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Chieng CY, Patel A, Nazir H, Ali S, Bhatti N, Mcleod N. Condyle head fracture management: A systematic review of outcomes. J Craniomaxillofac Surg 2024:S1010-5182(24)00244-0. [PMID: 39266432 DOI: 10.1016/j.jcms.2024.08.019] [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: 11/12/2023] [Accepted: 08/19/2024] [Indexed: 09/14/2024] Open
Abstract
The management of Condylar Head fractures (CHFs) has historically been with closed treatments(CTR); however, contemporary studies suggest that Open Reduction and Internal Fixation(ORIF) may produce better clinical and radiographic results. Our primary aim was to review the literature on the clinical and radiological outcomes of open and closed management of CHFs. A systematic literature search was undertaken using EMBASE, MEDLINE and PubMed, using PRISMA guidelines, for all studies relating to outcomes following CHF. The inclusion criteria include 1) studies focused on CHF in adult patients that included at least 20 cases 2) published in English language. ROBINS-1 tool was used for risk assessment. Data extracted was analysed and compared using the relative risks. A total of 29 studies reporting on 1550 ORIF and 798 CTR were included. ORIF resulted in significantly less trismus (RR 9.5), chin deviation (RR 7.3), malocclusion (RR 6.5), TMJ clicking (RR 4.3) and pain(RR 12.6) than CTR. Due to the substantial heterogeneity of studies, firm conclusions are difficult but there does appear to be objective benefits in outcomes following ORIF than CTR. Satisfactory results may however be achieved with CTR. Further large studies using standardised outcome measurements will be required to help elucidate exactly which CHF are best served by ORIF.
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Affiliation(s)
- Chiew Ying Chieng
- Department of Oral & Maxillofacial Surgery, Royal London Hospital, Whitechapel Road, London, E1 1FR, United Kingdom.
| | - Anika Patel
- Department of Oral & Maxillofacial Surgery, Royal London Hospital, Whitechapel Road, London, E1 1FR, United Kingdom
| | - Hira Nazir
- Department of Oral & Maxillofacial Surgery, Royal London Hospital, Whitechapel Road, London, E1 1FR, United Kingdom
| | - Sana Ali
- Department of Oral & Maxillofacial Surgery, Royal London Hospital, Whitechapel Road, London, E1 1FR, United Kingdom
| | - Nabeel Bhatti
- Department of Oral & Maxillofacial Surgery, Royal London Hospital, Whitechapel Road, London, E1 1FR, United Kingdom
| | - Niall Mcleod
- Department of Oral & Maxillofacial Surgery, University Hospitals Coventry and Warwickshire NHS Trust, United Kingdom.
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Liu X, Shao S, Lou H, Xia Y. Application of Crus of Helix Incision Through the Posterior Parotid Gland Approach in the Mid-Level or High-Level Mandibular Condylar Fractures. J Craniofac Surg 2024:00001665-990000000-01479. [PMID: 38688015 DOI: 10.1097/scs.0000000000010167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE This study is to explore the clinical effect of crus of helix incision through the posterior parotid gland approach in the treatment of Mid-or High-Level mandibular condylar fractures. METHODS From September 2020 to June 2023, we performed incision reduction internal fixation of 23 patients with mid-level or high-level fractures of the mandibular condylar through the approach of the posterior parotid gland, and observed the effect of the operation. RESULTS After a follow-up period of 6 to 12 months, all patients showed no signs of postoperative facial paralysis or salivary gland fistula. In addition, satisfactory scars were observed in the operation area, and the occlusion function had recovered well. CONCLUSION The approach of using a crus of helix incision through the posterior parotid gland proved to be an effective method for treating mid-level or high-level fractures of the condylar fractures. This technique offers several advantages, including adequate exposure, minimal facial nerve injury, ease of incision and reduction, inconspicuous scarring, and a more concealed incision.
