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Maurer M, Klaes T, Fiedler M, Taxis J, Schuderer JG, Waiss W, Gottsauner M, Meier JK, Reichert TE, Ettl T. Patient's Perception of Outcome after Extracapsular Fractures of the Mandibular Condyle Differs from Objective Evaluation-Experience of a Third-Level Hospital. J Clin Med 2024; 13:1395. [PMID: 38592235 PMCID: PMC10931758 DOI: 10.3390/jcm13051395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/27/2024] [Accepted: 02/27/2024] [Indexed: 04/10/2024] Open
Abstract
Background: The aim of this study is to assess patients' subjective perception of treatment outcome after extracapsular fractures of the mandibular condyle. Methods: A questionnaire survey regarding facial nerve palsy (FNP), malocclusion, pain, reduction in maximum mouth opening (MMO) and further discomfort after 3, 6, and 12 months was carried out. Patients aged 18 or more presenting with an extracapsular condylar fracture between 2006 and 2020 were identified by purposive sampling Questionnaires were received from 115 patients. Fractures were classified on the basis of the pre-treatment imaging, the way of treatment was obtained from patients' medical records. Data were analyzed using Pearsons' chi-square-test, descriptive statistics and Student's t-test. Results: 93.0% of the fractures were treated by open reduction and internal fixation (ORIF). MMO reduction was the most common post-treatment complication (55.6%). ORIF was associated with less pain after 3 months (p = 0.048) and lower VAS scores compared to conservative treatment (p = 0.039). Comminuted fractures were more frequently associated with post-treatment malocclusion (p = 0.048), FNP (p = 0.016) and MMO reduction (p = 0.001). Bilateral fractures were significantly accompanied by malocclusion (p = 0.029), MMO reduction (p = 0.038) and pain occurrence (p < 0.001). Conclusions: Patients report less pain after ORIF. Comminuted and bilateral fractures seem to be major risk factors for complications. Subjective perception of complications after extracapsular condylar fractures differs from objectively assessed data.
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Affiliation(s)
- Michael Maurer
- Department of Cranio- and Maxillofacial Surgery, Hospital of the University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
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Banerjee A, Rana M, Chakraborty A, Biswas JK, Chowdhury AR. In-silico study of type 'B' condylar head fractures and evaluating the influence of two positional screw distance in two-screw osteosynthesis construct. Proc Inst Mech Eng H 2023; 237:1297-1305. [PMID: 37924244 DOI: 10.1177/09544119231201782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Abstract
Clinical fixation screws are common in clinical practices to fix mandibular condyle fractures. Evidence suggests significance of 'working length' that is, distance between proximal and distal fixation screws in proximity to the fracture in orthopaedic implant design. In pursuit of stable implant-bone construct, this study aims to investigate the biomechanical performance of each configuration considered in the study and provide an optimal working length between the screws for clinical reference. Finite element models of virtually designed broken condyle as type 'B' were simulated and analysed in ANSYS Workbench. Screws are implanted according to previous literature at five varied distances 'd' maintaining five different ratios with the fracture length 'D'. Based on a literature review, boundary conditions, muscle traction forces and non-linear contacts were assigned to obtain precise results. Each case is considered an individual configuration and von Mises distribution, microstrain in bone, screw-bone interface micromotion and fracture dislocation were evaluated for all these configurations. Stress-shielding phenomenon is observed for maximum von Mises stresses in bone. Microstrain concentration was significant in cancellous bone in the vicinity of the screw around the fracture line. Configurations were compared based on the stress-strain along with micromotion to support the required amount of osseointegration between implant and bone. Presented data from all five conditions supported the assumption that under physiological loading conditions, the D3 configuration provided stability for fracture healing. Further research on screw shapes, diameters and material properties, or investigating the direction of forces within the screws could provide further insight into this topic.
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Affiliation(s)
- Anik Banerjee
- Department of Aerospace Engineering and Applied Mechanics, Indian Institute of Engineering Science and Technology, Shibpur, Howrah, West Bengal, India
| | - Masud Rana
- Department of Aerospace Engineering and Applied Mechanics, Indian Institute of Engineering Science and Technology, Shibpur, Howrah, West Bengal, India
| | - Arindam Chakraborty
- Department of Aerospace Engineering and Applied Mechanics, Indian Institute of Engineering Science and Technology, Shibpur, Howrah, West Bengal, India
| | - Jayanta Kumar Biswas
- Department of Mechanical Engineering, National Institute of Technology, Patna, Bihar, India
| | - Amit Roy Chowdhury
- Department of Aerospace Engineering and Applied Mechanics, Indian Institute of Engineering Science and Technology, Shibpur, Howrah, West Bengal, India
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Inchingolo F, Patano A, Inchingolo AM, Riccaldo L, Morolla R, Netti A, Azzollini D, Inchingolo AD, Palermo A, Lucchese A, Di Venere D, Dipalma G. Analysis of Mandibular Muscle Variations Following Condylar Fractures: A Systematic Review. J Clin Med 2023; 12:5925. [PMID: 37762866 PMCID: PMC10532393 DOI: 10.3390/jcm12185925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/30/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
This review analyzes muscle activity following mandibular condylar fracture (CF), with a focus on understanding the changes in masticatory muscles and temporomandibular joint (TMJ) functioning. MATERIALS AND METHODS The review was conducted following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. A search was performed on online databases using the keywords "masticatory muscles" AND ("mandibular fracture" OR "condylar fracture"). The eligibility criteria included clinical trials involving human intervention and focusing on muscle activity following a condylar fracture. RESULTS A total of 13 relevant studies were reviewed. Various studies evaluated muscle activity using clinical evaluation, bite force measurement, electromyography (EMG), magnetic sensors and radiological examinations to assess the impact of mandibular fractures on masticatory muscles. CONCLUSIONS Mandibular condylar fractures can lead to significant changes in muscle activity, affecting mastication and TMJ functioning. EMG and computed tomography (CT) imaging play crucial roles in assessing muscle changes and adaptations following fractures, providing valuable information for treatment planning and post-fracture management. Further research is required to explore long-term outcomes and functional performance after oral motor rehabilitation in patients with facial fractures. Standardized classifications and treatment approaches may help improve the comparability of future studies in this field.
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Affiliation(s)
- Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70121 Bari, Italy; (A.P.); (A.M.I.); (R.M.); (A.N.); (D.A.); (A.D.I.); (D.D.V.); (G.D.)
| | - Assunta Patano
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70121 Bari, Italy; (A.P.); (A.M.I.); (R.M.); (A.N.); (D.A.); (A.D.I.); (D.D.V.); (G.D.)
| | - Angelo Michele Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70121 Bari, Italy; (A.P.); (A.M.I.); (R.M.); (A.N.); (D.A.); (A.D.I.); (D.D.V.); (G.D.)
| | - Lilla Riccaldo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70121 Bari, Italy; (A.P.); (A.M.I.); (R.M.); (A.N.); (D.A.); (A.D.I.); (D.D.V.); (G.D.)
| | - Roberta Morolla
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70121 Bari, Italy; (A.P.); (A.M.I.); (R.M.); (A.N.); (D.A.); (A.D.I.); (D.D.V.); (G.D.)
| | - Anna Netti
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70121 Bari, Italy; (A.P.); (A.M.I.); (R.M.); (A.N.); (D.A.); (A.D.I.); (D.D.V.); (G.D.)
| | - Daniela Azzollini
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70121 Bari, Italy; (A.P.); (A.M.I.); (R.M.); (A.N.); (D.A.); (A.D.I.); (D.D.V.); (G.D.)
| | - Alessio Danilo Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70121 Bari, Italy; (A.P.); (A.M.I.); (R.M.); (A.N.); (D.A.); (A.D.I.); (D.D.V.); (G.D.)
| | - Andrea Palermo
- College of Medicine and Dentistry, Birmingham B4 6BN, UK;
| | - Alessandra Lucchese
- Unit of Dentistry-Orthodontics, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
- Unit of Dentistry, Research Center for Oral Pathology and Implantology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Daniela Di Venere
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70121 Bari, Italy; (A.P.); (A.M.I.); (R.M.); (A.N.); (D.A.); (A.D.I.); (D.D.V.); (G.D.)
| | - Gianna Dipalma
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70121 Bari, Italy; (A.P.); (A.M.I.); (R.M.); (A.N.); (D.A.); (A.D.I.); (D.D.V.); (G.D.)
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Sasaki R, Watanabe Y, Miyamoto NS, Agawa K, Okamoto T. Innsbruck-style Retromandibular Anterior Trans-parotid Approach for Condylar Fractures: A Retrospective Review of 39 Fractures. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5091. [PMID: 37351120 PMCID: PMC10284331 DOI: 10.1097/gox.0000000000005091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/05/2023] [Indexed: 06/24/2023]
Abstract
The retromandibular anterior trans-parotid (RAT) approach and a triangular-positioned double mini-plate osteosynthesis (TDO) technique have been reported from Innsbruck Medical University. This minimally invasive technique involves direct visualization of the condyle and is associated with lower incidence of facial palsy. Methods A retrospective review was performed on the RAT approach and TDO technique conducted by a surgeon and team at two hospitals in Tokyo during a period of 3 years and 10 months. Results This technique was performed on 35 patients with 39 condylar fractures. Sixty-nine percent of cases were due to accidental fall, 17% to traffic accidents, and 9% to sports. Furthermore, 92% cases were condylar base fractures. Nighty-seven percent of cases achieved good occlusion. The mean maximum mouth opening was 49 ± 1.3 mm. Postoperatively, facial palsy developed in three patients (7.7%), and two of them developed Frey syndrome at approximately 2.5 years postoperatively (5.1%). All patients completely recovered within 3 months postoperatively. One case each of salivary fistula, visible scar, and condylar resorption was found (2.6%). No case of massive bleeding during surgery, hematoma, or TMJ pain after surgery was found. Conclusion This technique could achieve good occlusion with low incidence of complications and could contribute to early social reintegration among patients.
