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ORHAN K, ÖZEMRE M, KÖSEOĞLU SEÇGİN C, KARSLIOĞLU H, KAMBUROGLU K, GÜR GG, VURAL S. Comparison of Panoramic, Lateral Skull Projection and CBCT Images in Detection of Mandibular Condyle Fractures. CUMHURIYET DENTAL JOURNAL 2021. [DOI: 10.7126/cumudj.881763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Bindal M, Joshi A, Bhat A, Anehosur V. Are Facial Asymmetry and Condylar Displacement Associated With Ramal Height and Treatment Outcomes in Unilateral Condylar Fracture When Managed by the Closed Method? J Oral Maxillofac Surg 2018; 77:789.e1-789.e8. [PMID: 30576677 DOI: 10.1016/j.joms.2018.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 11/12/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE This study measured the mandibular ramal height in patients with unilateral condylar fractures managed by the closed method using elastic intermaxillary fixation. Its correlation with facial asymmetry and condylar displacement was assessed. This will determine whether the treatment outcome is in favor of the closed or open method. MATERIALS AND METHODS A prospective cohort study was performed. The study included patients with unilateral condylar fractures who reported to SDM Craniofacial Surgery and Research Centre, Dharwad, India. All patients in the study were managed by the closed method (nonsurgically using arch bars and elastic intermaxillary fixation). Standardized panoramic radiographs were used to assess ramal height and condylar displacement in the sagittal plane. Posteroanterior mandible and reverse Towne radiographs were used to assess facial asymmetry and condylar displacement in the coronal plane before treatment; immediately after treatment; and at 3, 6, and 12 months of follow-up. Data were subjected to statistical analysis using the analysis-of-variance test and the Pearson correlation coefficient method. RESULTS The study included 25 patients with unilateral condylar fractures managed by closed treatment; they showed a significant reduction in ramal height on the affected side by 1.15 mm (P = .0001) at 12 months' follow-up. The change in facial asymmetry was reported as 1.05 mm (P = .0016) at 12 months' follow-up. Its correlation with ramal height was noted to be insignificant (P = .07). The only significant correlation noted between facial asymmetry and condylar displacement was in the coronal plane at 12 months' follow-up (P = .04). CONCLUSIONS A weak positive correlation was noted among the assessed values on radiographs obtained during the 12-month follow-up. Facial symmetry was not greatly affected when the ramal height at the time of injury on the fractured side was reduced by 3.25 ± 0.6 mm.
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Affiliation(s)
- Mohit Bindal
- Resident, SDM Craniofacial Surgery and Research Centre, SDM College of Dental Science and Hospital, Dharwad, India
| | - Abhijit Joshi
- Associate Professor, SDM Craniofacial Surgery and Research Centre, SDM College of Dental Science and Hospital, Dharwad, India.
| | - Adithi Bhat
- Resident, SDM Craniofacial Surgery and Research Centre, SDM College of Dental Science and Hospital, Dharwad, India
| | - Venkatesh Anehosur
- Professor and Head of Department, SDM Craniofacial Surgery and Research Centre, SDM College of Dental Science and Hospital, Dharwad, India
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Chaudhary M, Pant H, Singh M, Vashistha A, Kaur G. Evaluation of trapezoidal-shaped 3-D plates for internal fixation of mandibular subcondylar fractures in adults. J Oral Biol Craniofac Res 2015; 5:134-9. [PMID: 26587378 DOI: 10.1016/j.jobcr.2015.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 07/28/2015] [Indexed: 10/23/2022] Open
Abstract
AIMS The purpose of this study is to evaluate the clinical results and to assess the efficacy, stability, and rigidity of trapezoidal 3-D plates for osteosynthesis in adult mandibular subcondylar fracture patients. METHODS This study included 15 cases of trauma having mandibular subcondylar fractures, in which open reduction and internal fixation are indicated. After selecting patient according to the inclusion criteria, all patients underwent open reduction and rigid fixation. Fracture was then stabilized using 4 hole, 2.0 mm trapezoidal-shaped 3-D titanium plates using retromandibular incision. Postoperative clinical examination was carried out on 3rd day; 1st, 2nd, and 4th weeks; and 3rd and 6th months. RESULTS The results of this study suggest that the fixation of mandibular subcondylar fracture with trapezoidal-shaped 3-D plates provides three-dimensional stability and carries low morbidity. CONCLUSION Patients with gross displacement of condylar fragment, major reduction in posterior facial height, and deranged occlusion can be successfully managed by open reduction of condylar fracture and its fixation using 3-D plates.
