15 years follow-up on condylar fractures

Long-term follow-up of subcondylar fractures in children by electronic computer-assisted recording of condylar movements

Twenty-eight patients have been followed up for an average of 15.1 years after uni- or bilateral subcondylar fractures sustained during their growth period. The conservative treatment, using orovestibular plates, has been evaluated with special reference to clinical, radiographic and functional parameters. TMJ function was tested using an electronic computer-assisted recording system. Condylar remodelling occurred in only about half of the individuals. Nevertheless, because of the good esthetic and functional results there seems to be no indication for operative reduction of the displaced condyle during the growth period.

New generation biodegradable plate for fracture fixation: comparison of bending strengths of mandibular osteotomies fixed with absorbable self-reinforced multi-layer poly-l-lactide plates and metallic plates--an experimental study in sheep

Eighteen osteotomies of sheep's mandibular corpus were fixed: nine with self-reinforced multi-layer poly-l-lactide (SR-PLLA) plates and nine with metallic plates. Both plates were fixed with similar metallic screws. The right corpus of each sheep acted as a control. Radiographic analysis was carried out at 3 weeks and at sacrifice (6, 12 or 24 weeks) when the bending force needed to break the osteotomy site was measured. At 6 and 12 weeks of follow-up the osteotomy fixed with the PLA-plate seemed to tolerate the bending force better but no significant differences were detected at 3 or 24 weeks. The results have been satisfactory and have led the authors to continue with the development of a SR-PLLA plate-and-screw device for fracture fixation.

A comparative study of the treatment of unilateral fractured and dislocated mandibular condyles in the rabbit

This study evaluated the results of three methods of managing simulated unilateral dislocated fractured mandibular condyles in the rabbit. The first method consisted of surgical reduction of the fractured condyle to its anatomic position and its subsequent fixation with a titanium plate. The second method differed from the first by completely detaching the condyle, then replacing it as free graft. The third method left the fractured condyle in its dislocated position outside the glenoid fossa. Eighteen rabbits were used, 6 animals for each method. Half the animals in each group were killed at 4 weeks, the other half at 14 weeks postoperatively. Clinical, morphologic, functional, radiologic, and histologic examinations were conducted on all animals. The results indicated that open reduction with internal fixation with no disruption of the blood supply to the condyle provided the most favorable results. While closed reduction without internal fixation gave good functional results, definite reduction in ramus height on the operated site was observed in this group of animals. Animals that had open reduction and internal fixation using the condyle as a free graft did not do as well as the other two groups. Despite good mouth opening and occlusion, more animals showed facial asymmetry and it was more severe. None of the condyles were lost as result of necrosis, but healing took longer when compared with the other group of animals.

Comparison of absorbable self-reinforced poly-L-lactide screws and metallic screws in the fixation of mandibular condyle osteotomies: an experimental study in sheep

Nine osteotomies of the neck of the mandibular condylar process in sheep were fixed with self-reinforced poly-L-lactide screws and nine with metallic screws; two osteotomies were left unfixed. Radiographic examination was carried out at 3 weeks. The animals were killed at 6, 12, and 24 weeks. Malalignment was detected at 3 and 12 weeks in both unfixed condyles. The consolidation of the fixed osteotomies seemed to be faster in the polylactide group than in the metallic group. There were no complications in the healing of the fixed osteotomies.

Open reduction and internal rigid fixation of subcondylar fractures via an intraoral approach

Extraoral open reduction and rigid fixation of mandibular subcondylar fractures is controversial among surgeons. An intraoral approach with a percutaneous trocar and miniplates demonstrated satisfactory reduction. This technique can be more easily performed than a preauricular or submandibular incision, and risk of facial nerve damage is diminished. Early function with proper vertical dimension was restored with minimal postoperative morbidity.

Signs and symptoms of TMJ dysfunction in patients with mandibular condyle fractures

Signs and symptoms of TMJ dysfunction in a total of 52 mandibular fracture patients comprising 15 with condylar fractures (Group I), 22 with combined condylar and mandibular body fractures (Group II), and 15 with mandibular body fractures (Group III) were examined an average of 44 months after injury. In terms of the Helkimo dysfunction index, it was shown that more severe subjective and objective dysfunctions were observed in the Group II, in which condylar fracture patients were treated with long-term intermaxillary fixation (IMF) and in which the patients' injuries were caused by more energetic impacts. There was, nevertheless, a tendency for the dysfunction to be graded as milder as the time elapsing since the injury increased.

[Functional treatment after condylar fractures with and without an activator]

A follow-up study was carried out of 21 patients aged between three and 13 years who had sustained fractures of the condylar process. The patients were divided into three groups according to the type of treatment carried out--functional orthopaedics, intermaxillary fixation with functional orthopaedics and intermaxillary fixation with exercises. The clinical results showed in all cases good, even excellent restoration of the function. Radiological examination, however, revealed that restoration of anatomical form only occurred in 20% of the patients. Since several years after the trauma the orthodontically treated group showed even a remodelling of the fractured condyles functional treatment approach is recommended.

Management of malunited mandibular condylar fractures

The non-surgical treatment of mandibular condylar fractures, may occasionally result in articular imbalance and temporomandibular joint dysfunction. This may be attributed to condylar head displacement and resorption, resulting in a shortened vertical ramus and lost posterior vertical facial height. Restoring the vertical ramus height is essential in the treatment of such dysfunction, and may be accomplished by unilateral, or bilateral ramus osteotomies. Four examples of patients treated with mandibular ramus osteotomies to restore vertical ramus height, with subsequent improvement in occlusal balance and function are presented. The use of the sagittal split mandibular osteotomy and the external vertical ramus osteotomy, stabilized with small osseous plates, and monocortical screws, is discussed.