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Affiliation(s)
- Xiang Liu
- Department of Oral and Maxillofacial Surgery, The First People's Hospital of Yunnan Province
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Shengjie Shao
- Department of Oral and Maxillofacial Surgery, The First People's Hospital of Yunnan Province
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Huiquan Lou
- Department of Oral and Maxillofacial Surgery, The First People's Hospital of Yunnan Province
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Yichao Xia
- Department of Oral and Maxillofacial Surgery, The First People's Hospital of Yunnan Province
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
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Diarra D, Ni XQ, Li Z. Combined Plate and Long Screw Fixation of Transverse Condylar Head Fractures. J Craniofac Surg 2023; 34:e607-e608. [PMID: 37463301 DOI: 10.1097/scs.0000000000009548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 05/21/2023] [Indexed: 07/20/2023] Open
Abstract
We describe a method of fixing transverse condylar head fractures using a combination of a plate and long screw fixation. In the technical procedure, a 4-hole mini-plate was placed on the lateral side of the condylar head and the condylar stump after the fracture reduction. The first hole was drilled in the lateral side of the condylar head, and one 9 mm mini-screw was inserted, a second hole drilled from the lateral side of the condyle stump through the medial pole of the condylar head and a 16 mm screw was inserted in an oblique direction from inferior to superior, then 2 more 9 mm mini-screws were inserted just below the long one to complete the procedure. This technique showed excellent results in both short and long-term stability of and healing of the fracture. Furthermore, it is more standardized, reproducible, and less technically demanding.
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Affiliation(s)
- Drissa Diarra
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Xiao-Qi Ni
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Zhi Li
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China
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Serious Condylar Head Absorption in Children With Intracapsular Condylar Fractures Treated Operatively With Long Screws. J Craniofac Surg 2023; 34:658-662. [PMID: 36173941 DOI: 10.1097/scs.0000000000009023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/12/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study was performed to explore bone remodelling in children with intracapsular condylar fractures after the condylar fracture fragments were fixed using long screws and to offer possible explanations about the underlying mechanism. PATIENT AND METHODS Records of children (less than 12 y old) who sustained intracapsular condylar fractures and fixed with long screws from May 2012 to January 2015 were retrieved. Age, gender, dates of injury, admission, and discharge, mechanism of trauma, location and pattern of fracture, other mandibular fractures, treatment methods, and time of review were recorded and analyzed. Image dates of pretreatments and posttreatments, including the date of review, were also recorded. RESULTS A total of 8 patients completed their follow-up, and all patients (n=5) who were followed up after more than 3 months showed serious resorption of the condylar head. The condylar head resorbed until the height (or articular surface) dropped and aligned with the surface of the screw. The shortest time of absorption, as shown by the computed tomography scan was 106 days, and the longest time was 171 days (average time of 141.8 d). CONCLUSIONS Intracapsular condyle fractures in children should be managed conservatively as much as possible. However, if the height of the fracture fragments drops remarkably, open reduction and rigid internal fixation become possible choices.
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Bertin E, Meyer C, Louvrier A, Weber E, Barrabé A, Pons M. Intraoperative Cone-Beam Computed Tomography for open reduction and internal fixation of condylar head fractures. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e593-e597. [PMID: 34906728 DOI: 10.1016/j.jormas.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/23/2021] [Accepted: 12/07/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Eugénie Bertin
- Chirurgie Maxillo-faciale, Stomatologie et Odontologie hospitalière, CHU-Besançon, F-25000 Besançon, France.
