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Niedzielski D, Niedzielska I, Wziątek-Kuczmik D, Kamiński M, Baron S, Grzegorczyn S. Influence of Method of Treatment of Mandibular Condylar Fractures on Range of Articular Path Measured by Cadiax Device. J Clin Med 2024; 13:3706. [PMID: 38999272 PMCID: PMC11242559 DOI: 10.3390/jcm13133706] [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: 05/20/2024] [Revised: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: The aim of this study was to evaluate the function of the treated temporomandibular joint based on the analysis of the image of the articular path using the Cadiax device depending on the choice of treatment method for unilateral condylar fracture of the mandible. Methods: Sixty patients who were treated for condylar fractures of the mandible at the Maxil-lofacial Surgery Department in Katowice were qualified for the analysis of the range of movements of the mandibular heads using the Cadiax device. From the group of patients who suffered fractures of the mandible, including condylar processes, patients were finally qualified for the measurement of the articular path of the injured and healthy joint according to strict criteria. Results: The condylar examination was performed in 20 patients who had conservative condylar fracture treatment and 40 patients who underwent various surgeries in the course of a single condylar fracture. The control group consisted of 20 patients whose mean values for the articular pathway measured for both sides were 12.73 and 12.69 and fell within the standard developed for healthy joints tested with the Cadiax device. Conclusions: We have achieved an almost ideal treatment for condylar fractures. We are also beginning to notice the need for rehabilitation of patients after this type of surgery.
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Affiliation(s)
- Damian Niedzielski
- Department of Cranio-Maxillofacial Surgery, Faculty of Medical Sciences, Medical University of Silesia, 40-027 Katowice, Poland
| | - Iwona Niedzielska
- Department of Cranio-Maxillofacial Surgery, Faculty of Medical Sciences, Medical University of Silesia, 40-027 Katowice, Poland
| | - Daria Wziątek-Kuczmik
- Department of Cranio-Maxillofacial Surgery, Faculty of Medical Sciences, Medical University of Silesia, 40-027 Katowice, Poland
| | - Maciej Kamiński
- Department of Cranio-Maxillofacial Surgery, Faculty of Medical Sciences, Medical University of Silesia, 40-027 Katowice, Poland
| | - Stefan Baron
- Department of Temporomandibular Disorders, Medical University of Silesia in Katowice; Traugutta sq. 2, 41-800 Zabrze, Poland
| | - Sławomir Grzegorczyn
- Department of Biophysics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 19 H. Jordan Str., 41-808 Zabrze, Poland
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Liokatis P, Tzortzinis G, Gerasimidis S, Smolka W. Application of the lambda plate on condylar fractures: Finite element evaluation of the fixation rigidity for different fracture patterns and plate placements. Injury 2022; 53:1345-1352. [PMID: 35101256 DOI: 10.1016/j.injury.2022.01.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/11/2022] [Accepted: 01/18/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The treatment challenges of condylar fractures necessitated the production of several plate designs. Among the relatively new plate designs is the lambda plate, for which biomechanical and clinical data are lacking. The purpose of this study is to examine the rigidity of fixation achieved when the lambda plate is applied to different fractures of the condylar neck and base. METHODS Five fractures of the condylar area were designed on a virtual model of a healthy mandible obtained from a CT scan. The fractures were reduced using the lambda plate. For the same fractures, alternative placements of the plate were simulated. The generated models were analysed using the finite element analysis for a 500 N bite load. The displacement of the two condylar fragments along the fracture line was calculated as an indicator of the rigidity of the fixation. RESULTS The displacement along the fracture was less than 0.144 mm for the neck fractures and greater than 0.165 mm for the fractures of the condylar base. A more cranial placement of the plate for the neck fractures further reduced the displacement, while a more anterior placement of the plate for the base fractures resulted in displacements greater than 0.330 mm. CONCLUSION According to our study, the lambda plate offers better rigidity when applied as cranially as possible for condylar neck fractures. The lambda plate did not provide adequate fixation for base fractures. A second plate at the sigmoid notch should be considered to achieve better stabilization along the fracture if the lambda plate is eventually used.
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Affiliation(s)
- Paris Liokatis
- Senior Resident, Department of Oral & Maxillofacial Surgery, Ludwig-Maximilians-University of Munich, Germany.
| | - Georgios Tzortzinis
- Dresden Center for Intelligent Materials (DCIM), Technische Universität Dresden, Dresden, Germany
| | - Simos Gerasimidis
- Assistant Professor, Department of Civil and Environmental Engineering, University of Massachusetts, Amherst, MA, USA
| | - Wenko Smolka
- Senior Consultant, Department of Oral & Maxillofacial Surgery, Ludwig-Maximilians-University of Munich, Germany
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Reliability of a Trapezium Miniplate with Endoscope-Assisted Internal Fixation in Mandibular Subcondylar Fractures: A Three-Dimensional Analysis. J Clin Med 2021; 11:jcm11010207. [PMID: 35011948 PMCID: PMC8745675 DOI: 10.3390/jcm11010207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/15/2021] [Accepted: 12/25/2021] [Indexed: 01/11/2023] Open
Abstract
This study aimed to evaluate the reliability of a trapezium plate for open reduction and internal fixation (ORIF) of mandibular subcondylar fractures with the simultaneous use of an endoscope. We selected and retrospectively studied 18 patients (12 males and 6 females) with unilateral mandibular subcondylar fractures who visited the Wonju Severance Christian Hospital. The mean age of the patients was 43.43 ± 15.76 years. Patients underwent ORIF with trapezium miniplate application through an intraoral incision under general anesthesia. The clinical and radiographic findings of the fractured side were compared with those of the non-operated side at 6 months follow-up. All occlusions became stable, and transient functional disturbances disappeared within 6 months of periodic follow-up. Functional mandibular movement recovered within the normal range, with an average mouth opening of 41.5 mm, protrusion of 7.5 mm, and lateral excursion of 7 mm at 6 months. Radiographic controls and statistical analysis confirmed a decent anatomical reduction in all 18 cases. In conclusion, the use of a trapezium miniplate with endoscope-assisted ORIF in mandibular subcondylar fractures can be useful for fixation and functional recovery.
