1
|
Al-Moraissi EA, Neff A, Kaur A, Falci SGM, Maria de Souza G, Ellis E. Treatment for Adult Mandibular Condylar Process Fractures: A Network Meta-Analysis of Randomized Clinical Trials. J Oral Maxillofac Surg 2023; 81:1252-1269. [PMID: 37423262 DOI: 10.1016/j.joms.2023.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE Using network meta-analyses (NMA) has become increasingly valuable as it enables the comparison of interventions that have not been directly compared in a clinical trial. To date, there has not been a NMA of randomized clinical trials (RCT) that compares all types of treatments for mandibular condylar process fractures (MCPFs). The aim of this NMA was to compare and rank all the available methods used in the treatment of MCPFs. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search was conducted in 3 major databases up to January 2023 to retrieve RCTs that compared various closed and open treatment methods for MCPFs. The predictor variable is treatment techniques: arch bars (ABs) + wire maxillomandibular fixation (MMF), rigid MMF with intermaxillary fixation screws, AB + functional therapy with elastic guidance (AB functional treatment), AB rigid MMF/functional treatment, single miniplate, double miniplate, lambda miniplate, rhomboid plate, and trapezoidal miniplate. Postoperative complications were the outcome variables and included occlusion, mobility, and pain, among other things. Risk ratio (RR) and standardized mean difference were calculated. Version 2 of the Cochrane risk-of-bias tool and Grading of Recommendations, Assessment, Development, and Evaluations system were used to determine the certainty of the results. RESULTS The NMA included a total of 10,259 patients from 29 RCTs. At ≤6 months, the NMA revealed that the use of 2-miniplates significantly reduced malocclusion compared to rigid MMF (RR = 2.93; confidence interval [CI]: 1.79 to 4.81; very low quality) and functional treatment (RR = 2.36; CI: 1.07 to 5.23; low quality).Further, at ≥6 months, 2-miniplates resulted in significantly lower malocclusion compared to rigid MMF with functional treatment (RR = 3.67; CI: 1.93 to 6.99; very low quality).Trapezoidal plate and AB functional treatment were ranked as the best options in 3-dimensional (3D) plates and closed groups, respectively.3D-miniplates (very low-quality evidence) were ranked as the most effective treatment for reducing postoperative malocclusion and improving mandibular functions after MCPFs, followed closely by double miniplates (moderate quality evidence). CONCLUSIONS This NMA found no substantial difference in functional outcomes between using 2-miniplates versus 3D-miniplates to treat MCPFs (low evidence).However, 2-miniplates led to better outcomes than closed treatment (moderate evidence).Additionally, 3D-miniplates produced better outcomes for lateral excursions, protrusive movements, and occlusion than closed treatment at ≤6 months (very low evidence).
Collapse
Affiliation(s)
- Essam Ahmed Al-Moraissi
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Thamar University, Yemen.
| | - Andreas Neff
- Professor, Chairman and Medical Director, Department of Oral and Craniomaxillofacial Plastic Surgery, Oral Surgery and Implantology, University Hospital Marburg, Marburg, Hesse, Germany
| | - Amanjot Kaur
- Assistant Professor, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Vijaypur, Jammu, Jammu and Kashmir, India
| | - Saulo Gabriel Moreira Falci
- Adujunct Professor, Department of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri - UFVJM, Diamantina, Minas Gerais, Brazil
| | - Glaciele Maria de Souza
- Adujunct Professor, Department of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri - UFVJM, Diamantina, Minas Gerais, Brazil
| | - Edward Ellis
- Professor and Chair, Department of Oral and Maxillofacial Surgery University of Texas Health Science Center at San Antonio
| |
Collapse
|
2
|
Mallya SM, Ahmad M, Cohen JR, Kaspo G, Ramesh A. Recommendations for imaging of the temporomandibular joint. Position statement from the American Academy of Oral and Maxillofacial Radiology (AAOMR) and the American Academy of Orofacial Pain (AAOP). Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:639-648. [DOI: 10.1016/j.oooo.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/15/2022] [Accepted: 06/19/2022] [Indexed: 10/17/2022]
|
3
|
Friedrich RE, Kohlrusch FK. Preauricular Swelling Mimicking a Tumour: Dissolution of Mandibular Capitulum Following Trauma in a 15-Year Old Child. In Vivo 2021; 34:1235-1245. [PMID: 32354914 DOI: 10.21873/invivo.11897] [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: 03/17/2020] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 11/10/2022]
Abstract
AIM The report is about diagnosis, therapy, and follow-up of a 15-year old boy, who experienced facial swelling and impaired mouth opening after a sport accident. CASE REPORT Diagnosis of mandibular damage was delayed due to inadequate clinical investigation and radiography after trauma and only became clear after a parotid swelling occurred sometime later resulting from the dissolution of the upper part of the articular process. Follow-up control over a period of three years showed a partial restoration of the articular process but some inhibition of mouth opening combined with slight deviation of the mandible to the affected side remained over the years. CONCLUSION This report reminds us that parotid swelling can be the result of mandibular trauma without a recent history of physical injury to this region. Therefore, the basic standards of radiologic diagnosis should be maintained and the limited restoring capacity of the condylar process in adolescence should be acknowledged.
