Is masticatory performance affected after a unilateral condylar fracture? A cross-sectional study

Anatomical position of the mandibular condyle after open versus closed treatment of unilateral fractures: A three-dimensional analysis

This study aimed to compare open and closed treatment for unilateral mandibular condyle neck and base fractures by final three-dimensional (3D) condylar position at 6 months follow-up. 3D position was associated with mandibular functioning and pain. A total of 21 patients received open (n = 11) or closed (n = 10) treatment. 3D positions were assessed on cone-beam computed tomography scans. Volume differences, root mean square, translations, and rotations were obtained related to the pursued anatomical position and compared between treatment groups by the Mann-Whitney U test. The 3D position parameters were associated with the maximum interincisal opening (MIO), mixing ability test (MAT), Mandibular Function Impairment Questionnaire (MFIQ), and pain based on Spearman correlation coefficients (rs). Translation in the medial-lateral direction was smaller after open treatment (P = 0.014). 3D position was not associated with the MAT; however, worse position was associated with a smaller MIO. A larger pitch rotation was associated with a worse MFIQ (rs = 0.499, P = 0.025). Volume reduction of the affected condyle was associated with more pain (rs = -0.503, P = 0.020). In conclusion, after unilateral condylar fractures, worse 3D position is associated with a smaller mouth opening and worse patient-reported outcomes. This is independent of the chosen treatment, despite a better anatomical reduction after open treatment.

Oral functioning after open versus closed treatment of unilateral condylar neck or base fractures: A two-centre controlled clinical trial

BACKGROUND

Oral functioning and rehabilitation in patients after condylar trauma can be measured by objective functional outcomes and patient-reported outcomes. The similarities or differences between these outcomes may contribute to the decision if open treatment (OT) or closed treatment (CT) will obtain the most advantageous results.

OBJECTIVES

The aim of this study was to compare OT versus CT for unilateral condylar mandibular neck or base fractures in a two-centre controlled clinical trial by objective functional outcomes and patient-reported outcomes measured at 6 weeks and 6 months follow-up. Additionally, these outcomes were compared within each group.

METHODS

Patients were enrolled between January 2017 and November 2019. In one centre, patients received OT by extra-oral open reduction and internal fixation. In another centre, patients received CT by maxillomandibular fixation. Objective measurements included the mixing ability test (MAT) and mandibular active range of motion (ROM). Patient-reported outcomes included the mandibular function impairment questionnaire (MFIQ) and visual analogue scale (VAS) for pain. Independent t-tests and Mann-Whitney U-tests were used to determine differences between the treatment groups at 6 weeks and 6 months follow-up. Paired t-tests and Wilcoxon signed rank tests were used to determine differences within each group.

RESULTS

Thirty-three patients were enrolled. No differences were found between the groups treated with OT or CT for MAT, ROM, MFIQ and VAS. Both groups showed functional improvement.

CONCLUSION

Good objective functional outcomes and patient-reported outcomes were achieved with both OT and CT in patients with unilateral condylar mandibular neck or base fractures.

Long-term masticatory performance and ability following closed treatment for unilateral mandibular condylar neck or base fractures: a cross-sectional study

PURPOSE

The aim of this study was to find explanatory variables for objective and patient-reported long-term masticatory functioning in patients treated with maxillomandibular fixation for unilateral condylar neck or base fractures. These outcomes were compared to healthy control subjects.

METHODS

Patients treated between 1996 and 2013 were enrolled in the study. Objective measurements included the mixing ability test (MAT) for masticatory performance, and range of motion of the mandible. Patient-reported measurements included the mandibular function impairment questionnaire (MFIQ) for masticatory ability, and the visual analogue scale for pain. Healthy subjects were recruited between October 2018 and January 2019, and performed the MAT and MFIQ.

RESULTS

Twenty-one patients and 30 healthy subjects were included. The average follow-up period was 11.67 years. In adjusted regression analysis, the amount of occlusal units (OU) was associated with the MAT (P = 0.020; R² = 0.253) and MFIQ (P = 0.001, R² = 0.454). The MAT outcome was similar in both groups when correcting for OU (P = 0.001; R² = 0.201). The MFIQ was inferior in the patient group (P = 0.001).

CONCLUSION

Long-term masticatory performance was similar in patients with a history of condylar neck or base fracture and healthy subjects; however, masticatory ability was inferior in patients compared to healthy subjects.

Masticatory performance is influenced by masticatory muscle activity balance and the cumulative occlusal contact area

OBJECTIVE

To investigate the influence of masticatory muscle activity balance, occlusal contact area balance and the area of occlusal contact on masticatory performance in healthy dentate adults.