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Liokatis P, Tzortzinis G, Gerasimidis S, Smolka W. Finite element analysis of different titanium miniplates: Evaluation of three-dimensional designs applied on condylar neck fractures. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:184-190. [PMID: 34186228 DOI: 10.1016/j.jormas.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/26/2021] [Accepted: 06/24/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The fixation of condylar neck fractures is raising difficulties and for this reason, many plate designs have been developed. The current study compares the performance of four miniplates used in the condylar neck. MATERIAL AND METHODS A virtual condylar neck fracture in a mandible obtained from a CT scan was fixed with four miniplates (two straight miniplates, lambda, strut, and trapezoidal). Using finite element analysis, we examined the fragments' displacements and stress distribution in the titanium material and bone. The models were analyzed under two loading conditions: a reduced bite force of 135 N and a force of 500 N. RESULTS No risk of material failure was observed. For a load of 135 N, all four plates offer an adequate fixation. For 500 N of applied loading, the lambda and strut plates showed the best rigidity and lowest bone strains. The two parallel plates showed the lowest rigidity and the trapezoidal plate the highest bone strains around all screws. DISCUSSION These findings imply that three-dimensional miniplates (lambda, strut) perform better when higher loads are applied. On the other hand, the trapezoidal plate has an increased risk of screw loosening and the two straight plates higher mobility of the fragments.
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Affiliation(s)
- Paris Liokatis
- Department of Oral & Maxillofacial Surgery, Ludwig-Maximilians-University of Munich, Germany.
| | - Georgios Tzortzinis
- Department of Civil and Environmental Engineering, University of Massachusetts, Amherst, MA, USA
| | - Simos Gerasimidis
- Department of Civil and Environmental Engineering, University of Massachusetts, Amherst, MA, USA
| | - Wenko Smolka
- Department of Oral & Maxillofacial Surgery, Ludwig-Maximilians-University of Munich, Germany
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Three-Dimensional Osteosynthesis Plates for the Surgical Treatment of Mandibular Fractures. J Craniofac Surg 2021; 32:e728-e735. [PMID: 34172684 DOI: 10.1097/scs.0000000000007709] [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] Open
Abstract
OBJECTIVES Mandible fractures can be treated with different plate systems, that is, miniplates or three-dimensional (3D) plates. This systematic review describes the effectiveness and clinical outcomes of 3D plates used in fractures of the mandible and aims to critically evaluate its risks and benefits. MATERIALS AND METHODS A comprehensive electronic search was conducted without date but with restriction to articles written in English. Studies in humans, including randomized or quasi-randomized controlled trials and retrospective studies, were included. The outcome parameters measured were number of patients, fracture classification, results, follow-up period, postoperative complications, and mean age of patients. Major complications were defined as those needing additional surgical intervention, for example, malocclusion, infection or plate fracture. Accordingly, complications not needing additional surgical intervention were defined as minor (ie, dehiscence, trismus). RESULTS Guided by the PRISMA statement and the Cochrane Handbook for Systematic Reviews of Interventions, the authors identified 44 publications with a total of 1790 patients. Among the articles selected for the final review, there were 32 reported prospective studies, 12 reported retrospective studies. Regarding the evaluation of quality, 8 studies showed a low value of the risk of bias, 17 a moderate risk, and 19 a high risk. There were statistically significant advantages for 3D plates in mandibular fractures in terms of postoperative complications, for example, wound dehiscences or plate fracture. CONCLUSIONS The 3D plate is an effective treatment modality for mandibular fractures, with low incidence of major complications, decreased length of operation time, and increased stability of osteosynthesis.
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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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Xu X, Cheng KJ, Liu YF, Fan YY, Wang JH, Wang R, Baur DA, Jiang XF, Dong XT. Experimental validation of finite element simulation of a new custom-designed fixation plate to treat mandibular angle fracture. Biomed Eng Online 2021; 20:15. [PMID: 33546713 PMCID: PMC7866451 DOI: 10.1186/s12938-021-00851-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of the study was to validate biomechanical characteristics of a 3D-printed, novel-designated fixation plate for treating mandibular angle fracture, and compare it with two commonly used fixation plates by finite element (FE) simulations and experimental testing. METHODS A 3D virtual mandible was created from a patient's CT images as the master model. A custom-designed plate and two commonly used fixation plates were reconstructed onto the master model for FE simulations. Modeling of angle fracture, simulation of muscles of mastication, and defining of boundary conditions were integrated into the theoretical model. Strain levels during different loading conditions were analyzed using a finite element method (FEM). For mechanical test design, samples of the virtual mandible with angle fracture and the custom-designed fixation plates were printed using selective laser sintering (SLS) and selective laser melting (SLM) printing methods. Experimental data were collected from a testing platform with attached strain gauges to the mandible and the plates at different 10 locations during mechanical tests. Simulation of muscle forces and temporomandibular joint conditions were built into the physical models to improve the accuracy of clinical conditions. The experimental vs the theoretical data collected at the 10 locations were compared, and the correlation coefficient was calculated. RESULTS The results show that use of the novel-designated fixation plate has significant mechanical advantages compared to the two commonly used fixation plates. The results of measured strains at each location show a very high correlation between the physical model and the virtual mandible of their biomechanical behaviors under simulated occlusal loading conditions when treating angle fracture of the mandible. CONCLUSIONS Based on the results from our study, we validate the accuracy of our computational model which allows us to use it for future clinical applications under more sophisticated biomechanical simulations and testing.
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Affiliation(s)
- Xu Xu
- Department of Stomatology, People's Hospital of Quzhou, Quzhou, 324000, China
| | - Kang-Jie Cheng
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou, 310023, China
- Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou, 310023, China
- National International Joint Research Center of Special Purpose Equipment and Advanced Processing Technology, Zhejiang University of Technology, Hangzhou, 310023, China
| | - Yun-Feng Liu
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou, 310023, China.
- Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou, 310023, China.
