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Franke A, Matschke JB, Weiland B, Schröder TA, McLeod NMH, Lauer G, Leonhardt H. A single-centre retrospective 10-year experience of the rhombic 3D condylar fracture plate for open reduction and internal fixation of condylar neck and base fractures. J Craniomaxillofac Surg 2024; 52:622-629. [PMID: 38582680 DOI: 10.1016/j.jcms.2024.03.001] [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: 10/28/2023] [Revised: 12/16/2023] [Accepted: 03/05/2024] [Indexed: 04/08/2024] Open
Abstract
Fractures of the mandibular condyle account for a significant proportion of mandibular fractures. The specific functional loads require particular specifications for the implant design used for open reduction and internal fixation of such fractures. The clinical and radiographic outcomes in patients treated using a single rhombic 3D condylar fracture plate for open reduction and internal fixation at a single institution, and who fulfilled the inclusion and exclusion criteria, are presented. The primary outcome variables were: occlusion, maximum interincisal distance and mandibular excursion at 1, 3, and 6 months postoperatively, and radiographic measurements for mandibular height and gonion angle. In total, 263 patients were included, of whom 173 (65.8%) were male and 90 (34.2%) female. The mean age was 40.4 ± 18.9 years. There was satisfactory occlusion in 98.9% of patients at the 6-month follow-up, and a significant improvement in all parameters for mandibular excursion (p < 0.001), with a reduced ramus height and an increase in the gonion angle on the fractured side. Excellent clinical and radiographic results were achieved using the rhombic-shaped implant, deeming it appropriate for the osteosynthesis of mandibular condyle fractures.
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Affiliation(s)
- Adrian Franke
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany.
| | - Jan Bernard Matschke
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Bernhard Weiland
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Tom Alexander Schröder
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany; Else Kröner Fresenius Center for Digital Health, Technische Universität Dresden, Dresden, Germany
| | - Niall M H McLeod
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Günter Lauer
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Henry Leonhardt
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
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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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Maurer M, Klaes T, Meier JK, Gottsauner JM, Taxis J, Schuderer J, Reichert TE, Ettl T. Treatment of extracapsular fractures of the mandibular condylar process: A retrospective evaluation of 377 cases. Dent Traumatol 2023; 39:586-596. [PMID: 37485754 DOI: 10.1111/edt.12871] [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: 05/04/2023] [Revised: 06/21/2023] [Accepted: 07/05/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND/AIM Mandibular condylar fractures represent 25%-35% of all mandibular fractures. Despite profound research, there is still a controverse debate about treating these fractures conservatively or by open reduction and internal fixation (ORIF). The aim of this study is to analyse the outcome after open and closed treatment of extracapsular mandibular condyle fractures regarding general characteristics, post-treatment malocclusion, facial nerve palsy (FNP), maximum mouth opening (MMO) and parotid complications. METHODS A retrospective cohort of 377 fractures (350 open, 27 closed treatment) was reviewed by reference to clinical and radiological pre- and postoperative documentation. Follow-up period was 12 months. Pearsons' chi-square-test, correlations, Kruskal-Wallis test and t-test were carried out for statistical analysis. RESULTS The dominant type of fracture was type II in Spiessl and Schroll classification (50.1%). In the open treated fractures, the most common approach was retromandibular transparotid (91.7%). Post-treatment malocclusion occurred in 18.0% and was significantly increased in bilateral fractures (p = .039), in luxation fractures (p = .016) and in patients with full dentition (p = .004). After open reduction and internal fixation (ORIF), temporary FNP was documented in 7.1% whereas a permanent paresis occurred in 1.7%. FNP was significantly associated with high fractures (p = .001), comminution (p = .028) and increased duration of surgery (p = .040). Parotid complications were significantly associated with revision surgery (p = .009). Post-treatment reduction of MMO mainly occurred in female patients (p < .001) as well as in patients with bilateral fractures (p < .001), high fractures (p = .030) and concomitant mandibular (p = .001) and midfacial fractures (p = .009). CONCLUSION Malocclusion seems to be the most frequent long-term complication after open reduction and osteosynthesis of extracapsular mandibular condyle fractures. We suggest ORIF by a transparotid approach to be an appropriate treatment with a low complication rate regarding especially FNP for extracapsular fractures of the mandibular condyle.