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Affiliation(s)
- Ryo Sasaki
- From the Department of Oral and Maxillofacial Surgery, Tokyo Women’s Medical University, School of Medicine, Tokyo, Japan
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Yorikatsu Watanabe
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Noriko Sangu Miyamoto
- From the Department of Oral and Maxillofacial Surgery, Tokyo Women’s Medical University, School of Medicine, Tokyo, Japan
| | - Kaori Agawa
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Toshihiro Okamoto
- From the Department of Oral and Maxillofacial Surgery, Tokyo Women’s Medical University, School of Medicine, Tokyo, Japan
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Weinberg FM, Rosenberg AJWP, Withagen KPA, Gilijamse M, Forouzanfar T, Speksnijder CM. Oral functioning after open versus closed treatment of unilateral condylar neck or base fractures: A two-centre controlled clinical trial. J Oral Rehabil 2023; 50:194-202. [PMID: 36533877 PMCID: PMC10107207 DOI: 10.1111/joor.13403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 09/25/2022] [Accepted: 11/27/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Oral functioning and rehabilitation in patients after condylar trauma can be measured by objective functional outcomes and patient-reported outcomes. The similarities or differences between these outcomes may contribute to the decision if open treatment (OT) or closed treatment (CT) will obtain the most advantageous results. OBJECTIVES The aim of this study was to compare OT versus CT for unilateral condylar mandibular neck or base fractures in a two-centre controlled clinical trial by objective functional outcomes and patient-reported outcomes measured at 6 weeks and 6 months follow-up. Additionally, these outcomes were compared within each group. METHODS Patients were enrolled between January 2017 and November 2019. In one centre, patients received OT by extra-oral open reduction and internal fixation. In another centre, patients received CT by maxillomandibular fixation. Objective measurements included the mixing ability test (MAT) and mandibular active range of motion (ROM). Patient-reported outcomes included the mandibular function impairment questionnaire (MFIQ) and visual analogue scale (VAS) for pain. Independent t-tests and Mann-Whitney U-tests were used to determine differences between the treatment groups at 6 weeks and 6 months follow-up. Paired t-tests and Wilcoxon signed rank tests were used to determine differences within each group. RESULTS Thirty-three patients were enrolled. No differences were found between the groups treated with OT or CT for MAT, ROM, MFIQ and VAS. Both groups showed functional improvement. CONCLUSION Good objective functional outcomes and patient-reported outcomes were achieved with both OT and CT in patients with unilateral condylar mandibular neck or base fractures.
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Affiliation(s)
- Florine M Weinberg
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Antoine J W P Rosenberg
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Koen P A Withagen
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Tymour Forouzanfar
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam University Medical Centers and Academic Center for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Caroline M Speksnijder
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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6
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Kumar S, Chugh A, Kaur A, G. A, Srivastav S, P.G. G, Kumar P, Chaudhry K. Treatment Outcome Comparison Between two 3-Dimensional Plates (Y-Shaped Plate Versus Trapezoidal Condylar Plate) in Management of Mandible Condylar Fracture: A Randomized Control Trial. J Maxillofac Oral Surg 2023; 22:25-32. [PMID: 36703652 PMCID: PMC9871142 DOI: 10.1007/s12663-021-01662-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 10/21/2021] [Indexed: 01/29/2023] Open
Abstract
Aim To compare the treatment outcomes (clinical, functional and radiographical) using the two different 3-Dimensional plates in open reduction internal fixation of mandibular condylar fracture (MCF). Assessment of ease of fixation and fixation time were also performed. Methodology 20 MCF patients were divided equally into two groups (Group A: Trapezoidal Condylar Plate and Group B: Y-shaped plate) and the treatment outcomes were compared. Intraoperatively time required for fixation was also compared. The patients were followed up at different timelines till 3 months. Result Baseline parameters had statistically insignificant distribution in both groups implying effective randomization and balanced confounding factors. Intraoperatively, adequate anatomical reduction was achieved in both groups with statistically insignificant difference in time required for fixation. Postoperatively, no statistically significant difference was found in radiographic and functional parameters. None of the patients in either group reported with facial nerve injury, condylar resorption, Temporomandibular Disorders. However, 02 patients in Group A and 01 patient in Group B presented with infection, parotid fistula, and hardware failure respectively with statistically insignificant difference. Conclusion This study concluded that the treatment outcomes were satisfactory with the use of both 3-D plate, but further studies with larger sample size and longer follow up are required.
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Affiliation(s)
- Shailendra Kumar
- Oral and Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan 342005 India
| | - Ankita Chugh
- Oral and Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan 342005 India
| | - Amanjot Kaur
- Oral and Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan 342005 India
| | - Aparna G.
- Oral and Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan 342005 India
| | - Shival Srivastav
- Department of Physiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan 342005 India
| | - Gigi P.G.
- Oral and Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan 342005 India
| | - Pravin Kumar
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan 342005 India
| | - Kirti Chaudhry
- Oral and Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan 342005 India
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Satishchandran S, Umorin M, Manhan AJ, Abramowicz S, Amin D. Does the Treatment Approach for Mandibular Condyle Fractures Impact Self-Perceived Quality of Life? J Oral Maxillofac Surg 2023; 81:184-193. [PMID: 36375512 DOI: 10.1016/j.joms.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE There is no consensus in mandibular condylar fracture/s treatment. In medicine, quality of life (QOL) includes the individual's satisfaction toward their own health condition, disease, or treatment. The purpose of this study was to investigate self-perception QOL outcomes for patients who sustained mandibular condylar fracture/s. METHODS This cross-sectional study surveyed patients at Grady Memorial Hospital in Atlanta, Georgia from November 2016 to June 2020. The study included patients who were at least 16 years old at the time of injury, diagnosed with mandibular condylar fracture/s, treated by close reduction or open reduction and internal fixation (ORIF), presented for 6-months post-operative follow-up, and had a valid phone number. The primary predictor variable was treatment approach. The primary outcome variable was mood. Covariates were demographics, injury details, and self-perception QOL questionnaire. Univariate, bivariate, and ordinal regression analysis were performed (P < .05 significance). RESULTS A total of 108 patients met inclusion criteria. Response rate was 84.2%. Our data showed that patients who underwent ORIF treatment were statistically more likely to experience no or milder pain when chewing (tau = 0.390, P = .002), to not require pain medications (tau = 0.389, P = .002), to report larger maximum mouth opening (tau = 0.402, P = .0003), and to report better QOL (tau = 0.440, P = 7.407e-05). Ordinal regression analysis showed that patients who had undergone ORIF treatment were positively associated with better mood (estimate: -0.062; OR: 0.54; P = .29) and statistically significant associated with excellent QOL (estimate: -2; OR: 0.13; P = 3.99e-05). Patients who sustained class III Lindahl mandibular condyle fracture were statistically significantly associated with depressed mood (estimate: 1.46; OR: 4.33; P = .002). CONCLUSION ORIF treatment was positively associated with better QOL when compared to closed reduction for mandibular condyle fracture.
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Affiliation(s)
- Sruthi Satishchandran
- Resident, Oral and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, GA
| | - Mikhail Umorin
- Assistant Professor, Department of Biomedical Sciences, School of Dentistry, Texas A & M University, Dallas, TX
| | - Andrew J Manhan
- Medical Student Researcher, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Shelly Abramowicz
- Associate Professor in Oral and Maxillofacial Surgery and Pediatrics, Emory University School of Medicine, Chief of Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA
| | - Dina Amin
- Clinical Associate Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Texas A & M University, Dallas, TX.
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Pohranychna K, Ohonovskyi R, Rybert Y, Minko L, Hlova O. EFFICACY OF ARTHROCENTESIS FOR TREATMENT OF INTERNAL POST-TRAUMATIC TEMPOROMANDIBULAR JOINT DISORDERS. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:155-160. [PMID: 36883504 DOI: 10.36740/wlek202301121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
OBJECTIVE The aim: To study the consequences of temporomandibular joint injury and efficacy of arthrocentesis for treatment of post-traumatic internal temporoman-dibular disorders. PATIENTS AND METHODS Materials and methods: 24 patients who experienced trauma history in the head without jaw fractures underwent CT, ultrasound and/or MRI. TMJ ar¬throcentesis was performed according to a modified method of D. Nitzan (1991) under local anesthesia by means of blockade of the peripheral branch of the auricular-temporal nerve on the background of intravenous sedation. RESULTS Results: The ages of the patients varied between 18 and 44 years, and mean was 32,58 years. The causes of trauma were diverse, as traffic accident - 3 (12,5%), assault 12 (50%), hit by materials 3 (12, 5%), and fall-down 6 (25%). According to clinical and radiological signs after traumatic temporomandibular disorders, patients were divided into two groups according to Wilkes classification (1989): 13 patients with stage II (early-middle) and 11 - with stage III (middle).The control ultrasound and MRI carried out 3-6 months after arthrocentesis showed no signs of hemarthrosis in 84.61% of patients with intra-articular disorders of the second degree, and in 72.72% of patients with internal disorders of the third degree, the position and function of the articular disc was restored. CONCLUSION Conclusions: Arthrocentesis with TMJ lavage is a minimally invasive surgical manipulation that has proven itself in temporomandibular disorders of traumatic origin, in particular after fractures of the articular process of the mandible.
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Affiliation(s)
| | - Roman Ohonovskyi
- DANYLO HALYTSKYI LVIV NATIONAL MEDICAL UNIVERSITY, LVIV, UKRAINE
| | | | - Lidiya Minko
- DANYLO HALYTSKYI LVIV NATIONAL MEDICAL UNIVERSITY, LVIV, UKRAINE
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Sabbagh H, Nikolova T, Kakoschke SC, Wichelhaus A, Kakoschke TK. Functional Orthodontic Treatment of Mandibular Condyle Fractures in Children and Adolescent Patients: An MRI Follow-Up. LIFE (BASEL, SWITZERLAND) 2022; 12:life12101596. [PMID: 36295031 PMCID: PMC9605380 DOI: 10.3390/life12101596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The purpose of this study was to retrospectively evaluate and follow up a conservative treatment approach with functional orthodontic appliances for the management of mandibular condyle fractures in children and adolescent patients. METHODS Between 2020 and 2022, the treatment records of patients with mandibular condyle fractures receiving a functional orthodontic treatment (FOT) were evaluated. In addition to the clinical and functional findings, magnetic resonance images of the mandibular condyles and surrounding structures were assessed. RESULTS Out of 61 patients, 8 met the inclusion criteria. The follow-up examination records showed no functional limitations. In 75% of cases, mild midline deviations persisted (mean 1.1 mm) without significant alterations to the occlusal relationships. Magnetic resonance imaging (MRI) showed the remodeling of the condyles and the restitution of the ramus heights, even in dislocated and displaced fractures. In three cases, a partial displacement of the articular disc was observed at the follow-up. No differences in the remodeling patterns were noted depending on age, sex, or fracture location. CONCLUSIONS A FOT led to favorable functional and morphologic outcomes, supporting the concept of a conservative functional approach in children and adolescent patients. Functional adjunctive therapy should be considered in the conservative treatment of mandibular condyle fractures in growing patients.
