하악 과두 골절에 대한 4년간의 후향적 임상연구
A retrospective clinical study of condylar fractures of the mandible in a 4-year period
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The present study was performed to evaluate the function of the mandible according to the pattern of fracture and treatment methods of condylar fractures of the mandible and help operators in making a treatment plan. Sixty patients (average follow-up period was 7.8±9.4 months) who were treated for condylar fracture from June, 2002 to May, 2006 at the Department of Oral and Maxillofacial surgery, Chonnam National University Hospital were reviewed. The common causes of the condylar fracture were traffic accident and fall-down (35.0%). In concomitant injuries, laceration was 46.7% and the fracture of the mandibular symphysis was highest incidence (60.0%). The common site of the fracture was the condylar head (47.8%), followed by subcondyle (36.2%) and condylar neck (15.9%). Under 15 years old patients, the closed reduction was performed in 87.5% out of the patients. All of the condylar fragments were fixed to the mandible with titanium miniplates in cases of open reduction. The mean period of intermaxillary fixation (IMF) was 14.2±6.5 days in closed reduction and 10.0±4.2 days in open reduction. The old patient with bilateral condylar head fractures, who were treated by closed reduction with IMF for 3 weeks, showed the limitation of mandibular movements. But, there was no significant different results between open reduction and closed reduction with the respect of the Helkimo's mandibular mobility index and clinical dysfunction index (DI). Complications, such as fibrous ankylosis and resorption of the mandibular condyle, were not observed in all patients. These results suggest that the good results can be obtained by closed reduction with proper IMF periods and functional exercise in most condylar fractures of the mandible except severely displaced extracapsular fractures.
Abstract
The present study was performed to evaluate the function of the mandible according to the pattern of fracture and treatment methods of condylar fractures of the mandible and help operators in making a treatment plan. Sixty patients (average follow-up period was 7.8±9.4 months) who were treated for condylar fracture from June, 2002 to May, 2006 at the Department of Oral and Maxillofacial surgery, Chonnam National University Hospital were reviewed. The common causes of the condylar fracture were traffic accident and fall-down (35.0%). In concomitant injuries, laceration was 46.7% and the fracture of the mandibular symphysis was highest incidence (60.0%). The common site of the fracture was the condylar head (47.8%), followed by subcondyle (36.2%) and condylar neck (15.9%). Under 15 years old patients, the closed reduction was performed in 87.5% out of the patients. All of the condylar fragments were fixed to the mandible with titanium miniplates in cases of open reduction. The mean period of intermaxillary fixation (IMF) was 14.2±6.5 days in closed reduction and 10.0±4.2 days in open reduction. The old patient with bilateral condylar head fractures, who were treated by closed reduction with IMF for 3 weeks, showed the limitation of mandibular movements. But, there was no significant different results between open reduction and closed reduction with the respect of the Helkimo's mandibular mobility index and clinical dysfunction index (DI). Complications, such as fibrous ankylosis and resorption of the mandibular condyle, were not observed in all patients. These results suggest that the good results can be obtained by closed reduction with proper IMF periods and functional exercise in most condylar fractures of the mandible except severely displaced extracapsular fractures.
참고문헌 (34)
- Villarreal PM, "Mandibular condyle fractures: determinants of treatment and outcome", J Oral Maxillofac Surg, 62, pp.155~163 (2004)
- Fonceca GD, "Experimental study on fractures of the mandibular condylar process", Int J Oral Surg, 3, pp.89~101 (1974)
- Lindahl 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, pp.12~21 (1977)
- Umstadta HE, "Mu ¨llerb HH, Austermanna KH: Functional reconstruction of the TM joint in cases of severely displaced fractures and fracture dislocation", J Cranio Maxillofac Surg, 28, pp.97~105 (2000)