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Affiliation(s)
- Michael Maurer
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Tabea Klaes
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Johannes K Meier
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | | | - Jürgen Taxis
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Johannes Schuderer
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Torsten E Reichert
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Tobias Ettl
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
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Huang CM, Chan MY, Hsu JT, Su KC. Biomechanical analysis of subcondylar fracture fixation using miniplates at different positions and of different lengths. BMC Oral Health 2021; 21:543. [PMID: 34674692 PMCID: PMC8532336 DOI: 10.1186/s12903-021-01905-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/11/2021] [Indexed: 11/24/2022] Open
Abstract
Background Many types of titanium plates were used to treat subcondylar fracture clinically. However, the efficacy of fixation in different implant positions and lengths of the bone plate has not been thoroughly investigated. Therefore, the primary purpose of this study was to use finite element analysis (FEA) to analyze the biomechanical effects of subcondylar fracture fixation with miniplates at different positions and lengths so that clinicians were able to find a better strategy of fixation to improve the efficacy and outcome of treatment. Methods The CAD software was used to combine the mandible, miniplate, and screw to create seven different FEA computer models. These models with subcondylar fracture were fixed with miniplates at different positions and of different lengths. The right unilateral molar clench occlusal mode was applied. The observational indicators were the reaction force at the temporomandibular joint, von Mises stress of the mandibular bone, miniplate and screw, and the sliding distance on the oblique surface of the fracture site at the mandibular condyle. Results The results showed the efficacy of fixation was better when two miniplates were used comparing to only one miniplates. Moreover, using longer miniplates for fixation had better results than the short one. Furthermore, fixing miniplates at the posterior portion of subcondylar region would have a better fixation efficacy and less sliding distance (5.46–5.76 μm) than fixing at the anterolateral surface of subcondylar region (6.10–7.00 μm). Conclusion Miniplate fixation, which was placed closer to the posterior margin, could effectively reduce the amount of sliding distance in the fracture site, thereby achieving greater stability. Furthermore, fixation efficiency was improved when an additional miniplate was placed at the anterior margin. Our study suggested that the placement of miniplates at the posterior surface and the additional plate could effectively improve stability.
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Affiliation(s)
- Chao-Min Huang
- Department of Stomatology, Taichung Veterans General Hospital, Taichung, 407, Taiwan
| | - Man-Yee Chan
- Department of Dentistry, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, 427, Taiwan.,School of Dentistry, College of Oral Medicine, Chung Shan Medical University, Taichung, 402, Taiwan
| | - Jui-Ting Hsu
- School of Dentistry, China Medical University, Taichung, 404, Taiwan
| | - Kuo-Chih Su
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, 407, Taiwan. .,Department of Biomedical Engineering, Hungkuang University, Taichung, 433, Taiwan. .,Department of Chemical and Materials Engineering, Tunghai University, Taichung, 407, Taiwan.
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Liokatis P, Tzortzinis G, Gerasimidis S, Smolka W. Finite Element Analysis of Different Titanium Plates for Internal Fixation of Fractures of the Mandibular Condylar Neck. J Oral Maxillofac Surg 2021; 79:665.e1-665.e10. [DOI: 10.1016/j.joms.2020.09.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
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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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Burkhard JPM, Koba S, Schlittler F, Iizuka T, Schaller B. Clinical results of two different three-dimensional titanium plates in the treatment of condylar neck and base fractures: A retrospective study. J Craniomaxillofac Surg 2020; 48:756-764. [DOI: 10.1016/j.jcms.2020.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 05/12/2020] [Accepted: 06/07/2020] [Indexed: 12/19/2022] Open
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Leonhardt H, Franke A, Nowak A, McLeod N, Lauer G. Clinical experience and results with a Rhombic Plate for transoral endoscopically-assisted osteosynthesis of fractures of the condylar neck. Br J Oral Maxillofac Surg 2019; 57:1063-1067. [PMID: 31594713 DOI: 10.1016/j.bjoms.2019.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 09/18/2019] [Indexed: 10/25/2022]
Abstract
The intraoral approach is favoured by many patients and surgeons for the treatment of fractures of the condylar neck, but the limited space offered by this approach can make positioning and fixation of the osteosynthesis plate difficult. A rhombic-shaped plate was designed specifically for use with the intraoral approach, and introduced into our clinical practice in 2012. We present the clinical and functional results in 81 patients with 98 fractures of the condylar neck who we have treated with this technique. Of these six required surgical revision, and ultimately all but two had satisfactory occlusion and mandibular function. Our complication rate of 6/81 (7.4%) compares favourably with those reported elsewhere, and confirms that open reduction and internal fixation of condylar fractures using the Rhombic plate through an intra-oral approach provides good outcomes.