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Affiliation(s)
- Hisham Sabbagh
- Department of Orthodontics and Dentofacial Orthopedics, University Hospital, LMU Munich, Goethestrasse 70, 80336 Munich, Germany
- Correspondence: ; Tel.: +49-89-4400-53223
| | - Trayana Nikolova
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81337 Munich, Germany
| | - Sara Carina Kakoschke
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Lindwurmstrasse 2a, 80337 Munich, Germany
- Department of General, Visceral, and Transplant Surgery, University Hospital, LMU Munich, Marchioninistrasse 15, 81337 Munich, Germany
| | - Andrea Wichelhaus
- Department of Orthodontics and Dentofacial Orthopedics, University Hospital, LMU Munich, Goethestrasse 70, 80336 Munich, Germany
| | - Tamara Katharina Kakoschke
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Lindwurmstrasse 2a, 80337 Munich, Germany
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10
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Girhe V, Patil V, Bhujbal R, Singh R, Dewang P, Vaprani G. Pre-auricular Transparotid Approach for the Management of Mandibular Condylar Fracture: An Experience of 82 Cases. J Maxillofac Oral Surg 2022; 21:916-922. [PMID: 36274863 PMCID: PMC9474963 DOI: 10.1007/s12663-021-01565-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 04/10/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose This paper retrospectively analyses the functional outcomes and complications associated with pre-auricular transparotid approach for the management of mandibular condylar fractures. Material and Methodology The retrospective data of 82 condylar fractures were analysing in 73 patients who underwent open reduction and internal fixation with pre-auricular transparotid approach. Evaluation of post-operative complications and the post-operative occlusion status, maximal inter-incise opening, adequacy of reduction and stability of fixation were assessed clinically and radiographically. Results The exposure of fracture segment was adequate in all the cases, and fixation was easy with 2 mm delta miniplate. Transient facial nerve palsy occurred in 2 patients (2.43%). 1 patient developed sialocele which was managed conservatively. There were slight occlusal discrepancies in 10 patients at the end of 1-week follow-up which was corrected with guiding elastics at the end of 1-month follow-up. The reduction was adequate, and fixation was stable. The functional outcomes were satisfactory in term of mouth-opening and range of motion. Conclusion The pre-auricular transparotid approach provides direct access to the fracture site resulting in less retraction of the tissue containing facial nerve and also less amount of periosteal stripping is required, thus it maintains good vascularity to the fracture segments. It provides direct visualization of the fracture without much retraction of the tissue containing facial nerve branches. It allows better fixation of the fracture with very less complication which results in good functional outcomes.
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Affiliation(s)
- Vijaykumar Girhe
- Department of Oral and Maxillofacial Surgery, DR HSRSM Dental College, Hingoli, India
| | - Vinay Patil
- Department of Oral and Maxillofacial Surgery, Nanded Rural Dental College and Research Centre, Nanded, India
| | - Ravi Bhujbal
- Department of Oral and Maxillofacial Surgery, Nanded Rural Dental College and Research Centre, Nanded, India
| | - Rohit Singh
- Craniomaxillofacial Trauma, Hitkarini Dental College & Hospital, Jabalpur, India
| | - Prashant Dewang
- Department of Oral & Maxillofacial Surgery, CSMSS Dental College and Hospital, Aurangabad, India
| | - Ganesh Vaprani
- Department of Oral and Maxillofacial Surgery, Nanded Rural Dental College and Research Centre, Nanded, India
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Bera RN, Anand Kumar J, Kanojia S, Mashhadi Akbar Boojar F, Chauhan N, Hirani MS. How far we have come with the Management of Condylar Fractures? A Meta-Analysis of Closed Versus Open Versus Endoscopic Management. J Maxillofac Oral Surg 2022; 21:888-903. [PMID: 36274885 PMCID: PMC9475017 DOI: 10.1007/s12663-021-01587-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 05/01/2021] [Indexed: 10/21/2022] Open
Abstract
Background The treatment approaches for condylar fractures of the mandible include functional, closed reduction and open reduction-internal fixation. Recently endoscopic management of condylar fractures has been emphasized in the literature. We systematically review the studies comparing closed versus open versus endoscopic-assisted condyle fracture management with regard to the indications, effectiveness and complications of each modality. Methods A total of 11 articles were selected based on the inclusion and exclusion criteria from PubMed, Cochrane and clinical trials.gov. Differences in means and risk ratios were used as principal summary measures with p value < 0.05 as significant. For detection of any possible biases in sample sizes, the OR and its 95% CI for each study were plotted against the number of participants. Chi-square test, I2 test and the Cochrane bias tool were used to assess the bias in and across studies. Results Except for deviation on opening there was no significant difference between open versus closed treatment of condylar fractures. Endoscopic approach and open surgical approaches differed only in terms of operating time and TMJ pain. There was no significant difference in facial nerve injury among the two groups. Discussion Closed reduction is particularly indicated for minimally displaced fractures; for moderate to severe displacement, open reduction is preferred. Open reduction can also be preferred over endoscopic approaches as there is no significant advantage of using latter. Limitations of the study included specific treatment according to the site of fracture not addressed, limited data regarding pediatric condylar fracture, lack of homogenous classification schemes, etc.
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Affiliation(s)
- Rathindra Nath Bera
- Unit of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Room No 142 sushruta hostel Trauma Centre BHU, Varanasi, Uttar Pradesh 221005 India
| | - Janani Anand Kumar
- Unit of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Room No 142 sushruta hostel Trauma Centre BHU, Varanasi, Uttar Pradesh 221005 India
| | - Shweta Kanojia
- Unit of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Room No 142 sushruta hostel Trauma Centre BHU, Varanasi, Uttar Pradesh 221005 India
| | | | - Nishtha Chauhan
- Unit of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Room No 142 sushruta hostel Trauma Centre BHU, Varanasi, Uttar Pradesh 221005 India
| | - Mehul Shashikant Hirani
- Unit of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Room No 142 sushruta hostel Trauma Centre BHU, Varanasi, Uttar Pradesh 221005 India
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12
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Temporomandibular joint prosthesis as treatment option for mandibular condyle fractures: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2022; 52:88-97. [PMID: 35752530 DOI: 10.1016/j.ijom.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 05/29/2022] [Accepted: 05/31/2022] [Indexed: 11/24/2022]
Abstract
The aim of this study was to perform a systematic review of the literature on the temporomandibular joint (TMJ) prosthesis as a treatment option after mandibular condyle fracture. Three databases were searched (PubMed, Embase, Cochrane Library) and 2670 unique papers were identified. A total of 337 studies were included (121 case reports, 89 case series, and 127 cohort/clinical studies). In total 14,396 patients and 21,560 prostheses were described. Of the 127 cohort or clinical studies, 100 (79%) reported inclusion criteria, 54 (43%) reported exclusion criteria, and 96 (76%) reported the inclusion period. The base population from which patients were recruited was reported in 57 studies (45%). The reason for TMJ prosthesis implantation was reported for 4177 patients (29.0%). A history of condylar fracture was present in 83 patients (2.0%); a history of mandibular trauma was present in 580 patients (13.9%). The meta-analysis showed a pooled prevalence of condylar fracture of 1.6% (95% confidence interval 0.9-2.4%) and a pooled prevalence of trauma or condylar fracture of 11.3% (95% confidence interval 7.1-16.0%). Heterogeneity was highly significant (P < 0.001). The TMJ prosthesis appears to be reserved for patients with persistent pain, bony or fibrous ankylosis, or osteomyelitis after primary closed or open treatment of fractures of the mandibular condyle.
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13
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Gilliland J, Ritto F, Tiwana P. Complications of the Transmasseteric Anteroparotid Approach for Subcondylar Fractures: A Retrospective Study. Craniomaxillofac Trauma Reconstr 2022; 15:66-71. [PMID: 35265280 PMCID: PMC8899356 DOI: 10.1177/19433875211016923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Study Design A retrospective analysis of patients with subcondylar fractures treated via a transmasseteric anteroparotid approach by the Oral and Maxillofacial Department at the University of Oklahoma. Objective The goal of this study was to evaluate complications, morbidity, and safety with the transmasseteric anteroparotid approach for treatment of subcondylar fractures, and compare it to other findings previously reported in the literature. Methods A retrospective study was conducted that consisted of 23 surgically treated patients in the past 2 years for subcondylar fractures. Only patients with pre-operative malocclusion and who underwent open reduction with internal fixation with the transmasseteric anteroparotid (TMAP) approach were included. Exclusion criteria included 1) patients treated with closed reduction 2) patients who failed the minimum of 1, 3, and 6-week post-operative visits. The examined parameters were the degree of mouth opening, occlusal relationship, facial nerve function, incidence of salivary fistula and results of imaging studies. Results 20 of the surgically treated patients met the inclusion criteria. Two patients were excluded due to poor post-operative follow up and 1 was a revision of an attempted closed reduction by an outside surgeon that presented with pre-existing complications. There were no cases of temporary or permanent facial nerve paralysis reported. There were 3 salivary fistulas and 2 sialoceles, which were managed conservatively and resolved within 2 weeks, and 2 cases of inadequate post-surgical maximal incisal opening (<40 mm) were observed. Conclusion The transmasseteric anteroparotid approach is a safe approach for open reduction and internal fixation of low condylar neck and subcondylar fractures, and it has minimal complications.
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Affiliation(s)
- Jared Gilliland
- Jared Gilliland, DDS, Department of Oral and Maxillofacial Surgery, University of Oklahoma Health, 1201 N Stonewall Ave, Oklahoma City, OK 73104-5410, USA.
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14
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Schönegg D, Müller GT, Blumer M, Essig H, Wagner MEH. Two-versus three-screw osteosynthesis of the mandibular condylar head: A finite element analysis. J Mech Behav Biomed Mater 2022; 127:105077. [PMID: 35033984 DOI: 10.1016/j.jmbbm.2022.105077] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/31/2021] [Accepted: 01/07/2022] [Indexed: 10/19/2022]
Abstract
Titanium screws are commonly used for osteosynthesis of mandibular condylar head fractures. Evidence suggests that the insertion of three screws may result in better fracture stability. Two screws only, on the other hand, could reduce adverse effects, mainly bone resorption. This study aimed to investigate the biomechanical differences in mandibular condylar head osteosynthesis with two versus three titanium screws using finite element analysis. A finite element model of the mandible with a right type P condylar head fracture fixed with two or three titanium screws was analyzed in ANSYS Mechanical. The geometry of the model assembly was constructed in ANSYS Spaceclaim. Biomechanical load boundary conditions were obtained from a validated musculoskeletal model in AnyBody Modeling System™. The preprocessing of the finite element model and mapping of the obtained boundary conditions was done in docq VIT. Fracture displacement, fragment deformation, von Mises stress distribution, and reaction forces within the screws were evaluated in ANSYS for three different loading scenarios. Finite element analysis showed similar results when comparing osteosynthesis with two versus three titanium screws for all three loading scenarios. Contralateral molar loading resulted in the highest stress on both the fracture and the screws with the maximum von Mises stress being found at the condylar neck. Stress concentration within the screws was found in the fracture gap and was higher in the lateral fragment. In all scenarios, maximum von Mises stress values were smaller when forces were distributed among three screws. However, stability was also adequate when two screws were used. Mandibular condylar head osteosynthesis with two titanium screws appears to provide sufficient fracture stability. Further clinical studies are needed to clarify the implications of these results.