DESIGN

This cross-sectional study included ninety-three healthy subjects with complete dentition. Surface electromyography (sEMG) was used to record bilateral anterior temporalis activity and masseter muscle activity during maximum voluntary clenching and while chewing a test food. Seven levels of area of occlusal contact and near contact (ACNC) were registered and calculated cumulatively. The percentage overlapping coefficients were calculated for both muscle groups at maximum voluntary clenching and chewing and all levels of ACNC. Masticatory performance was measured by determining the median particle size of frankfurter sausage after 15 chewing cycles. Pearson's correlation and stepwise multiple linear regression analyses were used to assess the correlations between variables and the influence of the variables on masticatory performance, respectively, at the 0.05 level of significance.

RESULTS

Muscle balance during clenching and chewing, all near contact levels of cumulative ACNC and ACNC balance correlated negatively with median particle size (P <  0.05). The model based on stepwise multiple linear regression analysis showed muscle balance during clenching and cumulative ACNC at < 250 μm influenced median particle size.

CONCLUSION

Masticatory muscle activity balance during maximum voluntary clenching and the cumulative amount of near contact area were associated with masticatory performance, suggesting the amount of occlusal contact area-as well the balance of masticatory muscle activity-play a role in masticatory performance.

Does Open Reduction and Internal Fixation Provide a Quality-of-Life Benefit Over Traditional Closed Reduction of Mandibular Condyle Fractures?

PURPOSE

This study sought to estimate patient-reported outcomes and compare quality-of-life (QOL) measures between patients electing for either open reduction internal fixation (ORIF) or closed reduction with intermaxillary fixation (CRIMF).

PATIENTS AND METHODS

This was a retrospective cohort study of patients with unilateral condyle fractures who had undergone either ORIF or CRIMF at the New York University Tisch Hospital and Bellevue Hospital Center. The primary study predictor was treatment choice (ORIF or CRIMF). Other study predictors were patient age, gender, and the presence of any other coexisting facial fractures. The 9 study outcomes were derived from an 11-item postoperative QOL questionnaire evaluating self-reported perceptions of pain and function. Univariate comparisons and multivariate regression models were calculated.

RESULTS

A total of 38 patients (21 CRIMF and 17 ORIF) comprised the study sample. All patients were eligible for either ORIF or CRIMF, and the choice of treatment was decided through shared decision making after a comprehensive discussion of risks and benefits. With respect to pain outcomes, patients who underwent ORIF reported lower overall pain scores at 2 weeks (P < .01) and 2 months (P = .01), less mastication pain at 3 months (P = .01), and a lower rate of persistent headaches after 6 weeks (P = .04). With respect to functional outcomes, patients who underwent ORIF reported better range of motion at 3 months (P = .01), less treatment-related weight loss (P = .01), and more ease when performing physical (P < .01) and work-related (P < .01) activities. In the multivariate regression models, ORIF was independently associated with decreased pain at 2 weeks (P < .01) and decreased difficulty in obtaining nutrition (P < .01), performing physical activities (P = .02), and performing work-related activities (P < .01).

CONCLUSIONS

Patients who underwent ORIF appeared to experience subjective favorable pain and functional QOL outcomes. Given the clinical controversy, the choice of treatment should synthesize patient-reported outcomes and be approached through shared decision making.

Reproducibility and construct validity of the utrecht mixing ability Test to obtain masticatory performance outcome in patients with condylar mandibular fractures

OBJECTIVE

This study assessed the test-retest reproducibility of the Utrecht mixing ability test (MAT) and the construct validity of the MAT in relation to the Mandibular Function Impairment Questionnaire (MFIQ) in patients with mandibular condylar fractures.

MATERIAL AND METHODS

Twenty-six patients treated for a mandibular condylar fracture participated in this clinimetric study; all patients performed the MAT twice. Simultaneously the MFIQ was conducted. Test-retest reliability and construct validity were assessed using the intra-class correlation coefficient (ICC) and Spearman correlation, respectively.

RESULTS

The ICC of the MAT was 0.906 (95% CI: 0.801-0.957), which indicates an excellent reliability. A weak correlation of 0.386 (P = .052) between the first MAT and the overall outcome of the MFIQ was found. A significant moderate correlation of 0.401 (P = .042) was found between the retest of the MAT and the overall outcome of the MFIQ. One question on the MFIQ (about yawning) showed a moderate positive correlation of 0.569 (P = .002) and 0.416 (P = .034) for the MAT test and retest, respectively.

CONCLUSION

The MAT is an easy test to use in follow-up of patients. The test-retest reliability of this test is excellent in condylar trauma patients. As the validity of the MAT and the MFIQ could not be confirmed, the MFIQ may be an addition to patient's feedback about the rehabilitation process of their mandibular functioning.