Comparison of therapeutic results of closed and open repair of mandibular condylar fractures.

IF 1.4 Q3 EMERGENCY MEDICINE International Journal of Burns and Trauma Pub Date : 2021-10-15 eCollection Date: 2021-01-01
Amir Tabatabaee, Amin Javanbakht, Meysam Mohammadi Khah, Mehrdad Shahsavari-Pour, Farnaz Dehabadi
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Abstract

Background: Mandibular condylar fractures mostly result from traumatic accidents or strife. There is still dispute on the effectiveness of various therapeutic methods. Here we aimed to evaluate and compare the open or closed repair methods for mandibular condylar fractures.

Methods: This is a clinical trial that was performed in 2015-2021 in Iran on all patients that referred to our medical centers with mandibular fractures due to traumatic events. Those cases with severe lateral dislocation of the mandibular condyles or severe dislocations of the fractured parts were assigned to the open surgical treatment group. The other patients were treated using Arch bar + intermaxillary fixation (IMF). The patient's abilities of mouth opening were assessed in centimeters within 1 month, 3 months, 6 months, 1 year and 2 years after the operations.

Results: 726 mandibular fractures were evaluated. Our data showed that 302 fractures (41.6%) were in the mandibular condyles. Of the 302 condylar fractures, 172 fractures (57.1%) occurred due to automobile accidents and 82 fractures (27.5%) occurred due to direct trauma. 203 patients (67.2%) underwent the close surgical procedures using maxillary and mandibular fixation using arch bar + IMF. 99 patients (32.8%) underwent open mandibular fixation operation and internal fixation (ORIF). Assessments of mouth opening showed significant improvements in this ability within the follow-up period in both groups (P<0.001 for both). Furthermore, we observed that patients treated by the open mandibular fixation procedure had significantly better results within the 6 months and 1 year after the procedures but after 2 years, no significant differences could be observed between groups.

Conclusion: Both open and closed surgical approaches for condylar fractures are associated with significant improvements, however, patients that were treated with ORIF had better clinical results in the first year after the surgical procedures.

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下颌髁突骨折闭式与开放式修复的疗效比较。
背景:下颌骨髁突骨折多由外伤性事故或冲突所致。各种治疗方法的有效性仍存在争议。在这里,我们的目的是评估和比较开放或封闭修复方法下颌骨髁骨折。方法:这是一项临床试验,于2015-2021年在伊朗对所有因创伤性事件导致下颌骨折的患者进行了临床试验。对严重髁突外侧脱位或骨折部位严重脱位的患者,采用开放手术治疗组。其余患者采用弓棒+上颌间固定(IMF)治疗。术后1个月、3个月、6个月、1年、2年以厘米为单位评估患者的开口能力。结果:对726例下颌骨骨折进行了评估。我们的数据显示302例骨折(41.6%)位于下颌髁。302例髁突骨折中,172例(57.1%)为车祸所致,82例(27.5%)为外伤所致。203例(67.2%)患者接受了上颌和下颌弓棒+ IMF固定的闭合手术。99例(32.8%)患者行切开下颌骨内固定手术(ORIF)。结论:髁突骨折的开放和封闭手术入路均有显著改善,然而,接受ORIF治疗的患者在手术后的第一年有更好的临床效果。
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