- National International Joint Research Center of Special Purpose Equipment and Advanced Processing Technology, Zhejiang University of Technology, Hangzhou, 310023, China.
| | - Ying-Ying Fan
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou, 310023, China
- Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou, 310023, China
- National International Joint Research Center of Special Purpose Equipment and Advanced Processing Technology, Zhejiang University of Technology, Hangzhou, 310023, China
| | - Joanne H Wang
- Department of Orthopedic Surgery, University Hospitals of Cleveland, Case Medical Center, 11100 Euclid Ave., Cleveland, OH, 44016, USA
| | - Russell Wang
- Department of Comprehensive Care, Case Western Reserve University School of Dental Medicine, 10900 Euclid Ave., Cleveland, OH, 44106-4905, USA
| | - Dale A Baur
- Department of Oral Maxillofacial Surgery, Case Western Reserve University School of Dental Medicine, 10900 Euclid Ave., Cleveland, OH, 44106-4905, USA
| | - Xian-Feng Jiang
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou, 310023, China
- Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou, 310023, China
| | - Xing-Tao Dong
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou, 310023, China
- Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou, 310023, China
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Scott C, Ramakrishnan K, Vivek N, Saravanan C, Prashanthi G. Does Three-Dimensional Plate Offer Better Outcome and Reduce the Surgical Time Following Open Reduction and Internal Fixation of Adult Mandibular Unilateral Subcondylar Fractures. A Randomized Clinical Study. J Oral Maxillofac Surg 2020; 79:1330.e1-1330.e12. [PMID: 33524326 DOI: 10.1016/j.joms.2020.12.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE The management of the condyle fractures continue to be a source of perineal controversy in the field of oral and maxillofacial trauma. The aim of this study was to compare the surgical feasibility, functional outcome, and stability of fixation between the conventional miniplate and 3-dimensional plate in the management of adult mandibular unilateral subcondylar fractures. MATERIALS AND METHODS A prospective randomized clinical study with well-structured inclusion and exclusion criteria was carried out. Patients were allocated into Group A (Miniplates) and Group B (3-D Plates). The primary outcome variables were time taken for fixation, maximum mouth opening, occlusal stability, increase in angulation, and increase in the gap between fractured segments in the radiograph. The secondary outcome variables were needed for intermaxillary fixation (IMF) with guiding elastics and jaw movements. Statistical analysis was done using χ2 test and student's t test with P value less than 0.05 indicating statistical significance. RESULTS Forty-four patients (40 male and 4 female) were enrolled, with 22 patients in each group. Time taken for fixation using 3-D plates was significantly lower than conventional miniplates (9.6 ± 0.9 minutes with P value 0.001). Although clinical parameters showed improved results for Group B, there was no statistical significance. Radiological parameters ie increase in angulation, and increase in the gap, showed statistically significant results. Group A had significant increases in the angulation of the fractured condyle at the end of the third and sixth months with a P value of 0.008 and 0.0001, respectively. The gap between the fractured segments was significantly increased in Group A at the end of the first and third months, with a P value of 0.022 and 0.003, respectively. CONCLUSIONS Our results concluded that 3-D plate offers superior fracture fragment stability and less displacement of the fractured segments. It has an added advantage of the ease of adaptation and shorter operating time.
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Affiliation(s)
- Cynthia Scott
- Assistant Professor, Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, Potheri, Kattankulathur, Chengalpattu District, Tamil Nadu, India.
| | - Karthik Ramakrishnan
- Associate Professor, Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, Potheri, Kattankulathur, Chengalpattu District, Tamil Nadu, India
| | - Narayanan Vivek
- Professor, Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, Potheri, Kattankulathur, Chengalpattu District, Tamil Nadu, India
| | - Chandran Saravanan
- Professor, Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, Potheri, Kattankulathur, Chengalpattu District, Tamil Nadu, India
| | - Gurram Prashanthi
- Associate Professor, Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, Potheri, Kattankulathur, Chengalpattu District, Tamil Nadu, 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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Ergezen E, Akdeniz SS. Evaluation of Stress Distribution of Four Different Fixation Systems at High- and Low-Level Subcondylar Fractures on a Nonhomogenous Finite Element Model. J Oral Maxillofac Surg 2020; 78:1596.e1-1596.e12. [PMID: 32445628 DOI: 10.1016/j.joms.2020.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of the present study was to provide insight into a suitable fixation system for subcondylar fractures located at different levels. MATERIALS AND METHODS High and low subcondylar fractures were simulated on a nonhomogenous mandibular model, and rhombic, trapezoid, and lambda plates and 2 miniplates were used for fixation. The stress in the bone and displacement of the fracture site were measured using finite element analysis. RESULTS For both high and low subcondylar fractures, the lowest von Mises stress was measured in the rhombic plate system. For high subcondylar fractures, the highest tension in the cortical bone was measured in the trapezoid plate system, and the highest compression was measured in the rhombic plate system. For low subcondylar fractures, the highest tension in the bone was measured in the rhombic system and the highest compression was measured in the trapezoid system. In both high and low subcondylar fracture models, the least displacement amount was measured in the 2-plate system. CONCLUSIONS The results of the present study have shown that the rhombic plate system might be the proper choice for high subcondylar fractures and the 2-plate system might provide better results for low subcondylar fractures.
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Affiliation(s)
- Ezgi Ergezen
- Specialist, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Başkent University, Ankara, Turkey.
| | - Sıdıka Sinem Akdeniz
- Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Başkent University, Ankara, Turkey
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Open Surgery Versus Closed Treatment of Unilateral Mandibular Condyle Fractures. J Craniofac Surg 2020; 31:484-487. [DOI: 10.1097/scs.0000000000006080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] 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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Cheng KJ, Liu YF, Wang JH, Jun JC, Jiang XF, Wang R, Baur DA. Biomechanical behavior of mandibles reconstructed with fibular grafts at different vertical positions using finite element method. J Plast Reconstr Aesthet Surg 2018; 72:281-289. [PMID: 30482534 DOI: 10.1016/j.bjps.2018.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 08/13/2018] [Accepted: 10/28/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND For large mandibular defects, surgical reconstruction using microvascular fibular grafts has advantages over other alternatives in terms of blood supply and good quality of grafted bone. However, the fibular segment is usually lower in height than that of the original mandible, meaning that the vertical positioning of the fibular graft is variable, with different biomechanical consequences on the reconstructed mandible. OBJECTIVES To use finite element method (FEM) to evaluate stress distribution and displacement of a reconstructed mandible versus an intact mandible under occlusal loads. METHODS A three-dimensional intact edentulous mandibular bone (Model I) and a reconstructed mandible bone with fibular graft were created from CBCT images. Calculation models were generated with fibular bone graft extracted from the reconstructed mandible of identical length placed into a mimicked defect area on the right-hand side of the mandible at three different vertical positions: superior (Model II), intermediate (Model III), and inferior (Model IV). Forces were applied at lower left first molar region and lower left central incisor area. Von Mises stresses and mandibular displacement were calculated as outcome measurements during loadings. RESULTS Maximum stress and strain within the reconstructed mandible were identified at the posterior border of the graft and the contralateral condyle. Maximum displacement occurred near the interface of fibular graft and anterior segment of the mandible. Stress distribution in the graft under functional loads is much higher than that in the residual mandibular segments from Models II to IV. The combined average maximum stress from anterior and posterior loads is 10.66 times higher in the mandible with inferiorly positioned graft (Model IV), 8.72 times for superior graft (Model II), and 3.68 times for intermediate graft (Model III) than that in the control group (Model I). The worst displacement result during functional loadings was in the group with fibular graft located at the inferior border of the mandible. CONCLUSIONS The position of fibular graft placed in the surgical resection site has significant effects on the mechanical behavior of the reconstructed mandible. The fibular graft aligned with the inferior border of the mandible, the most common site designated location by clinicians, has the worst effects on the stress distribution and displacement to the mandibular under functional loads. The fibular graft placed at the intermediate location has the best biomechanics and provides favorable condition for subsequent prosthetic reconstruction.