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Affiliation(s)
- H Leonhardt
- University Hospital Carl Gustav Carus at Technical University Dresden, Clinic of Maxillofacial Surgery, Fetscherstr. 74, 01309 Dresden, Germany.
| | - A Franke
- University Hospital Carl Gustav Carus at Technical University Dresden, Clinic of Maxillofacial Surgery, Fetscherstr. 74, 01309 Dresden, Germany
| | - A Nowak
- University Hospital Carl Gustav Carus at Technical University Dresden, Clinic of Maxillofacial Surgery, Fetscherstr. 74, 01309 Dresden, Germany
| | - Nmh McLeod
- Barts Health NHS Trust, The Royal London Dental Hospital, Turner Street, Whitechapel, London, E1 1BB, United Kingdom
| | - G Lauer
- University Hospital Carl Gustav Carus at Technical University Dresden, Clinic of Maxillofacial Surgery, Fetscherstr. 74, 01309 Dresden, Germany
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Ben Achour A, Meißner H, Teicher U, Haim D, Range U, Brosius A, Leonhardt H, Lauer G. Biomechanical Evaluation of Mandibular Condyle Fracture Osteosynthesis Using the Rhombic Three-Dimensional Condylar Fracture Plate. J Oral Maxillofac Surg 2019; 77:1868.e1-1868.e15. [PMID: 31112678 DOI: 10.1016/j.joms.2019.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 04/17/2019] [Accepted: 04/17/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of the present study was to evaluate the biomechanical stability of osteosynthesis in mandibular condyle fractures using a newly designed rhombic 3-dimensional (3D) condylar fracture plate and compare it with that using standard two 4-hole miniplates and with that in nonfractured condyles. MATERIALS AND METHODS Using 200 porcine mandibles, 3 different monocortical plating techniques were evaluated. The condyles were fractured along a defined line tangentially through the sigmoid notch and perpendicular to the posterior border. After anatomic reduction, osteosynthesis was performed using either standard rhombic 3D condylar fracture plates and standard screws (group A) or locking rhombic 3D condylar fracture plates, which were fixed either with standard screws (group B) or locking screws (group C). For comparison, nonfractured condyles (group D) and condyles fixed with standard two 4-hole miniplates and 8 screws (group E) were included. Using a universal mechanical testing machine (TIRA Test 2720; TIRA GmbH Schalkau, Germany), each group was subjected to linear loading from laterally to medially, medially to laterally, anteriorly to posteriorly, and posteriorly to anteriorly. The maximum axial force and displacement at the maximum force were measured. The mean values were compared for statistical significance using analysis of variance with Bonferroni's correction (statistical significance set at P < .05). RESULTS The main mode of failure in the plating techniques investigated was the pull out of screws from the proximal fragment. We found no statistically significant differences in the stability of osteosynthesis between the two 4-hole miniplates and the rhombic 3D condylar fracture plate when loading from posteriorly to anteriorly, laterally to medially, and medially to laterally. However, when loading from anteriorly to posteriorly, a statistically significant difference between the standard and locking system and the two 4-hole miniplate system was observed, with the latter proving more stable. CONCLUSIONS The results of the present biomechanical study suggest that the rhombic 3D condylar fracture plates are suitable for the treatment of condylar neck fractures. Both types of the plate are able to resist physiologic strains comparable to the two 4-hole miniplates.
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Affiliation(s)
- Anas Ben Achour
- Resident, Chair of Forming Processes, Institute of Manufacturing Technology, Technische Universität Dresden, Dresden, Germany.
| | - Heike Meißner
- Resident, Department of Prosthetic Dentistry, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Uwe Teicher
- Resident, Chair of Forming Processes, Institute of Manufacturing Technology, Technische Universität Dresden, Dresden, Germany
| | - Dominik Haim
- Resident, Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ursula Range
- Resident, Institute for Medical Informatics and Biometry, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Alexander Brosius
- Professor and Head, Chair of Forming Processes, Institute of Manufacturing Technology, Technische Universität Dresden, Dresden, Germany
| | - Henry Leonhardt
- Resident, Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Günter Lauer
- Professor and Head, Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Ahuja SA, Galinde J, Asnani U, Mistry YA. Comparative Evaluation of Clinical Outcomes Using Delta Plates and Conventional Miniplates for Internal Fixation of Mandibular Condylar Fractures in Adults. J Oral Maxillofac Surg 2018; 76:1255-1266. [DOI: 10.1016/j.joms.2017.12.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/20/2017] [Accepted: 12/20/2017] [Indexed: 11/17/2022]
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Albogha MH, Mori Y, Takahashi I. Three-dimensional titanium miniplates for fixation of subcondylar mandibular fractures: Comparison of five designs using patient-specific finite element analysis. J Craniomaxillofac Surg 2018; 46:391-397. [DOI: 10.1016/j.jcms.2017.12.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 12/12/2017] [Accepted: 12/18/2017] [Indexed: 10/18/2022] Open
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Comparison of Different Fixation Types Used in Unilateral Mandibular Condylar Fractures: An In Vivo Study With New Biomechanical Model. J Craniofac Surg 2016; 27:1277-81. [PMID: 27315307 DOI: 10.1097/scs.0000000000002754] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The aim of this in vivo study is to compare the single-titanium, double-titanium mini plate, and single resorbable plate systems used in internal rigid fixation of the unilateral mandibular condylar fractures on new design biomechanical model. METHODS Thirty synthetic polyurethane models were used for biomechanical testing. Fracture lines were created for each model. Fragments were fixed with single-titanium plates in Group A (n = 10), double-titanium plates in Group B (n = 10), and single biodegradable plate (PPLA) in Group C (n = 10). Masticatory forces were applied to the models and the biomechanical properties of the titanium plate and screws, resorbable plate, and screws were evaluated. RESULTS The average failure force for Group A, Group B, and Group C is 199, 324, 177N and the average bone displacement for Group A, Group B, Group C is 1.9, 0.3, 2.1 mm, respectively. DISCUSSION Double titanium plates showed the most acceptable results in the fixation of unilateral subcondylar fractures where the single titanium and biodegradable plate systems failed to provide enough stability in unilateral subcondylar fracture fixation. Biodegradable plate systems are still not an alternative in fixation of unilateral condylar fractures.
