Function Impairment and Pain After Closed Treatment of Fractures of the Mandibular Condyle

Clinical outcomes in the treatment of unilateral condylar fractures: a cross-sectional study

The treatment of mandibular condyle fractures has been the subject of considerable discussion, especially whether open or closed treatment should be used. There is a need for practical,evidence-based guidelines, and both objective and subjective parameters should be measured. To date, fewstudies have considered clinically relevant subjective parameters. This study was performed to evaluate the outcomes of the treatment of condylar fractures using the Mandibular Function Impairment Questionnaire (MFIQ) and the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and to compare the outcomes of open and the closed treatment. Patients with condylar fractures and at least 1year of follow-up were examined. These patients completed the MFIQ and other questionnaires, and were examined according to the DC/TMD. Seventy-four of 171 eligible patients participated in this study. The mean MFIQ score was 10.70 (standard error 2.9) in the open group and 4.96 (standard error 1.3) in the closed group (P=0.023), an outcome in favour of the closed treatment group. Examination according to the DC/TMD did not reveal a significant prevalence of TMD complaints. Closed treatment appears to be a safe and appropriate modality for most unilateral condylar fractures. Although the open group in general showed similar outcomes, this treatment should be reserved for limited indications.

A Treatment Protocol for Fractures of the Edentulous Mandible

PURPOSE

The incidence of fractures of edentulous mandibles is relatively low. Knowledge about the management of these fractured edentulous mandibles relies heavily on case reports and observational studies. On the basis of the current literature, we compiled a treatment protocol for fractures of the edentulous mandible and hypothesized that this protocol would result in fewer complications.

PATIENTS AND METHODS

We conducted a retrospective cohort study of edentulous patients with mandibular fractures. The predictor variable was the fulfillment of the treatment protocol (yes or no). The outcome variables were postoperative complications and reoperations. Patient demographic characteristics were collected from patient records. The χ² test was used for statistical analysis between predictor and outcome variables.

RESULTS

Of 61 edentulous mandibular fractures (36 patients), 53 were treated according to the protocol and 8 were not. We observed 4 complications in the first group (complication rate, 7.5% [4 of 53]) and 4 in the second group (complication rate, 50% [4 of 8]). The fracture treatments that followed the protocol had a significantly lower postoperative complication rate (P = .001; odds ratio, 0.082) and needed fewer reoperations (P = .0001; odds ratio, 0.019) compared with the treatments that did not follow the protocol.

CONCLUSIONS

The results of this study show that following the compiled treatment protocol for fractures of edentulous mandibles significantly reduces postoperative complications and reoperations.

Physiotherapy Maneuver Is Critical to Recover Mouth Opening After Pediatric Trauma

PURPOSE

A restricted mouth opening (MO) is predominantly a complication of maxillofacial trauma in pediatric patients and develops in 4 to 26.2% of cases. The purpose of the present study was to quantitatively investigate the influence of patient demographic data, fracture characteristics, and regular vigorous physiotherapy, with either voluntary or forcible MO exercises, on the recovery of a post-traumatic restricted MO in pediatric patients.

PATIENTS AND METHODS

A prospective cohort study was performed of pediatric patients with maxillofacial injuries who had been referred to Al-Zahraa and El-Fayoum Hospitals from 2013 to 2015. The predictive variables were patient demographic data, fracture characteristics, and regular vigorous physiotherapy. The patients were treated with a closed technique. The MO measurements were the clinical outcome variables and were recorded at the first week and then monthly for 12 months. Regular vigorous physiotherapy was performed until the patients had returned to their preoperative MO. The data were tabulated and statistically analyzed.

RESULTS

Eighty-six patients were enrolled in the present study. Males predominated. Falls were the most common cause of fracture. Condylar fractures had the greatest incidence. A restricted MO occurred in 81 patients. The results showed no interaction between MO recovery and age, gender, etiology, or fracture site. After physiotherapy, the patients had returned to their preoperative MO at the fourth month, with the measurements fixed at normal values at the sixth month. The recovery rate was nonlinear, with faster improvement in the months closest to the injury.

CONCLUSION

Physiotherapy is more critical in the recovery of the MO and prevention of bony ankylosis than patient data or fracture characteristics in pediatric trauma. We highly advocate the performance of voluntary mouth exercises, even in the absence of fracture. Forcible MO exercises are mandatory to recover a restricted MO. These exercises should be performed under close supervision of the patient's surgeon with the parents motivated to cooperate for at least 6 months.

Unilateral superior condylar neck fracture with dislocation in a child treated with an acrylic splint in the upper arch for functional repositioning of the mandible

BACKGROUND

To present the outcomes for a case of unilateral mandibular subcondylar fracture with dislocation in an 11-year-old female treated with an acrylic splint for functional repositioning of the mandible.

CLINICAL PRESENTATION

A splint was placed in the upper arch to restore the functional repositioning of the mandible. The splint's height was increased up to 5.5 mm on the side of the fracture to stimulate growth on the deficient side. To correct the mandibular asymmetry, a construction bite was made by 4 mm advancing. The total treatment time was 16 months. Long-term five-year follow up showed complete healing. A portion of the ramus appeared lateral with respect to the condylar head, whereas the mandibular deviation to the right side was fully corrected.

CONCLUSION

Conservative treatment may be an appropriate method for children in select cases, as they have an increased potential for spontaneous regeneration.

Principais instrumentos para avaliação da disfunção temporomandibular, parte I: índices e questionários; uma contribuição para a prática clínica e de pesquisa

Na literatura especializada, encontram-se variados instrumentos para avaliação da disfunção temporomandibular (DTM), sob a forma de índices, questionários, protocolos, escalas de avaliação e critérios de diagnóstico. Este estudo, dividido em duas partes, visou caracterizar os principais instrumentos de avaliação da DTM disponíveis na literatura, para auxiliar o clínico e o pesquisador na correta escolha da ferramenta apropriada para contemplar seus objetivos clínicos ou científicos. Nesta parte I são apresentados dois índices clínicos e três questionários (anamnésicos e funcionais); na parte II, um questionário funcional e dois conjuntos de critérios diagnósticos. Os índices são ferramentas que organizam a avaliação de sinais e sintomas, pela obtenção de pontuações. Os questionários são melhor aplicados para traçar perfis populacionais em estudos epidemiológicos. Para avaliação dos eventuais impactos da DTM nas atividades de vida diária, os questionários funcionais são mais adequados. Finalmente, há poucos conjuntos de critérios sistematizados para obter o diagnóstico da disfunção. A utilização de uma ou outra ferramenta depende de sua aplicabilidade e dos objetivos do profissional que a irá utilizar.