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Affiliation(s)
- Kang-Jie Cheng
- Key Laboratory of E&M (Zhejiang University of Technology), Ministry of Education & Zhejiang Province, 18 Chaowang Rd., Hangzhou, Zhejiang 310014, China
| | - Yun-Feng Liu
- Key Laboratory of E&M (Zhejiang University of Technology), Ministry of Education & Zhejiang Province, 18 Chaowang Rd., Hangzhou, Zhejiang 310014, China.
| | - Joanne H Wang
- Department of Orthopedic Surgery, University Hospitals of Cleveland, Case Medical Center, 11100 Euclid Ave., Cleveland, OH 44016, USA
| | - Janice C Jun
- Department of Oral Maxillary Surgery, Case Western Reserve University School of Dental Medicine, 10900 Euclid Ave., Cleveland, OH 44106-4905, USA
| | - Xian-Feng Jiang
- Key Laboratory of E&M (Zhejiang University of Technology), Ministry of Education & Zhejiang Province, 18 Chaowang Rd., Hangzhou, Zhejiang 310014, China
| | - Russell Wang
- Department of Comprehensive Care, Case Western Reserve University School of Dental Medicine, 10900 Euclid Ave., Cleveland, OH 44106-4905, USA
| | - Dale A Baur
- Department of Oral Maxillary Surgery, Case Western Reserve University School of Dental Medicine, 10900 Euclid Ave., Cleveland, OH 44106-4905, USA
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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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Conci RA, Garbin EÁ, Griza GL, Érnica NM, Noritomi PY, Silveira Tomazi FH, Fritscher GG, Heitz C. Does lag screw fixation of condylar fractures result in adequate stability? A finite element analysis. J Craniomaxillofac Surg 2018; 46:1041-1045. [PMID: 29735385 DOI: 10.1016/j.jcms.2018.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/25/2018] [Accepted: 04/04/2018] [Indexed: 10/17/2022] Open
Abstract
The great incidence and controversies related to the diagnosis, treatment, surgical accesses, and type of osteosynthesis materials confer an outstanding role to condylar fractures among facial fractures. Plate configurations, with diverse formats and sizes, may be used to surgically resolve condylar fractures. With the purpose of improving the advantages and minimizing the disadvantages of fixation techniques, the neck screw was developed aiming at the needed stabilization to render a correct fixation through a system of dynamic compression. This is achieved by increasing the contact between the fractured bone stumps, as well as assisting at the time of fracture reduction. The present paper aims at comparing the fixation and stability of mandibular condylar fractures using the neck screw and an overlaid "L"-shaped-4-hole-2 mm plate on the one hand, with a system in which the neck screw and the "L"-shaped plate form a single structure, having been joined by a welded point, on the other hand. The results with the neck screw are satisfactory, and, thus, it is an alternative for the reduction and fixation of fractures of the mandibular condyle, whether or not a plate is joined to the structure, provided it is correctly prescribed and with adequate surgical sequence and technique.
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Affiliation(s)
- Ricardo Augusto Conci
- Department of Oral and Maxillofacial Surgery, Universidade Estadual do Oeste do Paraná, (UNIOESTE), Brazil.
| | - Eleonor Álvaro Garbin
- Department of Oral and Maxillofacial Surgery, Universidade Estadual do Oeste do Paraná, (UNIOESTE), Brazil
| | - Geraldo Luiz Griza
- Department of Oral and Maxillofacial Surgery, Universidade Estadual do Oeste do Paraná, (UNIOESTE), Brazil
| | - Natasha Magro Érnica
- Department of Oral and Maxillofacial Surgery, Universidade Estadual do Oeste do Paraná, (UNIOESTE), Brazil
| | - Pedro Yoshito Noritomi
- Three-Dimensional Technologies Division, Center for Information Technology Renato Archer - Brazilian Ministry of Science and Technology (MCT), Brazil
| | | | - Guilherme Genehr Fritscher
- Department of Oral and Maxillofacial Surgery, Pontifícia Universidade Católica do Rio Grande do Sul, (PUCRS), Brazil
| | - Claiton Heitz
- Department of Oral and Maxillofacial Surgery, Pontifícia Universidade Católica do Rio Grande do Sul, (PUCRS), Brazil
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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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de Souza GM, Rodrigues DC, Celegatti Filho TS, Moreira RWF, Falci SGM. In-vitro comparison of mechanical resistance between two straight plates and a Y-plate for fixation of mandibular condyle fractures. J Craniomaxillofac Surg 2017; 46:168-172. [PMID: 29208487 DOI: 10.1016/j.jcms.2017.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/08/2017] [Accepted: 11/02/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To compare the mechanical resistance of conventional plates with a modified Y-plate in mandibular condyle fracture. MATERIALS AND METHODS 40 synthetic hemi-mandibular polyurethane replicates were used. Two groups of fixing materials were included: 20 mandibles fixed with 40 straight plates with four roles each (2.0 mm system) and 20 mandibles fixed with 20 Y-shaped plates (2.0 mm system and 1.5 mm thickness). The samples were submitted to linear loading in the following directions: 10 mandibles from each group from lateral to medial and 10 mandibles from each group from anterior to posterior. A universal loading machine, Instron Universal 4411, was used to performed the tests, and the resistance of each fixed mandible was assessed at displacements of 1 mm, 3 mm, and 5 mm. The t-test for independent samples was performed. The p value was set at <0.05. RESULTS The worst mechanical resistance was found in the Y-plates loaded from anterior to posterior. The best mechanical resistance was in two straight hole plates loaded from lateral to medial. The Y-plates and two straight hole plates showed similar resistance when a lateral to medial load was applied. CONCLUSION There was no difference between the plates when lateral to medial loading was tested.
