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Trauma Surgery. J Oral Maxillofac Surg 2023; 81:E147-E194. [PMID: 37833022 DOI: 10.1016/j.joms.2023.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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Ganguly A, Mittal G, Garg R. Comparison between 3D delta plate and conventional miniplate in treatment of condylar fracture: A randomised clinical trial. J Craniomaxillofac Surg 2021; 49:1026-1034. [PMID: 34635372 DOI: 10.1016/j.jcms.2021.01.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 11/26/2020] [Accepted: 01/31/2021] [Indexed: 10/22/2022] Open
Abstract
The aim of the study was to conduct a randomized clinical trial comparing the efficacy of standard non-compression miniplate and 3-dimensional (3D) titanium plate in the open reduction internal fixation (ORIF) of the mandibular condylar fractures. Patients who underwent open reduction of mandibular condylar fracture were recruited for the study. The patients satisfying the inclusion criteria were randomly assigned to two groups in a 1:1 ratio. Group A comprised patients treated using conventional miniplates, and Group B comprised patients treated using 3D Delta Plate. Informed consent was provided. All the patients underwent ORIF under GA via retromandibular approach. The sample size was set at 20 participants, with 10 participants in each group who were randomly allocated. Our study showed that patients in Group A had a significant statistical difference operating time (141.20 ± 2.59 min) than that of Group B (117.2 ± 9.63 min). Mouth opening was significantly greater in the 3rd-month follow-up in Group B (mean = 42.40 ± 1.82) compared to Group A (mean = 35.80 ± 1.30). Biting efficiency in Group B was observed to be clinically and statistically better compared to Group A (P = 0.012). Wound dehiscence was managed efficiently by judicious use of antibiotics and wounds were free of any signs of infections or discharge in the consecutive follow-ups. No plate removal was required in either group. Patients treated with 3D delta plates have superior outcomes with regard to operation time, mouth opening, and biting efficiency compared with miniplates. Hence, it can be concluded that the triangular shape of the 3D Delta plate allows the stress distribution to be superior and multidimensional, leading to better post-operative stability, faster healing, and reduced complications.
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Affiliation(s)
- Aneesh Ganguly
- Department of Oral and Maxillofacial Surgery, Institute of Dental Studies and Technologies (IDST), Modinagar, Uttar Pradesh, India.
| | - Gaurav Mittal
- Department of Oral and Maxillofacial Surgery, Institute of Dental Studies and Technologies (IDST), Modinagar, Uttar Pradesh, India.
| | - Ritesh Garg
- Department of Oral and Maxillofacial Surgery, Institute of Dental Studies and Technologies (IDST), Modinagar, Uttar Pradesh, India.
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Rozeboom A, Speksnijder C, Dubois L, Lobbezoo F, Koutris M, de Lange J. Is masticatory performance affected after a unilateral condylar fracture? A cross-sectional study. J Oral Rehabil 2018; 45:777-782. [DOI: 10.1111/joor.12688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 05/31/2018] [Accepted: 06/30/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Antoinette Rozeboom
- Department of Oral and Maxillofacial Surgery; Academic Medical Center of Amsterdam; University of Amsterdam; Amsterdam The Netherlands
| | - Caroline Speksnijder
- Department of Oral and Maxillofacial Surgery and Special Dental Care; University Medical Center Utrecht; Utrecht University; Utrecht The Netherlands
| | - Leander Dubois
- Department of Oral and Maxillofacial Surgery; Academic Medical Center of Amsterdam; University of Amsterdam; Amsterdam The Netherlands
| | - Frank Lobbezoo
- Department of Oral Kinesiology; Academic Centre for Dentistry Amsterdam (ACTA); University of Amsterdam and Vrije Universiteit Amsterdam; Amsterdam The Netherlands
| | - Michail Koutris
- Department of Oral and Maxillofacial Surgery; Academic Medical Center of Amsterdam; University of Amsterdam; Amsterdam The Netherlands
- Department of Oral Kinesiology; Academic Centre for Dentistry Amsterdam (ACTA); University of Amsterdam and Vrije Universiteit Amsterdam; Amsterdam The Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery; Academic Medical Center of Amsterdam; University of Amsterdam; Amsterdam The Netherlands