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Affiliation(s)
- Manoj Chaudhary
- Head, Department of Oral & Maxillofacial Surgery, Kothiwal Dental College & Research Centre, Moradabad, Uttar Pradesh 244001, India
| | - Harshvardhan Pant
- Resident, Department of Oral & Maxillofacial Surgery, Kothiwal Dental College & Research Centre, Moradabad, Uttar Pradesh 244001, India
| | - Manpreet Singh
- Reader, Department of Oral & Maxillofacial Surgery, Kothiwal Dental College & Research Centre, Moradabad, Uttar Pradesh 244001, India
| | - Arpit Vashistha
- Resident, Department of Oral & Maxillofacial Surgery, Kothiwal Dental College & Research Centre, Moradabad, Uttar Pradesh 244001, India
| | - Gagandeep Kaur
- Reader, Department of Conservative Dentistry & Endodontics, Kothiwal Dental College & Research Centre, Moradabad, Uttar Pradesh 244001, India
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Kisnisci R. Management of Fractures of the Condyle, Condylar Neck, and Coronoid Process. Oral Maxillofac Surg Clin North Am 2013; 25:573-90. [DOI: 10.1016/j.coms.2013.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kim BK, Kwon YD, Ohe JY, Choi YH, Choi BJ. Usefulness of the Retromandibular Transparotid Approach for Condylar Neck and Condylar Base Fractures. J Craniofac Surg 2012; 23:712-5. [DOI: 10.1097/scs.0b013e31824dbb35] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Goto ÂADA, Aguiar SAD, Denardin OVP, Rapoport A. Tratamento cirúrgico das fraturas subcondilares: avaliação da abordagem retromandibular de hinds. Rev Col Bras Cir 2007. [DOI: 10.1590/s0100-69912007000500005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Avaliar retrospectivamente os resultados dos procedimentos terapêuticos cirúrgicos, através da abordagem retromandibular de Hinds, no tratamento das fraturas subcondilares. MÉTODO: o protocolo foi observacional, transversal, retrospectivo com inclusão de 31 casos divididos em quatro grupos, de acordo com a lateralidade, desvio da fratura e associação de fraturas em outros sítios. O sucesso terapêutico foi classificado de acordo com a necessidade de tratamento fisioterápico e bloqueio, permanência de desvios ou lateralidade de abertura bucal, amplitude reduzida de abertura bucal (menos de 40 mm), presença de dor moderada à intensa ou ausência de redução da fratura e instabilidade da osteossíntese. Para avaliação dos fatores determinantes de sucesso foram incluídas as variáveis: gênero, idade, causa da fratura, lateralidade, desvio, fraturas associadas e localização das fraturas. O método estatístico utilizou tabelas de associação cruzada com análise pelo teste não paramétrico do qui-quadrado. Em todas as situações foi arbitrado um valor de significância de 5% (p< 0,05). RESULTADOS: Encontrou-se uma resposta de sucesso total em 19 casos (61%) e sucesso parcial em 12 casos (39%). Não foram encontradas associações entre a resposta cirúrgica e as variáveis gênero, idade, causa da lesão e presença de fratura associada. Os casos com desvios laterais e bilateralidade da lesão obtiveram maior freqüência de sucessos parciais. CONCLUSÃO: Na amostra estudada, a abordagem retromandibular de Hinds para o tratamento das fraturas subcondilares, na maioria dos casos, teve sucesso total após o procedimento.