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Affiliation(s)
- Glaciele Maria de Souza
- Oral and Maxillofacial Surgery Section, Department of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187 - Diamantina -MG, 39100-000, Brazil
| | - Danillo Costa Rodrigues
- Oral and Maxillofacial Surgery Section, Department of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187 - Diamantina -MG, 39100-000, Brazil
| | - Tóride Sebastião Celegatti Filho
- Oral and Maxillofacial Surgery Section, Department of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187 - Diamantina -MG, 39100-000, Brazil
| | - Roger William Fernandes Moreira
- Oral and Maxillofacial Surgery Section, Department of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187 - Diamantina -MG, 39100-000, Brazil
| | - Saulo Gabriel Moreira Falci
- Oral and Maxillofacial Surgery Section, Department of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187 - Diamantina -MG, 39100-000, Brazil.
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Wagner F, Strasz M, Traxler H, Schicho K, Seemann R. Evaluation of an experimental oblique plate for osteosynthesis of mandibular condyle fractures. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:537-541. [PMID: 29056288 DOI: 10.1016/j.oooo.2017.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/04/2017] [Accepted: 09/14/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this study was to test the bone thickness and potential screw length for osteosynthesis of condylar base fractures (according to the Loukota classification) with an experimental titanium plate, placed in an ideal position against 2 types of conventional plates. STUDY DESIGN After exclusion of completely edentulous mandibles, 28 dentate macerated mandibles available at the time of the study were included. Linear regression models 1 and 2 compared the sums of the 2 cranial bone thicknesses and the 3 caudal thicknesses among the 3 different plate designs, and linear models 3 and 4 tested the bone thickness in the 2 most cranial screw axes. RESULTS Linear models 1 and 2 revealed significantly higher potential screw lengths for the experimental oblique plate. Equally, linear models 3 and 4 indicated significantly higher bone thickness for the novel oblique plate. CONCLUSION The novel proposed oblique plate allows for favorable plate positioning in a biomechanically ideal location with sufficient amounts of local bone for stable plate fixation. When plates with 15-degree angulated screw holes are used, stable bicortical plate fixation can be achieved.
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Affiliation(s)
- Florian Wagner
- University Clinic for Cranio- and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria.
| | - Martin Strasz
- University Clinic for Cranio- and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria
| | - Hannes Traxler
- Department for Systematic Anatomy, Medical University of Vienna, Vienna, Austria
| | - Kurt Schicho
- University Clinic for Cranio- and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria
| | - Rudolf Seemann
- University Clinic for Cranio- and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria
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Bischoff EL, Carmichael R, Reddy LV. Plating Options for Fixation of Condylar Neck and Base Fractures. Atlas Oral Maxillofac Surg Clin North Am 2017; 25:69-73. [PMID: 28153185 DOI: 10.1016/j.cxom.2016.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Eric L Bischoff
- US Navy, USA; Baylor University Medical Center, Texas A&M University School of Dentistry, Dallas, TX 75246, USA
| | - Ryan Carmichael
- Baylor University Medical Center, Texas A&M University School of Dentistry, Dallas, TX 75246, USA
| | - Likith V Reddy
- Department of Oral and Maxillofacial Surgery, Baylor University Medical Center, Texas A&M University School of Dentistry, 3302 Gaston Avenue, Dallas, TX 75246, USA.
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Weiss JP, Sawhney R. Update on mandibular condylar fracture management. Curr Opin Otolaryngol Head Neck Surg 2016; 24:273-8. [DOI: 10.1097/moo.0000000000000272] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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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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22
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Kanno T, Sukegawa S, Tatsumi H, Karino M, Nariai Y, Nakatani E, Furuki Y, Sekine J. Does a Retromandibular Transparotid Approach for the Open Treatment of Condylar Fractures Result in Facial Nerve Injury? J Oral Maxillofac Surg 2016; 74:2019-32. [PMID: 27318190 DOI: 10.1016/j.joms.2016.05.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/17/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The retromandibular transparotid approach (RMA) to condylar fractures of the mandible provides excellent access, but can increase the risk of complications. The aim of this study was to estimate the frequency of facial nerve paralysis (FNP) and associated postoperative complications after open reduction and rigid internal fixation (ORIF) of subcondylar fractures through the RMA. MATERIALS AND METHODS This was a retrospective cohort study of patients with condylar fractures requiring ORIF through the RMA. The inclusion criteria were 1) a medical record of surgical treatment of a subcondylar fracture by RMA; 2) preoperative and postoperative radiographs; 3) mental status permitting an adequate neuromotor examination; 4) absence of a post-injury or pretreatment functional facial nerve deficit; and 5) regular postoperative follow-up longer than 6 months with documentation of complications, functional results, and fixation stability. The predictive variables were age, gender, fracture site, fracture pattern, concomitant fractures, etiology, and plate types. The outcome variable was FNP. Univariate, bivariate, and multiple logistic regression statistics were computed. RESULTS Fifty patients with 55 displaced mandibular subcondylar fractures (35 men, 15 women; mean age, 44.5 yr; range, 17 to 87 yr) met the inclusion criteria. The condylar fracture involved the neck in 35 patients (63.6%) and the base in 20 patients (36.4%). The fracture pattern was deviation in 11 patients (20.0%), displacement in 23 (41.8%), and dislocation in 21 (38.2%). Precise ORIF with double-buttress fixation resulted in immediate functional recovery in all patients. Seven fractures (12.7%) were associated with FNP that resolved completely within 6 months. Further statistical analysis showed that dislocated and displaced condylar neck fractures were significant risk factors for postoperative FNP (P < .05). Other postoperative complications were minimal. CONCLUSION The RMA for subcondylar fractures is feasible and safe. Dislocated condylar neck fractures are associated with a highly increased risk of temporary postoperative FNP as a surgical complication.