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Affiliation(s)
- Daphne Schönegg
- Department of Oral and Maxillofacial Surgery, University Hospital of Zurich, Head of Department ad interim: PD Dr. med. Dr. med. dent. Harald Essig, Frauenklinikstrasse 24, CH-8091 Zurich, Switzerland.
| | - Günter T Müller
- Department of Oral and Maxillofacial Surgery, University Hospital of Zurich, Head of Department ad interim: PD Dr. med. Dr. med. dent. Harald Essig, Frauenklinikstrasse 24, CH-8091 Zurich, Switzerland
| | - Michael Blumer
- Department of Oral and Maxillofacial Surgery, University Hospital of Zurich, Head of Department ad interim: PD Dr. med. Dr. med. dent. Harald Essig, Frauenklinikstrasse 24, CH-8091 Zurich, Switzerland
| | - Harald Essig
- Department of Oral and Maxillofacial Surgery, University Hospital of Zurich, Head of Department ad interim: PD Dr. med. Dr. med. dent. Harald Essig, Frauenklinikstrasse 24, CH-8091 Zurich, Switzerland
| | - Maximilian E H Wagner
- Department of Oral and Maxillofacial Surgery, University Hospital of Zurich, Head of Department ad interim: PD Dr. med. Dr. med. dent. Harald Essig, Frauenklinikstrasse 24, CH-8091 Zurich, Switzerland
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15
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Nogami S, Yamauchi K, Izumita K, Kitamura J, Takeda Y, Otake Y, Koyama S, Okuyama K, Sasaki K, Takahashi T. Clinical course of masticatory function recovery following arthrocentesis in patients with unilateral mandibular condyle head fracture. J Craniomaxillofac Surg 2021; 50:225-229. [PMID: 34930666 DOI: 10.1016/j.jcms.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 12/01/2021] [Accepted: 12/10/2021] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to investigate the clinical course of masticatory function recovery following arthrocentesis. Patients with a unilateral condylar head fracture who underwent arthrocentesis for therapeutic reasons were evaluated and compared with patients with a unilateral condylar head fracture who did not undergo arthrocentesis. At 3 months after treatment, the occlusal contact area and maximum bite force in patients with a fracture treated with arthrocentesis were greater than in those who did not receive arthrocentesis at the same time points, although the differences were not significant. Moreover, at 1 and 3 months following arthrocentesis, mean (±SD) occlusal contact area (1 month: 1.99 ± 0.55 mm2, p = 0.01; 3 months: 2.90 ± 1.36 mm2, p = 0.03) and maximum bite force (1 month: 82.45 ± 15.04 N, p = 0.01; 3 months: 101.11 ± 14.53 N, p = 0.01) on the fractured side in patients who underwent that treatment were significantly reduced when compared with those on the non-fractured side. The authors conclude that if the priority is to avoid open reduction and internal fixation, then the arthrocentesis approach might be a less invasive alternative, albeit with the price of a prolonged healing interval.
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Affiliation(s)
- Shinnosuke Nogami
- Division of Oral and Maxillofacial Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan.
| | - Kensuke Yamauchi
- Division of Oral and Maxillofacial Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan
| | - Kuniyuki Izumita
- Joint Research Department of Next-Generation Dental Materials Engineering, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan
| | - Jun Kitamura
- Division of Oral and Maxillofacial Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan
| | - Yuri Takeda
- Division of Oral and Maxillofacial Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan
| | - Yoshio Otake
- Division of Oral and Maxillofacial Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan
| | - Shinki Koyama
- Division of Oral and Maxillofacial Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan
| | - Kyosuke Okuyama
- Division of Oral and Maxillofacial Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan
| | - Keiichi Sasaki
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan
| | - Tetsu Takahashi
- Division of Oral and Maxillofacial Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan
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Mooney S, Gulati RD, Yusupov S, Butts SC. Mandibular Condylar Fractures. Facial Plast Surg Clin North Am 2021; 30:85-98. [PMID: 34809889 DOI: 10.1016/j.fsc.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mandibular condyle fractures can result in short-term and long-term morbidity. As a weak area of the mandible, the condyle is vulnerable to injury by a direct impact or an indirect force. Current treatment recommendations aim to better match the severity of the fracture with the choice of closed or open approach. Long-term follow-up of patients provides the best opportunity to monitor the degree of functional restoration after treatment. There is a growing consensus regarding the use of standardized fracture classification methods and outcomes measures that will allow better assessment of treatment results and strengthen the quality of outcomes research.
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Affiliation(s)
- Sean Mooney
- Department of Otolaryngology, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Box 126, Brooklyn, NY 11203, USA
| | - Rahul D Gulati
- Department of Otolaryngology, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Box 126, Brooklyn, NY 11203, USA
| | - Steve Yusupov
- Staten Island University Hospital/Northwell Health, 256-C Mason Avenue, Staten Island, NY 10305, USA
| | - Sydney C Butts
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, SUNY Downstate Health Sciences University, Kings County Hospital Center, 450 Clarkson Avenue, Box 126, Brooklyn, NY 11203, USA.
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17
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Neuhaus MT, Zeller AN, Desch L, Dhawan A, Jehn P, Gellrich NC, Zimmerer R. Endoscopically Assisted Treatment of Condylar Base and Neck Fractures: A Single Institution Analysis of Outcomes and Complications. J Maxillofac Oral Surg 2021; 20:665-673. [PMID: 34776701 DOI: 10.1007/s12663-020-01398-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/19/2020] [Indexed: 11/26/2022] Open
Abstract
Background Conservative treatment, including observation and closed treatment, as well as open reduction and internal fixation are existing options for treating condylar process fractures. Extraoral approaches are widely preferred for open reduction and internal fixation. Transoral access for condylar base and neck fractures is not yet commonly used as it is technically demanding and requires special equipment. Purpose In this study, the transoral endoscopically assisted approach is described, and its outcomes and complications were investigated. Imaging data and clinical records of 187 patients with condylar process fractures, treated via endoscopically assisted transoral approach between 2007 and 2017 were analyzed. Parameters included diagnosis and fracture classification, treatment, osteosynthesis configuration and postoperative complications. Results Early complications, including infection, transient postoperative malocclusion, pain and limited mouth opening, occurred in 35 patients (18.7%). Late onset complications, such as screw loosening were documented in only 4 patients (2.1%). Revision surgery following postoperative 3D imaging was required in only 3 cases (1.6%). Fragment length ranged from 15.5 to 38.3 mm. In 57.7% of patients with condylar fragment length < 20 mm, a single osteosynthesis plate was used, with no elevated complication rate. Two osteosynthesis plates with 4 screws each was used as standard in longer fragments. Conclusion Endoscopically assisted transoral treatment of condylar process fractures is a reliable, yet technical demanding technique. It allows for reduction and fixation of fractures with a condylar fragment length of > 15 mm with low postoperative complication and revision rates.
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Affiliation(s)
- Michael-Tobias Neuhaus
- Department for Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Alexander-Nicolai Zeller
- Department for Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Lena Desch
- Department for Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Amit Dhawan
- Sri Guru Ram Das Institute of Dental Sciences and Research, Amritsar, India
| | - Philipp Jehn
- Department for Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Nils-Claudius Gellrich
- Department for Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Rüdiger Zimmerer
- Department for Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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18
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Evaluating the efficacy of disc repositioning in the management of high condylar fracture — A prospective clinical trial. J Craniomaxillofac Surg 2021; 50:310-315. [DOI: 10.1016/j.jcms.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 10/02/2021] [Accepted: 11/10/2021] [Indexed: 11/23/2022] Open
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Mandibular Subcondylar Fracture: Improved Functional Outcomes in Selected Patients with Open Treatment. Plast Reconstr Surg 2021; 148:398e-406e. [PMID: 34432692 DOI: 10.1097/prs.0000000000008294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Subcondylar fractures represent 25 to 35 percent of all mandibular fractures, yet the treatment paradigm has remained controversial. Closed treatment relies on the plasticity of the condyle head during recovery, whereas open treatment is challenging and risks facial nerve injury. Perioperative, functional, and patient-reported outcomes were measured to compare methods of open versus closed treatment of subcondylar fractures. METHODS Selected displaced subcondylar fracture cases with open (open reduction and internal fixation of subcondylar fracture with maxillomandibular fixation) versus closed (maxillomandibular fixation) treatment were compared (n = 60). Demographics, perioperative data, complications, persistent symptoms, chin deviation, malocclusion, change in mouth opening, functional scores, and FACE-Q patient satisfaction were recorded. RESULTS Open versus closed groups had similar demographics and perioperative data, except the open group had longer operating room time (76.39 minutes versus 56.15 minutes). In long-term follow-up, open-treated patients had fewer symptoms (9 percent versus 67 percent), less chin deviation (0 percent versus 40 percent), a less restricted mouth opening (3mm versus 5mm), and better functional scores (1.92 versus 0.861). Transient facial nerve weakness was seen in 6 percent of open cases. CONCLUSION For selected subcondylar fracture patients, open treatment with endoscopic assistance, nerve monitoring, and specialized plates provides superior long-term results compared to closed treatment when considering symptoms and functional parameters. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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20
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Buller J, Noetzel N, Kröger N, Zöller JE, Zirk M. Outcomes of the Nonendoscopic Transoral Approach to Subcondylar Mandible Fractures. J Oral Maxillofac Surg 2021; 80:114-120. [PMID: 34453908 DOI: 10.1016/j.joms.2021.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The transoral approach (TRA) to subcondylar fractures without any endoscopic or transbuccal assistance is not a common technique. The purpose of this study was to measure and compare the quality of open reduction and internal fixation (ORIF) between the TRA and the retromandibular approach (RMB), including types and frequencies of postoperative complications. METHODS In our retrospective cohort study, we enrolled a sample of patients with displaced subcondylar mandible fractures treated by ORIF. The predictor was the approach mode: TRA or RMB. In postoperative computed tomography (CT) data sets, we measured the angles of the condylar process in relation to references: 1) midline, 2) lateral ramus border, and 3) posterior ramus border. The primary outcome variable was the reduction outcome, which was calculated as the difference between the total of all angles of the operated side and the non-affected side. Secondary outcomes were postoperative complications extracted from patients' files. Other variables were age, gender, number of plates, operation time and a modified AO trauma score. In bivariate analysis, we compared the outcome between both groups. RESULTS Sixty-four patients were included in total, with TRA performed in 50%. Patients with TRA were younger (31 vs 41, P = .003), and the trauma score was lower (1.9 vs 3.3, P < .001). Reduction outcome remained comparable between both techniques (mean 3.7° for both, P = .92). Complication rates were similar, although facial nerve palsy was absent for TRA (0 vs 4, P = .039). CONCLUSION We suggest TRA for selected patients with displaced, single fragmented subcondylar fractures. Reduction outcome shows a comparable exactness to RMB, while TRA is safer for the facial nerve.
