Pediatrik ünilateral kondil kırığında konservatif tedavi yaklaşımı: Olgu Raporu

Pediatrik hastalarda travma sonrası kondil kırıklarına rastlanma sıklığı yüksektir. 9 yaşında kız hasta, bisikletten düştükten sonra alt çene ucuna aldığı darbe sonucu sağ çenesinde gelişen ağrı şikayeti ile kliniğimize başvurdu. Ağız açmada kısıtlılık ve ağız kapamada sağ tarafta erken temas gözlendi. Panoramik röntgende sağ kondil boynunda horizontal kırık hattı gözlendi ve dental volumetrik tomografisinde kırık segmentin mediale deviasyon gösterdiği saptandı. Tedavi planlamasında genel anestezi altında kapalı redüksiyon ve intermaksiller fiksasyon (IMF) yapılmasına karar verildi. Hastanın karışık dişlenmesi ve daimi azı dişlerindeki çürükler sebebiyle her iki çeneye arch bar ile modifiye edilmiş akrilik splint yerleştirilmesine karar verildi. Operasyon esnasında üst çeneye adapte edilen splintin kırılması ile tedavi planı değiştirildi. Çoğunluğu daimi dişlerden oluşan üst çeneye ligatür telleri yardımı ile arch bar uygulandı ve elastikler ile IMF sağlandı. Ekstrakapsüler kırıkların tedavisinde en iyi yaklaşımın çiğneme olmayan beslenme ve elastik rehberliğinde yapılan kapalı redüksiyon olduğu belirtilmektedir. Süt dişlerine arch bar uygulaması ile avülsiyon riski bulunsa da doğru planlama, komplikasyon oluşma ihtimalini düşürmektedir. Bu olgu sunumunda karışık dişlenme döneminde pediatrik hastada meydana gelen tek taraflı kondil kırığına uygulanan konservatif tedavi yaklaşımının sunulması amaçlanmaktadır.

Conservative treatment approach in pediatric unilateral condylar fracture: A Case Report

The incidence of condylar fractures after trauma is high in pediatric patients. A 9-year-old female patient was admitted to our clinic with the complaint of pain in her right jaw as a result of a blow to the tip of her lower jaw after falling off the bicycle. Limitation of mouth opening and early contact on the right side during mouth closing were observed. A horizontal fracture line was observed in the right condyle neck on the panoramic x-ray and dental volumetric tomography revealed medial deviation of the fractured segment. In the treatment planning, it was decided to perform closed reduction and intermaxillary fixation (IMF) under general anesthesia. Due to the patient's mixed dentition and caries in her permanent molar teeth, it was decided to place acrylic splints modified with arch bar in both jaws. The treatment plan was changed during the operation after the fracture of the splint that was adapted to the upper jaw. An arch bar was applied to the upper jaw, mostly consisting of permanent teeth, with the help of ligature wires, and the IMF was provided with elastics. It is stated that the best approach in the treatment of extracapsular fractures is non-chewing nutrition and closed reduction with elastic guidance. Although arch bar application on deciduous teeth runs the risk of avulsion, correct planning reduces the possibility of complications. In this case report, it is aimed to present the conservative treatment approach applied to unilateral condyle fractures in a pediatric patient during mixed dentition.

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