Collapse
Affiliation(s)
- Reinhard E Friedrich
- Department of Oral and Cranio-Maxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany
| | - Felix K Kohlrusch
- Department of Oral and Cranio-Maxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany
| |
Collapse
|
4
|
Abstract
The aim of the present study is to assess the reliability and accuracy of different 3-dimensional (3D) reconstruction algorithms in detecting undisplaced condylar, zygomatic arc, and orbital rim fractures based on cone-beam computed tomography data set. Twenty sheep heads were used in the present study. Sixty fractured and 60 nonfractured (control) zones were randomly allocated. Three groups consisting of nondisplaced fractures of condyle (CF, n = 20), orbital (OF, n = 20), and zygomatic arc (ZF, n = 20) were created by using a diamond cutting disc. Soft tissues were only dissected and no fractures were generated in the control group (n = 60). The 3D reconstructions were created by using multiplanar reconstruction (MPR), surface rendering (SR), volume rendering (VR), and maximum intensity projection (MIP) algorithms. Final 3D models were examined in Osirix software (Pixmeo SARL, Bernex, Switzerland) by 6 observers. Diagnostic accuracies of each algorithm were statistically compared by receiver operating characteristics (ROC) and area under the ROC curves (AUCs). For the detection of CF, AUC for VR algorithm was found to be statistically larger than that of MIP while AUCs for VR and MIP were larger than those of MPR and SR for OF detection. For the detection of ZF, AUCs for MPR and VR were significantly larger than those of MIP and SR (P < 0.05 for each). Within the limitations of this experimental study, it can be concluded that for maxillofacial surgeons, it is more likely to detect condylar, orbital, and zygomatic fractures by using VR algorithm in 3D reconstruction.
Collapse
|
5
|
Bilateral Mandibular Condylar Fractures with Associated External Auditory Canal Fractures and Otorrhagia. Radiol Case Rep 2016; 2:24-9. [PMID: 27303456 PMCID: PMC4891586 DOI: 10.2484/rcr.v2i1.79] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A rare case of bilateral mandibular condylar fractures associated with bilateral external auditory canal fractures and otorrhagia is reported. The more severe external auditory canal fracture was present on the side of high condylar fracture, and the less severe external auditory canal fracture was ipsilateral to the condylar neck fracture. A mechanism of injury is proposed to account for such findings.
Collapse
|
6
|
Devireddy SK, Kumar RVK, Gali R, Kanubaddy SR, Rao DM, Siddhartha M. Three-dimensional assessment of unilateral subcondylar fracture using computed tomography after open reduction. Indian J Plast Surg 2014; 47:203-9. [PMID: 25190915 PMCID: PMC4147454 DOI: 10.4103/0970-0358.138945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective: The aim was to assess the accuracy of three-dimensional anatomical reductions achieved by open method of treatment in cases of displaced unilateral mandibular subcondylar fractures using preoperative (pre op) and postoperative (post op) computed tomography (CT) scans. Materials and Methods: In this prospective study, 10 patients with unilateral sub condylar fractures confirmed by an orthopantomogram were included. A pre op and post op CT after 1 week of surgical procedure was taken in axial, coronal and sagittal plane along with three-dimensional reconstruction. Standard anatomical parameters, which undergo changes due to fractures of the mandibular condyle were measured in pre and post op CT scans in three planes and statistically analysed for the accuracy of the reduction comparing the following variables: (a) Pre op fractured and nonfractured side (b) post op fractured and nonfractured side (c) pre op fractured and post op fractured side. P < 0.05 was considered as significant. Results: Three-dimensional anatomical reduction was possible in 9 out of 10 cases (90%). The statistical analysis of each parameter in three variables revealed (P < 0.05) that there was a gross change in the dimensions of the parameters obtained in pre op fractured and nonfractured side. When these parameters were assessed in post op CT for the three variables there was no statistical difference between the post op fractured side and non fractured side. The same parameters were analysed for the three variables in pre op fractured and post op fractured side and found significant statistical difference suggesting a considerable change in the dimensions of the fractured side post operatively. Conclusion: The statistical and clinical results in our study emphasised that it is possible to fix the condyle in three-dimensional anatomical positions with open method of treatment and avoid post op degenerative joint changes. CT is the ideal imaging tool and should be used on a regular basis for cases of condylar fractures.
