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

Öz

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.

Anahtar Kelimeler

• closed reduction
• intermaxillary fixation
• mandibular subcondyl fracture
• malocclusion

MANDİBULAR SUBKONDİLER KIRIKLARDA TEDAVİ YAKLAŞIMLARI İLE KOMPLİKASYONLAR ARASINDAKİ İLİŞKİ

Öz

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.

Anahtar Kelimeler

• kapalı redüksiyon
• intermaksiller fiksasyon
• mandibular subkondil kırığı
• maloklüzyon

Kaynakça

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