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Zachariades N, Mezitis M, Mourouzis C, Papadakis D, Spanou A. Fractures of the mandibular condyle: A review of 466 cases. Literature review, reflections on treatment and proposals. J Craniomaxillofac Surg 2006; 34:421-32. [PMID: 17055280 DOI: 10.1016/j.jcms.2006.07.854] [Citation(s) in RCA: 221] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2004] [Accepted: 07/11/2006] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION The incidence of condylar fractures is high. Condylar fractures can be extracapsular (condylar neck or subcondylar) or intracapsular, undisplaced, deviated, displaced or dislocated. Treatment depends on the age of the patient, the co-existence of other mandibular or maxillary fractures, whether the condylar fracture is unilateral or bilateral, the level and displacement of the fracture, the state of dentition and the dental occlusion, and the surgeon's experience. PURPOSE This report presents the experience acquired in the treatment of 466 condylar fractures over 7 years, reviews the pertinent literature and proposes guidelines for treatment. MATERIAL AND METHODS The archives of KAT, General District Hospital between 1995 and 2002 were scrutinized and the condylar fractures were recorded. The aetiology, age, sex, level of fracture, degree of displacement, associated facial fractures, malocclusion, and type of treatment were noted. RESULTS Four hundred and sixty-six condylar fractures were admitted, the male:female ratio was 3.5:1. Road traffic accidents were the main cause and most fractures were unilateral, displaced, subcondylar, occurred on the left side and were treated conservatively. CONCLUSIONS Early mobilization is the key in treating condylar fractures. Whilst rigid internal fixation provides stabilization and allows early mobilization, conservative treatment is the treatment of choice for the majority of fractures. Children and intracapsular fractures are treated conservatively with or without maxillo-mandibular fixation. Open reduction is recommended in selected cases to restore the occlusion, in severely displaced and dislocated fractures, in cases of loss of ramus height, and in edentulous patients. It may be considered in those with 'medical problems' where intermaxillary fixation is not recommended.
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Affiliation(s)
- Nicholas Zachariades
- Oral and Maxillofacial Department, KAT (Trauma Rehabilitation Center), General District Hospital of Attica, Kifissia, Athens, Greece.
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Takatsuka S, Terai K, Yoshida K, Narinobou M, Ueki K, Nakagawa K, Yamamoto E. A comparative study of unilateral dislocated mandibular condyle fractures in the rabbit. J Craniomaxillofac Surg 2005; 33:180-7. [PMID: 15878518 DOI: 10.1016/j.jcms.2005.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2003] [Accepted: 01/20/2005] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The purpose of this study was to clarify the influence of patients age and the degree of dislocation on the healing of mandibular condyle fractures. MATERIAL AND METHODS Sixty-two Japanese white rabbits (30 adolescent and 30 adult ones) were used. They underwent unilateral condylar neck osteotomy. The proximal fragments were positioned differently. In group I animals, the fragments were reduced into the original position, in group II animals the small fragment was dislocated 55-90 degrees to the ramus. In group III animals the proximal fragment was dislocated 135 degrees to the ramus. Gross and microscopic assessment was performed 4, 6, 8, 12 and 24 weeks postoperatively. RESULTS In adolescent animals, complete healing of the fracture was observed, irrespective of the degree of dislocation. In the adult animals, there was complete healing of the fractures in groups I and II. In group III animals, there was a decrease of ramus height accompanied by some fibro-cartilaginous changes. CONCLUSION Even in rabbits condylar deformation has been found following heavily dislocated artificial condylar fractures in adult animals. This result will help to decide for or against surgical treatment of condylar fractures in humans.
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Affiliation(s)
- Shigeyuki Takatsuka
- Oral and Maxillofacial Surgery, Graduate School of Medicine, Kanazawa University, Kanazawa, Japan.