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Rozeboom A, Dubois L, Bos R, Spijker R, de Lange J. Closed treatment of unilateral mandibular condyle fractures in adults: a systematic review. Int J Oral Maxillofac Surg 2017; 46:456-464. [DOI: 10.1016/j.ijom.2016.11.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 08/24/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
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Lee YS, Yi YJ, Kim YK, Lee NK, Larson BE. Conservative interdisciplinary treatment of a case with multiple facial and condyle fractures. Dent Traumatol 2016; 33:226-229. [PMID: 27273291 DOI: 10.1111/edt.12290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2016] [Indexed: 11/29/2022]
Abstract
The purpose of this case report is to describe an interdisciplinary approach for a 51-year-old male who underwent multiple facial fractures including bilateral condyle fractures. The patient underwent emergency surgery, which included open reduction of the maxilla and mandibular symphysis and closed reduction of the bilateral condyle fractures. Although the patient recovered a comfortable range of mouth opening and alleviation of the temporomandibular joint (TMJ) symptoms after surgery, he suffered from a large anterior-posterior discrepancy due to less stability on the condyle-fossa relationships and from open bite with contacts only on both second molars and right second premolars. In this case, first, to increase the occlusal contact, comprehensive orthodontic treatment was completed. Second, occlusal equilibration was selectively performed to relieve the interferences and establish a stable range of mandibular movement without any changes in the vertical dimension. Third, both the upper central incisors and left lateral incisor were minimally restored with splinted and single zirconia crowns, which had modified lingual contours to provide adequate anterior guidance permitting the anterior-posterior discrepancy of the posterior teeth during protrusion. This conservative interdisciplinary treatment, including open and closed reduction, orthodontic treatment, occlusal adjustment, and minimal prosthetic restorations, resulted in a stable mandibular position and recovery of mastication function.
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Affiliation(s)
- You-Sun Lee
- Department of Orthodontics, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yang-Jin Yi
- Department of Prosthodontics, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young-Kyun Kim
- Department of Oral and Maxillofacial Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Dentistry & Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Nam-Ki Lee
- Department of Orthodontics, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Brent E Larson
- Division of Orthodontics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
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Ugolini A, Mapelli A, Segù M, Galante D, Sidequersky FV, Sforza C. Kinematic analysis of mandibular motion before and after orthognathic surgery for skeletal Class III malocclusion: A pilot study. Cranio 2016; 35:94-100. [DOI: 10.1080/08869634.2016.1154681] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Alessandro Ugolini
- Laboratorio di Anatomia Funzionale dell’Apparato Stomatognatico (LAFAS), Facoltà di Medicina e Chirurgia, Dipartimento di Scienze Biomediche per la Salute, Functional Anatomy Research Center (FARC), Università degli Studi di Milano, via Mangiagalli 31, I-20133 Milano, Italy
| | - Andrea Mapelli
- Laboratorio di Anatomia Funzionale dell’Apparato Stomatognatico (LAFAS), Facoltà di Medicina e Chirurgia, Dipartimento di Scienze Biomediche per la Salute, Functional Anatomy Research Center (FARC), Università degli Studi di Milano, via Mangiagalli 31, I-20133 Milano, Italy
| | - Marzia Segù
- Laboratorio di Anatomia Funzionale dell’Apparato Stomatognatico (LAFAS), Facoltà di Medicina e Chirurgia, Dipartimento di Scienze Biomediche per la Salute, Functional Anatomy Research Center (FARC), Università degli Studi di Milano, via Mangiagalli 31, I-20133 Milano, Italy
| | - Domenico Galante
- Laboratorio di Anatomia Funzionale dell’Apparato Stomatognatico (LAFAS), Facoltà di Medicina e Chirurgia, Dipartimento di Scienze Biomediche per la Salute, Functional Anatomy Research Center (FARC), Università degli Studi di Milano, via Mangiagalli 31, I-20133 Milano, Italy
| | - Fernanda V. Sidequersky
- Laboratorio di Anatomia Funzionale dell’Apparato Stomatognatico (LAFAS), Facoltà di Medicina e Chirurgia, Dipartimento di Scienze Biomediche per la Salute, Functional Anatomy Research Center (FARC), Università degli Studi di Milano, via Mangiagalli 31, I-20133 Milano, Italy
| | - Chiarella Sforza
