Avtor/Urednik		Vesnaver, Aleš; Kansky, Andrej; Eberlinc, Andreja; Gorjanc, Matija; Dovšak, David
Naslov		Kirurško zdravljenje zlomov sklepnega odrastka mandibule s transparotidnim pristopom kot pri faceliftu - uvedba nove metode zdravljenja
Prevedeni naslov		Surgical treatment of mandibular condyle fractures using the transparotid facelift approach - introducing a new method of treatment
Tip		članek
Vir		Zdrav Vestn
Vol. in št.		Letnik 73, št. 7-8
Leto izdaje		2004
Obseg		str. 569-75
Jezik		slo
Abstrakt		Background. In the past, fractures of the mandibular condylar process were treated almost exclusively conservatively at our institution, by means of a three week period of intermaxillary fixation (IMF), followed by excercises and a soft diet. In the last three years, we started treating these fractures surgically with increasing frequency by open reduction and internal fixation with mini plates and screws. Our goal was to determine the safety and efficiency of surgical treatment as the results of conservative treatment were often unsatisfactory. Patients and methods. So far, 34 patients with 36 extraarticular condyle fractures were treated surgically by a periauricular transparotid approach. The operative procedure is demanding. Namely, branches of the facial nerve have to be identified, dissected and retracted, in order to reach the fracture site. The fracture was reduced and fixed with one or two mini plates. Patients were carefully followed up and were asked to answer a survey paper, which was completed by 32 patients. Results. All of the patients were able to open their mouth immediately postoperatively. The postoperative IMF lasted 1 week at maximum and the facial symetry was achieved in all cases. Pre-traumatic occlusion was achieved in 31 out of 33 dentate patients (94%). Eight out of 36 cases (22%) had transitory weakness of the facial nerve branches, most often the buccal and zygomatic branch. Of these, 5 resolved completely at 2-8 weeks, while a mild degree of weakness is still present in the lower eyelid and half of the upper lip in a female patient, 13 months postoperatively. The cosmetic effect is good as the periauricular facelift incision leaves a barely perceptible scar. According to the postoperative survey completed by 32 patients, 30 of them (94%) were very satisfied with the outcome of treatment Conclusion. The procedure is safe with a careful surgical technique and the results of operative treatment are excellent.
Izvleček		Izhodišča. V preteklosti so se zlomi kondilarnih oz sklepnih odrastkov mandibule tudi na naši ustanovi praviloma zdravili konzervativno, s tremi tedni intermaksilarne fiksacije (IMF), kasnejšim razgibavanjem in uživanjem mehke hrane. V zadnjih treh letih pa smo začeli te zlome na našem oddelku vse pogosteje zdraviti kirurško, z odprto repozicijo in interno fiksacijo z mini ploščicami in vijaki. Cilj naše raziskave je bil ugotoviti varnost in učinkovitost kirurškega zdravljenja, saj z rezultati konzervativnega zdravljenja pogosto nismo bili zadovoljni. Bolniki in metode. Skupno smo s periavrikularnim transparotidnim pristopom operirali 34 pacientov s 36 ekstraartikularnimi zlomi kondila. Operacija je zahtevna, saj moramo najti, spreparirati in odmakniti veje obraznega živca, da lahko do zloma sploh pridemo. Zlom smo reponirali pod nadzorom očesa in fiksirali z eno do dvema mini ploščicama. Bolnike smo skrbno sledili in jih nato prosili, da izpolnijo anketo, čemur se je odzvalo 32 pacientov. Rezultati. Vsi pacienti so lahko po operaciji odpirali usta, nihče izmed njih ni potreboval daljše pooperativne IMF kot en teden, simetrija obraza je bila dosežena pri vseh. Okluzija, enaka kot pred poškodbo, je bila dosežena pri 31 od 33 ozobjenih pacientov (94%). Osem od 36 primerov (22%) je imelo prehodno parezo nekaterih vej facialisa, največkrat bukalne in zigomatične veje. Od teh je pri 7 bolnikih popolnoma izginila v 2 do 8 tednih, pri eni bolnici pa je po 13 mesecih še malenkostno opazna šibkost spodnje veke in polovice zgornje ustnice. Kozmetični učinek posega je dober, saj je pri periavrikularnem rezu po tipu facelifta brazgotina komaj opazna. V anketi je 30 od 32 bolnikov (94%) odgovorilo, da so zelo zadovoljni z izidom zdravljenja. Zaključek. Pri dobri kirurški tehniki je poseg varen, uspehi kirurškega zdravljenja pa odlični.
Deskriptorji		MANDIBULAR FRACTURES MANDIBULAR CONDYLE FRACTURE FIXATION, INTERNAL BONE PLATES BONE SCREWS TREATMENT OUTCOME