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Villarreal PM, Monje F, Junquera LM, Mateo J, Morillo AJ, González C. Mandibular condyle fractures: determinants of treatment and outcome. J Oral Maxillofac Surg 2004; 62:155-63. [PMID: 14762747 DOI: 10.1016/j.joms.2003.08.010] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The objective of this study was to analyze the principal variables that determine the choice of the method of treatment and the outcome in condylar fractures. MATERIALS AND METHODS We conducted a retrospective analysis of 104 mandibular condyle fractures to analyze and determine the relation between the principal clinical variables and the postoperative results. All patients underwent a clinic-radiologic investigation focusing on fracture remodeling, evolution, dental occlusion, and symmetry of the mandible. We analyzed the influence of the preoperative clinical variables (level of fracture, treatment, postoperative physical therapy, displacement and dislocation, comminution, loss of ramus height, patient age, gender, etiology, occlusion, status of dentition, and presence of facial and mandibular fractures) over the postoperative results and outcome. RESULTS The principal factors that determined the treatment decision were the level of the fracture and the degree of displacement. The level of the fracture influenced the degree of preoperative coronal and sagittal displacement (neck fractures had greater medial and anterior displacement than head and subcondylar fractures) and the treatment applied. The functional improvement obtained by open methods was greater than that obtained by closed treatment. Open treatment increased the incidence of postoperative condylar deformities and mandibular asymmetry. CONCLUSION The variables that influenced the method of treatment and predicted the prognosis are the level of fracture, degree and direction of displacement of the fractured segments, age, medical status of the patient, concomitant injuries, and status of dentition.
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Affiliation(s)
- Pedro M Villarreal
- Department of Oral and Macillofacial Surgery, Hospital de Calbueñes, Gijón, Spain.
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Ellis E, Throckmorton G. Facial symmetry after closed and open treatment of fractures of the mandibular condylar process. J Oral Maxillofac Surg 2000; 58:719-28; discussion 729-30. [PMID: 10883686 DOI: 10.1053/joms.2000.7253] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE This study compares vertical measures of mandibular and facial morphology after open or closed treatment for fractures of the mandibular condylar process. PATIENTS AND METHODS One hundred forty-six patients (121 male, 25 female), 81 treated by closed and 65 by open methods, were included in this study. Towne's and panoramic radiographs, taken at several intervals, were used to quantify the displacement of the condylar process fractures. Posteroanterior cephalograms taken at 6 weeks, 6 months, 1 year, and 2 to 3 years after treatment were used to assess posterior facial height and bigonial and occlusal plane angles. Additionally, panoramic radiographs were used to assess ramus height at the same periods. Standard statistical methods were used to assess differences between groups. RESULTS Patients whose condylar process fractures were treated by closed methods had significantly shorter posterior facial and ramus heights on the side of injury, and more tilting of the occlusal and bigonial planes toward the fractured side, than patients whose fractures were treated by open methods. Most of the asymmetry in patients treated by closed methods was present by 6 weeks after injury. CONCLUSIONS Patients treated by closed methods develop asymmetries characterized by shortening of the face on the side of injury. It is likely that loss of posterior facial height on the side of fracture in these patients is an adaptation that helps reestablish a new temporomandibular articulation.
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Affiliation(s)
- E Ellis
- Division of Oral and Maxillofacial Surgery, University of Texas Southwestern Medical Center, Dallas 75390-9109, USA.
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Chossegros C, Cheynet F, Blanc JL, Bourezak Z. Short retromandibular approach of subcondylar fractures: clinical and radiologic long-term evaluation. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1996; 82:248-52. [PMID: 8884820 DOI: 10.1016/s1079-2104(96)80347-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The classic technique for open reduction of subcondylar fracture is the submandibular approach. The aim of this study was to evaluate long-term clinical and radiologic results of the short retromandibular approach to displaced subcondylar fractures. MATERIAL AND METHODS During a period of 66 months we performed a prospective study with a modified version of the retromandibular approach in 38 patients with displaced subcondylar fractures. In this article we describe clinical and radiologic results in 19 patients with follow-ups longer than 6 months (range, 6 to 66 months). Preoperatively all patients had malocclusion and radiology demonstrated displacement. RESULTS The retromandibular surgical approach was successful in all cases. Roughly 25 months after surgery, mouth opening was 43 mm with symmetric laterotrusive movements. Permanent marginal nerve palsy was never observed. CONCLUSIONS Our findings indicate that the short retromandibular approach is an easy and safe technique for displaced subcondylar fractures.