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Affiliation(s)
- Takahiro Kanno
- Associate Professor, Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan; and Attending OMS Surgeon, Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa, Japan.
| | - Shintaro Sukegawa
- Chief Consultant OMS Surgeon, Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa, Japan
| | - Hiroto Tatsumi
- Formerly Assistant Professor, Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan, and Director, Division of Oral and Maxillofacial Surgery, Oki Hospital, Oki, Shimane, Japan
| | - Masaaki Karino
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | - Yoshiki Nariai
- Director and Chair, Division of Oral and Maxillofacial Surgery, Matsue City Hospital, Matsue, Shimane, Japan
| | - Eiji Nakatani
- Biostatistician, Translational Research Informatics Center, Foundation of Biomedical Research and Innovation, Kobe, Japan
| | - Yoshihiko Furuki
- Director and Chair, Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa, Japan
| | - Joji Sekine
- Professor and Head, Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan
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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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24
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Kanno T, Okuma S, Karino M, Yoshino A, Sekine J. Unexpected Plate Fracture in a Three-Dimensional Subcondylar Locking Plate System. J HARD TISSUE BIOL 2016. [DOI: 10.2485/jhtb.25.442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Takahiro Kanno
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
| | - Satoe Okuma
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Division of Oral and Maxillofacial Surgery, Masuda Red Cross Hospital
| | - Masaaki Karino
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
| | - Aya Yoshino
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
| | - Joji Sekine
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
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Chaudhary M, Pant H, Singh M, Vashistha A, Kaur G. Evaluation of trapezoidal-shaped 3-D plates for internal fixation of mandibular subcondylar fractures in adults. J Oral Biol Craniofac Res 2015; 5:134-9. [PMID: 26587378 DOI: 10.1016/j.jobcr.2015.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 07/28/2015] [Indexed: 10/23/2022] Open
Abstract
AIMS The purpose of this study is to evaluate the clinical results and to assess the efficacy, stability, and rigidity of trapezoidal 3-D plates for osteosynthesis in adult mandibular subcondylar fracture patients. METHODS This study included 15 cases of trauma having mandibular subcondylar fractures, in which open reduction and internal fixation are indicated. After selecting patient according to the inclusion criteria, all patients underwent open reduction and rigid fixation. Fracture was then stabilized using 4 hole, 2.0 mm trapezoidal-shaped 3-D titanium plates using retromandibular incision. Postoperative clinical examination was carried out on 3rd day; 1st, 2nd, and 4th weeks; and 3rd and 6th months. RESULTS The results of this study suggest that the fixation of mandibular subcondylar fracture with trapezoidal-shaped 3-D plates provides three-dimensional stability and carries low morbidity. CONCLUSION Patients with gross displacement of condylar fragment, major reduction in posterior facial height, and deranged occlusion can be successfully managed by open reduction of condylar fracture and its fixation using 3-D plates.
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Affiliation(s)
- Manoj Chaudhary
- Head, Department of Oral & Maxillofacial Surgery, Kothiwal Dental College & Research Centre, Moradabad, Uttar Pradesh 244001, India
| | - Harshvardhan Pant
- Resident, Department of Oral & Maxillofacial Surgery, Kothiwal Dental College & Research Centre, Moradabad, Uttar Pradesh 244001, India
| | - Manpreet Singh
- Reader, Department of Oral & Maxillofacial Surgery, Kothiwal Dental College & Research Centre, Moradabad, Uttar Pradesh 244001, India
| | - Arpit Vashistha
- Resident, Department of Oral & Maxillofacial Surgery, Kothiwal Dental College & Research Centre, Moradabad, Uttar Pradesh 244001, India
| | - Gagandeep Kaur
- Reader, Department of Conservative Dentistry & Endodontics, Kothiwal Dental College & Research Centre, Moradabad, Uttar Pradesh 244001, India
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Ramos A, Duarte R, Mesnard M. An ex vivo experimental study of strain and stiffness of different cadaveric mandible condyle sizes. Comput Methods Biomech Biomed Engin 2015; 18 Suppl 1:2036-7. [PMID: 26230547 DOI: 10.1080/10255842.2015.1069610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- A Ramos
- a TEMA, Biomechanics Research Group , University of Aveiro , Aveiro , Portugal
| | - R Duarte
- b Université de Bordeaux, Institut de Mécanique et d'Ingénierie - CNRS UMR 5295 , Bordeaux , France
| | - M Mesnard
- b Université de Bordeaux, Institut de Mécanique et d'Ingénierie - CNRS UMR 5295 , Bordeaux , France
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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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Treatment of condylar fractures with an intraoral approach using an angulated screwdriver: Results of a multicentre study. J Craniomaxillofac Surg 2015; 43:34-42. [DOI: 10.1016/j.jcms.2014.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 10/10/2014] [Accepted: 10/10/2014] [Indexed: 11/23/2022] Open
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Development plates for stable internal fixation: Study of mechanical resistance in simulated fractures of the mandibular condyle. J Craniomaxillofac Surg 2015; 43:158-61. [DOI: 10.1016/j.jcms.2014.10.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 08/28/2014] [Accepted: 10/22/2014] [Indexed: 11/20/2022] Open
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de Jesus G, Vaz L, Gabrielli M, Passeri L, V. Oliveira T, Noritomi P, Jürgens P. Finite element evaluation of three methods of stable fixation of condyle base fractures. Int J Oral Maxillofac Surg 2014; 43:1251-6. [DOI: 10.1016/j.ijom.2014.07.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 04/07/2014] [Accepted: 07/21/2014] [Indexed: 10/24/2022]
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31
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Position paper from the IBRA Symposium on Surgery of the Head – The 2nd International Symposium for Condylar Fracture Osteosynthesis, Marseille, France 2012. J Craniomaxillofac Surg 2014; 42:1234-49. [DOI: 10.1016/j.jcms.2014.03.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 12/20/2013] [Accepted: 03/10/2014] [Indexed: 11/18/2022] Open
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Zapata U, Watanabe I, Opperman LA, Dechow PC, Mulone T, Elsalanty ME. In Vitro Mechanical Evaluation of Mandibular Bone Transport Devices. J Med Device 2014. [DOI: 10.1115/1.4026561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Bone transport distraction osteogenesis (BTDO) is a surgical procedure that has been used over the last 30 years for the correction of segmental defects produced mainly by trauma and oncological resections. Application of BTDO has several clinical advantages over traditional surgical techniques. Over the past few years, several BTDO devices have been introduced to reconstruct mandibular bone defects. Based on the location and outline of the defect, each device requires a uniquely shaped reconstruction plate. To date, no biomechanical evaluations of mandibular BTDO devices have been reported in the literature. The present study evaluated the mechanical behavior of three different shaped prototypes of a novel mandibular bone transport reconstruction plate and its transport unit for the reconstruction of segmental bone defects of the mandible by using numerical models complemented with mechanical laboratory tests to characterize strength, fatigue, and stability. The strength test evaluated device failures under extreme loads and was complemented with optimization procedures to improve the biomechanical behavior of the devices. The responses of the prototypes were characterized to improve their design and identify weak and strong regions in order to avoid posterior device failure in clinical applications. Combinations of the numerical and mechanical laboratory results were used to compare and validate the models. In addition, the results remark the importance of reducing the number of animals used in experimental tests by increasing computational and in vitro trials.