- Laboratorio di Anatomia Funzionale dell’Apparato Stomatognatico (LAFAS), Facoltà di Medicina e Chirurgia, Dipartimento di Scienze Biomediche per la Salute, Functional Anatomy Research Center (FARC), Università degli Studi di Milano, via Mangiagalli 31, I-20133 Milano, Italy
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Kisnisci R. Management of Fractures of the Condyle, Condylar Neck, and Coronoid Process. Oral Maxillofac Surg Clin North Am 2013; 25:573-90. [DOI: 10.1016/j.coms.2013.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mandibular kinematics and masticatory muscles EMG in patients with short lasting TMD of mild-moderate severity. J Electromyogr Kinesiol 2013; 23:627-33. [DOI: 10.1016/j.jelekin.2013.01.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 01/27/2013] [Accepted: 01/28/2013] [Indexed: 11/21/2022] Open
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Chrcanovic BR. Open versus closed reduction: diacapitular fractures of the mandibular condyle. Oral Maxillofac Surg 2012; 16:257-265. [PMID: 22842852 DOI: 10.1007/s10006-012-0337-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 07/16/2012] [Indexed: 06/01/2023]
Abstract
PURPOSE The purpose of the study was to review the literature regarding the evolution of current thoughts on management of diacapitular fractures (DFs) of the mandibular condyle. METHODS An electronic search in PubMed was undertaken in March 2012. The titles and abstracts from these results were read to identify studies within the selection criteria. Eligibility criteria included studies reporting clinical series of DFs, including both animal and human studies, without date or language restrictions. RESULTS The search strategy initially yielded 108 references. Twenty-eight studies were identified without repetition within the selection criteria. Additional hand-searching of the reference lists of selected studies yielded three additional papers. CONCLUSIONS The current indications for open reduction and internal fixation (ORIF) of DFs described in the literature are: (a) fractures affecting the lateral condyle with reduction of mandibular height; (b) fractures in which the proximal fragment dislocates laterally out of the glenoid fossa, which cannot be reduced by closed or open treatment of another part of the mandibular fracture. The indications for conservative treatment are: (a) fractures that do not shorten the condylar height (a fracture with displacement of the medial parts of the condyle); (b) undisplaced fractures; (c) comminution of the condylar head, when the bony fragments are too small for stable fixation; and (d) fractures in children. As the temporomandibular joint disk plays an important role as a barrier preventing ankylosis, it is important to reposition the disk (if displaced/dislocated) during the surgical treatment of DFs. The lateral pterygoid muscle should never be stripped from the medially displaced fragment because its desinsertion disrupts circulation to the medial bony fragment, and also because this muscle helps to restore the muscle function after surgery. ORIF of selected DFs improves prognosis by anatomical bone and soft tissue recovery when combined with physical therapy. If conducted properly, surgical treatment of DFs is a safe and predictable procedure and yields good results.
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Park JY, Ahn KM, Lee JH, Cha HS. Full mouth rehabilitation on a bilateral condylar fractured patient using orthognathic surgery and dental implant. J Adv Prosthodont 2011; 3:51-5. [PMID: 21503195 PMCID: PMC3076575 DOI: 10.4047/jap.2011.3.1.51] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 03/05/2011] [Accepted: 03/11/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mandibular displacement is a common complication of condylar fracture. In the mandibular displacement due to condylar fracture, it is difficult to restore both esthetics and function without using orthognathic surgery. CASE DESCRIPTION This clinical report described a full mouth rehabilitation in the patient with bilateral condylar fractures and displaced mandible using bilateral sagittal split ramus osteotomy (BSSRO) and simultaneous dental implant surgery. Mandibular position was determined by model surgery through the diagnostic wax up and restoration of fractured teeth. The precise amount of the mandibular shift can be obtained from the ideal intercuspation of remaining teeth. CLINICAL IMPLICATION Mandibular displacement by both condylar fractures can be successfully treated by orthognathic surgery. Determination of occlusal plane and visualization from diagnostic wax up are mandatory for mandibular repositioning of model surgery. Stable occlusion and regular recall check up are needed for long-term outcome.