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Affiliation(s)
- C Chossegros
- Department of Oral and Maxillofacial Surgery, Timone University Hospital Center, Marseille, France
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Widmark G, Bågenholm T, Kahnberg KE, Lindahl L. Open reduction of subcondylar fractures. A study of functional rehabilitation. Int J Oral Maxillofac Surg 1996; 25:107-11. [PMID: 8727580 DOI: 10.1016/s0901-5027(96)80052-x] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Open reduction of dislocated subcondylar fractures was carried out in 19 adult patients between 1990 and 1992. A comparison of the results between two groups of patients was made 1 year after trauma. The reference group consisted of patients with the same type of fracture but treated with only intermaxillary fixation (IMF) and moderate jaw exercises after release of IMF. Dysfunction of the masticatory system was noticed in only a few cases of either group. Open reduction with plate osteosynthesis made it possible to avoid IMF in 12 of 19 patients. The results in the two groups did not differ significantly from a functional point of view. There are, however, specific indications for open reduction based on the degree of dislocation and concomitant subjective symptoms.
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Affiliation(s)
- G Widmark
- Department of Oral and Maxillofacial Surgery, Mölndal Hospital, Sweden
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Affiliation(s)
- M B Hall
- Oral and Maxillofacial Surgery, College of Dentistry, University of Kentucky Medical Center, Lexington 40536-0084
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Worsaae N, Thorn JJ. Surgical versus nonsurgical treatment of unilateral dislocated low subcondylar fractures: a clinical study of 52 cases. J Oral Maxillofac Surg 1994; 52:353-60; discussion 360-1. [PMID: 8133366 DOI: 10.1016/0278-2391(94)90436-7] [Citation(s) in RCA: 136] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
To compare open versus closed reduction of unilaterally dislocated low subcondylar fractures in adults, 101 consecutive dentulous patients were treated either by closed reduction with a median of 4 weeks of maxillomandibular fixation, or with a median of 6 weeks of maxillomandibular fixation after surgical repositioning and transosseous wiring of the dislocated condylar fragment. No selection of patients was done for either treatment. Fifty-two patients were seen at a median of 2 years postoperatively. Complications such as malocclusion, mandibular asymmetry, impaired masticatory function, and pain located to the affected joint or masticatory muscles were seen significantly more frequent in patients treated with closed reduction compared with those treated surgically (P = .005). Neither the degree of dislocation of the proximal fragment, concomitant mandibular fractures, nor the absence of posterior occlusal support seemed to influence the results.
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Affiliation(s)
- N Worsaae
- Department of Oral and Maxillofacial Surgery, Righospitalet, Copenhagen, Denmark
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Nørholt SE, Krishnan V, Sindet-Pedersen S, Jensen I. Pediatric condylar fractures: a long-term follow-up study of 55 patients. J Oral Maxillofac Surg 1993; 51:1302-10. [PMID: 8229408 DOI: 10.1016/s0278-2391(10)80132-6] [Citation(s) in RCA: 89] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Fifty-five patients between 5 and 20 years old who were previously treated conservatively for a fracture of the mandibular condyle were recalled for follow-up examination with a mean postoperative observation time of 10.1 years. Anamnestic information was obtained from a questionnaire, and clinical and radiologic examinations were performed. Anamnestic and clinical dysfunction indices were obtained. When the patients were divided into four different age groups it was found that the dysfunction index values increased significantly with increasing age at the time of trauma. Radiologic abnormalities such as reduced ramus height, deviation of the mandibular midline, and irregular shape of the condyle were seen frequently, but could not be correlated with the severity of dysfunction. No cases of ankylosis or serious asymmetry were found. The results support the opinion that conservative treatment is sufficient in pediatric patients, but in older age groups the results of conservative treatment are less satisfactory.
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Affiliation(s)
- J R Hayward
- Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor
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