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Affiliation(s)
- Johannes Buller
- Consultant, Department of Oral and Craniomaxillofacial and Plastic Surgery; Received from University of Cologne, Cologne, Germany.
| | - Nicolas Noetzel
- Resident, Department of Oral and Craniomaxillofacial and Plastic Surgery; Received from University of Cologne, Cologne, Germany
| | - Nadja Kröger
- Resident, Department of Oral and Craniomaxillofacial and Plastic Surgery; Received from University of Cologne, Cologne, Germany
| | - Joachim E Zöller
- Professor and Head, Department of Oral and Craniomaxillofacial and Plastic Surgery; Received from University of Cologne, Cologne, Germany
| | - Matthias Zirk
- Consultant, Department of Oral and Craniomaxillofacial and Plastic Surgery
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21
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Proximity of the middle meningeal artery and maxillary artery to the mandibular head and mandibular neck as revealed by three-dimensional time-of-flight magnetic resonance angiography. Oral Maxillofac Surg 2021; 26:139-146. [PMID: 34024006 PMCID: PMC8844155 DOI: 10.1007/s10006-021-00960-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 03/17/2021] [Indexed: 11/15/2022]
Abstract
Purpose The close topographic relationship between vascular and osseous structures in the condylar and subcondylar region and marked variability in the arterial course has been revealed by both imaging and cadaveric studies. This study aimed to verify the previously published information in a large sample and to determine a safe surgical region. Methods We analyzed the three-dimensional time-of-flight magnetic resonance angiography images of 300 individuals. Results The mean distance between the middle meningeal artery and the apex of the condyle or the most medial point of the condyle was 18.8 mm (range: 11.2–25.9 mm) or 14.5 mm (range: 8.8–22.9 mm) respectively. The course of the maxillary artery relative to the lateral pterygoid muscle was medial in 45.7% of cases and lateral in 54.3%. An asymmetric course was evident in 66 patients (22%). The mean distance between the maxillary artery and condylar process at the deepest point of the mandibular notch was 6.2 mm in sides exhibiting a medial course (range: 3.7–9.8 mm) and 6.6 mm in sides exhibiting a lateral course (range: 3.9–10.4 mm). The distances were significantly influenced by age, gender, and the course of the maxillary artery. Conclusion Our study emphasizes the marked inter- and intra-individual variability of the maxillary and middle meningeal arterial courses. We confirmed the proximity of the arteries to the condylar process. Extensive surgical experience and thorough preparation for each individual case are essential to prevent iatrogenic vascular injury.
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Prediction of Conservative Treatment Failure for Isolated Unilateral Mandibular Condylar Fractures Using Quantitative Measures: Suggestion of Indications for Intervention. Ann Plast Surg 2021; 85:384-391. [PMID: 32149842 DOI: 10.1097/sap.0000000000002316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Interest in the treatment of mandibular condyle fracture in cases of maxillofacial trauma has been a huge concern for decades because of a diversity of opinions on the topic and the relatively few studies conducted on individuals treated by physiotherapy or rehabilitation with or without intermaxillary fixation (IMF). METHODS We measured fracture gaps between bone ends over an 8-year period from 2012 to 2019. The study cohort was composed of only conservatively treated patients. This retrospective study was conducted to identify factors that influence treatment failure by comparing a functional treatment (physiotherapy) group with an IMF group in terms of fracture gaps and other variables. In addition, an algorithm was devised to enable clinicians to determine promptly whether IMF is needed for mandibular condylar fractures. RESULTS Significant correlations were observed between several parameters and malocclusion. Multiple regression analysis resulted in the following coefficients: 0.072 for fracture gap (P = 0.006) and 0.006 for age (P < 0.05) in functional treatment group. However, in the IMF group, correlations with malocclusion were 0.063 for fracture gap (P = 0.000) and 0.003 for age (P = 0.083). CONCLUSIONS We proposed a diagnostic algorithm for isolated unilateral mandibular condyle fractures that provides guidance regarding surgical correction. If indications for surgical correction, as regards anatomical location, fracture level, fracture gap between bone ends, and patient cooperability, are not satisfied, clinicians should select IMF or functional treatment (rehabilitation). If the fracture gap is less than 6 mm and the patient is cooperative, functional rehabilitation would be more suitable than IMF.
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Management of Medially Displaced Sub-Condylar Mandibular Fractures in Pediatric Population Using Novel Atraumatic Approach. J Craniofac Surg 2021; 32:851-854. [PMID: 32897973 DOI: 10.1097/scs.0000000000006993] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The appropriate treatment of pediatric mandibular condyle fractures is subject to much debate and concern among surgeons, with improper treatment potentially resulting in a number of adverse outcomes. Such outcomes include the disruption of mandible growth, decreased posterior facial height, facial asymmetry, and temporomandibular joint ankylosis. Several surgical and nonsurgical approaches to these fractures have been described in the literature; however, each one carries its own risk of various complications. In this study, the authors illustrate a new atraumatic approach for mild to moderately displaced subcondylar fractures, with least possible complications and unexpected outcomes. In this study, 6 patients (2 female and 4 male) with unilateral medially displaced condylar base and neck fractures, angulated between 30 and 45 degrees, were treated using a novel intraoral approach. The follow-up period varied from 12 to 18 months. All patients achieved normal occlusion and had painless functioning of the temporomandibular joint with proper mouth opening (>35 mm) without any recurrence at long term follow up. This minimally invasive approach could eliminate the possibility of major complications and be considered a safe and feasible surgical technique for certain cases of pediatric mandibular condyle fracture.
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Johner JP, Essig H, Neff A, Wagner MEH, Blumer M, Gander T. Volumetric Evaluated Bone Resorption After Open Reduction and Internal Fixation of Condylar Head Fractures of the Mandible. J Oral Maxillofac Surg 2021; 79:1902-1913. [PMID: 34062130 DOI: 10.1016/j.joms.2021.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Decision making in the management of condylar head fractures remains difficult due to its dependency on multiple factors like fracture type, degree of dislocation, patient`s age and dental condition. As open reduction and internal fixation (ORIF) of condylar head fractures (CHFs) becomes more popular, the question of osteosynthesis removal is controversial. So far, information on volumetric changes after ORIF are available for a short-term period (<6 months) only. This study, therefore, was performed to assess bone resorption after condylar head fractures and to follow-up intermediate-term (>1 year) remodelling after removal of metallic osteosynthesis material. Furthermore clinical outcome was measured using Helkimo Index and put in relation with bone resorption. MATERIALS AND METHODS A retrospective analysis of 19 patients who underwent open reduction and internal fixation of condylar head fractures at the University Hospital of Zürich between January 2016 and April 2018 using intraoperative cone-beam computed tomography repositioning control was conducted. The bone resorption on the condylar head was measured in the course after removal of osteosynthesis material by segmenting and superimposing of the postoperative 3D radiologic follow-up exam (T2) over the initial intraoperative cone-beam computed tomography (T1) using iPlan-CMF software. Complementary Helkimo index was assessed to put resorption rate in relation to clinical outcome. RESULTS A total of 19 patients fulfilled the inclusion criteria. The mean follow-up time was 15.6 months and the mean bone resorption on the condylar head was -0.348cm3 or -15.29% of segmented condylar head. There was no correlation of clinical outcome and bone resorption. CONCLUSIONS Helkimo index showed satisfying results; therefore, ORIF of condylar head fracture proves as a feasible treatment option. The mean bone resorption rate of -15.29% in the intermediate-term follow-up time (mean 15.6 months) is comparable to findings of other studies with short-term follow-up time (< 6 months). Thus, postinterventional remodeling activity and resorption seems highest in the first 4 to 6 postoperative months with little further resorption. In prevention of negative sequelae of protruding implants, timing of osteosynthesis material removal after this period of high bone remodeling activity is recommended. The resorption rate showed no correlation to clinical outcome.
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Affiliation(s)
- Jean-Pierre Johner
- Resident, Department of Craniomaxillofacial Surgery, University Hospital Zürich, Switzerland.
| | - Harald Essig
- Senior physician, Department of Craniomaxillofacial Surgery, University Hospital Zürich, Switzerland
| | - Andreas Neff
- Professor, Department of Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg, Germany
| | - Maximilian E H Wagner
- Attending physician, Department of Craniomaxillofacial Surgery, University Hospital Zürich, Switzerland
| | - Michael Blumer
- Attending physician, Department of Craniomaxillofacial Surgery, University Hospital Zürich, Switzerland
| | - Thomas Gander
- Senior physician, Department of Craniomaxillofacial Surgery, University Hospital Zürich, Switzerland
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Ganguly A, Mittal G, Garg R. Comparison between 3D delta plate and conventional miniplate in treatment of condylar fracture: A randomised clinical trial. J Craniomaxillofac Surg 2021; 49:1026-1034. [PMID: 34635372 DOI: 10.1016/j.jcms.2021.01.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 11/26/2020] [Accepted: 01/31/2021] [Indexed: 10/22/2022] Open
Abstract
The aim of the study was to conduct a randomized clinical trial comparing the efficacy of standard non-compression miniplate and 3-dimensional (3D) titanium plate in the open reduction internal fixation (ORIF) of the mandibular condylar fractures. Patients who underwent open reduction of mandibular condylar fracture were recruited for the study. The patients satisfying the inclusion criteria were randomly assigned to two groups in a 1:1 ratio. Group A comprised patients treated using conventional miniplates, and Group B comprised patients treated using 3D Delta Plate. Informed consent was provided. All the patients underwent ORIF under GA via retromandibular approach. The sample size was set at 20 participants, with 10 participants in each group who were randomly allocated. Our study showed that patients in Group A had a significant statistical difference operating time (141.20 ± 2.59 min) than that of Group B (117.2 ± 9.63 min). Mouth opening was significantly greater in the 3rd-month follow-up in Group B (mean = 42.40 ± 1.82) compared to Group A (mean = 35.80 ± 1.30). Biting efficiency in Group B was observed to be clinically and statistically better compared to Group A (P = 0.012). Wound dehiscence was managed efficiently by judicious use of antibiotics and wounds were free of any signs of infections or discharge in the consecutive follow-ups. No plate removal was required in either group. Patients treated with 3D delta plates have superior outcomes with regard to operation time, mouth opening, and biting efficiency compared with miniplates. Hence, it can be concluded that the triangular shape of the 3D Delta plate allows the stress distribution to be superior and multidimensional, leading to better post-operative stability, faster healing, and reduced complications.
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Affiliation(s)
- Aneesh Ganguly
- Department of Oral and Maxillofacial Surgery, Institute of Dental Studies and Technologies (IDST), Modinagar, Uttar Pradesh, India.
| | - Gaurav Mittal
- Department of Oral and Maxillofacial Surgery, Institute of Dental Studies and Technologies (IDST), Modinagar, Uttar Pradesh, India.
| | - Ritesh Garg
- Department of Oral and Maxillofacial Surgery, Institute of Dental Studies and Technologies (IDST), Modinagar, Uttar Pradesh, India.