Collapse
Affiliation(s)
- Sathya Kumar Devireddy
- Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Chintareddy Palem, Nellore, Andhra Pradesh, India
| | - R V Kishore Kumar
- Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Chintareddy Palem, Nellore, Andhra Pradesh, India
| | - Rajasekhar Gali
- Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Chintareddy Palem, Nellore, Andhra Pradesh, India
| | - Sridhar Reddy Kanubaddy
- Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Chintareddy Palem, Nellore, Andhra Pradesh, India
| | - Dasari Mallikarjuna Rao
- Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Chintareddy Palem, Nellore, Andhra Pradesh, India
| | - Mannava Siddhartha
- Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Chintareddy Palem, Nellore, Andhra Pradesh, India
| |
Collapse
|
7
|
Lu C, He D, Yang C. Which craniofacial fractures are associated with external auditory canal bleeding? J Oral Maxillofac Surg 2013; 72:121-6. [PMID: 24075233 DOI: 10.1016/j.joms.2013.07.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 07/24/2013] [Accepted: 07/25/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE External auditory canal bleeding (EACB) after facial trauma has been strongly associated with skull base fractures; however, EACB also can occur with other craniofacial fractures. The aim of this study was to analyze the frequency and causes of EACB in different craniofacial fracture types. PATIENTS AND METHODS The investigators used a retrospective cohort study design and enrolled a sample composed of patients with craniofacial fractures evaluated and treated from April 2006 through December 2011. The predictor variable was fracture type, which was categorized into 4 types: skull base fracture, midface fracture, and mandibular fracture with and without involvement of the condyle. The frequency of EACB among fracture types was compared with SPSS 13.0 (SPSS, Inc, Chicago, IL) and χ(2) test. Computed tomographic (CT) scans were analyzed to determine the cause of EACB. RESULTS EACB was found in 43 of 573 craniofacial fracture cases, with a frequency of 7.5%. There were 19 EACB sides in 123 skull base fracture cases (15.4%), 26 EACB sides in 150 mandibular fracture cases involving the 196 condyles (13.3%; of these 196 condyles, 92.3% were intracapsular condylar fractures [ICFs]), 2 EACB sides in 150 mandibular fracture cases not involving the condyle (1.3%), and 1 EACB case in 150 midface fracture cases (0.7%). Statistical analysis of EACB frequency for each fracture type showed a significant difference between skull base or mandibular fractures with condylar involvement and midface or mandibular fractures without condylar involvement (P < .05). However, there was no significant difference between skull base and mandibular fractures involving the condyle and midface fracture and mandibular fractures not involving the condyle (P > .05). CONCLUSIONS EACB is uncommon in craniofacial fractures. The frequency varies significantly based on fracture type. Skull base fracture and mandibular ICF are the 2 main causes of EACB.