| | - Christophe Meyer
- Chirurgie Maxillo-faciale, Stomatologie et Odontologie hospitalière, CHU-Besançon, F-25000 Besançon, France; Nanomedicine lab, Imagery and Therapeutics, EA 4662, UFR Sciences et Techniques, University of Franche-Comté, route de Gray, 25030 Besançon cedex, France
| | - Aurélien Louvrier
- Chirurgie Maxillo-faciale, Stomatologie et Odontologie hospitalière, CHU-Besançon, F-25000 Besançon, France; University of Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Host-Graft Interactions/Cell and Gene Engineering, 25000 Besançon, France
| | - Elise Weber
- Chirurgie Maxillo-faciale, Stomatologie et Odontologie hospitalière, CHU-Besançon, F-25000 Besançon, France
| | - Aude Barrabé
- Chirurgie Maxillo-faciale, Stomatologie et Odontologie hospitalière, CHU-Besançon, F-25000 Besançon, France
| | - Mélanie Pons
- Chirurgie Maxillo-faciale, Stomatologie et Odontologie hospitalière, CHU-Besançon, F-25000 Besançon, France
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Removal of Fracture Fragments in Intracapsular Condylar Fractures. J Craniofac Surg 2022; 33:e688-e692. [DOI: 10.1097/scs.0000000000008575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/29/2022] [Indexed: 11/25/2022] Open
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Palanivel I, Narayanan V, Chandran S, Ramakrishnan K, Gurram P. Open Reduction Internal Fixation of Condylar Head/Diacapitular Fracture of Mandible: Case Series. J Maxillofac Oral Surg 2021; 20:404-408. [PMID: 34408367 DOI: 10.1007/s12663-020-01436-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 08/04/2020] [Indexed: 10/23/2022] Open
Abstract
Objective Surgical management of condylar head is largely deferred due to the lack of appropriate armamentarium or instrumentation, restricted surgical access and risk of iatrogenic complications. Here we delineate open reduction internal fixation of condylar head fracture with various fixation modalities using specialized instrumentation for visualization and providing access for reduction with minimal complications. Methods A total of 21 patients were reported with condylar head fracture of mandible to the Department of Oral and Maxillofacial Surgery from January 2017 to June 2018. Three patients had bilateral condylar head fracture, making it a total of 24 fractures. All patients had clinical symptoms including deranged occlusion, limited mouth opening, jaw deviation and restricted mandibular movements. The radiological findings were dislocated or displaced condylar head medially or laterally. All patients were treated by open reduction internal fixation using lag screws or standard long screws. Results Among condylar head fractures, 19 of the study population were male and 2 were female. Distribution of age among the condylar head fractures ranges from 19 years to 40 years with the mean being 22 years. At the end of three-month follow-up, all patients had satisfactory results, both clinically and radiologically. The functional outcome of this study was found to be superior. Conclusion We recommend open reduction internal fixation of condylar head for patients with high risk of ankylosis, and it is possible without complications due to the availability of minimally invasive surgical access system.
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Affiliation(s)
- Indu Palanivel
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, Chennai, Tamil Nadu 603203 India
| | - Vivek Narayanan
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, Chennai, Tamil Nadu 603203 India
| | - Saravanan Chandran
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, Chennai, Tamil Nadu 603203 India
| | - Karthik Ramakrishnan
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, Chennai, Tamil Nadu 603203 India
| | - Prashanthi Gurram
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, Chennai, Tamil Nadu 603203 India
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Digital Design and Application of 3D Printed Surgical Guide for Long Screw Fixation of Condylar Sagittal Fracture. J Craniofac Surg 2021; 32:e632-e634. [PMID: 33674507 DOI: 10.1097/scs.0000000000007605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To explore a digital solution for long screw fixation of condylar sagittal fracture, and to achieve accurate positioning of the long screw. METHODS The CT data of the patient with condylar sagittal fracture was imported into Materialise Mimics, and the fractures were reduced by virtual surgery. The surgical guide for long screw fixation was designed in Materialise 3-matic, and then 3D printed for intraoperative assistance. RESULTS With the help of the 3D printed surgical guide, the long screw used to fix condylar sagittal fracture was accurately positioned, which was completely consistent with the preoperative design. CONCLUSION The digitally designed 3D printed surgical guide is an effective way to achieve accurate positioning of the long screw fixation of condylar sagittal fracture.