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Affiliation(s)
- Jee-Youn Park
- Divison of Prosthodontics, Department of Dentistry, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
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Sforza C, Ugolini A, Sozzi D, Galante D, Mapelli A, Bozzetti A. Three-dimensional mandibular motion after closed and open reduction of unilateral mandibular condylar process fractures. J Craniomaxillofac Surg 2010; 39:249-55. [PMID: 20673731 DOI: 10.1016/j.jcms.2010.06.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2009] [Revised: 05/14/2010] [Accepted: 06/10/2010] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To detect the changes in 3D mandibular motion after two types of condylar fracture therapies. MATERIALS AND METHODS Using a 3D motion analyzer, free mandibular border movements were recorded in 21 patients successfully treated for unilateral fractures of the mandibular condylar process (nine patients: open reduction, rigid internal fixation, and functional treatment; 12 patients: closed reduction and functional treatment; follow-up: 6-66 months), and in 25 control subjects. RESULTS No differences were found among the groups at maximum mouth opening (MO), protrusion and in lateral excursions. During opening, the patients had a larger maximal deviation to the fractured side than the controls (controls 2.3 mm, open treatment 3.9 mm, closed treatment 4.2 mm; Kruskal-Wallis test, p=0.014; closed treatment vs. controls, p=0.004), with a larger coronal plane angle (controls 2.4°, open treatment 3.6°, closed treatment 4.4°; p=0.016; closed treatment vs. controls, p=0.013). In the closed treatment patients, a longer follow-up was related to increased maximum MO (p=0.04), sagittal plane angle (p=0.03), and reduced lateral mandibular deviation during MO (p=0.03). CONCLUSION Mandibular condylar fractures can recover good function; some kinematic variables of mandibular motion were more similar to the norm in the open treatment patients than in closed treatment patients.
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Affiliation(s)
- Chiarella Sforza
- Functional Anatomy Research Center, Laboratorio di Anatomia Funzionale dell'Apparato Stomatognatico, Dipartimento di Morfologia Umana e Scienze Biomediche Città Studi, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, via Mangiagalli 31, I-20133 Milano, Italy.
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Mandibular kinematics after orthognathic surgical treatment. Br J Oral Maxillofac Surg 2010; 48:110-4. [DOI: 10.1016/j.bjoms.2008.09.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2008] [Indexed: 11/18/2022]
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Sforza C, Tartaglia GM, Lovecchio N, Ugolini A, Monteverdi R, Giannì AB, Ferrario VF. Mandibular movements at maximum mouth opening and EMG activity of masticatory and neck muscles in patients rehabilitated after a mandibular condyle fracture. J Craniomaxillofac Surg 2009; 37:327-33. [DOI: 10.1016/j.jcms.2009.01.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2008] [Revised: 12/29/2008] [Accepted: 01/08/2009] [Indexed: 11/25/2022] Open
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Zachariades N, Mezitis M, Mourouzis C, Papadakis D, Spanou A. Fractures of the mandibular condyle: A review of 466 cases. Literature review, reflections on treatment and proposals. J Craniomaxillofac Surg 2006; 34:421-32. [PMID: 17055280 DOI: 10.1016/j.jcms.2006.07.854] [Citation(s) in RCA: 221] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2004] [Accepted: 07/11/2006] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION The incidence of condylar fractures is high. Condylar fractures can be extracapsular (condylar neck or subcondylar) or intracapsular, undisplaced, deviated, displaced or dislocated. Treatment depends on the age of the patient, the co-existence of other mandibular or maxillary fractures, whether the condylar fracture is unilateral or bilateral, the level and displacement of the fracture, the state of dentition and the dental occlusion, and the surgeon's experience. PURPOSE This report presents the experience acquired in the treatment of 466 condylar fractures over 7 years, reviews the pertinent literature and proposes guidelines for treatment. MATERIAL AND METHODS The archives of KAT, General District Hospital between 1995 and 2002 were scrutinized and the condylar fractures were recorded. The aetiology, age, sex, level of fracture, degree of displacement, associated facial fractures, malocclusion, and type of treatment were noted. RESULTS Four hundred and sixty-six condylar fractures were admitted, the male:female ratio was 3.5:1. Road traffic accidents were the main cause and most fractures were unilateral, displaced, subcondylar, occurred on the left side and were treated conservatively. CONCLUSIONS Early mobilization is the key in treating condylar fractures. Whilst rigid internal fixation provides stabilization and allows early mobilization, conservative treatment is the treatment of choice for the majority of fractures. Children and intracapsular fractures are treated conservatively with or without maxillo-mandibular fixation. Open reduction is recommended in selected cases to restore the occlusion, in severely displaced and dislocated fractures, in cases of loss of ramus height, and in edentulous patients. It may be considered in those with 'medical problems' where intermaxillary fixation is not recommended.
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Affiliation(s)
- Nicholas Zachariades
- Oral and Maxillofacial Department, KAT (Trauma Rehabilitation Center), General District Hospital of Attica, Kifissia, Athens, Greece.
