fractures of the mandibular condylar process. J Oral Maxillofac Surg 58 : 719, 2000 https://doi.org/10.1053/joms.2000.7253
  24. Smets L, Damme P, Stoelinga P : Non-surgical treatment of condylar fractures in adults: a retrospective analysis. J Craniomaxillofac Surg 31 : 162, 2003 https://doi.org/10.1016/S1010-5182(03)00025-8
  25. Joos U, Kleinheinz J : Therapy of condylar neck fractures. Int J Oral Maxillofac Surg 27 : 247, 1998 https://doi.org/10.1016/S0901-5027(05)80505-3
  26. Villarreal P, Monje F, Junquera LM, et al : Mandibular condyle fractures: Determinants of treatment and outcome. J Oral Maxillofac Surg 62 : 155, 2004 https://doi.org/10.1016/j.joms.2003.08.010
  27. Chayra GA, Meador LR, Laskin DM : Comparison of panoramic and standard radiographs for the diagnosis of mandibular fractures. J Oral Maxillofac Surg 44 : 677, 1986 https://doi.org/10.1016/0278-2391(86)90033-9
  28. Ellis E III, Throckmorton G, Palmieri C : Open treatment of condylar process fractures: Assessment of adequacy of repositioning and maintanence of stability. J Oral Maxillofac Surg 58 : 27, 2000
  29. Sung HM, Lee DK, Min SK, et al : Clinico-stastical analysis of possible factors leading to problems in the surgical treatment of unilateral mandibular condyle fractures. J KAMPRS 23 : 31, 2001
  30. Iizuka T, Ladrach K, Greering A, et al : Open reduction without fixation of dislocated condylar process fractures: long-term clinical and radiologic analysis. J Oral Maxillofac Surg 56 : 553, 1998 https://doi.org/10.1016/S0278-2391(98)90450-5
  31. Choi BH, Huh JY, Yoo JH : Computed tomographic findings of the fractured mandibular condyle after open reduction. Int J Oral Maxillofac Surg 32 : 469, 2003 https://doi.org/10.1016/S0901-5027(03)90427-9
  32. Haug R, Assael L : Outcomes of open versus closed treatment of mandibular subcondylar fractures. J Oral Maxillofac Surg 59 : 370, 2001 https://doi.org/10.1053/joms.2001.21868