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Skroch L, Fischer I, Meisgeier A, Kozolka F, Apitzsch J, Neff A. Condylar remodeling after osteosynthesis of fractures of the condylar head or close to the temporomandibular joint. J Craniomaxillofac Surg 2020; 48:413-420. [DOI: 10.1016/j.jcms.2020.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/20/2020] [Accepted: 02/10/2020] [Indexed: 10/25/2022] Open
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Kozakiewicz M, Zieliński R, Krasowski M, Okulski J. Forces Causing One-Millimeter Displacement of Bone Fragments of Condylar Base Fractures of the Mandible after Fixation by All Available Plate Designs. MATERIALS 2019; 12:ma12193122. [PMID: 31557809 PMCID: PMC6804126 DOI: 10.3390/ma12193122] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 09/08/2019] [Accepted: 09/12/2019] [Indexed: 12/16/2022]
Abstract
Background: There has been no direct comparison of all existing plates dedicated for fracture osteosynthesis of mandibular condyle base until now. The aim of the study was to test mechanically all available designs of titanium plates on the market on polyurethane mandibles using an individually designed clamping system. Methods: Forces required for a 1 mm displacement of fixed fracture and incidents of screw loosening were recorded. Results indicated the best mechanical plates among all existing designs available. Results: It has occured that some of osseofixation plates should not be used any more, whereas some shape of the single plates are similar shape to two single plates shape are regarded as the best osseofixation method for condyle base fracture. Conclusion: General observation is the bigger plate and more screws, the better rigid stable osteosynthesis of mandibular condyle base. 4 plates of current designs of total 30 tested series can be recommended for open rigid internal fixation of fractures of the base of the mandibular condyle. The rest of 26 existing plates should not be used in condylar base fractures.
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Affiliation(s)
- Marcin Kozakiewicz
- Department of Maxillofacial Surgery, Medical University of Lodz, 1st Gen. J. Hallera Pl., 90-647 Lodz, Poland.
| | - Rafal Zieliński
- Department of Maxillofacial Surgery, Medical University of Lodz, 1st Gen. J. Hallera Pl., 90-647 Lodz, Poland.
| | - Michał Krasowski
- Material Science Laboratory, Medical University of Lodz, 251st Pomorska, 92-213 Lodz, Poland.
| | - Jakub Okulski
- Department of Maxillofacial Surgery, Medical University of Lodz, 1st Gen. J. Hallera Pl., 90-647 Lodz, Poland.
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Yan G, Chuo W, Zhang R, Zhou Q, Yang M. Evaluation of the Effect of Bioresorbable Plates and Screws in the Treatment of Condylar Fractures, Assisted by Digital Preoperative Planning. J Oral Maxillofac Surg 2019; 77:1434.e1-1434.e16. [DOI: 10.1016/j.joms.2019.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
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Pavlychuk T, Shydlovsky M, Kopchak A. A comparative biomechanical evaluation of different osteosynthesis techniques used for intracapsular condylar head fractures. J Oral Biol Craniofac Res 2019; 9:123-127. [PMID: 30815344 DOI: 10.1016/j.jobcr.2019.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/21/2018] [Accepted: 02/01/2019] [Indexed: 11/28/2022] Open
Abstract
Purpose The aim of the present experimental study was to evaluate the biomechanical behavior in different types of osteosynthesis (titanium screws, bioresorbable pins and miniplates) used in management of intracapsular condylar head fractures. Method Experimental models of the condylar head fractures were simulated on 15 dry human cadaveric mandibles. Osteotomized mandibles were randomly divided into three groups with different fixation systems used: 1) 15 mm long titanium screws, 2) 15 mm long bioresorbable pins Sonic Pins Rx, 3) T-shaped titanium miniplate and 7 mm long titanium screws. Mandibles were loaded in TIRAtest testing machine (Germany). The main types of deformations, including torsion, bending and shearing, were simulated to study the biomechanical characteristics of the fixation systems. Results Titanium bicortical screws demonstrated the highest stiffness in standard loading conditions. The fixation with bioresorbable pins showed lower stiffness in both frontal and sagittal loads. This is indicative of the fact that resorbable pins, which have numerous advantages for clinical usage, cannot provide adequately stable fixation in maximal masticatory loads. The mandibles fixed with T-shaped plate had the lowest stiffness. Conclusion Screw or pin fixation, regardless of the material used, was not resistant to rotational loads. On the contrary, the stiffness of T-shaped plates was quite significant. In real clinical conditions, if rotational displacements are not effectively compensated by irregularities in the fracture surface and precise repositioning of the bone fragments, combined use of miniplates and bicortical titanium screws or two screws can be beneficial.