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Darwich MA, Albogha MH, Abdelmajeed A, Darwich K. Assessment of the Biomechanical Performance of 5 Plating Techniques in Fixation of Mandibular Subcondylar Fracture Using Finite Element Analysis. J Oral Maxillofac Surg 2016; 74:794.e1-8. [DOI: 10.1016/j.joms.2015.11.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 11/19/2015] [Accepted: 11/19/2015] [Indexed: 10/22/2022]
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Surgical treatment of mandibular condyle fractures using the retromandibular anterior transparotid approach and a triangular-positioned double miniplate osteosynthesis technique: A clinical and radiological evaluation of 124 fractures. J Craniomaxillofac Surg 2015; 43:944-9. [PMID: 26027860 DOI: 10.1016/j.jcms.2015.04.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/27/2015] [Accepted: 04/22/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Different modalities have been described regarding the treatment of mandibular condyle fractures. The most advantageous and safest one is still a topic of discussion. The present analysis describes the combination of a retromandibular, transparotideal approach combined to a triangular-positioned double-miniplate osteosynthesis, with a special regard for the patients' long term outcomes. MATERIAL AND METHODS Clinical data of 102 patients with 124 condyle fractures treated with the mentioned surgical procedure were evaluated. Functional parameters such as the maximal interincisal distance, deviations/deflections, facial nerve function, occlusion as well as complications regarding the parotid gland, osteosynthesis, and esthetics were evaluated 1 week, 2 weeks, 3 months, and 6 months postoperatively. RESULTS The mean maximal interincisal distance ranged from 38 mm after 1 week to 45 mm after 6 months. Deviations/deflections were seen in 22.5% of the cases 1 week postoperatively and decreased to 2% at 6 months postoperatively. A temporary facial palsy was diagnosed in 3.9% during the first follow-up, whereas no impairment was recorded after 3 or 6 months. At the same time, no patient had occlusional disturbances or complications regarding the parotid gland or the osteosynthesis 6 months postoperatively. CONCLUSIONS Direct fracture visualization and a stable three-dimensional fracture stabilization are the main advantages of the presented combination of a surgical approach and osteosynthesis technique. Additionally, the absence of long-term complications confirms the safety of the procedure. Therefore, it may be considered as a successful treatment option for mandibular condyle fractures.
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Cortelazzi R, Altacera M, Turco M, Antonicelli V, De Benedittis M. Development and Clinical Evaluation of MatrixMANDIBLE Subcondylar Plates System (Synthes). Craniomaxillofac Trauma Reconstr 2015; 8:94-9. [PMID: 26000078 PMCID: PMC4428734 DOI: 10.1055/s-0034-1395382] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 07/09/2014] [Indexed: 01/24/2023] Open
Abstract
In this article, authors report the different steps of development and clinical validation of MatrixMANDIBLE Subcondylar Plates (Synthes, Soletta, Switzerland), a specialized osteosynthesis system developed by Synthes during the past 4 years. Between 2009 and 2013, a total of 62 patients were treated for subcondylar and condylar neck fractures via a preauricular or retromandibular/transparotid approach. The MatrixMANDIBLE Subcondylar Plates System consists of a Trapezoidal Plate, a three-dimensional (3D) 4-hole 1.0-mm plate for smaller fracture areas, the Lambda Plate, a 7-hole 1.0-mm linear plate which mimics the two miniplates technique, and the Strut Plate, a 3D 1.0-mm plate with great versatility of employment. All devices satisfy the principles of a functionally stable osteosynthesis as stated by Champy et al. None of the plates broke and no macroscopic condylar displacement was noted on radiological follow-up. Clinical and functional parameters assessed at 6 months postoperative (mandibular range of motion, pain, dental occlusion) were almost restored. MatrixMANDIBLE Subcondylar Plates System (Synthes) has proved to provide sufficient mechanical stiffness and anatomically accurate fracture reduction to avoid major postoperative drawbacks of subcondylar and condylar neck fractures.
