Does Fracture Pattern Influence Functional Outcomes in the Management of Bilateral Mandibular Condylar Injuries?

Treatment of pediatric bilateral condylar fractures: A comprehensive analysis

Pediatric bilateral condylar fractures (PBCF) is a rare clinical pathology, where the management is carried out with both conservative and surgical approaches. The purpose of this study was to analyze and compare these two treatment approaches and their associated long term complications in PBCF. An extensive literature review- through the search of online databases- was conducted to survey, collect, analyze and compare the reported outcomes of different treatment modalities for PBCF. The number of studies presenting PBCF case reports was 16, while the number of such retrospective studies included here was 19. Analyses of these studies revealed that the conservative treatment is preferred in PBCF patients younger than 12 years of age. Moreover, a composite approach where the open reduction and internal fixation (ORIF) is carried out for one side while the intermaxillary fixation (IMF) for the contralateral side is frequently reported for the management of PBCF cases; this approach appears effective in improving daily functioning of temporomandibular joint and reducing long term complications. Performing ORIF for one side while IMF for the contralateral side seems the most common treatment approach in PBCF. This study may help in rapid decision making for treatment selection of PBCF patients while minimizing the risk for late complications.

Let Bilateral Condylar Fracture Fixation Be the Norm and Not a Choice

In lieu of a lack of consensus among the global community, it becomes imperative to address the pitfalls in the surgical management of bilateral mandibular condylar fractures with the contemporary technique of open reduction and internal fixation of only one side. This dictum inevitably leads to postoperative complications despite the best efforts of the surgical team to optimize care. We present a case series comprising residual deformities and complications arising out of the inadequate treatment of bilateral condylar fractures. We aim to highlight the significance of open reduction and internal fixation of bilateral mandibular condylar fractures and reiterate that conventional subcondylar osteotomy is an effective method for revision surgery.

Accurate Treatment of Condylar Fracture Assisted by Three-Dimensional Prototype and Bioresorbable Plates

PURPOSE

Although open treatments of condylar fracture have become the conventional treatment option, the accuracy is often not guaranteed. The purpose of this study was to improve the accuracy of fracture reduction assisted by three-dimensional (3D) prototype and bioresorbable plates in the treatment of condylar fractures.

METHODS

This was a prospective cohort study. Patients with condylar fractures were treated by surgery from October 2017 to November 2019 at School of Stomatology of China Medical University (Shenyang, China). The patients in the experimental group were treated with 3D-prototype and fixed with absorbable plates. Patients in the control group were treated routinely reduction and fixed with absorbable plates. Primary predictor variables were surgical treatment. Primary outcome was accurate reduction. Secondary outcomes were postoperative efficacy including maximum mouth opening, occlusal status, lateral excursion movements, and patient satisfaction. Other variables of interest included age, sex, type of patients. Continuous variables are reported as mean ± standard deviation. χ² test and t test were used for analysis.

RESULTS

The sample was composed of 48 patients (65 sides) who were treated surgically (25 men, 23 women; mean age, 39.50 year; range, 17 to 65 year) ; 27 patients (38 sides) were treated with the 3D-prototype approach and 21 patients (27 sides) were treated with the traditional approach. All 48 patients completed reduction and fixation of fractures. Preoperative and postoperative CT comparisons showed that 4 patients did not achieve accurate reduction, all in the control group, of which 3 patients had occlusal disorder. All patients in the experimental group achieved accurate reduction, of which 1 patient had occlusal disorder.

CONCLUSION

Our results suggest that using 3D prototype for bending the bioresorbable plate is an effective method for accurate treatment of condylar fracture.