MANDİBULAR SUBKONDİLER KIRIKLARDA TEDAVİ YAKLAŞIMLARI İLE KOMPLİKASYONLAR ARASINDAKİ İLİŞKİ

Year 2023, Volume: 30 Issue: 3, 544 - 550, 23.09.2023

Mehmet Tapan Hasan Murat Ergani

https://doi.org/10.17343/sdutfd.1349794

Abstract

Amaç
Mandibula kondil kırıkları, mandibulada en sık görülen
kırık türlerinden biri olmasına rağmen tedavisi
tartışmalıdır. Bu çalışmanın amacı tedavi yönteminin
güvenliğini belirlemek, postoperatif komplikasyonları
azaltmak ve klinik deneyimimizi anlatmaktır.
Gereç ve Yöntem
Subkondiler mandibular kırığı olan 53 hasta dahil edildi.
Hastalar kapalı redüksiyon (KR) veya açık redüksiyon
ve internal fiksasyon (ARIF) ile tedavi edildi. Tüm
hastalarda intermaksiller fiksasyon (IMF) için arch bar
veya intermaksiller vidalar ve lastik kullanıldı. Ardından
istatistiksel analiz yapıldı.
Bulgular
Çalışmaya toplam 37 erkek hasta ve 16 kadın hasta
dahil edildi. Çalışmada mandibula kırıklarının en sık
nedeni düşmelerdi (n=23; %43,3). Ameliyat sonrası
komplikasyonlar arasında maloklüzyon, temporomandibular
disfonksiyon (ağız açıklığının 30 mm'den az
olması), fasiyal sinir nöropraksisi ve enfeksiyon yer
alıyordu. Ameliyat sonrası maloklüzyon komplikasyonu
açısından KR ve ARIF grupları arasında istatistiksel
olarak anlamlı bir fark yoktu.Maloklüzyona sahip
hastaların tamamında (n=8) eşlik eden kırıklar (n=23)
mevcuttu. Ameliyat sonrası maloklüzyon komplikasyonu
açısından alt gruplar (eşlik eden kırığı olan grup ve
eşlik eden kırığı olmayan grup) arasında istatistiksel
olarak anlamlı fark vardı. Ortalama 21 günlük bir süre
de her zaman temporomandibular disfonksiyon ile ilişkilendirilmiştir
Sonuç
Bu çalışma, uygun tedavi seçiminin belirlenmesinde
avantaj ve dezavantajları dengelemenin gerekliliğini
ortaya koymuştur. ARIF'in birçok avantajı vardır; ancak
ameliyat sonrası komplikasyonlar da eşlik edebilir.
IMF'nin kullanım süresi fonksiyonel bozukluklara yol
açabileceğinden hastaların tedavi kararında hekimlerle
iş birliği yapması gerekmektedir.

Keywords

kapalı redüksiyon, intermaksiller fiksasyon, mandibular subkondil kırığı, maloklüzyon

THE RELATIONSHIP BETWEEN THE TREATMENT APPROACHES AND COMPLICATIONS IN MANDIBULAR SUBCONDYLAR FRACTURES

Abstract

Objective
Although mandibular condylar fractures represent one
of the most frequent types of fractures in the mandible,
their treatment remains controversial. This study
aimed to determine the safety of treatment method,
reduce postoperative complications, and describe our
clinical experience.
Material and Method
Fifty-three patients with subcondylar mandibular fractures
were included. The patients were treated with
closed reduction (CR) or open reduction and internal
fixation (ORIF). Arch bar or intermaxillary screws, and
rubber were used for intermaxillary fixation (IMF) in all
patients. Statistical analysis was subsequently performed.
Results
A total of 37 male patients and 16 female patients
were included in this study. Falls were the most
common cause of mandibular fractures in the study
(n=23; 43.3%). Postoperative complications included
malocclusion, temporomandibular dysfunction (mouth
opening less than 30 mm), facial nerve neuropathy,
and infection. There was no statistically significant difference
between the CR and ORIF groups in the postoperative
complication of malocclusion.All patients
with malocclusion (n=8) had concomitant fractures
(n=23). There was a statistically significant difference
between the subgroups (group with concomitant fracture
and group without concomitant fracture) in terms
of postoperative malocclusion complications. A mean
duration of 21 days was also always associated with
temporomandibular dysfunction.
Conclusion
This study demonstrated the need for balancing the
pros and cons in determining the proper treatment
choice. ORIF has several advantages; however, it
can be accompanied by postoperative complications.
The duration of IMF can lead to functional disorders,
and patients should cooperate with consultants in the
treatment decision.