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Stiesch-Scholz M, Schmidt S, Eckardt A. Condylar Motion After Open and Closed Treatment of Mandibular Condylar Fractures. J Oral Maxillofac Surg 2005; 63:1304-9. [PMID: 16122594 DOI: 10.1016/j.joms.2005.05.293] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2004] [Indexed: 11/27/2022]
Abstract
PURPOSE A comparative study was performed to evaluate the function of the temporomandibular system after open and closed treatment of condylar fractures. MATERIALS AND METHODS A total of 37 temporomandibular joints were examined that had undergone either open treatment (n = 24) or closed treatment with maxillomandibular fixation (n = 13) for condylar fracture. The joints were investigated clinically and on the basis of radiographs. In addition, the movements of the condyles of the temporomandibular system were recorded in 3 dimensions with a computed electronic jaw tracking system (stereognathograph). RESULTS The clinical investigation revealed no severe functional abnormality in either of the 2 groups. The mean of the recorded condyle paths was, however, consistently lower in the temporomandibular joints with closed treatment than in those with open treatment, although the difference was only significant for movements without tooth contact (Mann-Whitney U test, P < .05). CONCLUSIONS In summary, open as well as closed treatment gave clinically acceptable functional results. However, condylar mobility was markedly greater after open treatment than after closed treatment.
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Ellis E, Throckmorton GS. Treatment of mandibular condylar process fractures: Biological considerations. J Oral Maxillofac Surg 2005; 63:115-34. [PMID: 15635566 DOI: 10.1016/j.joms.2004.02.019] [Citation(s) in RCA: 161] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The topic of condylar injury in adults has generated more discussion and controversy than any other in the field of maxillofacial trauma. It is an important subject because such injuries are common and complications of trauma to the temporomandibular joint (TMJ) are far-reaching in their effects. Why are there so many different methods to treat this injury? How can seemingly disparate treatment options all produce satisfactory outcomes in the majority of patients? The reason lies with the biological adaptations that occur within the masticatory system that are poorly understood, not readily quantifiable, and variable from one person to the next. This discussion presents our current understanding of the adaptations that must occur to provide the patient with a satisfactory outcome. The adaptations for patients treated open are different than for those treated closed. However, it is when these adaptations fail to occur that unsatisfactory outcomes occur, regardless of how they were treated.
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Affiliation(s)
- Edward Ellis
- Division of Oral and Maxillofacial Surgery, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
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Smets LMH, Van Damme PA, Stoelinga PJW. Non-surgical treatment of condylar fractures in adults: a retrospective analysis. J Craniomaxillofac Surg 2003; 31:162-7. [PMID: 12818602 DOI: 10.1016/s1010-5182(03)00025-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim of the study was to investigate the results of non-surgical treatment of condylar fractures in a group of 60 patients with 71 condylar fractures, in order to establish a protocol to select patients for surgical treatment of condylar fractures. MATERIAL Out of a group of 91 patients treated in a non-surgical fashion, 60 patients with a total of 71 condylar fractures responded to the request for follow-up. METHODS Retrospective study, including clinical analysis of occlusion, asymmetry at rest and during mouth opening, maximum interincisal distance, signs of TMJ-dysfunction and analysis of radiographic data, i.e. shortening of the ascending ramus as measured on sequential orthopantomograms. RESULTS There were five patients (8%) with an unacceptable malocclusion of which one also had considerably limited mouth opening. Fifty-five patients (92%) had none or only minor signs of TMJ-dysfunction not requiring further treatment. CONCLUSION Only in selected patients with shortening of the ascending ramus of 8mm or more and/or considerable displacement of the condylar fragment, surgical repositioning and rigid internal fixation should be considered.