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Affiliation(s)
- Uriel Zapata
- Mechanical Engineering Department, EAFIT University, Medellin 050022, Colombia e-mail:
| | - Ikuya Watanabe
- Department of Dental and Biomedical
Materials Science, Nagasaki University Graduate School of Biomedical Science, Nagasaki 852-8588, Japan
| | | | - Paul C. Dechow
- Baylor College of Dentistry, Texas A&M University, Dallas, TX 75246
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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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Évolution du traitement chirurgical des fractures du condyle mandibulaire en France entre 2005 et 2012. ACTA ACUST UNITED AC 2013; 114:341-8. [DOI: 10.1016/j.revsto.2013.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 01/21/2013] [Accepted: 05/16/2013] [Indexed: 11/22/2022]
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Vesnaver A, Ahčan U, Rozman J. Evaluation of surgical treatment in mandibular condyle fractures. J Craniomaxillofac Surg 2012; 40:647-53. [DOI: 10.1016/j.jcms.2011.10.029] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Revised: 09/26/2011] [Accepted: 10/06/2011] [Indexed: 11/26/2022] Open
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Kyzas PA, Saeed A, Tabbenor O. The treatment of mandibular condyle fractures: A meta-analysis. J Craniomaxillofac Surg 2012; 40:e438-52. [DOI: 10.1016/j.jcms.2012.03.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Revised: 03/02/2012] [Accepted: 03/05/2012] [Indexed: 11/26/2022] Open
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Costa FWG, Bezerra MF, Ribeiro TR, Pouchain EC, Sabóia VDPA, Soares ECS. Biomechanical analysis of titanium plate systems in mandibular condyle fractures: a systematized literature review. Acta Cir Bras 2012; 27:424-9. [PMID: 22666761 DOI: 10.1590/s0102-86502012000600011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 04/16/2012] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: To conduct a systematized review of the literature about the main methodologies used to evaluate the biomechanical fixation systems with titanium plates in fractures of the mandibular condyle. METHODS: A systematized review of literature was performed in the electronic databases PubMed, EMBASE, LILACS and MEDLINE without restriction of the publication date. The eligibility criteria were laboratory studies involving mandibular condyle fractures, studies using titanium plates, biomechanical studies, in vitro and computational studies involving the finite element method (FEM). RESULTS: Eleven articles that met the eligibility criteria were selected, including seven articles involving in vitro studies and four studies with biomechanical analysis by using FEM. CONCLUSION: Although few articles have used the finite element method, the results of in vitro studies were similar to those found in computational studies, regarding to the stable use of two titanium miniplates.
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Christopoulos P, Stathopoulos P, Alexandridis C, Shetty V, Caputo A. Comparative biomechanical evaluation of mono-cortical osteosynthesis systems for condylar fractures using photoelastic stress analysis. Br J Oral Maxillofac Surg 2011; 50:636-41. [PMID: 22206717 DOI: 10.1016/j.bjoms.2011.12.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 12/02/2011] [Indexed: 11/28/2022]
Abstract
Fractures of the condyle account for 20-30% of all mandibular fractures, and are therefore one of the most common facial injuries. Precise evaluation of the mechanical stresses that develop in a fractured mandible is essential, particularly for the testing of systems currently used for stabilisation of the condylar fragment. Photoelastic stress analysis can be used to visualise alterations in the strain that is induced in the mandible by a fracture, and in the osteosynthesis materials used to stabilise it. This method, used on currently used osteosynthesis materials, showed that stabilisation of a subcondylar fracture with a single miniplate does not provide enough stability, whereas the use of two miniplates - properly positioned - offers sufficient stability in all loading conditions. A microplate may be used as a tension-resisting plate with equally good results.
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Affiliation(s)
- Panos Christopoulos
- Oral and Maxillofacial Surgery Department, University of Athens, School of Dentistry, Greece
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Singh V, Bhagol A, Dhingra R. A comparative clinical evaluation of the outcome of patients treated for bilateral fracture of the mandibular condyles. J Craniomaxillofac Surg 2011; 40:464-6. [PMID: 21978428 DOI: 10.1016/j.jcms.2011.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 07/31/2011] [Accepted: 08/03/2011] [Indexed: 10/17/2022] Open
Abstract
AIM To compare open reduction and internal fixation (ORIF) with closed treatment and maxillomandibular fixation (CRMMF) for management of bilateral subcondylar fractures of the mandible. PATIENTS AND METHODS This study involved a retrospective analysis of bilateral subcondylar fractures of the mandible treated at Government Dental College, Rohtak from 2007 to 2010. Data were collected by a review of pertinent inpatient and outpatient clinic records, and radiographic results. Patients were followed up weekly for 4 weeks and then at 2, 3 and 6 months after surgery. At these visits, careful attention was paid to clinical parameters included mouth opening, protrusion, laterotrusion, deviation on mouth opening and occlusion. RESULTS The patient sample ranged in age from 19 to 55 years, with an average age of 28.2 years. In total, 44 patients with 88 mandibular subcondylar fractures were included in the study. Out of these, 20 patients were managed by closed treatment and 24 by ORIF of the subcondylar fractures (19 unilateral and 5 bilateral). Regarding mouth opening/lateral excursion/protrusion, significant (p=0.00) differences were observed between both groups (open 37.6/11.5/5.9 mm versus closed 31.5/7.8/3.1mm). The visual analogue scoring revealed significant (p=0.00) difference with less pain in the operative treatment group (1.3 open versus 7.2 closed). Statistically significant difference was found between two groups for occlusion (p=0.00). CONCLUSION The current retrospective study shows that operative treatment was superior in all objective and subjective functional parameters. It is concluded that if either of the condyles is displaced ORIF is the most satisfactory method of treatment.
