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Transorale operative Therapie von Kiefergelenkfrakturen mit einer 3D-Platte

Transoral osteosynthesis of condylar neck fractures using a three-dimensional plate

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Zusammenfassung

Fragestellung

Der transorale Zugang reduziert das Risiko einer Schädigung des N. facialis, aber das Anbringen von zwei Osteosyntheseplatten am proximalen Fragment zur Erzielung einer ausreichenden Stabilität ist oft nicht möglich. Um eine stabile Osteosynthese auch höher gelegener Frakturen zu ermöglichen, wurde eine neue deltaförmige Osteosyntheseplatte entwickelt, die den Belastungsverhältnissen am Kiefergelenk gerecht wird. Diese Platte wurde klinisch getestet.

Patienten und Methode

Insgesamt 11 Patienten mit 13 Kiefergelenkfrakturen (Spiessl I: n = 2, Spiessl II: n = 10, Spiessl III: n = 1, davon 3 beidseitige Frakturen) wurden über einen transoralen Zugangsweg operiert und klinisch sowie röntgenologisch nachkontrolliert. Beurteilt wurden funktionelle Parameter sowie die Frakturstellung im Röntgenbild.

Ergebnisse

Nach mehr als 6 Monaten hatte sich die Funktion mit einer maximalen Schneidekantendistanz von 42 mm sowie Pro- und Laterotrusion von über 5 mm normalisiert. Die Röntgenkontrollen zeigten postoperativ bei 7 der 8 Patienten bzw. nach 6 Monaten bei 6 der 8 Patienten eine vollständige Wiederherstellung der Ramushöhe im Orthopantogramm. Die Clementschitsch-Aufnahme zeigte bei 12 der 13 Frakturen postoperativ bzw. bei 10 der 13 Frakturen nach 6 Monaten eine anatomisch korrekte Position. Plattenbrüche oder Plattendeformierungen traten nicht auf. Bei 2 Patienten wurden zum Zeitpunkt der Materialentfernung gelockerte Schrauben gefunden.

Schlussfolgerungen

Die neu entwickelte 3D-Platte ließ sich gut handhaben und war zur Versorgung von Kiefergelenkfrakturen ausreichend stabil. Zur operativen Therapie über einen transoralen Zugang unter Vermeidung extraoraler Narben und einer Schädigung des N. facialis kann die Platte empfohlen werden.

Abstract

Aim

The transoral approach minimizes the risk of damaging the facial nerve. However, stable osteosynthesis with two miniplates at the proximal fragment is often not possible. To achieve a stable fixation also of condylar neck fractures a new delta-shaped plate was developed, which meets the biomechanical demands of this region. This plate was tested in a clinical study.

Patients and methods

In total 11 patients suffering from 13 condyle fractures (Spiessl I: n = 2, Spiessl II: n = 10, Spiessl III: n = 1, 3 bilateral fractures) were treated via a transoral approach and assessed clinically as well as radiologically in the follow-up period. Functional parameters and fracture alignment were assessed.

Results

After 6 months postoperative function had returned to normal with a mouth opening of 42 mm and pro- and laterotrusion of more than 5 mm. Postoperative radiographic controls showed a good fracture alignment in 7 of 8 patients respectively in 6 of 8 cases after 6 months. In 12 of 13 fractures directly postoperative and in 10 of 13 fractures 6 months postoperative, respectively, Towne's view radiographs showed an anatomical correct position. No plate fracture and no bending of plates were observed. Loosening of screws was found in 2 patients during plate removal.

Conclusion

The newly developed three-dimensional plate was easy to handle, and a sufficiently stable osteosynthesis of condyle fractures was possible. This plate can be recommended for surgical fracture treatment via a transoral approach omitting extraoral scars and damage to the facial nerve.

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Authors and Affiliations

  1. Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany

    G. Lauer, W. Pradel, M. Schneider & U. Eckelt

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  1. G. Lauer
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  2. W. Pradel
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  3. M. Schneider
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  4. U. Eckelt
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Correspondence to G. Lauer.

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Lauer, G., Pradel, W., Schneider, M. et al. Transorale operative Therapie von Kiefergelenkfrakturen mit einer 3D-Platte. Mund Kiefer GesichtsChir 10, 335–340 (2006). https://doi.org/10.1007/s10006-006-0014-8

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