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Affiliation(s)
- Luc M H Smets
- Department of Oral and Cranio-Maxillofacial Surgery, University Medical Centre, Nijmegen, The Netherlands
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Throckmorton GS, Ellis E. Recovery of mandibular motion after closed and open treatment of unilateral mandibular condylar process fractures. Int J Oral Maxillofac Surg 2000. [DOI: 10.1016/s0901-5027(00)80072-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Umstadt HE, Ellers M, Müller HH, Austermann KH. Functional reconstruction of the TM joint in cases of severely displaced fractures and fracture dislocation. J Craniomaxillofac Surg 2000; 28:97-105. [PMID: 10958422 DOI: 10.1054/jcms.2000.0123] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In a clinical and axiographic study the outcome of patients with severely displaced fractures and fracture dislocations of the mandibular condyle was evaluated. Two operation methods were compared one via an intraoral approach without joint revision and another via a preauricular approach with open reduction of the joint. In the group with joint revision, resorbable material was used for osteosynthesis. Twenty-eight patients (32 joints) treated without revision of the joint and 26 patients (29 joints) with open reduction of the joint were evaluated. The mean observation time following surgery was 3 years and 10 months (range 1-7.5 years). Clinical examination utilized the Helkimo-index, while the electronic axiographical results were evaluated by using a five point scheme of joint-mobility. Concerning clinical evaluation, 20 out of 28 patients (71%) without joint revision and 23 out of 26 (89%) patients with joint revision had none or only slight dysfunction of the stomatognathic system. When focusing on arthralgia and pain in motion (part D and E of Helkimo's-index) significantly better results were achieved by open joint revision (Helkimo D: p< or =0.007; Helkimo E: p = 0.0029). No patient exhibited severe dysfunction (group D3). In axiographic evaluation optimal results (group A1) were achieved in seven joints (24%) with revision and four joints (12%) without revision. Twelve out of 29 joints with revision (41%) and six out of 32 joints without revision (19%) were classified as group A2 with a slightly shortened condylar excursion. Revision of joints with disc reduction and reconstruction of ligaments in cases of severely displaced or dislocated fractures resulted in better mobility and less pain. This was seen clinically and in the axiographic results. Looking at the long-term outcome of patients better mobility of the joint without internal derangement due to surgical repair also protects the contralateral (nonoperated) joint. When managing severe TMJ-trauma we suggest that both, bony and soft tissue structures should be reconstructed if there are any signs of internal derangement. However, the limits between bony reconstruction with or without joint revision are still not defined. Our results appear to be promising concerning mobility and absence of pain of the joints after open reduction. Further research comparing the two operative treatment regimes in a randomized controlled clinical trial will be necessary.
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Affiliation(s)
- H E Umstadt
- Department of Oral- and Maxillofacial Surgery, Philipps-Universität, Marburg, Germany.
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Palmieri C, Ellis E, Throckmorton G. Mandibular motion after closed and open treatment of unilateral mandibular condylar process fractures. J Oral Maxillofac Surg 1999; 57:764-75; discussion 775-6. [PMID: 10416622 DOI: 10.1016/s0278-2391(99)90810-8] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE This study compared mandibular and condylar mobility after open or closed treatment for fractures of the mandibular condylar process. PATIENTS AND METHODS One hundred thirty-six patients (111 male, 25 female), 74 treated by closed and 62 by open methods, were included in this study. They underwent testing of mandibular and condyle mobility at 6 weeks, 6 months, and 1, 2, and 3 years postsurgery. A jaw-tracking device was used to assess mandibular motion. Radiographs that were traced and digitized were used to assess condylar displacement and condylar mobility. Standard statistical methods were used to assess differences between groups. RESULTS Patients treated by open reduction had significantly greater initial displacement of their condylar processes than did the group treated closed. Immediately after treatment and uprighting of the condyles in the open treatment group, patients treated closed had significantly more displacement. At 6 weeks, patients treated closed had some measures of mandibular mobility that were significantly greater than those in patients treated by open reduction. However, after the 6-week period there were minimal differences in mandibular mobility between groups. At 6 weeks, patients treated by open reduction had significantly greater vertical mobility of the condyle than patients treated closed despite less mouth opening. After the 6-week period, patients treated by open reduction continued to have greater condylar mobility on the fractured side than did patients treated by closed methods. No measures of postsurgical displacement correlated with mobility measures in patients treated by open reduction. However, several measures of mandibular displacement correlated with measures of mobility in patients treated closed, indicating that the more displaced the condylar process, the more limited the mobility of the mandible. CONCLUSIONS Based on this study, patients treated for fractures of the mandibular condylar process by open reduction had somewhat greater condylar mobility than patients treated closed, even though the former group had more severely displaced fractures before surgery. Therefore, open reduction may produce functional benefits to patients with severely displaced condylar process fractures.