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Affiliation(s)
- Roberto Cortelazzi
- Department of Maxillo-facial Surgery, General Regional Hospital “F. Miulli,” Bari, Italy
- Gradute School of Maxillo-facial Surgery, University of Bari, Bari, Italy
| | - Mario Altacera
- Department of Maxillo-facial Surgery, General Regional Hospital “F. Miulli,” Bari, Italy
| | - Monica Turco
- Department of Maxillo-facial Surgery, General Regional Hospital “F. Miulli,” Bari, Italy
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Aquilina P, Parr WCH, Chamoli U, Wroe S. Finite element analysis of patient-specific condyle fracture plates: a preliminary study. Craniomaxillofac Trauma Reconstr 2014; 8:111-6. [PMID: 26000081 DOI: 10.1055/s-0034-1395385] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 06/03/2014] [Indexed: 10/24/2022] Open
Abstract
Various patterns of internal fixation of mandibular condyle fractures have been proposed in the literature. This study investigates the stability of two patient-specific implants (PSIs) for the open reduction and internal fixation of a subcondylar fracture of the mandible. A subcondylar fracture of a mandible was simulated by a series of finite element models. These models contained approximately 1.2 million elements, were heterogeneous in bone material properties, and also modeled the muscles of mastication. Models were run assuming linear elasticity and isotropic material properties for bone. The stability and von Mises stresses of the simulated condylar fracture reduced with each of the PSIs were compared. The most stable of the plate configurations examined was PSI 1, which had comparable mechanical performance to a single 2.0 mm straight four-hole plate.
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Affiliation(s)
- Peter Aquilina
- Department of OMFS, Westmead Hospital, Sydney, Australia ; Department of Plastic and Reconstructive Surgery, The Nepean Hospital, Kingswood, Sydney, Australia ; Computational Biomechanics Research Group, School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, Australia
| | - William C H Parr
- Surgical and Orthopaedic Research Laboratory, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Uphar Chamoli
- Department of Orthopaedic Surgery, St. George Hospital Clinical School, University of New South Wales, Sydney, New South Wales, Australia ; School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen Wroe
- Computational Biomechanics Research Group, Zoology Division, School of Environmental and Rural Science, University of New England, Armidale, Australia
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Kunert-Keil C, Botzenhart U, Gedrange T, Gredes T. Interrelationship between bone substitution materials and skeletal muscle tissue. Ann Anat 2014; 199:73-8. [PMID: 25159858 DOI: 10.1016/j.aanat.2014.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 07/18/2014] [Accepted: 07/30/2014] [Indexed: 01/25/2023]
Abstract
Bone density and quantity are primary conditions for the insertion and stability of dental implants. In cases of a lack of adequate maxillary or mandibulary bone, bone augmentation will be necessary. The use of synthetic bioactive bone substitution materials is of increasing importance as alternatives to autogenously bone grafts. It is well known that bone can influence muscle function and muscle function can influence bone structures. Muscles have a considerable potential of adaptation and muscle tissue surrounding an inserted implant or bone surrogate can integrate changes in mechanical load of the muscle and hereupon induce signaling cascades with protein synthesis and arrangement of the cytoskeleton. The Musculus latissimus dorsi is very often used for the analyses of the in vivo biocompatibility of newly designed biomaterials. Beside macroscopically and histologically examination, biocompatibility can be assessed by analyses of the biomaterial influence of gene expression. This review discusses changes in the fiber type distribution, myosin heavy chain isoform composition, histological appearance and vascularization of the skeletal muscle after implantation of bone substitution materials. Especially, the effects of bone surrogates should be described at the molecular-biological and cellular level.