Collapse
Affiliation(s)
- Chuan Lu
- Resident, Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Key Laboratory of Stomatology, Shanghai, China
| | - Dongmei He
- Associate Professor, Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Key Laboratory of Stomatology, Shanghai, China.
| | - Chi Yang
- Professor, Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Key Laboratory of Stomatology, Shanghai, China
| |
Collapse
|
8
|
Cone-beam computed tomography for the diagnosis of mandibular condylar fractures: 11 case reports. Oral Radiol 2012. [DOI: 10.1007/s11282-012-0100-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
9
|
He D, Yang C, Chen M, Zhang X, Qiu Y, Yang X, Li L, Fang B. Traumatic Temporomandibular Joint Ankylosis: Our Classification and Treatment Experience. J Oral Maxillofac Surg 2011; 69:1600-7. [DOI: 10.1016/j.joms.2010.07.070] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 07/20/2010] [Indexed: 11/16/2022]
|
10
|
Sirin Y, Guven K, Horasan S, Sencan S. Diagnostic accuracy of cone beam computed tomography and conventional multislice spiral tomography in sheep mandibular condyle fractures. Dentomaxillofac Radiol 2011; 39:336-42. [PMID: 20729182 DOI: 10.1259/dmfr/29930707] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES the aim of this study was to compare diagnostic accuracy of cone beam CT (CBCT) and multislice CT in artificially created fractures of the sheep mandibular condyle. METHODS 63 full-thickness sheep heads were used in this study. Two surgeons created the fractures, which were either displaced or non-displaced. CBCT images were acquired by the NewTom 3G CBCT scanner (NIM, Verona, Italy) and CT imaging was performed using the Toshiba Aquillon multislice CT scanner (Toshiba Medical Systems, Otawara, Japan). Two-dimensional (2D) cross-sectional images and three-dimensional (3D) reconstructions were evaluated by two observers who were asked to determine the presence or absence of fracture and displacement, the type of fracture, anatomical localization and type of displacement. The naked-eye inspection during surgery served as the gold standard. Inter- and intra-observer agreements were calculated with weighted kappa statistics. The receiver operating characteristics (ROC) curve analyses were used to compare statistically the area under the curve (AUC) of both imaging modalities. RESULTS kappa coefficients of intra- and interobserver agreement scores varied between 0.56 - 0.98, which were classified as moderate and excellent, respectively. There was no statistically significant difference between the imaging modalities, which were both sensitive and specific for the diagnosis of sheep condylar fractures. CONCLUSIONS this study confirms that CBCT is similar to CT in the diagnosis of different types of experimentally created sheep condylar fractures and can provide a cost- and dose-effective diagnostic option.
Collapse
Affiliation(s)
- Y Sirin
- Department of Oral Surgery, Faculty of Dentistry Istanbul Universitesi, Istanbul, Turkey.
| | | | | | | |
Collapse
|
11
|
Learreta JA, Matos JLF, Matos MF, Durst AC. Current diagnosis of temporomandibular pathologies. Cranio 2009; 27:125-33. [PMID: 19455924 DOI: 10.1179/crn.2009.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The current scientific knowledge of TMJ pathologies points to the importance of etiological research and the need for differential diagnosis using the most modem technological resources. Those include MRI, computed tomography, serologic studies, genetic mapping, and bioelectronic instruments which allow clinicians to study, understand, and measure respectively, the structural changes of soft and hard tissues, infections, genetic susceptibility for autoimmune diseases, and stomatognathic function. The purpose of this article is an overview of the current knowledge and related tools for the diagnosis of TMJ pathologies.
Collapse
|
12
|
He D, Yang C, Chen M, Jiang B, Wang B. Intracapsular Condylar Fracture of the Mandible: Our Classification and Open Treatment Experience. J Oral Maxillofac Surg 2009; 67:1672-9. [DOI: 10.1016/j.joms.2009.02.012] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2008] [Accepted: 02/22/2009] [Indexed: 10/20/2022]
|
13
|
Napolitano G, Sodano A, Califano L, Grassi R, Brunese L. Multidetector Row Computed Tomography with Multiplanar and 3D Images in the Evaluation of Posttreatment Mandibular Fractures. Semin Ultrasound CT MR 2009; 30:181-7. [DOI: 10.1053/j.sult.2009.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
14
|
Landes CA, Day K, Lipphardt R, Sader R. Closed Versus Open Operative Treatment of Nondisplaced Diacapitular (Class VI) Fractures. J Oral Maxillofac Surg 2008; 66:1586-94. [DOI: 10.1016/j.joms.2007.06.668] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Revised: 05/21/2007] [Accepted: 06/12/2007] [Indexed: 11/28/2022]
|
15
|
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.