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Koirala U, Subedi S. Retromandibular transparotid approach for subcondylar mandibular fracture: A retrospective study. Dent Traumatol 2020; 37:314-320. [PMID: 33190403 DOI: 10.1111/edt.12626] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 09/30/2020] [Accepted: 10/04/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The retromandibular transparotid approach provides the shortest and the most direct access to mandibular sub-condylar fractures. However, this approach is less preferred due to the fear of facial nerve injury. The aim of this study was to evaluate the safety and morbidity of the retromandibular transparotid approach for open reduction and internal fixation of sub-condylar mandibular fractures. METHODS A retrospective cohort study of 29 patients with 35 sub-condylar mandibular fractures who underwent open reduction and internal fixation through the retromandibular transparotid approach was conducted. The primary study variable was facial nerve palsy, whereas the secondary variables were infection, sialocele, salivary fistula, stability of the fractured segments, post-operative malocclusion, Frey's syndrome, and unesthetic scar. All patients were followed up for 6 months. Predictor variables included age, gender, side, location, displacement, etiology, concomitant maxillofacial fractures, and healing status. Fisher's exact test was calculated to find the association between primary variables and predictor variables. RESULT Out of 35 sub-condylar fractures (29 patients; 23 male, 6 female), four (11.42%) developed transient facial nerve palsy. Fractures at the condylar neck level (P = .045) and with displacement (P = .026) were significantly associated with the development of facial nerve palsy. Four patients (13.8%) developed slight malocclusion, two had surgical site infections, two developed sialoceles, and one had a salivary fistula. CONCLUSION The retromandibular transparotid approach is safe and effective with rare major complications in the management of sub-condylar fractures of the mandible. Condylar neck fractures and displaced fractured segments are associated with an increased risk of development of facial nerve palsy.
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Affiliation(s)
- Ujjwal Koirala
- Department of Oral and Maxillofacial Surgery, Gandaki Medical College, Pokhara, Nepal
| | - Sushil Subedi
- Department of Oral and Maxillofacial Surgery, Gandaki Medical College, Pokhara, Nepal
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Naik K, Lee KC, Torroni A. Does Open Reduction and Internal Fixation Provide a Quality-of-Life Benefit Over Traditional Closed Reduction of Mandibular Condyle Fractures? J Oral Maxillofac Surg 2020; 78:2018-2026. [PMID: 32777245 DOI: 10.1016/j.joms.2020.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/11/2020] [Accepted: 07/13/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE This study sought to estimate patient-reported outcomes and compare quality-of-life (QOL) measures between patients electing for either open reduction internal fixation (ORIF) or closed reduction with intermaxillary fixation (CRIMF). PATIENTS AND METHODS This was a retrospective cohort study of patients with unilateral condyle fractures who had undergone either ORIF or CRIMF at the New York University Tisch Hospital and Bellevue Hospital Center. The primary study predictor was treatment choice (ORIF or CRIMF). Other study predictors were patient age, gender, and the presence of any other coexisting facial fractures. The 9 study outcomes were derived from an 11-item postoperative QOL questionnaire evaluating self-reported perceptions of pain and function. Univariate comparisons and multivariate regression models were calculated. RESULTS A total of 38 patients (21 CRIMF and 17 ORIF) comprised the study sample. All patients were eligible for either ORIF or CRIMF, and the choice of treatment was decided through shared decision making after a comprehensive discussion of risks and benefits. With respect to pain outcomes, patients who underwent ORIF reported lower overall pain scores at 2 weeks (P < .01) and 2 months (P = .01), less mastication pain at 3 months (P = .01), and a lower rate of persistent headaches after 6 weeks (P = .04). With respect to functional outcomes, patients who underwent ORIF reported better range of motion at 3 months (P = .01), less treatment-related weight loss (P = .01), and more ease when performing physical (P < .01) and work-related (P < .01) activities. In the multivariate regression models, ORIF was independently associated with decreased pain at 2 weeks (P < .01) and decreased difficulty in obtaining nutrition (P < .01), performing physical activities (P = .02), and performing work-related activities (P < .01). CONCLUSIONS Patients who underwent ORIF appeared to experience subjective favorable pain and functional QOL outcomes. Given the clinical controversy, the choice of treatment should synthesize patient-reported outcomes and be approached through shared decision making.
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Affiliation(s)
- Keyur Naik
- Resident, Division of Oral and Maxillofacial Surgery, New York University/Bellevue Hospital Center, New York, NY.
| | - Kevin C Lee
- Resident, Division of Oral and Maxillofacial Surgery, New York-Presbyterian/Columbia University Medical Center, New York, NY
| | - Andrea Torroni
- Associate Professor, Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, NY
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Alyahya A, Bin Ahmed A, Nusair Y, Ababtain R, Alhussain A, Alshafei A. Mandibular condylar fracture: a systematic review of systematic reviews and a proposed algorithm for management. Br J Oral Maxillofac Surg 2020; 58:625-631. [PMID: 32245577 DOI: 10.1016/j.bjoms.2020.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 03/14/2020] [Indexed: 01/02/2023]
Abstract
The choice of surgical or non-surgical treatment of mandibular condylar fractures remains controversial. Earlier trials documented multiple complications of surgical treatment and recommended a non-surgical approach, while more recent trials have shown superior outcomes of surgical compared with non-surgical treatment in some cases. In this paper we systematically review the systematic reviews on the topic that were published before January 2019 and which followed the PRISMA statement, and propose an algorithm for the management of these fractures. Two systematic reviews met the inclusion criteria of the current review, both of which showed better outcome from surgical than non-surgical treatment. We propose an algorithm based on the feasibility of fixation, ability to restore joint and occlusal function, and ensure adequate healing, and consider patient-associated factors that facilitate decision-making.
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Ibrahim MH, Ali S, Abdelaziz O, Galal N. Will Closed Treatment Provide Better Mandibular Motion Than Open Reduction and Internal Fixation in Cases of Unilateral Displaced Subcondylar Fracture? A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2020; 78:1795-1810. [PMID: 32554064 DOI: 10.1016/j.joms.2020.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of the present systematic review was to determine whether closed treatment (CLT) with intermaxillary fixation (IMF) is superior or equivalent to open reduction and internal fixation (ORIF) in the management of unilateral displaced subcondylar fractures regarding the range of mandibular motion. MATERIALS AND METHODS To address our question, we conducted a systematic review and meta-analysis of the reported data after a comprehensive manual and electronic database search of studies reported up to 2017 in the English language that had compared CLT and ORIF of mandibular condyle fractures in adults. The following outcomes were recorded: maximum interincisal opening (MIO), protrusive movement (PM), lateral excursion toward the fractured side (LEFS), and lateral excursion toward the nonfractured side (LENFS). RESULTS The search resulted in 8 studies, 4 of which were included in the meta-analysis. The MIO and PM showed no statistically significant differences, with an effect size of -0.823 (P = .112) and -0.633 (P = .079), respectively. However, the LEFS and LENFS were superior after CLT, with an effect size of -0.710 (P = .031) and -0.682 (P = .017), respectively. CONCLUSIONS The findings from the present review suggest that both ORIF and CLT can provide comparable MIO and PM in subjects with unilateral displaced subcondylar fractures. However, CLT was superior to ORIF for both LEFS and LENFS.
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Affiliation(s)
- Mohamed H Ibrahim
- Master's Degree Candidate, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt.
| | - Sherif Ali
- Lecturer, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Omniya Abdelaziz
- Lecturer, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Nadia Galal
- Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
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Postoperative outcomes of adult patients with sagittal fractures of mandibular condyle: Quantitative evaluation and retrospective factor analysis. J Craniomaxillofac Surg 2020; 48:421-426. [DOI: 10.1016/j.jcms.2020.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 01/26/2020] [Accepted: 02/14/2020] [Indexed: 11/23/2022] Open
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Radiologic Analysis of Surgically Treated Fractures of the Condylar Process by an Endoscopic-Assisted Transoral Approach. J Oral Maxillofac Surg 2020; 78:1151-1155. [PMID: 32201123 DOI: 10.1016/j.joms.2020.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/10/2020] [Accepted: 02/16/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE This study analyzed the radiologic outcomes of patients with unilateral mandibular condylar fractures treated with open reduction-internal fixation (ORIF) through a transoral approach. PATIENTS AND METHODS In this retrospective study, the radiologic images of 40 patients who underwent open reduction-internal fixation through a transoral approach were presented to 2 independent examiners. All patients underwent the surgical procedure between January 2015 and December 2016 at the Department of Cranio-Maxillofacial Surgery at UniversitätsSpital Zürich and were included in a previous functional outcome study. The surgical results were analyzed and graded as poor, acceptable, or good. The examiners declared whether they would have made any intraoperative revisions if the radiologic information had been available. Finally, the examiners estimated the required duration of elastic intermaxillary fixation (IMF) from the radiologic images, which was compared with the actual duration. RESULTS Fracture reduction was classified as good in 33 cases (82.5%), acceptable in 5 cases, and poor in 2 cases by one examiner and as good in 32 cases (80%), acceptable in 6 cases, and poor in 2 cases by the other examiner. The inter-rater reliability was determined to be good (Cohen κ = 0.92). Correct osteosynthesis placement was found in 19 cases by one examiner and in 21 cases by the other examiner, with good inter-rater reliability (κ = 0.8). Moderate inter-rater reliability (κ = 0.4) was found for the required duration of elastic IMF. Furthermore, the estimated elastic IMF duration matched the actual duration in fewer than half of the cases. CONCLUSIONS It is feasible to achieve reliably good radiologic results when operating on condylar process fractures by a transoral approach with endoscopic assistance and angled instruments. Intraoperative 3-dimensional imaging enables instant quality control and prompts surgical revision if needed.
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Simple Way of Facilitating Reduction the Fragment for Fractures With Condyle. J Craniofac Surg 2020; 31:568-569. [PMID: 31934974 DOI: 10.1097/scs.0000000000006279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To describe a technique that uses a fixation screw with a steel wire ring which is implanted into the mandibular to facilitate the condylar fracture reduction. This technique has been used on 382 patients over the last 8 years from the Department of Oral and Cranio-Maxillofacial Science of Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. No complication has been encountered. Applying this approach, the displaced proximal condylar fragment can be found quickly, and then the fragment can be effectively prevented from being broken again in the reduction process.