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Affiliation(s)
- Christiane Kunert-Keil
- Department of Orthodontics, Carl Gustav Carus Campus, Technische Universität Dresden, Fetscherstr. 74, Haus 28, D-01307 Dresden, Germany.
| | - Ute Botzenhart
- Department of Orthodontics, Carl Gustav Carus Campus, Technische Universität Dresden, Fetscherstr. 74, Haus 28, D-01307 Dresden, Germany
| | - Tomasz Gedrange
- Department of Orthodontics, Carl Gustav Carus Campus, Technische Universität Dresden, Fetscherstr. 74, Haus 28, D-01307 Dresden, Germany
| | - Tomasz Gredes
- Department of Orthodontics, Carl Gustav Carus Campus, Technische Universität Dresden, Fetscherstr. 74, Haus 28, D-01307 Dresden, Germany
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18
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Aquilina P, Parr WCH, Chamoli U, Wroe S, Clausen P. A Biomechanical Comparison of Three 1.5-mm Plate and Screw Configurations and a Single 2.0-mm Plate for Internal Fixation of a Mandibular Condylar Fracture. Craniomaxillofac Trauma Reconstr 2014; 7:218-23. [PMID: 25136411 DOI: 10.1055/s-0034-1375172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 10/15/2013] [Indexed: 10/25/2022] Open
Abstract
The most stable pattern of internal fixation for mandibular condyle fractures is an area of ongoing discussion. This study investigates the stability of three patterns of plate fixation using readily available, commercially pure titanium implants. Finite element models of a simulated mandibular condyle fracture were constructed. The completed models were heterogeneous in bone material properties, contained approximately 1.2 million elements and incorporated simulated jaw adducting musculature. Models were run assuming linear elasticity and isotropic material properties for bone. No human subjects were involved in this investigation. The stability of the simulated condylar fracture reduced with the different implant configurations, and the von Mises stresses of a 1.5-mm X-shaped plate, a 1.5-mm rectangular plate, and a 1.5-mm square plate (all Synthes (Synthes GmbH, Zuchwil, Switzerland) were compared. The 1.5-mm X plate was the most stable of the three 1.5-mm profile plate configurations examined and had comparable mechanical performance to a single 2.0-mm straight four-hole plate. This study does not support the use of rectangular or square plate patterns in the open reduction and internal fixation of mandibular condyle fractures. It does provide some support for the use of a 1.5-mm X plate to reduce condylar fractures in selected clinical cases.
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Affiliation(s)
- Peter Aquilina
- Department of Maxillofacial Surgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - William C H Parr
- Computational Biomechanics Research Group, School of Biological, Earth and Environmental Sciences, Sydney, New South Wales, Australia
| | - Uphar Chamoli
- Department of Orthopaedic Surgery, Spine Service, St. George Hospital Clinical School, University of New South Wales, Sydney, Australia
| | - Stephen Wroe
- Division of Zoology, School of Environmental and Rural Science, Armidale, Australia
| | - Philip Clausen
- School of Engineering, University of Newcastle, Newcastle, Australia
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Akbay E, Cevik C, Damlar I, Altan A. Treatment of displaced mandibular condylar fracture with botulinum toxin A. Auris Nasus Larynx 2014; 41:219-21. [DOI: 10.1016/j.anl.2013.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 07/19/2013] [Accepted: 09/20/2013] [Indexed: 10/26/2022]
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20
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Zrounba H, Lutz JC, Zink S, Wilk A. Epidemiology and treatment outcome of surgically treated mandibular condyle fractures. A five years retrospective study. J Craniomaxillofac Surg 2014; 42:879-84. [PMID: 24485271 DOI: 10.1016/j.jcms.2014.01.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 10/08/2013] [Accepted: 01/03/2014] [Indexed: 11/19/2022] Open
Abstract
Surgical management of mandibular condyle fractures is still controversial. Although it provides better outcome than closed treatment questions still remain about the surgical approach and the osteosynthesis devices to be used. Between 2005 and 2010, we managed 168 mandibular condyle fractures with open treatment. Two surgical approaches were used in this study, a pre-auricular and a high submandibular approach (one or the other or as a combined approach). Internal fixation was performed using TCP(®) plates (Medartis, Basel, Switzerland) or with two lag screws (15 and 17 mm). Delta plates were used in 15 cases (8.9%). We report the epidemiology of these fractures and the outcomes of the surgical treatment. We assessed the complications related to the surgical procedure and those related to the osteosynthesis material. The facial nerve related complication rate was very low and the osteosynthesis materials used proved to be strong enough to realize a stable fixation. The two approaches used in this study appeared to be safe with good aesthetic results. Most of the surgical procedure failures occurred in high subcondylar fractures especially when bilateral.