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Affiliation(s)
- T Pavlychuk
- Department of Stomatology, Bogomolets National Medical University, Kyiv, Ukraine
| | - M Shydlovsky
- Institute of Mechanical Engineering, National Technical University of Ukraine "Igor Sikorsky Kyiv Politechnic Institute", Ukraine
| | - A Kopchak
- Department of Stomatology, Bogomolets National Medical University, Kyiv, Ukraine
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Raghani MJ, Pappachan B, Raghani N. Use of Two Lag Screws for ORIF of Mandibular Condylar Sagittal Split fracture: An Anti-rotational Concept-A Prospective Clinical Trial. J Maxillofac Oral Surg 2019; 18:617-622. [PMID: 31624446 DOI: 10.1007/s12663-018-1177-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 11/28/2018] [Indexed: 11/25/2022] Open
Abstract
Background Condylar process fracture is one of the most common mandibular fractures. Approximately 11-16% of all facial fractures and 30-40% of all mandibular fractures are fractures of the mandibular condyle. Treatment can broadly be divided into open or closed, but there are no clear criteria to determine the choice between them. Sagittal split fracture of the mandibular condyle is rare and can be easily missed on conventional radiographs, like OPG and multiple standard films, but because of the high incidence of subsequent ankylosis is an important entity. So a CT scan with axial and coronal cuts is advisable in high condylar or intracapsular fractures of mandibular condyle. Purpose The hypothesis in this study is that open reduction and internal fixation (ORIF) of sagittal split mandibular condylar fractures with two lag screws is more stable and there is no rotation of the medial fractured segment of condyle. Methods In this prospective clinical trial, ORIF of four patients with sagittal split fracture of mandibular condyle was done using two lag screws. In all the patients, pre-op and post-op clinical and radiological findings were evaluated, with a follow-up of two years. Results All the patients were evaluated postoperatively at periodical interval with various clinical parameters, viz. mouth opening, occlusion, pain, deviation of mandible while opening, other complaints (like clicking, tenderness), and radiologically with CT scans. All patients showed good occlusion and adequate mouth opening postoperatively. In this series, there was no pain, deviation of mandible while opening and other complaints like tenderness and clicking. In CT scan, the medial fragment was reduced anatomically in position and the lag screws were not protruding in the TM joint space. Conclusion Use of two lag screws for ORIF of sagittal split mandibular condylar fractures is recommended to prevent the rotation of fractured medial condylar segment and for more stable fixation.
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Affiliation(s)
- Manish J Raghani
- 1Department of Dentistry, Cranio-Maxillofacial Surgery Clinic, All India Institute of Medical Sciences (AIIMS), G.E. Road, Tatibandh, Raipur, Chhattisgarh India
| | - Biju Pappachan
- 2Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Raipur, Chhattisgarh India
| | - Nisha Raghani
- 3Rungta College of Dental Sciences and Research Centre, Bhilai, Chhattisgarh India
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Minimally-invasive removal of a screw in the mandibular condyle using computer-assisted navigation. Br J Oral Maxillofac Surg 2017; 55:865-867. [PMID: 28735638 DOI: 10.1016/j.bjoms.2017.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/27/2017] [Indexed: 11/20/2022]
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Chuanjun C, Xiaoyang C, Jing C. [Extramedullary fixation combined with intramedullary fixation in the surgical reduction of sagittal mandibular condylar fractures]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2016; 34:474-477. [PMID: 28326704 DOI: 10.7518/hxkq.2016.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study aimed to evaluate the clinical effect of extramedullary fixation combined with intramedullary fixation during the surgical reduction of sagittal mandibular condylar fractures. METHODS Twenty-four sagittal fractures of the mandibular condyle in18 patients were fixed by two appliances: intramedullary with one long-screw osteosynthesis or Kirschner wire and extramedullary with one micro-plate. The radiologically-recorded post-operative stability-associated com-plications included the screw/micro-plate loosening, micro-plate twisting, micro-plate fractures, and fragment rotation. The occluding relations, the maximalinter-incisal distances upon mouth opening, and the mandibular deflection upon mouth opening were evaluated based on follow-up clinical examination. RESULTS Postoperative panoramic X-ray and CT scans showed good repositioning of the fragment, with no redislocation or rotation, no screw/plate loosening, and no plate-twisting or fracture. Clinical examination showed that all patients regained normal mandibular movements, ideal occlusion, and normal maximal inter-incisal distances upon mouth opening. CONCLUSIONS Extramedullary fixation combined with intramedullary fixation is highly recommended for sagittal condylar fractures because of the anti-rotation effect of the fragment and the reasonable place-ment of the fixation appliances.