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Weinberg FM, Vermaire JA, Forouzanfar T, Rosenberg AJWP, Speksnijder CM. Reproducibility and construct validity of the utrecht mixing ability Test to obtain masticatory performance outcome in patients with condylar mandibular fractures. J Oral Rehabil 2019; 47:460-466. [PMID: 31785007 PMCID: PMC7079003 DOI: 10.1111/joor.12917] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/09/2019] [Accepted: 11/20/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This study assessed the test-retest reproducibility of the Utrecht mixing ability test (MAT) and the construct validity of the MAT in relation to the Mandibular Function Impairment Questionnaire (MFIQ) in patients with mandibular condylar fractures. MATERIAL AND METHODS Twenty-six patients treated for a mandibular condylar fracture participated in this clinimetric study; all patients performed the MAT twice. Simultaneously the MFIQ was conducted. Test-retest reliability and construct validity were assessed using the intra-class correlation coefficient (ICC) and Spearman correlation, respectively. RESULTS The ICC of the MAT was 0.906 (95% CI: 0.801-0.957), which indicates an excellent reliability. A weak correlation of 0.386 (P = .052) between the first MAT and the overall outcome of the MFIQ was found. A significant moderate correlation of 0.401 (P = .042) was found between the retest of the MAT and the overall outcome of the MFIQ. One question on the MFIQ (about yawning) showed a moderate positive correlation of 0.569 (P = .002) and 0.416 (P = .034) for the MAT test and retest, respectively. CONCLUSION The MAT is an easy test to use in follow-up of patients. The test-retest reliability of this test is excellent in condylar trauma patients. As the validity of the MAT and the MFIQ could not be confirmed, the MFIQ may be an addition to patient's feedback about the rehabilitation process of their mandibular functioning.
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Affiliation(s)
- Florine M Weinberg
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jorine A Vermaire
- Division of Medical Imaging, Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Tymour Forouzanfar
- Department of Oral and Maxillofacial Surgery/Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam and Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Antoine J W P Rosenberg
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Caroline M Speksnijder
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Exclusive Functional Treatment for Mandibular Condylar Fractures. J Oral Maxillofac Surg 2019; 77:2523.e1-2523.e8. [DOI: 10.1016/j.joms.2019.06.188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 06/26/2019] [Accepted: 06/26/2019] [Indexed: 11/20/2022]
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Brucoli M, Boffano P, Romeo I, Corio C, Benech A, Ruslin M, Forouzanfar T, Rodríguez-Santamarta T, de Vicente JC, Tarle M, Dediol E, Pechalova P, Pavlov N, Daskalov H, Doykova I, Kelemith K, Tamme T, Kopchak A, Shumynskyi I, Corre P, Bertin H, Bourry M, Guyonvarc'h P, Dovšak T, Vozliè D, Birk A, Anièiæ B, Konstantinovic VS, Starch-Jensen T. Management of mandibular condylar fractures in patients with atrophic edentulous mandibles. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 121:226-232. [PMID: 31655226 DOI: 10.1016/j.jormas.2019.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Treatment of condylar fractures in patients with atrophic edentulous mandibles is a peculiar field that has been little considered in the literature. The aim of the study was to assess the demographic and clinical variables as well as management and outcome of mandibular condylar fractures in edentulous patients with atrophic mandibles that were treated at several European departments of oral and maxillofacial surgery. METHODS The data of all patients with fractures of the atrophic edentulous mandible from the involved maxillofacial surgical units across Europe between January 1, 2008, and December 31, 2017. Only patients that were diagnosed with condylar fractures of the edentulous atrophic mandible were included. RESULTS A total of 52 patients met the inclusion criteria and were included in the study: 79% of patients reported one or more comorbidities. Thirty-four unilateral neck or subcondylar fractures, 9 bilateral neck or subcondylar condylar fractures, 7 unilateral head condylar fractures, and 2 bilateral head condylar fractures were diagnosed. No treatment was performed in 37 cases, whereas in 4 patients a closed treatment was decided, and 11 patients underwent open reduction and internal fixation. Outcome was considered to be satisfying in 48 patients, with no complications. CONCLUSIONS The golden rule still remains that the diagnosis of a subcondylar or neck fracture in an edentulous patient should constitute an indication for open reduction and internal fixation. However, an appropriate choice of management options has to be individualized on a case by case basis, also depending on the patient consent.
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Affiliation(s)
- M Brucoli
- Division of Maxillofacial Surgery, University Hospital "Maggiore della Carità", University of Eastern Piedmont, Novara, Italy
| | - P Boffano
- Division of Maxillofacial Surgery, University Hospital "Maggiore della Carità", University of Eastern Piedmont, Novara, Italy.
| | - I Romeo
- Division of Maxillofacial Surgery, University Hospital "Maggiore della Carità", University of Eastern Piedmont, Novara, Italy
| | - C Corio
- Division of Maxillofacial Surgery, University Hospital "Maggiore della Carità", University of Eastern Piedmont, Novara, Italy
| | - A Benech
- Division of Maxillofacial Surgery, University Hospital "Maggiore della Carità", University of Eastern Piedmont, Novara, Italy
| | - M Ruslin
- Department of Oral and Maxillofacial Surgery, Hasanuddin University, Makassar, Indonesia
| | - T Forouzanfar
- Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - T Rodríguez-Santamarta
- Servicio de Cirugía Maxilofacial, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - J C de Vicente
- Servicio de Cirugía Maxilofacial, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - M Tarle
- Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - E Dediol
- Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - P Pechalova
- Department of Oral surgery, Faculty of Dental Medicine, Medical University, Plovdiv, Bulgaria
| | - N Pavlov
- Private practice of oral surgery, Plovdiv, Bulgaria
| | - H Daskalov
- Department of Oral surgery, Faculty of Dental Medicine, Medical University, Plovdiv, Bulgaria
| | - I Doykova
- Department of maxillofacial surgery, Faculty of Dental Medicine, Medical University, Plovdiv, Bulgaria
| | - K Kelemith
- Department of maxillo-facial surgery, North Estonia Medical Centre Foundation, Tallinn, Estonia
| | - T Tamme
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - A Kopchak
- Bogomolets National Medical University, Stomatological medical center, Kyiv, Ukraine
| | - I Shumynskyi
- Bogomolets National Medical University, Kyiv City Clinical Emergency Hospital, Kyiv, Ukraine
| | - P Corre
- Division of Maxillofacial Surgery, CHU de Nantes, Nantes, France
| | - H Bertin
- Division of Maxillofacial Surgery, CHU de Nantes, Nantes, France
| | - M Bourry
- Division of Maxillofacial Surgery, CHU de Nantes, Nantes, France
| | - P Guyonvarc'h
- Division of Maxillofacial Surgery, CHU de Nantes, Nantes, France
| | - T Dovšak
- Department of Maxillofacial and Oral Surgery of the University Medical Centre, Ljubljana, Slovenia
| | - D Vozliè
- Department of Maxillofacial and Oral Surgery of the University Medical Centre, Ljubljana, Slovenia
| | - A Birk
- Department of Maxillofacial and Oral Surgery of the University Medical Centre, Ljubljana, Slovenia
| | - B Anièiæ
- Department of Maxillofacial surgery, School of Dental Medicine, University of Belgrade, Serbia
| | - V S Konstantinovic
- Department of Maxillofacial surgery, School of Dental Medicine, University of Belgrade, Serbia
| | - T Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark
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Kuang SJ, He YQ, Zheng YH, Zhang ZG. Open reduction and internal fixation of mandibular condylar fractures: A national inpatient sample analysis, 2005-2014. Medicine (Baltimore) 2019; 98:e16814. [PMID: 31517812 PMCID: PMC6750236 DOI: 10.1097/md.0000000000016814] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to compare outcomes of open reduction and internal fixation (ORIF) versus closed reduction (CR) for mandibular condylar fractures.Patients included in the National Inpatient Sample (NIS) database (2005-2014) who were admitted to the hospital for unilateral mandibular condylar fracture were included in the analysis. Patient characteristics and clinical outcomes were compared between those who received ORIF and those receiving CR. Logistic regression analysis was performed to estimate odds ratios (ORs) for each aspect of the main observed events.NIS data of 12,303 patients who underwent ORIF and 4310 patients who underwent CR were analyzed. Compared to CR, ORIF had an increased risk of longer hospital stay (adjusted OR [aOR] = 1.78, 95% confidence intervals [CIs] = 1.51-2.09), higher total medical cost (aOR = 2.57, 95% CI = 2.17-3.05), and hematoma development (aOR = 10.66, 95% CI = 1.43-75.59), but had a lower risk of having wound complications (aOR = 0.86, 95% CI = 0.79-0.93).Patients with mandibular condylar fractures who receive ORIF have greater risk of having an extended hospital stay, higher total medical costs, and hematoma development but lower risk of experiencing wound complications compared to those who receive CR.
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Parihar VS, Bandyopadhyay TK, Chattopadhyay PK, Jacob SM. Retromandibular transparotid approach compared with transmasseteric anterior parotid approach for the management of fractures of the mandibular condylar process: a prospective randomised study. Br J Oral Maxillofac Surg 2019; 57:880-885. [PMID: 31402192 DOI: 10.1016/j.bjoms.2019.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 07/09/2019] [Indexed: 12/18/2022]
Abstract
Fractures of the mandibular condyle lead to displacement of the condyle and loss of the height of the ramus. A retromandibular approach is the most commonly used for open reduction and internal fixation (ORIF) of such fractures. We aimed to compare the complications associated with a retromandibular transparotid approach with a retromandibular transmasseteric anterior parotid (TMAP) approach for their management. Thirty patients were randomly selected into two groups (15 in each): Group A comprised the retromandibular transparotid approach and Group B the retromandibular TMAP. The variables evaluated were: operating time, facial nerve injury, occurrence of Frey syndrome, and sialocoele at one week, four weeks, three months, and six months. The mean (SD) age in group A and B was 33.93 (17.97) years and 33.53 (16.15) years, respectively, and there were 28 men and two women. Mean (SD) exposure time in the transparotid approach was 26.93 (5.19) minutes and 25.4 (8.35) minutes in the TMAP approach. The incidence of facial nerve injury was 2/15 patients in the transparotid group and 3/15 in the TMAP group, all of which resolved within six months. The incidence of sialocoele was 2/15 in the transparotid group. The results did not show any significant difference in complications between the two approaches, but the retromandibular transparotid approach provided straight-line access in fractures of the condylar neck, with fewer incidences of nerve injury. The anterior parotid approach, on the other hand, provided easier access for fractures that were medially dislocated or of the condylar base but had an increased incidence of facial nerve injuries.