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Affiliation(s)
- C Palmieri
- Division of Oral and Maxillofacial Surgery, University of Texas Southwestern Medical Center, Dallas 75235-9109, USA
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Throckmorton GS, Talwar RM, Ellis E. Changes in masticatory patterns after bilateral fracture of the mandibular condylar process. J Oral Maxillofac Surg 1999; 57:500-8; discussion 508-9. [PMID: 10319822 DOI: 10.1016/s0278-2391(99)90061-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Because the morphology of the temporomandibular joint is thought to control movements of the mandible during mastication, bilateral fractures of the condylar process should disrupt masticatory patterns. The purposes of this study were 1) to document changes in masticatory patterns after such fractures, and 2) to determine whether and when normal masticatory patterns are recovered. PATIENTS AND METHODS Twenty-two patients (15 men and 7 women) were examined at 6 weeks, 6 months, 1 year, 2 years, and 3 years after bilateral condylar process fractures. Patients were age and sex matched to a control sample. Incisor movements in three dimensions, along with muscle activity from the anterior temporalis, posterior temporalis, and superficial masseter, were recorded at 500 Hz during mastication of a gummy candy. RESULTS Although the patients showed no reduction of interincisal opening during mastication, the opening was achieved with reduction of anterior translation of the condyles. Patients had significantly narrower chewing cycles, with significantly lower adductor muscular effort during the closing phases of mastication. Differences from controls were no longer detectable 1 year after the fractures. CONCLUSION The amount of opening during mastication may appear clinically normal in patients with bilateral condylar process fractures. However, disruption of controlling structures and lateral pterygoid function appears to reduce the amount of anterior translation and lateral excursion during the chewing cycle. Reduced adductor muscle activity during the closing phases may reduce loads on the fractured condylar processes. In general, these patients recover normal masticatory cycles within 1 year.
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Affiliation(s)
- G S Throckmorton
- Cell Biology and Neuroscience, University of Texas Southwestern Medical Center, Dallas 75235-9109, USA
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Santler G, Kärcher H, Ruda C, Köle E. Fractures of the condylar process: surgical versus nonsurgical treatment. J Oral Maxillofac Surg 1999; 57:392-7; discussion 397-8. [PMID: 10199490 DOI: 10.1016/s0278-2391(99)90276-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to compare outcomes from surgical and nonsurgical treatment of condylar process fractures. PATIENTS AND METHODS Two hundred thirty-four patients with fractures of the mandibular condylar process were treated by open or closed methods. In the follow-up study, 150 patients with a mean follow-up time of 2.5 years were analyzed using radiologic and objective and subjective clinical examinations. RESULTS No significant difference in mobility, joint problems, occlusion, muscle pain, or nerve disorders were observed when the surgically and nonsurgically treated patients were compared. The only significant difference was in subjective discomfort. Surgically treated patients showed significantly more weather sensitivity and pain on maximum mouth opening. CONCLUSION Because of its disadvantages, open surgery is only indicated in patients with severely dislocated condylar process fractures.
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Affiliation(s)
- G Santler
- Department of Oral and Maxillofacial Surgery, University Clinic for Dentistry, Graz, Austria.
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Wichelhaus A, Haas R, Sander FG, Kreidler JF. The influence of the spring activator on the mobility of the lower jaw in traumatically injured patients. J Orofac Orthop 1998; 59:340-51. [PMID: 9857603 DOI: 10.1007/bf01299770] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
For functional rehabilitation and improvement of mandibular mobility, 14 patients with dislocated collum or collum fracture dislocations were treated with a spring activator after surgical-conservative treatment. With an interincisal distance of < 12 mm, therapy was started with a loop spring. The average age of the patients was 26.6 years. Eight patients showed additional traumatic injuries, 2 patients were seriously polytraumatically injured. The clinical investigations referring to the maximum mouth opening and maximal interincisal distance resulted in a good to very good functional rehabilitation in all cases. The average maximal interincisal distance of 31.7 mm at the beginning of the spring activator therapy could be increased to 47.3 mm. The largest increase of the maximal interincisal distance was observed after 4 weeks of therapy. The type of reaction, however, differed interindividually. Three patients showed a spontaneous improvement of the interincisal distance within the first 2 to 3 weeks of removal of intermaxillary fixation, whereas 7 patients showed no improvement or only slightly improved values until insertion of the spring activator. An enlargement of the interincisal distance could be achieved in almost every patient within a relatively short period of time despite a drastically reduced mouth opening. Consequently, because of its mode of action in the form of a neuromuscular influence, the spring activator is especially suitable for the functional rehabilitation of patients with fractures of the condylar process.
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Affiliation(s)
- A Wichelhaus
- Department of Orthodontics, University of Ulm, Germany.