Collapse
Affiliation(s)
- Constantin A Landes
- Mund-, Kiefer und Plastische Gesichtschirurgie, Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, Frankfurt, Germany.
| | | | | | | |
Collapse
|
16
|
Prospective Evaluation of Closed Treatment of Nondisplaced and Nondislocated Mandibular Condyle Fractures Versus Open Reposition and Rigid Fixation of Displaced and Dislocated Fractures in Children. J Oral Maxillofac Surg 2008; 66:1184-93. [DOI: 10.1016/j.joms.2007.06.667] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2007] [Revised: 05/29/2007] [Accepted: 06/11/2007] [Indexed: 11/22/2022]
|
17
|
Landes CA, Lipphardt R. Prospective evaluation of a pragmatic treatment rationale: open reduction and internal fixation of displaced and dislocated condyle and condylar head fractures and closed reduction of non-displaced, non-dislocated fractures. Int J Oral Maxillofac Surg 2006; 35:115-26. [PMID: 16412949 DOI: 10.1016/j.ijom.2005.04.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2004] [Revised: 02/18/2005] [Accepted: 04/13/2005] [Indexed: 11/20/2022]
Abstract
This study prospectively evaluated closed reduction (CR) outcomes in non-displaced, non-dislocated high-condylar and condylar-head fractures (Class VI after Spiessl and Schroll) and open reduction and internal fixation (ORIF) of displaced (Class III) or dislocated (Class V) fractures. Thirty-eight patients with 54 fractures (16 (42%) with bilateral fractures, 14 (37%) CR, 24 (63%) ORIF) were enrolled in a 1 year follow-up that 18 patients with 33 fractures completed. Condylar translation in Class VI fractures recovered to 11 mm for vertical opening, 8mm for protrusion and 10 mm for mediotrusion; Class III synonymously 8 mm, 8 mm and 6 mm; and Class V 7 mm, 6mm and 7 mm; incisal movements recovered to 38 mm, 8 mm and 8 mm in Class VI; 55 mm, 7 mm and 10 mm in Class III with 1 (8%) malocclusion, 1 (8%) impaired vertical opening and 55 mm, 7 mm and 9 mm in Class V with 2 (18%) malocclusions. Fragment-reduction versus the non-fractured condyle was -0.3 mm to +1.3 mm and +3 degrees to +9 degrees in Class VI, -1 mm to -0.2 mm and +3 degrees to +2 degrees in Class III, -3.3 mm to +3.1 mm and -11.2 degrees to +1 degrees in Class V. Malocclusion and joint locking were unreliable determinants for a treatment decision, being forged by concomitant fractures. Joint movements were within normal range at 1-year follow-up except Classes III and V vertical opening translation. After predefined criteria, 92% successful outcomes were attained. Multiple factor analysis should be used to prospectively evaluate the unacceptable clinical outcomes. Class VI fractures with intact vertical support should prospectively be evaluated whether these benefit from ORIF.
Collapse
Affiliation(s)
- C A Landes
- Maxillofacial and Plastic-Facial Surgery, The Frankfurt University Medical Center, Germany
| | | |
Collapse
|
18
|
Abstract
The aim of diagnostic imaging for maxillofacial trauma is to provide additional information that can positively influence medical or surgical patient management. Current advances in diagnostic imaging have come from the confluence of 3 driving forces: (1) the demand from clinicians to enhance and expand their diagnostic abilities; (2) the development of new theoretical concepts by basic scientists; and (3) the application of concepts by engineers and manufacturers to provide increasingly sophisticated imaging capabilities. The role of imaging within the health care environment is, however, also buffeted by the complex, sometimes competing, interactions of external social, political, economic, and technological pressures at the national, regional, and local levels. The purposes of this review are to provide a perspective on current imaging modalities used for maxillofacial trauma and to provide an insight into the influences, both technologic and external, on future developments and applications.
Collapse
Affiliation(s)
- William Charles Scarfe
- University of Louisville School of Dentistry, Department of Surgical/Hospital Dentistry, Louisville, KY 40292, USA.