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Affiliation(s)
- Chen Chuanjun
- Stomatological School, Wannan Medical College, Wuhu 241002, China
| | - Chen Xiaoyang
- Dept. of Oral and Maxillofacial Surgery, The Third Affiliated Hospital of Anhui Medical University, Hefei 230061, China
| | - Chen Jing
- Dept. of Stomatology, Anhui Jimin Tumor Hospital, Hefei 230011, China
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Guo SS, Zhou WN, Wan LZ, Yuan H, Yuan Y, Du YF, Jiang HB. Computer-aided design-based preoperative planning of screw osteosynthesis for type B condylar head fractures: A preliminary study. J Craniomaxillofac Surg 2016; 44:167-76. [DOI: 10.1016/j.jcms.2015.11.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 10/15/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022] Open
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Sikora M, Olszowski T, Sielski M, Stąpor A, Janiszewska-Olszowska J, Chlubek D. The use of the transparotid approach for surgical treatment of condylar fractures – Own experience. J Craniomaxillofac Surg 2015; 43:1961-5. [DOI: 10.1016/j.jcms.2015.10.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/17/2015] [Accepted: 10/01/2015] [Indexed: 11/28/2022] Open
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Observational Study of Surgical Treatment of Sagittal Fractures of Mandibular Condyle. J Craniofac Surg 2015; 26:e359-64. [PMID: 26080265 DOI: 10.1097/scs.0000000000001791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study was conducted to investigate the complications that occur after surgical treatment of sagittal fracture of the mandibular condyle (SFMC). METHODS A retrospective study was conducted on patients in whom SFMC was treated using surgical methods (87 patients, 105 sides) between January 1995 and December 2011 (79 sides were treated by rigid internal fixation and the remaining 26 sides were removed the condylar fragments). The longest follow-up was 17 years, and the shortest was 2 years. Follow-ups were conducted to assess mandibular activity, mouth opening, and computed tomography scans of condylar morphologic alterations. The postoperative complications were evaluated and the causes were analyzed. RESULTS We observed 3 patients with joint ankylosis (all of them were removed the condylar fragments); 8, mouth opening less than 30 mm; 23, deviation on mouth opening at 6 months. At 4 weeks, 19 patients had facial nerve weakness, which was resolved within 6 months. The radiological investigation showed complete remodeling in 56.2% of the condyles (in the 59 sides, 57 sides were treated by rigid internal fixation and 2 sides were removed the condylar fragments); partial remodeling 27.6% condyles (in the 29 sides, 20 sides were treated by rigid internal fixation and 9 sides were removed the condylar fragments); poor remodeling, 16.2% condyles (in the 17 sides, 2 sides were treated by rigid internal fixation and 15 sides were removed the condylar fragments). CONCLUSIONS Surgical treatment of SFMC is not perfect. There were some complications that occurred after the surgical treatment of SFMC. The findings also indicate that condylar anatomic reduction is the basis for functional recovery and, therefore, rigid fixation should be implemented. Furthermore, the removal of condylar fragments should be performed with caution, and if used, the fragments should be removed entirely.