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Talwar RM, Ellis E, Throckmorton GS. Adaptations of the masticatory system after bilateral fractures of the mandibular condylar process. J Oral Maxillofac Surg 1998; 56:430-9. [PMID: 9541341 DOI: 10.1016/s0278-2391(98)90707-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The objective of this investigation was to evaluate the adaptations that occur in the masticatory system after treatment of bilateral fractures of the mandibular condylar process. PATIENTS AND METHODS Twenty-two patients (15 men and seven women) with bilateral condylar process fractures treated by open reduction and rigid internal fixation (n = 6), closed therapy (n = 14), or a combination of these techniques (n = 2) were compared with 22 sex- and age-matched controls. Measures of mandibular range of motion, bite force, muscle activity, estimated joint forces, and skeletal morphology were determined at 6 weeks, 6 months, and 1, 2, and 3 years after treatment in all subjects. Various statistical tests were used for comparing differences between patients and controls. RESULTS There was no significant difference in the patients' morphologic measures for the open and closed reduction procedures; therefore, all of these patients were tested as a single group. After treatment, patients had significantly increased mandibular plane and gonial angles and decreased facial axis angles. They also showed a significant reduction in posterior facial height and moment arm length for the masseter and pterygoid muscles. Anterior and posterior temporalis muscle direction also was significantly different between patients and controls. Patients had significantly limited mobility during the first year after fracture. Bite forces were lower for patients at all times and tooth positions, with a significant difference at 6 weeks after treatment. Patients had a tendency to use proportionally higher temporalis muscle activity during maximum biting; however, the differences were not statistically significant, probably because of the small sample size. The estimated joint force magnitudes were essentially identical between patients and controls; however, the direction of the patients' joint forces were more posteriorly directed for both incisor and molar bites. CONCLUSION The results of this study suggest that early reduction in mandibular range of motion, bite force, and the distribution of masticatory muscle activity assist in preventing overloading of the bilaterally fractured mandibular condylar processes.
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Affiliation(s)
- R M Talwar
- University of Texas Southwestern Medical Center, Dallas 75235-9109, USA
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Abstract
OBJECTIVE To audit a series of isolated unilateral fractures of the mandibular condyle treated in a number of units in the United Kingdom. DESIGN Prospective confidential multicentre audit with review by a single external examiner between July 1993 and January 1994. SETTING Nine Maxillofacial units. Pro-formas were alphanumerically coded. Units are referred to by code letter. SUBJECTS 142 patients with fractures of the mandibular condyle. MAIN OUTCOME MEASURES Pain, crepitus, interincisal opening, mandibular deviation on movement, occlusion and posteroanterior and lateral radiographic analysis by a single examiner. RESULTS Of the 142 patients, 135 over the age of 12 years had unilateral condylar fractures. Seventy-three attended appointments at both 6 and 12 weeks. Forty-one had identifiable symptoms attributable to the injury at 12 weeks, and most of these had fracture displacements or dislocations which had not been openly reduced. There was a 50-85% positive correlation between radiographic findings of the first clinician and the external auditor. Open reduction and internal fixation was uncommon. CONCLUSIONS Follow-up studies of trauma patients are difficult because of poor attendance. Fractures of the mandibular condyle should be treated by specialists in the management of facial fractures. Accurate clinical and radiographic diagnosis is more difficult than commonly supposed. Fracture displacements and dislocations have a suboptimal outcome in nearly 30% of cases. More should be spent to improve care of these patients. A consensus on objective indicators of satisfactory outcome is needed to establish a 'gold standard' and close the audit loop.
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Affiliation(s)
- D A Mitchell
- Department of Oral and Maxillofacial Surgery, Leeds Dental Institute, UK
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Spitzer WJ, Vanderborght G, Dumbach J. Surgical management of mandibular malposition after malunited condylar fractures in adults. J Craniomaxillofac Surg 1997; 25:91-6. [PMID: 9174891 DOI: 10.1016/s1010-5182(97)80051-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Fourteen patients who had occlusal disturbance and mandibular malposition following malunited condylar fractures are presented, to demonstrate the variety of surgical corrective procedures used. In order to achieve an anatomically correct mandibular position, a subcondylar osteotomy was performed in 2 patients, and in 11 patients a uni- or bilateral sagittal split osteotomy was carried out. In 1 patient, a Le Fort I osteotomy was the method of choice. In all patients, it was possible to correct the occlusal and mandibular imbalance, as well as to facilitate normal mandibular movement.
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Affiliation(s)
- W J Spitzer
- Department of Oral & Cranio-Maxillofacial Surgery, Erlangen-Nuremberg University, Germany
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