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Affiliation(s)
- Hugues Zrounba
- Service de Chirurgie Maxillo-Faciale (Head: Prof. Astrid Wilk), Hopital Civil, 1, Place de L'hopital, 67000 Strasbourg, France.
| | - Jean-Christophe Lutz
- Service de Chirurgie Maxillo-Faciale (Head: Prof. Astrid Wilk), Hopital Civil, 1, Place de L'hopital, 67000 Strasbourg, France
| | - Simone Zink
- Service de Chirurgie Maxillo-Faciale (Head: Prof. Astrid Wilk), Hopital Civil, 1, Place de L'hopital, 67000 Strasbourg, France
| | - Astrid Wilk
- Service de Chirurgie Maxillo-Faciale (Head: Prof. Astrid Wilk), Hopital Civil, 1, Place de L'hopital, 67000 Strasbourg, France
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21
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Kozakiewicz M, Swiniarski J. "A" shape plate for open rigid internal fixation of mandible condyle neck fracture. J Craniomaxillofac Surg 2013; 42:730-7. [PMID: 24359864 DOI: 10.1016/j.jcms.2013.11.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 08/26/2013] [Accepted: 11/04/2013] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Reduction of the fracture is crucial for proper outcome of the treatment. The stability of reduction is closed connected to the method of its fixation. The topic of condylar fracture osteosynthesis still remains highly controversial and challenging. That is why authors decided to propose novel design of the fixating plate and the example of its application. The aim of this study was to present A-shape plate dedicated to rigid fixation of mandible condyle neck fracture. MATERIAL AND METHODS A-shape condylar plate (ACP) design is prepared of 1.0 mm thick titanium alloy (grade 5) sheet: posterior and anterior bars are reinforced by widening to 2.5 mm and anatomically curved along the compression and traction lines in ramus and condylar neck. Superior three-hole-group has triangular organization and located on the level of condylar head. The inferior extensions of the bars are equipped in three holes located at each of lower tails. Connecting bar (2.0 mm wide) connects the first hole of each lower tails closing upper part of ACP in triangular shape. The connecting bar runs along compression line of condylar neck. Holes in ACP has 2.0 mm diameter for locking or normal screws. Height of ACP is 31 mm. The proposed new type of plate was compared by finite element analysis (FEA) to nowadays manufactured 9-hole trapezoid plate as the most similar device. ACP design was evaluated by finite element analysis (FEA) and later applied in patient affected with high condylar neck fracture complicated by fracture of coronoid process. RESULTS FEA revealed high strength of ACP and more stabile fixation than trapezoid plate. The result was caused by multipoint fixation at three regions of the plate and reinforced bars supported by semi-horizontal connecting bar. Clinical application of ACP was as versatile as makes possible to simultaneous fixation of high condylar neck and coronoid process fracture. CONCLUSION Application of proposed A-shape condylar plate would be possible in all levels of neck fractures and can be use for stabilization additionally existed coronoid process fracture.
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Affiliation(s)
- Marcin Kozakiewicz
- Department of Maxillofacial Surgery (Head: Marcin Kozakiewicz), Medical University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland.
| | - Jacek Swiniarski
- Department of Strength of Materials and Structures (Head: Zbigniew Kolakowski), Technical University of Lodz, Stefanowskiego 1/15, 90-924 Lodz, Poland
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Aquilina P, Chamoli U, Parr WC, Clausen PD, Wroe S. Finite element analysis of three patterns of internal fixation of fractures of the mandibular condyle. Br J Oral Maxillofac Surg 2013; 51:326-31. [DOI: 10.1016/j.bjoms.2012.08.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 08/15/2012] [Indexed: 11/26/2022]
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Abstract
PURPOSE Conventional radiography is a well-established method for imaging of the temporomandibular joint (TMJ) structures. However, the dental computer tomography becomes more important for the visualization of teeth in the jaw-bone. The applicability of dental computer tomography for the visualization of the TMJ it not yet been proven. The aim of the study was to identify TMJ structures using reference points with the magnetic resonance imaging (MRI) and the computed tomography (CT). METHODS In order to compare the visualization and measurement of the TMJ a total of eight human cadaver heads was examined with CT and MRI and analysed using reference points. RESULTS In both imaging techniques the selected reference points and distances are well definable and allow objective evaluation of anatomical structures. The CT images display a clearly better contrast to noise ratio than the MR images. The distance measurement of different width and length showed significant correlation of both images techniques. CONCLUSIONS In TMJ diagnostics, maximum information could be obtained using both imaging techniques together due to synergistic effects.
