Versorgung von Kiefergelenksfrakturen: Möglichkeiten und Erfolgsaussichten

Zusammenfassung

Der vorliegende Beitrag beschreibt die funktionskieferorthopädische und chirurgische Behandlung von Kiefergelenksfortsatz- und Capitulumfrakturen des Unterkiefers. Bei einer transoralen endoskopiegestützten Versorgung von Gelenkfortsatzfrakturen können wichtige nervale Strukturen geschont und sichtbare Narben verhindert werden. Bei Kindern ist die Therapie mit einem funktionskieferorthopädischen Gerät fest etabliert. Auch bei Erwachsenen können diese unterstützend oder bei der Behandlung von Capitulumfrakturen regelhaft angewendet werden.

Abstract

This article describes the functional orthodontic and surgical treatment of subcondylar mandibular and condylar fractures. By endoscopy-assisted treatment of condylar mandibular fractures important neural structures can be protected and visible scars are prevented. In children, the therapy with orthodontic devices is well established. In adults, these devices can also be used supportive or for condylar fracture treatment.

Schlüsselwörter

Unterkiefer - Kiefergelenksfortsatz- und Capitulumfrakturen - Endoskopie Funktionskieferorthopädie

Key words

mandible - subcondylar and condylar fractures - endoscopy - functional orthodontics

• Literatur

• 1 Ellis E, Moos KF, el-Attar A. Ten years of mandibular fractures: an analysis of 2,137 cases. Oral Surg Oral Med Oral Pathol 1985; 59: 120-129
• 2 Neff A, Cornelius C-P, Rasse M. et al. The comprehensive AOCMF classification system: Condylar process fractures – level 3 tutorial. Craniomaxillofacial Trauma Reconstr 2014; 7: S044-S058
• 3 Schön R, Roveda SI, Carter B. Mandibular fractures in Townsville, Australia: incidence, aetiology and treatment using the 2.0 AO/ASIF miniplate system. Br J Oral Maxillofac Surg 2001; 39: 145-148
• 4 Sharif MO, Fedorowicz Z, Drews P. et al. Interventions for the treatment of fractures of the mandibular condyle. Cochrane Database Syst Rev 2010; CD006538 DOI: doi 10.1002/14651858.CD006538.pub2.
• 5 Neff A, Cornelius C-P, Rasse M. et al. Kiefergelenkfortsatzfrakturen nach der AO-CMF-Trauma-Klassifikation. MKG-Chir 2017; 10: 113-126
• 6 Eckelt U. Fractures of the mandibular condyle. Mund- Kiefer- Gesichtschirurgie MKG 2000; 4 (Suppl. 01) S110-S117
• 7 Loukota RA, Eckelt U, De Bont L. et al. Subclassification of fractures of the condylar process of the mandible. Br J Oral Maxillofac Surg 2005; 43: 72-73
• 8 Rasse M. Recent developments in therapy of condylar fractures of the mandible. Mund- Kiefer- Gesichtschirurgie MKG 2000; 4: 69-87
• 9 Ellis E, Dean J. Rigid fixation of mandibular condyle fractures. Oral Surg Oral Med Oral Pathol 1993; 76: 6-15
• 10 Schmelzeisen R, Cienfuegos-Monroy R, Schn R. et al. Patient Benefit From Endoscopically Assisted Fixation of Condylar Neck Fractures?A Randomized Controlled Trial. J Oral Maxillofac Surg 2009; 67: 147-158
• 11 Chen CT, Lai JP, Tung TC. et al. Endoscopically assisted mandibular subcondylar fracture repair. Plast Reconstr Surg 1999; 103: 60-65
• 12 Lauer G, Schmelzeisen R. Endoscope-assisted fixation of mandibular condylar process fractures. J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg 1999; 57: 36-39 discussion 39–40
• 13 Schön R, Gutwald R, Schramm A. et al. Endoscopy-assisted open treatment of condylar fractures of the mandible: extraoral vs intraoral approach. Int J Oral Maxillofac Surg 2002; 31: 237-243
• 14 Farronato G, Grillo ME, Giannini L. et al. Long-term results of early condylar fracture correction: case report. Dent Traumatol Off Publ Int Assoc Dent Traumatol 2009; 25: e37-e42
• 15 Goth S, Sawatari Y, Peleg M. Management of pediatric mandible fractures. J Craniofac Surg 2012; 23: 47-56
• 16 Tavares CAE, Allgayer S. Conservative orthodontic treatment for a patient with a unilateral condylar fracture. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod 2012; 141: e75-e84
• 17 Hayward JR, Scott RF. Fractures of the mandibular condyle. J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg 1993; 51: 57-61
• 18 Takenoshita Y, Ishibashi H, Oka M. Comparison of functional recovery after nonsurgical and surgical treatment of condylar fractures. J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg 1990; 48: 1191-1195
• 19 Kambalimath HV, Agarwal SM, Kambalimath DH. et al. Maxillofacial Injuries in Children: A 10 year Retrospective Study. J Maxillofac Oral Surg 2013; 12: 140-144
• 20 Rowe NL. Fractures of the jaws in children. J Oral Surg Am Dent Assoc 1965 1969; 27: 497-507
• 21 Iatrou I, Theologie-Lygidakis N, Tzerbos F. Surgical protocols and outcome for the treatment of maxillofacial fractures in children: 9 years’ experience. J Cranio-Maxillo-Fac Surg Off Publ Eur Assoc Cranio-Maxillo-Fac Surg 2010; 38: 511-516
• 22 Schoen R, Gellrich N-C, Schmelzeisen R. Minimally invasive open reduction of a displaced condylar fracture in a child. Br J Oral Maxillofac Surg 2005; 43: 258-260
• 23 Kahl-Nieke B, Fischbach R. Condylar restoration after early TMJ fractures and functional appliance therapy. Part I: Remodelling. J Orofac Orthop Fortschritte Kieferorthopadie Organ. Official J Dtsch Ges Kieferorthopadie 1998; 59: 150-162