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Xiang GL, Long X, Deng MH, Han QC, Meng QG, Li B. A retrospective study of temporomandibular joint ankylosis secondary to surgical treatment of mandibular condylar fractures. Br J Oral Maxillofac Surg 2014; 52:270-4. [PMID: 24485809 DOI: 10.1016/j.bjoms.2014.01.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 01/03/2014] [Indexed: 10/25/2022]
Abstract
We investigated the incidence of ankylosis of the temporomandibular joint (TMJ) after open operations for fractures of the mandibular condyle, and analysed possible risk factors in a total of 385 patients with 492 condylar fractures who had been operated on in our department from 2001 to 2010. Sixteen patients developed postoperative ankylosis of the TMJ with 26 joints (5%) affected during a follow-up of 6 months-10 years. Of the 492 condylar fractures, the most common ones that were associated with postoperative ankylosis were those of the condylar head (20/248), followed by the condylar neck (6/193). Subcondylar fractures did not cause postoperative ankylosis (0/51). Among the 16 patients with postoperative ankylosis, 13 had associated anterior mandibular fractures. Long-screw (bicortical screw) fixation of fractures of the condylar head seemed to be associated with a lower incidence of postoperative ankylosis than fixation by miniplate and wire or removal of the fractured fragment. The articular discs were damaged in all ankylosed joints, and the remaining fractured fragment was found in 10 ankylosed joints after fractures of the condylar head. The results suggest that fractures of the condylar head are more prone to lead to postoperative ankylosis of the TMJ, and that the possible risk factors seem to include the technique used for fixation and damage to the disc, together with an anterior mandibular fracture with the fractured fragment remaining.
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Affiliation(s)
- Guo-lin Xiang
- Department of Oral and Maxillofacial Surgery, Puai Hospital of Tongji Medical College, Huazhong University of Science and Technology, Hanzheng Street 473, Wuhan 430033, PR China; The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine, Ministry of Education, Department of Oral and Maxillofacial Surgery, School & Hospital of Stomatology, Wuhan University, Luoyu Road 237, Wuhan 430079, PR China
| | - Xing Long
- The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine, Ministry of Education, Department of Oral and Maxillofacial Surgery, School & Hospital of Stomatology, Wuhan University, Luoyu Road 237, Wuhan 430079, PR China.
| | - Mo-hong Deng
- The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine, Ministry of Education, Department of Oral and Maxillofacial Surgery, School & Hospital of Stomatology, Wuhan University, Luoyu Road 237, Wuhan 430079, PR China
| | - Qian-chao Han
- Department of Oral and Maxillofacial Surgery, Puai Hospital of Tongji Medical College, Huazhong University of Science and Technology, Hanzheng Street 473, Wuhan 430033, PR China
| | - Qing-gong Meng
- The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine, Ministry of Education, Department of Oral and Maxillofacial Surgery, School & Hospital of Stomatology, Wuhan University, Luoyu Road 237, Wuhan 430079, PR China
| | - Bo Li
- The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine, Ministry of Education, Department of Oral and Maxillofacial Surgery, School & Hospital of Stomatology, Wuhan University, Luoyu Road 237, Wuhan 430079, PR China
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Wang WH, Deng JY, Zhu J, Li M, Xia B, Xu B. Computer-assisted virtual technology in intracapsular condylar fracture with two resorbable long-screws. Br J Oral Maxillofac Surg 2012; 51:138-43. [PMID: 22546281 DOI: 10.1016/j.bjoms.2012.04.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 04/09/2012] [Indexed: 11/19/2022]
Abstract
Our aim was to fix intracapsular condylar fractures (ICF) with two resorbable long screws using preoperative computer-assisted virtual technology. From February 2008 to July 2011, 19 patients with ICF were treated with two resorbable long screws. Preoperatively we took panoramic radiographs and spiral computed tomography (CT). Depending on their digital imaging and communications in medicine (DICOM) data, the dislocated condylar segments were restored using the SimPlant Pro™ software, version 11.04. The mean (SD) widths of the condylar head and neck from lateral to medial were 19.01 (1.28)mm and 13.84 (1.13)mm, respectively. In all patients, the mandibles and the ICF seen intraoperatively corresponded with the preoperative three-dimensional and virtual reposition. All patients were followed up for 6-46 months (mean 21). Occlusion and mouth opening had been restored completely in all but one patient, and absolute anatomical reduction was also achieved in most cases. Computer-assisted virtual technology plays an important part in the diagnosis of ICF, as well as in its preoperative design. Fixation with only two resorbable long screws is an effective and reliable method for fixing ICF.
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Affiliation(s)
- W H Wang
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital of Kunming Medical College, No. 193 Renmingxi Road, Kunming, Yunnan 650031, China
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