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Affiliation(s)
- V S Parihar
- Department of Oral and Maxillofacial Surgery, Army Dental Center (Research and Referral), Delhi Cantt, New Delhi, India.
| | - T K Bandyopadhyay
- Department of Oral and Maxillofacial Surgery, Army Dental Center (Research and Referral), Delhi Cantt, New Delhi, India
| | - P K Chattopadhyay
- Department of Oral and Maxillofacial Surgery, Army Dental Center (Research and Referral), Delhi Cantt, New Delhi, India
| | - S M Jacob
- Department of Oral and Maxillofacial Surgery, Army Dental Center (Research and Referral), Delhi Cantt, New Delhi, India
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Li J, Yang H, Han L. Open versus closed treatment for unilateral mandibular extra-capsular condylar fractures: A meta-analysis. J Craniomaxillofac Surg 2019; 47:1110-1119. [DOI: 10.1016/j.jcms.2019.03.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/08/2019] [Accepted: 03/18/2019] [Indexed: 11/16/2022] Open
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Weinberg FM, Speksnijder CM, Forouzanfar T, Rosenberg AJWP. Articular soft tissue injuries associated with mandibular condyle fractures and the effects on oral function. Int J Oral Maxillofac Surg 2019; 48:746-758. [PMID: 30773333 DOI: 10.1016/j.ijom.2019.01.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/08/2018] [Accepted: 01/28/2019] [Indexed: 11/26/2022]
Abstract
The majority of studies debating the optimization of treatment for condylar mandibular fractures focus on the bony aspect first. However, fractures of the mandibular condyle may go together with soft tissue injury of the temporomandibular joint. An electronic literature search for this topic was undertaken. Assessment of quality was carried out using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Sixteen articles were included in this review. The reviewed literature showed that intracapsular fractures and dislocated condylar fractures result in more severe injuries. Serious injury to the disc and capsule of the temporomandibular joint is a contributing factor towards development of complications after closed treatment. The results of this review give an overview of the published studies focusing on articular soft tissue injuries caused by condylar mandibular fractures. Additionally, an overview of the magnetic resonance imaging (MRI) settings used to detect these injuries is provided. Until now, the relation between soft tissue injuries and type of condylar trauma and their influence on clinical outcome has been insufficiently investigated. Before considering reduction of soft tissues next to reduction of the fracture, more research is needed into the impact of soft tissue injuries on oral functioning, in which a uniform classification is used.
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Affiliation(s)
- F M Weinberg
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, The Netherlands.
| | - C M Speksnijder
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - T Forouzanfar
- Department of Oral and Maxillofacial Surgery/Pathology, VU University Medical Center and Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - A J W P Rosenberg
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, The Netherlands
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Outcome of Surgically Treated Fractures of the Condylar Process by an Endoscopic Assisted Transoral Approach. J Oral Maxillofac Surg 2019; 77:133.e1-133.e9. [DOI: 10.1016/j.joms.2018.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 08/15/2018] [Accepted: 08/15/2018] [Indexed: 11/24/2022]
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Abstract
BACKGROUND Condylar fractures are considered the most controversial mandibular fractures, regarding both the diagnosis and the treatment. With the increase in surgical indications for handling this type of fracture, it is important to discuss about the advantages and disadvantages of the several surgical approaches available. This article describes the surgical details and postoperative results of the mini-retromandibular transparotid approach for treating extracapsular condylar fractures of the mandible. METHODS In a 1-year period, 16 patients affected by extracapsular condylar fractures with surgical indication were treated with the mini-retromandibular transparotid approach. All the surgeries were executed by the same surgeon. Preoperative and postoperative details of each patient were analyzed. RESULTS In the postoperatory, only 2 patients had purulent drainage in the associated fractures area and only 1 patient had paresis of the buccal branch of the facial nerve. No scar issues concerning the surgical wound were observed and reintervention was not necessary in any of the patients. CONCLUSION The mini-retromandibular transparotid approach offers advantages and should be included as an option for the open treatment of extracapsular condylar fractures of the mandible.
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Rozeboom A, Dubois L, de Lange J. Randomized clinical trial on condylar fractures: ‘open or closed’? Int J Oral Maxillofac Surg 2018; 47:683-684. [DOI: 10.1016/j.ijom.2018.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 01/18/2018] [Indexed: 10/18/2022]
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Algan S, Kara M, Cakmak MA, Tan O, Cinal H, Barin EZ, Inaloz A. Experiences with a modified preauricular mini incision with subdermally dissection in condylar and subcondylar fractures of the mandible. J Craniomaxillofac Surg 2018. [PMID: 29526414 DOI: 10.1016/j.jcms.2018.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Condylar and subcondylar fractures (CSFs) are among the most common mandible fractures. If reduction of these fractures is not carried out correctly, serious complications can result, including infection, damage to temporomandibular joint (TMJ) function, malocclusion, nonunion, malunion, and ankylosis of the TMJ. METHODS We used a preauricular, mini-incision, open technique (PMIOT) for CSF of the mandible. 66 patients (48 males, 18 females), with a total of 72 CSFs of the mandible, were repaired with PMIOT between 2011 and 2016. Average age was 37.8 years (range: 8-78). CSFs were located on the right side, left side, and bilaterally in 21, 27 and six patients, respectively. We used only one mini incision of length 2 cm for non-displaced subcondylar fractures. However, we had to perform a second mini incision for condylar fractures displaced by more than 45°, where subcondylar fractures overlapped, or where there was deep surgical exposure and difficulty with reduction. RESULTS No early complications, such as bleeding, hematoma, seroma, infection, or parotid fistula, were seen in any patients. Temporary facial nerve paresis was reported in three patients, but these recovered spontaneously with conservative treatment within 15 days. Permanent facial nerve paralysis occurred in none of the patients. CONCLUSION We believe that PMIOT is an effective, reliable, and feasible method for repair of CSF. It does not need any expensive and sophisticated tools, and has low complication rates. The mini incision used in our technique results in both a hidden scar and protection of essential structures in the region.
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Affiliation(s)
- Said Algan
- Medical Park Hospital, Plastic and Reconstructive and Aesthetic Surgery Clinic, Batman, Turkey.
| | - Murat Kara
- Regional Training and Research Hospital, Plastic and Reconstructive Surgery Clinic, Erzurum, Turkey
| | - Mehmet Akif Cakmak
- Ataturk University, Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Erzurum, Turkey
| | - Onder Tan
- Ataturk University, Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Erzurum, Turkey
| | - Hakan Cinal
- Ataturk University, Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Erzurum, Turkey
| | - Ensar Zafer Barin
- Ataturk University, Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Erzurum, Turkey
| | - Akin Inaloz
- Regional Training and Research Hospital, Plastic and Reconstructive Surgery Clinic, Erzurum, Turkey
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Merlet FL, Grimaud F, Pace R, Mercier JM, Poisson M, Pare A, Corre P. Outcomes of functional treatment versus open reduction and internal fixation of condylar mandibular fracture with articular impact: A retrospective study of 83 adults. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 119:8-15. [DOI: 10.1016/j.jormas.2017.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 08/20/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022]
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Elsayed SA. Unusual pattern of mandibular fracture displacement in a child: A case report. J Taibah Univ Med Sci 2017; 12:174-177. [PMID: 31435234 PMCID: PMC6695041 DOI: 10.1016/j.jtumed.2016.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 12/07/2016] [Accepted: 12/14/2016] [Indexed: 11/29/2022] Open
Abstract
Most mandibular fractures in children are greenstick-type fractures with minimal displacement. We report a case of a severely displaced condylar and coronoid mandibular fracture along with its clinical presentation and radiological and surgical features. The right condyle and coronoid were laterally displaced, riding completely over the lateral surface of zygomatic arch with a coronoid fragment displaced medially. There was a large haematoma collection in the lateral pharyngeal wall extending downward to the inferior border of the mandible with severe soft tissue injury at the submandibular region. The rarity of such paediatric trauma in the head and neck region and the management of such an injury make this case more interesting for maxillofacial surgeons.
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Affiliation(s)
- Shadia A Elsayed
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Taibah University, Almadinah Almunawwarah, KSA
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Ribeiro Ribeiro AL, da Silva Gillet LC, de Vasconcelos HG, de Castro Rodrigues L, de Jesus Viana Pinheiro J, de Melo Alves-Junior S. Facial Fractures: Large Epidemiologic Survey in Northern Brazil Reveals Some Unique Characteristics. J Oral Maxillofac Surg 2016; 74:2480.e1-2480.e12. [DOI: 10.1016/j.joms.2016.08.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 08/02/2016] [Accepted: 08/07/2016] [Indexed: 11/17/2022]
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D'Agostino A, Trevisiol L, Procacci P, Favero V, Odorizzi S, Nocini PF. Is the Retromandibular Transparotid Approach a Reliable Option for the Surgical Treatment of Condylar Fractures? J Oral Maxillofac Surg 2016; 75:348-356. [PMID: 27818079 DOI: 10.1016/j.joms.2016.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/10/2016] [Accepted: 10/02/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE This study evaluated the outcomes and complications of the surgical treatment of condylar fractures by the retromandibular transparotid approach. The authors hypothesized that such an approach would be safe and reliable for the treatment of most condylar fractures. MATERIALS AND METHODS A retrospective evaluation of patients who underwent surgical reduction of a condylar fracture from January 2012 to December 2014 at the Clinic of Dentistry and Maxillofacial Surgery of the University Hospital of Verona (Verona, Italy) was performed. Inclusion criteria were having undergone surgical treatment of condylar fractures with a retromandibular transparotid approach and the availability of computed tomograms of the preoperative and postoperative facial skeleton with a minimum follow-up of 1 year. Static and dynamic occlusal function, temporomandibular joint health status, presence of neurologic impairments, and esthetic outcomes were evaluated in all patients. RESULTS The sample was composed of 25 patients. Preinjury occlusion and temporomandibular joint health were restored in most patients. Esthetic outcomes were deemed satisfactory by clinicians and patients. Neither permanent neurologic impairments nor major postoperative complications were observed. CONCLUSIONS According to the results of the present study, the retromandibular transparotid approach is a viable and safe approach for the surgical treatment of condylar fractures.
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Affiliation(s)
- Antonio D'Agostino
- Associate Professor, Unit of Maxillofacial Surgery and Dentistry, University of Verona, Verona, Italy
| | - Lorenzo Trevisiol
- Associate Professor, Unit of Maxillofacial Surgery and Dentistry, University of Verona, Verona, Italy
| | - Pasquale Procacci
- Assistant Professor, Unit of Maxillofacial Surgery and Dentistry, University of Verona, Verona, Italy
| | - Vittorio Favero
- Clinical Assistant, Unit of Maxillofacial Surgery and Dentistry, University of Verona, Verona, Italy.
| | - Silvia Odorizzi
- Assistant, Unit of Maxillofacial Surgery and Dentistry, University of Verona, Verona, Italy
| | - Pier Francesco Nocini
- Professor and Chief, Unit of Maxillofacial Surgery and Dentistry, University of Verona, Verona, Italy
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Sikora M, Sielski M, Stąpor A, Chlubek D. Use of the Delta plate for surgical treatment of patients with condylar fractures. J Craniomaxillofac Surg 2016; 44:770-4. [DOI: 10.1016/j.jcms.2016.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/08/2016] [Accepted: 04/07/2016] [Indexed: 10/21/2022] Open
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