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Affiliation(s)
- Virendra Singh
- Department of Oral and Maxillofacial Surgery, Government Dental College, Pt. B.D. Sharma University of Health Sciences, Rohtak 124001, Haryana, India.
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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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CROOMA, complication rates of operatively treated mandibular fractures, paramedian and body. ACTA ACUST UNITED AC 2011; 111:449-54. [DOI: 10.1016/j.tripleo.2010.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 06/05/2010] [Accepted: 06/16/2010] [Indexed: 11/23/2022]
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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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Thorén H, Snäll J, Kormi E, Lindqvist C, Suominen-Taipale L, Törnwall J. Symptomatic plate removal after treatment of facial fractures. J Craniomaxillofac Surg 2010; 38:505-10. [DOI: 10.1016/j.jcms.2010.01.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Revised: 01/27/2010] [Accepted: 01/29/2010] [Indexed: 11/27/2022] Open
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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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Open Reduction and Internal Fixation of Low Subcondylar Fractures of Mandible Through High Cervical Transmasseteric Anteroparotid Approach. J Oral Maxillofac Surg 2009; 67:2446-51. [DOI: 10.1016/j.joms.2009.04.109] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2009] [Revised: 03/27/2009] [Accepted: 04/21/2009] [Indexed: 11/22/2022]
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Transoral endoscopic-assisted management of subcondylar fractures in 17 patients: An alternative to open reduction with rigid internal fixation and closed reduction with maxillomandibular fixation. Int J Oral Maxillofac Surg 2009; 38:19-25. [DOI: 10.1016/j.ijom.2008.11.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2007] [Revised: 05/06/2008] [Accepted: 11/13/2008] [Indexed: 11/24/2022]
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Landes CA, Day K, Lipphardt R, Sader R. Prospective closed treatment of nondisplaced and nondislocated condylar neck and head fractures versus open reposition internal fixation of displaced and dislocated fractures. Oral Maxillofac Surg 2008; 12:79-88. [PMID: 18618165 DOI: 10.1007/s10006-008-0108-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE assessment of open reduction internal fixation in displaced or dislocated fractures of the condylar neck and head assessed versus closed treatment of nondisplaced, nondislocated fractures. MATERIALS AND METHODS One hundred and twenty patients suffering from 158 fractures; classes II to V according to Spiessl and Schroll, e.g., displaced and dislocated fractures were operated on; classes I and VI nondisplaced, nondislocated fractures were treated conservatively. At 1year, facial symmetry, pain, facial nerve function, and scarring were assessed clinically; reossification and fragment angulation were assessed from radiographs; vertical position, incisal maximum movements, and condyle translation were judged by millimeters. RESULTS AND DISCUSSION Clinical courses were uncomplicated in classes I to IV and did reach horizontal and vertical fragment reposition with minor remodeling in follow-up. Single cases evinced persistent pain, dysocclusion, facial nerve palsy, and plate fractures. Results were less successful in classes V and VI: although open reposition internal fixation showed good repositioning in class V, marked vertical bone remodeling occurred; single cases suffered from pain, dysocclusion, and plate fracture. Class VI cases had the worst translation, likewise marked condyle remodeling, and frequent dysocclusion. CONCLUSION Classes V and VI remain challenging to treat, while the other classes can be treated reliably with this study's rationale. Condyle remodeling in classes V and VI, translation in class VI may benefit prospectively from even more careful mobilization, improved osteofixation as minimalized operation trauma.
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Affiliation(s)
- Constantin A Landes
- Mund-, Kiefer und Plastische Gesichtschirurgie, Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, Frankfurt, Germany.
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Clinical experience with osteosynthesis of subcondylar fractures of the mandible using TCP plates. J Craniomaxillofac Surg 2008; 36:260-8. [PMID: 18328720 DOI: 10.1016/j.jcms.2008.01.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the clinical and radiological results obtained with a new kind of osteosynthesis device (Modus TCP) plates, Medartis, Basel, Switzerland), especially designed for low subcondylar fracture (LSCF) and high subcondylar fracture (HSCF) of the mandible in association with the high submandibular approach (HSMA). METHOD A prospective clinical and radiological study was carried out over a 41-month period. All adult patients suffering from a displaced LSCF or HSCF who consented to the surgical treatment were included in the study. All fractures were operated on using an HSMA and were stabilised using a 4- or 9-hole TCP((R)) plate. No intermaxillary fixation was used and a soft diet was started on the 1st postoperative day. Clinical examinations and control X-rays were carried out on the 10th postoperative day, in the 1st, the 3rd and, at least, in the 6th postoperative months. MATERIAL Sixty-four patients (12 females, 52 males - mean age: 28.3) with a total of 75 fractures (54 LSCF, 21 HSCF) were included in the study. Mean postoperative follow-up was 14 months. RESULTS In the 6th postoperative month, all fractures were consolidated in 79% of the cases in an anatomical position. A secondary displacement of the fracture occurred in 6.6% of the cases. Plate fracture was not observed. Dental occlusion remained unchanged in 94% of the patients. The mandibular movements (mouth opening, protrusion, lateral movements on the unfractured and fractured side) had normal mean values (49.5, 10.4, 12.8, 12.1mm, respectively). These movements were symmetrical in 95% of the patients. No patient complained about articular pain or noise. No facial nerve palsy was noticed, not even a transiently one. All patients but one found the scars acceptable. CONCLUSION TCP plates, in association with HSMA, were found to be an efficient osteosynthesis device for stabilising subcondylar fractures.
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