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Biomechanical Study of the Delta Plate and the TriLock Delta Condyle Trauma Plate. J Oral Maxillofac Surg 2011; 69:2619-25. [DOI: 10.1016/j.joms.2011.01.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Revised: 11/29/2010] [Accepted: 01/04/2011] [Indexed: 11/20/2022]
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25
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Seemann R, Undt G, Lauer G, Holawe S, Schicho K, Czerny C, Krennmair G, Ewers R, Klug C, Perisanidis C. Is failure of condylar neck osteosynthesis predictable based on orthopantomography? ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2011; 111:362-371. [PMID: 21310356 DOI: 10.1016/j.tripleo.2010.11.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 11/25/2010] [Accepted: 11/30/2010] [Indexed: 05/30/2023]
Abstract
BACKGROUND Osteosynthesis failure rates of 11.3% with 1 miniplate, 6.7% with 2 miniplates, and 4.4% with a single Medartis condyle plate were reported in previous studies of our clinic. Current science is still focused on the osteosynthesis material. Besides clinical parameters, conventional radiographs are still the first choice to detect osteosynthesis failures. This study scrutinized several factors assessable in postoperative orthopantomographs which might elevate the risk of osteosynthesis failure. STUDY DESIGN A total of 136 patients (22 with osteosynthesis failure, 114 without) with 151 mandibular condyle fractures were included in this study. Eight parameters were assessed in postoperative orthopantomographs. RESULTS The best predictor of osteosynthesis failure was a simplified concept of ramus height. In cases of reduced or normal ramus height, the odds of osteosynthesis failure was significantly (P = .000001) reduced to a 10th. Isolated fractures were significantly more error prone (P = .0009). CONCLUSIONS Postoperative orthopantomographs depict factors which increase the risk of osteosynthesis failure.
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Affiliation(s)
- Rudolf Seemann
- University Hospital of Craniomaxillofacial and Oral Surgery, Medical University of Vienna, Vienna, Austria.
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26
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Dayi E, Omezli MM. Review of biomechanical experimental studies on different plating techniques of mandibular condyle fractures. Ann Maxillofac Surg 2011; 1:48-52. [PMID: 23483016 PMCID: PMC3591040 DOI: 10.4103/2231-0746.83157] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Mandibular condyle fractures are one of the most frequent injuries of the facial skeleton. The option for open treatment of mandibular condyle fractures has become more favorable since osteosynthesis materials were developed in the past few decades. However, the rigid fixation techniques of treating condyle fractures remain one of the controversial issues in maxillofacial trauma. These injuries are currently treated by plate-screw osteosynthesis and, depending on the case, the bone segments are fixed by one or two miniplates. Several techniques and plate types like adaption miniplates, minidynamic compression plates, resorbable plates and double plates have been evaluated biomechanically in various experimental and clinical studies. The biomechanical and physical behavior of mandibles have been investigated by different approaches. It can be divided into computer biomodels (e.g., finite element analysis) and physical models. Physical models allow testing on a gross level to give fatigue performance and fracture strength. The aim of this article is to carry out a review of the literature which deals with biomechanical evaluation made with physical models of plating techniques of mandibular condyle fracture. Based on the results of these studies, osteosynthesis with two miniplates seems to be the most stable way of treating mandible subcondylar fractures, and PLLA plates were not strong enough compared with metal plates.
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Affiliation(s)
- Ertunç Dayi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ataturk University, Erzurum, Turkey
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27
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Seemann R, Perisanidis C, Schicho K, Wutzl A, Poeschl WP, Köhnke R, Kinast B, Brunner J, Krennmair G, Ewers R, Klug C. Complication rates of operatively treated mandibular fractures—the mandibular neck. ACTA ACUST UNITED AC 2010; 109:815-9. [DOI: 10.1016/j.tripleo.2009.11.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 11/04/2009] [Accepted: 11/14/2009] [Indexed: 11/24/2022]
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28
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Lauer G, Pradel W, Leonhardt H, Loukota R, Eckelt U. Resorbable triangular plate for osteosynthesis of fractures of the condylar neck. Br J Oral Maxillofac Surg 2009; 48:532-5. [PMID: 19889489 DOI: 10.1016/j.bjoms.2009.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 10/05/2009] [Indexed: 10/20/2022]
Abstract
We describe a new design of resorbable plate for use in the treatment of fractures of the condylar neck, and report the outcome of initial treatment in two patients.
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Affiliation(s)
- Günter Lauer
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Dresden, Germany.
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Seemann R, Frerich B, Müller S, Koenke R, Ploder O, Schicho K, Piffko J, Poeschl P, Wagner A, Wanschitz F, Krennmair G, Ewers R, Klug C. Comparison of locking and nonlocking plates in the treatment of mandibular condyle fractures. ACTA ACUST UNITED AC 2009; 108:328-34. [DOI: 10.1016/j.tripleo.2009.04.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 03/23/2009] [Accepted: 04/16/2009] [Indexed: 11/29/2022]
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