- Ferri J, "Severe congenital hypoplasia of the mandibular condyle-diagnosis and treatment: a report of 2 cases", J Oral Maxillofac Surg, 64, pp.972~980 (2006)
- Hovinga J, "Long-term results of nonsurgical management of condylar fractures in children", Int J Oral Maxillofac Surg, 28, pp.429~440 (1999)
- Palmieri C, "Mandibular motion after closed and open treatment of unilateral mandibular condylar process fractures", J Oral Maxillofac Surg, 57, pp.764~775 (1999)
- Dingman RO, "Surgery of facial fractures", pp.143~145 (1964), Philadelphia, W.B. Saunders Co
- Helkimo M, "Studies on function and dysfunction of the masticatory system. II. Index for anamnestic and clinical dysfunction and occlusal state", Sven Tandlak Tidskr, 67, pp.101~121 (1974)
- Silvennoinen U, "Different patterns of condylar fractures: an analysis of 382 patients in a 3-year period", J Oral Maxillofac Surg, 50, pp.1032~1037 (1992)
- 이상철, "하악 과두 골절의 임상통계학적 연구", 대구외지, 24, pp.326~329 (1998)
- 이희철, "하악골 관절 과두돌기 골절의 임상적 연구", 대악성외지, 11, pp.287~295 (1989)
- 민승기, "하악 과두 골절에 관한 장기추적조사연구", 대한악안면성형재건외과학회지, 27(6), pp.535~544 (2005), 대한악안면성형재건외과학회
- Haug RH, "An epidemilogic survey of facial fractures and concomitnat injuries", J Oral Maxillofac Surg, 48, pp.925~932 (1990)
- Guven O, "Remodelling following condylar fractures in children", J Craniomaxillofac Surg, 29, pp.232~237 (2001)
- 유선열, "소아에서 하악과두 골절의 보존적 치료 후 골개조", 대한구강악안면외과학회지, 30(1), pp.49~55 (2004), 대한구강악안면외과학회
- MacLennan WD, "Consideration of 180 cases of typical fractures of the mandibular condylar process", Br J Plast Surg, 5, pp.122~128 (1952)
- Zide MF, "Indications for open reduction of mandibular condyle fractures", J Oral Maxillofac Surg, 41, pp.89~98 (1983)
- Silvennoinen U, "Occlusal and temporomandibular joint disorders in patients with unilateral condylar fracture. A prospective one-year study", Int J Oral Maxillofac Surg, 27, pp.280~285 (1998)
- Smets LM, "Non-surgical treatment of condylar fractures in adults: a retrospective analysis", J Craniomaxillofac Surg, 31, pp.162~167 (2003)
- Throckmorton GS, "Recovery of mandibular motion after closed and open treatment of unilateral mandibular condylar process fractures", Int J Oral Maxillofac Surg, 29, pp.421~427 (2000)
- Stiesch-Scholz M, "Condylar motion after open and closed treatment of mandibular condylar fractures", J Oral Maxillofac Surg, 63, pp.1304~1309 (2005)
- Ellis E 3rd, "Rigid fixation of mandibular condyle fractures", Oral Surg Oral Med Oral Pathol, 76, pp.6~15 (1993)
- Lachner J, "Open reduction and internal rigid fixation of subcondylar fractures via an intraoral approach", Oral Surg Oral Med Oral Pathol, 71, pp.257~261 (1991)
- Kendell BD, "Applied surgical anatomy of the head and neck In: Fonseca RJ, Walker RV, Betts NJ, Barber HD, PowersMP. Oral and maxillofacial trauma 3rd ed", St. Louis ElsevierSaunders Co, pp.281~328 (2005)
- Ellis E, "A method to rigidly fix highcondylar fractures", Oral Surg Oral Med Oral Pathol, 68, pp.369~374 (1989)
- Haug RH, "Outcomes of open versus closed treatment of mandibular subcondylar fractures", J Oral Maxillofac Surg, 59, pp.370~375 (2001)
- Konstantinovic FX, "Surgical versus conservative treatment of unilateral condylar process fractures: clinical and radiographic evaluation of 80 patients", J Oral Maxillofac Surg, 50, pp.352~353 (1992)
- Santler G, "Fractures of the condylar process: surgical versus nonsurgical treatment", J Oral MaxillofacSurg, 57, pp.392~397 (1999)
- Throckmorton G, "Masticatory motion after surgical or nonsurgical treatment for unilateral fractures of the mandibular condylar process", J Oral Maxillofac Surg, 62, pp.127~138 (2004)
- Marker P, "Fractures of mandibular condyle. Part2: results for treatment of 348 patients", Br J OralMaxillofac Surg, 38, pp.422~426 (2000)
- Andersson J, "Unilateral mandibular condylar fractures: a 31-year follow-up of non-surgical treatment", Int J Oral Maxillofac Surg, 36, pp.310~314 (2007)
- Neff A, "Surgical vs nonsurgical treatment in diacapitular and high condylar fractures with dislocation. A comparison based on magnetic resonance imaging and anxiography", Mund Kiefer GesichtsChir, 6, pp.66~73 (2002)
- Hlawitschka M, "Functional and radiological results of open and closed treatment of intracapsular (diacapitular) condylar fractures of the mandible", Int J Oal Maxillofac Surg, 34, pp.597~604 (2005)