以可吸收骨板開放式復位內固定合併環下顎骨結紮法處理兒童下顎骨聯合旁與骨體骨折－病例報告

Open Reduction with Internal Fixation with Resorbable Plates and Circumman-dibular Wiring for Management of Pediatric Mandibular Parasymphysis and Body Fractures-A Case Report

林彥宏(Arthur Yen-Hung Lin)

《臺灣口腔顎面外科學會雜誌》 28卷1期 (2017/03) Pp. 68-76

摘要

下顎骨骨折是兒童顎面外傷中最常見的類型之一，由於兒童下顎骨骨頭較有彈性且骨質較軟，骨折大部分爲不完全骨折，加上下顎骨有未萌發恆牙牙胚，所以治療上大部分採用保守性治療。閉鎖式骨復位治療已被確定對下顎骨骨折爲成功的治療方式，但隨著骨頭修復的人工材料與技術的進步，採用開放式復位内固定手術的比例對於治療兒童下顎骨骨折有越來越多的趨勢。本病例爲一名七歲女童因爲車禍導致顏面外傷，第一時間由他院初步處理。經環口影像學檢查和錐狀射束電腦斷層掃描診斷爲右側下顎聯合旁與左側下顎骨骨體骨折合併前牙開咬，轉診至本院口腔顎面外科尋求進一步評估和治療。考慮到下顎骨骨折位移過大與顏面歪斜，採開放式復位内固定手術，使用可吸收骨板和骨釘，及環下顎骨結紮做固定以避免恆牙胚與下齒槽神經傷害，術後不需使用上下顎間鋼絲固定牙齒，追蹤骨癒合及咬合狀況良好，並沒有下唇神經麻木後遺症。

關鍵字

兒童下顎骨骨折 ； 開放式內固定復位 ； 可吸收骨板

並列摘要

Mandibular fracture is one of the most common types of pediatric maxillofacial trauma. As the mandible in children is relatively soft and has good elasticity, incomplete fractures are more common; as there are permanent tooth buds in the mandible，the treatment of mandibular fractures in children is often conservative. Closed reduction and immobilization of mandible fractures has proven to be a predictable and successful modality of treatment for almost all types of mandible fractures. However, open reduction with internal fixation has slowly become a more accepted form of treatment in displaced and difficult fractures. Given the progress made in bone-repair materials and the improvement of bone-repair technology, the proportion of children with mandibular fractures treated with open reduction and internal xation (ORIF) has increased. In the present report, we presented a case of a 7-year-old girl who was suffered from a traffic accident and initial treatment was done at other hospital. After panoramic film and computed tomography examination, the diagnosis was fractures of right mandibular parasymphysis and left mandibular body with malocclusion and anterior openbite. The initial sutures of laceration wounds over face were done and then she was referred to our hospital for further evaluation and treatment. Considering about unfavorable fractures of mandible and facial asymmetry, we arranged open reduction and internal fixation with resorbable plates and circummandibular wiring for fixation in order to avoid injury of inferior alveolar nerve with teeth germ and increase strength of ridged fixation. The dental occlusion is recovery and no complication of numbness of lower lip.

並列關鍵字

Mandibular fracture in children ； Open reduction and internal fixation ； Resorbable plate