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

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