Keywords

closed reduction, intermaxillary fixation, mandibular subcondyl fracture, malocclusion

References

• 1. Ellis E III, Dean J. Rigid fixation of mandibular condyle fractures. Oral Surg Oral Med Oral Pathol 1993;76:6–15
• 2. 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 1977;6:12-21
• 3. Lee HC, Kang DH, Koo SH, et al. The outcome of open reduction via retromandibular approach for mandibular subcondyle fracture. J Korean Soc Plast Reconstr Surg 2005;32:739- 743
• 4. Kim SY, Ryu JY, Cho JY, et al. Outcomes of open versus closed treatment in the management of mandibular subcondylar fractures, J Korean Assoc Oral Maxillofac Surg 2014; 40(6):297-300
• 5. Zide MF, Kent JN. Indications for open reduction of mandibular condyle fractures. J Oral Maxillofac Surg 1983;41:89-98
• 6. Lee W, Kang DH. Study of the plating methods in the experimental model of mandibular subcondyle fracture. J Korean Cleft Palate-Craniofac Assoc 2011;12:12-16
• 7. Zide MF, Kent JN. Indications for open reduction of mandibular condyle fractures. J Oral Maxillofac Surg 1983;41:89–98
• 8. Sugamata A, Yoshizawa N, Jimbo Y. Open Reduction of Subcondylar Fractures Using a New Retractor, Plast Surg Int 2011;2011:421245
• 9. Rutges JP, Kruizinga EH, Rosenberg A, et al. Functional results after conservative treatment of fractures of the mandibular condyle. Br J Oral Maxillofac Surg 2007;45:30–34
• 10. Hlawitschka M, Loukota R, Eckelt U. Functional and radiological results of open and closed treatment of intracapsular (diacapitular) condylar fractures of the mandible. Int J Oral Maxillofac Surg 2005;34:597–604
• 11. Landes CA, Day K, Lipphardt R, et al. Prospective closed treatment of nondisplaced and nondislocated condylar neck and head fractures versus open reposition internal fixation of displaced and dislocated fractures. Oral Maxillofac Surg 2008;12:79–88
• 12. Ellis III E, McFadden D, Simon P, et al. Surgical complications with open treatment of mandibular condylar process fractures. J Oral Maxillofac Surg 2000;58:950–958
• 13. Manisali M, Amin M, Aghabeigi B, et al. Retromandibular approach to the mandibular condyle: a clinical and cadaveric study. Int J Oral Maxillofac Surg 2003;32:253–256
• 14. Narayanan V, Kannan R, Sreekumar K. Retromandibular approach for reduction and fixation of mandibular condylar fractures:a clinical experience. Int J Oral Maxillofac Surg 2009;38:835–839
• 15. Biglioli F, Colletti G. Transmasseter approach to condylar fractures by mini- retromandibular access. J Oral Maxillofac Surg 2009;67:2418–2424
• 16. Romagnoli R, Bernardi M, Tagliente F, et al. Effect of immobilization after treatment of mandibular fractures, Minerva Stomatol 1999;48:203-208
• 17. Larry H. Soft tissue and Skeletal Injuries of the Face. In:Harry Hollier JR, Kelley Patrick. Grabb, Smith Plastic Surgery (6th Ed.) Philadelphia, Lippincott Williams and Wilkins, 2007; 315- 332.
• 18. Theologie-Lygidakis N, Chatzidimitriou K, Tzerbos F, et al. Nonsurgical management of condylar fractures in children: A 15-year clinical retrospective study. J Craniomaxillofac Surg 2016;44:85-93
• 19. Kempers K.G, Quinn PD, Silverstein K. Surgical approaches to mandibular condylar fractures: a review. J Craniomaxillofac Trauma 1999; 5:25–30
• 20. Nam SN, Lee JH, Kim JH. The application of the Risdon approach for mandibular condyle fractures. BMC Surg. 2013;13:25
• 21. Jose A, Yadav P, Roychoudhury A, et al. Study of Topographic Anatomy of Temporal and Marginal Mandibular Branches of the Facial Nerve in Relation to Temporomandibular Joint Surgery. J Oral Maxillofac Surg 2021; 79:343.e1-343.e11