Unilateral mandibular condylar process fractures: a retrospective clinical comparison of open versus closed treatment

Personalized Temporomandibular Joint Total Alloplastic Replacement as a Solution to Help Patients with Non-Osteosynthesizable Comminuted Mandibular Head Fractures

Background: Treatment methods for mandibular head fractures are controversial, although effective techniques for open reduction and rigid fixation (ORIF) have been known since the late 1990s. Notably, some forms of posttraumatic comminution of the mandibular head can be reduced or fixed. Methods: This study presents a personalized treatment to cure patients with nonreduced comminuted fractures of the mandibular head: total temporomandibular joint alloplastic replacement (18 patients). The reference group included patients who underwent ORIF (11 patients). Results: Personalized alloplastic joint replacements resulted in a more stable mandibular ramus after three months compared with ORIF. Conclusions: The authors recommend not performing osteosynthesis when the height of the mandibular ramus cannot be stably restored or when periosteal elevation from most of the mandibular head is necessary for ORIF. Personalized TMJ replacement should be considered in such patients. Personalized medicine allows patients to maintain a normal mandibular ramus height for a long period of time.

Correlation of clinical manifestations and condylar morphology of patients with temporomandibular degenerative joint diseases

OBJECTIVE

To study the correlation between condylar morphology and clinical manifestations in patients with degenerative joint disease (DJD) of the temporomandibular joint (TMJ).

METHODS

A total of 175 joints of 131 patients with DJD were included. Data on patients' basic information and symptoms were collected and analyzed. Condylar morphology was evaluated using cone beam computed tomography (CBCT). The correlation between the condylar morphology and clinical manifestations was analyzed.

RESULTS

The prevalence of joint noises, clicks, and crepitus was 93/175 (53%), 73/175 (42%), and 20/175 (11%), respectively. Condylar anteroposterior diameter and condylar height were correlated with pain. There was a correlation between the shape of the condyle in the sagittal plane and joint noise.

CONCLUSION

Condylar morphology and clinical features of DJD were correlated to some extent.

Comparative Evaluation of Open Reduction with Internal Fixation Against Closed Reduction Methods for Condylar Fracture Management: A Systematic Review and Meta- analysis

Background

Mandibular fractures are frequent in facial trauma. Management of mandibular condylar fractures (MCF) remains an ongoing matter of controversy in maxillofacial injury. A number of techniques, from closed reduction (CR) to open reduction and internal fixation (ORIF), can be effectively used to manage these fractures. The best treatment strategy, that is, closed reduction or open reduction with internal fixation, remains controversial.

Aim

The aim of this study is to systematically review the existing scientific literature to determine whether open reduction with internal fixation or closed reduction is a better treatment alternative for the patients with condylar fractures through a meta-analysis.

Methods

A systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Electronic databases like PubMed, google scholar and Ebsco Host were searched from 2000 to December 2021 for studies reporting management of condylar fractures through open reduction with internal fixation against closed reduction and reporting the outcome in terms of mean and standard deviation (SD). Quality assessment of included case control and cohort studies was performed using Newcastle-Ottawa Scale, and randomized studies were evaluated using Cochrane risk-of-bias (ROB)-2 tool through its domains. The risk of bias summary graph and risk of bias summary applicability concern was plotted using RevMan software version 5.3. The standardized mean difference (SDM) was used as summary statistic measure with random effect model and p value <0.05 as statistically significant.

Results

Seventeen studies fulfilled the eligibility criteria and were included in qualitative synthesis, of which only nine studies were suitable for meta-analysis. The pooled estimate through the Standardized Mean Difference (SMD) of 0.80, 0.36 and 0.42 for maximum inter incisal opening, laterotrusion and protrusion favours CR compared to ORIF for condylar fracture management. Also, most results of heterogeneity tests were poor and most of the funnel plots showed asymmetry, indicating the presence of possible publication bias.

Conclusion

The results of our meta-analysis suggest that CR provides superior outcomes in terms of maximum inter incisal opening, laterotrusion and protrusion compared to ORIF in condylar fractures management. It is necessary to conduct more prospective randomized studies and properly control confounding factors to achieve effective results and gradually unify clinical guidelines.

Correlation of patients' demographics and clinical symptoms with temporomandibular disorders

OBJECTIVE

To investigate the correlation between basic characteristics and clinical features of patients with temporomandibular disorders (TMD).

METHODS

The R language statistical tool was used to analyze the clinical information of 500 TMD patients, i.e., age, sex, joint noises, mouth opening pattern, and pain symptoms, as well as the results of the mandibular push-back test. A pairwise correlation analysis of each clinical feature was carried out.

RESULTS

The highest incidence of TMD was observed in the age group of 20 to 30 years (240/500). Around 2/3 of the patients showed pain symptoms. Abnormal mouth opening patterns, joint noises, and temporomandibular joint synovitis (TMJS) were observed in 48.4, 65.4, and 34% of patients, respectively.

CONCLUSION

Joint click and the corrected deviation of the mouth opening pattern are signs of early-stage TMD, whereas limited mouth opening and TMJS are indicators of progressive stage and complicated TMD.

Comparative evaluation of post treatment CT scan and clinical parameters in open reduction and closed reduction treatment of condylar fractures

Background

Mandibular fracture is the second most common fracture of facial bone, next to nasal bone. Twenty-five to forty percent of mandibular fractures involve the condyle. In the literature, there exists no consensus "gold standard" treatment for mandibular condylar fractures, and there is a continuing debate on whether condylar fractures should undergo closed or open reduction.

Materials and Method

Twenty patients who had undergone open reduction and closed reduction treatment were included in the study. Clinically maximal interincisal opening, laterotrusive and protrusive movements, pain on mouth opening, malocclusion, chin deviation on mouth opening, facial nerve palsy, hematoma, infected implant, and bite force were evaluated after a minimum of 3 months postoperatively. Also, a postoperative CT is done to evaluate the anatomical position of fragment.

Results

On evaluation of clinical parameters, both groups had comparable results. However, none of the patients in open reduction group had deviation of mandible from midline on mouth opening. Also, better anatomical repositioning is obtained in open reduction group.

Conclusion

The results of this study suggest that the open reduction method is a better alternative to closed reduction in treatment of mandibular condylar fractures.

Preauricular Swelling Mimicking a Tumour: Dissolution of Mandibular Capitulum Following Trauma in a 15-Year Old Child

AIM

The report is about diagnosis, therapy, and follow-up of a 15-year old boy, who experienced facial swelling and impaired mouth opening after a sport accident.

CASE REPORT

Diagnosis of mandibular damage was delayed due to inadequate clinical investigation and radiography after trauma and only became clear after a parotid swelling occurred sometime later resulting from the dissolution of the upper part of the articular process. Follow-up control over a period of three years showed a partial restoration of the articular process but some inhibition of mouth opening combined with slight deviation of the mandible to the affected side remained over the years.

CONCLUSION

This report reminds us that parotid swelling can be the result of mandibular trauma without a recent history of physical injury to this region. Therefore, the basic standards of radiologic diagnosis should be maintained and the limited restoring capacity of the condylar process in adolescence should be acknowledged.