No Significant Bone Resorption after Open Treatment of Mandibular Condylar Head Fractures in the Medium-Term

Risk Factors and Impact of Intra-Articular Scarring After Open Reduction and Internal Fixation in Mandibular Condylar Head Fractures-A Prospective Analysis

Background: During the routine removal of osteosynthesis materials after surgical treatment (ORIF) of condylar head fractures (CHFs), as performed at our clinic, localised and sometimes pronounced intra-articular scarring were observed quite regularly. This prospective study therefore investigates the causes of intra-articular scarring and its impact on functionality after surgical treatment (ORIF) of condylar head fractures (CHFs). Methods: Moreover, 80/98 patients with 96/114 CHFs (ORIF between 2014 and 2024) were evaluated when performing hardware removal. Statistical analysis used logistic regression and sign tests. Results: Postoperative scarring was seen in 72/96 cases (75%), either localised (n = 54; 56%) or pronounced (n = 18; 19%). Scarring correlated with limitations of laterotrusion for pronounced scarring (p = 0.016; OR = 6.806; 95% CI [1.422, 32.570]; large effect size) and with limitations of mediotrusion for localised scarring (p = 0.013; OR = 0.236; 95% CI [0.076, 0.734]; very small effect size). Factors favouring localised scarring were reduced ipsilateral dental support (p = 0.022; OR = 3.36; 95% CI [1.191, 9.459]; medium effect size) and major fragmentation (p = 0.029; OR = 3.182; 95% CI [1.123, 9.013]; medium effect size). However, there was no correlation between scarring and types (screws w/wo microplates) or number of osteosynthesis materials. Pronounced scarring showed a significantly higher risk for osseous degenerative complications (p = 0.041; OR = 4.171; CI [1.058, 16.452]; medium effect size). Conclusions: Intra-articular scarring after ORIF of CHFs poses a risk for functional limitations and osseous degenerative changes. Early adhesiolysis during the removal of hardware seems favourable for functional outcomes after CHFs.

Quantitative Assessment of Condylar Remodeling After Open Reduction and Internal Fixation in Mandibular Condylar Head Fractures

Open reduction and internal fixation (OR/IF) and closed treatments are viable options, with OR/IF gaining popularity in mandibular condylar head fracture (CHF). Sufficient research is lacking on long-term condylar morphologic changes. This study quantitatively evaluated the morphologic changes in the condylar head in patients who underwent OR/IF for CHF without the removal of osteosynthesis material. A retrospective study analyzed patients who underwent OR/IF for CHF between November 2010 and August 2022. The transverse/lateral condyle width and condyle height were radiologically analyzed using panoramic and reverse Towne view x-ray images at immediate (T0), short-term (T1), and long-term (T2) postoperative periods. The study involved 29 patients with 32 surgically treated CHF. Long-term condyle height decreased significantly from 18.9±0.8 mm at T0 to 18.1±0.8 mm at T1 (P=0.042), and further to 17.3±0.7 mm at T2 (P=0.034). Transverse width slightly reduced from 18.7±0.7 mm at T0 to 17.9±0.8 mm at T1 (P=0.001) but remained stable from T1 to T2 (17.6±1.0 mm, P=0.756). Following surgery, maximal mouth opening averaged 39.5±6.1 mm, with one case of chin deviation and three cases of joint pain. The condyle undergoes long-term shortening without altering its width. Nevertheless, patients experience favorable functional outcomes, including satisfactory mouth opening and occlusion. In addition, it is advisable not to remove the osteosynthesis material, as the remaining material causes minimal functional impairment and bone resorption.

Remodelling of mandibular condylar head after fixation of fractures with ultrasound activated resorbable pins: A retrospective case series

The aim of this study was to assess whether the resorption of poly-lactic acid pins, used for condylar head fracture fixation, adversely affect remodelling of the condylar head. A retrospective review of patients was performed that underwent ORIF of CHF with ultrasound activated resorbable poly-lactic acid pins and had CT/CBCT scans of the condyle at least 18 months after surgery, at which point the fixation material was expected to be resorbed. We reviewed the size, shape and position of the condylar head and compared this to the normal side and compared this to the results of conservative management and ORIF with titanium screws in the literature. Most patients had condylar heads normally positioned and shaped, with minimal bone changes. The position of the condyle in the fossa, its shape and bone changes compare favourably with previous studies on CHF managed conservatively or with titanium screw fixation. There was no radiographic evidence of the pins after 18 months. In conclusion, ultrasound activated resorbable pins can provide suitable fixation for ORIF of condylar head fractures, avoiding the need for screw removal, and there was no evidence that the resorption process adversely affected the remodelling of the condylar head.

Maxillofacial Fractures: A Four-Year Retrospective Study of 1828 Cases in West China

OBJECTIVE

To analyze the epidemiological and clinical characteristics of maxillofacial fracture cases in a stomatological center in southwest China.

METHODS

This study includes 1828 cases of maxillofacial fractures treated in our hospital from January 2018 to December 2021. We analyzed the gender, age, causes of injury, fracture sites, concomitant injuries, treatment, and postoperative infection of these cases. Our data are also compared with those from similar domestic studies.

RESULTS

Among the 1828 cases, the male-to-female ratio was 2.48:1 with an average age of 34.55 ± 16.36 years. The highest incidence of fracture was 21-50 years old, and the most common cause of injury was falls (38.95%). There was a statistically significant difference in the composition of injury causes among different age groups(P<0.05). Mandible (37.56%) was the most easily fractured site, and limb injury (17.89%) was the most common concomitant body injury. In all cases, 85.23% of patients were treated with open reduction and internal fixation.  Conclusions: Maxillofacial fractures often occur in the mandible of young and middle-aged men. Falls and traffic accidents are the main causes of injury, often accompanied by limb and brain injuries. Open reduction and internal fixation is still the most commonly used treatment. There are some differences in the results reported by different domestic hospitals.

Serious Condylar Head Absorption in Children With Intracapsular Condylar Fractures Treated Operatively With Long Screws

OBJECTIVE

This study was performed to explore bone remodelling in children with intracapsular condylar fractures after the condylar fracture fragments were fixed using long screws and to offer possible explanations about the underlying mechanism.

PATIENT AND METHODS

Records of children (less than 12 y old) who sustained intracapsular condylar fractures and fixed with long screws from May 2012 to January 2015 were retrieved. Age, gender, dates of injury, admission, and discharge, mechanism of trauma, location and pattern of fracture, other mandibular fractures, treatment methods, and time of review were recorded and analyzed. Image dates of pretreatments and posttreatments, including the date of review, were also recorded.

RESULTS

A total of 8 patients completed their follow-up, and all patients (n=5) who were followed up after more than 3 months showed serious resorption of the condylar head. The condylar head resorbed until the height (or articular surface) dropped and aligned with the surface of the screw. The shortest time of absorption, as shown by the computed tomography scan was 106 days, and the longest time was 171 days (average time of 141.8 d).

CONCLUSIONS

Intracapsular condyle fractures in children should be managed conservatively as much as possible. However, if the height of the fracture fragments drops remarkably, open reduction and rigid internal fixation become possible choices.