| |
Collapse
|
19
|
Schneider A, Schulze J, Eckelt U, Laniado M. Lag screw osteosynthesis of fractures of the mandibular condyle: potential benefit of preoperative planning using multiplanar CT reconstruction. ACTA ACUST UNITED AC 2005; 99:142-7. [PMID: 15660082 DOI: 10.1016/j.tripleo.2004.05.021] [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: 11/26/2022]
Abstract
OBJECTIVE The purpose of the study was to develop a method of multiplanar CT reconstruction in fractures of the mandibular condyle in order to evaluate the feasibility of lag screw osteosynthesis. STUDY DESIGN Angulated axial and sagittal images of the mandibular ramus were calculated using collected CT data. In 183 mandibular rami the optimal position of the screw axis was determined retrospectively. The thickness of the covering bone as well as the degree of screw exposure were measured. RESULTS Application of the method led to medial (28.4% of cases) or lateral (3.8% of cases) correction of the usual screw axis. In 1.6% of cases an extraosseous position of screws could not be avoided by this correction. CONCLUSIONS Evaluation of the feasibility of lag screw osteosynthesis by this method is possible. Medial or lateral change of the axis ensures the optimal intraosseous screw position. Intraosseous screw placement is almost always possible.
Collapse
Affiliation(s)
- Alexander Schneider
- Department of Oral and Maxillofacial Surgery, University of Technology Dresden, Dresden, Germany.
| | | | | | | |
Collapse
|
20
|
Abstract
A case of vertical-split fracture of the right mandibular condyle and its sequelae is presented. The patient was a 16-year-old female being assessed for orthodontic treatment. Orthopantomograph and plain joint view radiographs showed a remodelled condyle which had suffered trauma 10 years previously. This type of fracture is unusual in nature but has not led to any secondary lack of growth, restriction of movement or facial asymmetry.
Collapse
|
21
|
Abstract
OBJECTIVES To compare the diagnostic efficacies of panoramic radiographs, mandibular trauma series, and digitized radiographs for detection of fractures of the mandible. METHODS Fractures were induced using blunt trauma in 25 cadaver mandibles. Panoramic radiographs, digitized radiographs, and mandibular series comprising an anteroposterior view, two lateral oblique, and a reverse Towne's were used. Six observers recorded their diagnoses using a five-point confidence rating scale. The data were analyzed using receiver operating characteristic (ROC) curve analysis. RESULTS Significant differences based on imaging modalities were found (p < 0.0015) in the area under the curves (A(z)): panoramic radiograph, 0.8762; mandibular series, 0.7521; panoramic plus anteroposterior radiographs combination, 0.8886; and digitized mandibular series, 0.7723. No observer-based differences were noted. Condylar and coronoid fractures were difficult to detect than those in other areas of the mandible (p < 0.033). Intra- and inter-observer agreements were high (kappa(w) = 0.81 and 0.76, respectively). CONCLUSIONS Panoramic radiographs are adequate for detection of mandibular fractures. Addition of an anteroposterior view augments diagnostic accuracy.
Collapse
Affiliation(s)
- M K Nair
- Oral and Maxillofacial Radiology, University of Pittsburgh, Pittsburgh, PA 15261-1923, USA.
| | | |
Collapse
|
22
|
Terakado M, Hashimoto K, Arai Y, Honda M, Sekiwa T, Sato H. Diagnostic imaging with newly developed ortho cubic super-high resolution computed tomography (Ortho-CT). ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2000; 89:509-18. [PMID: 10760735 DOI: 10.1016/s1079-2104(00)70133-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Ortho cubic super-high resolution computed tomography (Ortho-CT), which we have developed, is characterized by the small size of the unit and the ability to produce 3-dimensional images of high resolution with low-radiation doses. The purpose of this study was to investigate the clinical usefulness of Ortho-CT for the diagnosis of diseases in the oral and maxillofacial region. STUDY DESIGN Ortho-CT has been used for the imaging diagnosis of a radicular cyst of the upper first molar, mesiodense, tooth fractures in the upper anterior region, a fracture of the condylar process, or presurgical evaluation for a dental implant. The usefulness of 3-dimensional images obtained by Ortho-CT was investigated in this study. RESULTS Ortho-CT produced images of high resolution, enabling identification of the extent of the lesions and the fracture line, the condition of the impacted tooth, and the relationship with the maxillary sinus, mandibular canal, and adjacent teeth. CONCLUSION Because Ortho-CT can take high-resolution 3-dimensional images at any tomographic layer with only 1 exposure, it is useful for the diagnosis of diseases in the oral and maxillofacial region.
Collapse
Affiliation(s)
- M Terakado
- Nihon University, Department of Oral and Maxillofacial Surgery, School of Dentistry, Japan
| | | | | | | | | | | |
Collapse
|