Identification of malocclusion risk factors after closed treatment of condylar fractures using a novel three-dimensional computed tomography approach

Can dynamic elastic therapy be established as the standard protocol of closed reduction for moderately displaced extracapsular condylar fractures?

OBJECTIVE

This study was conducted with the aim to establish standard technique of closed reduction (CR) and compare functional outcomes in patients of moderately displaced unilateral extracapsular condylar fractures.

MATERIAL AND METHODS

This study is a retrospective randomized controlled trial, conducted at a tertiary care hospital setting from August, 2013 to November, 2018. Patients of unilateral extracapsular condylar fractures with ramus shortening < 7mm and deviation < 35° were divided in two groups by drawing lots and were treated by dynamic elastic therapy and maxillomandibular fixation (MMF). Mean and standard deviation were calculated for quantitative variables, and one way analysis of variance (ANOVA) and Pearson's Chi-square test were used to determine significance of outcomes between two modalities of CR. P value < 0.05 was taken as significant.

RESULTS

The numbers of patients treated by dynamic elastic therapy and MMF were 76 (38 in each group). Out of which 48 (63.15%) were male and 28 (36.84%) were female. The ratio of male to female was 1.7:1. The mean ± standard deviation (SD) of age was 32 ± 9.57 years. In patients treated by dynamic elastic therapy, the mean ± SD (at 6-month follow-up) of loss of ramus height (LRH), maximum incisal opening (MIO) and opening deviation were 4.6mm ± 1.08mm, 40.4mm ± 1.57mm and 1.1mm ± 0.87mm respectively. Whereas, LRH, MIO and opening deviation were 4.6mm ± 0.85mm, 40.4mm ± 2.37mm and 0.8mm ± 0.63mm respectively by MMF therapy. One-way ANOVA was statistically insignificant (P value > 0.05) for above mentioned outcomes. Pre-traumatic occlusion was achieved in 89.47% of patients by MMF and in 86.84% patients by dynamic elastic therapy. Pearson's Chi-square test was statistically insignificant (p value < 0.05) for occlusion.

CONCLUSION

Parallel results were obtained for both modalities; thus, the technique as dynamic elastic therapy, which promotes early mobilization and functional rehabilitation, can be favored as standard technique of closed reduction for moderately displaced extracapsular condylar fractures. This technique eases patients' stress associated with MMF and prevents ankylosis.

Evaluation and Prediction of Healing Morphology After Closed Reduction for Unilateral Mandibular Condyle Fractures: A Retrospective Study

Although closed reduction is common for condylar fractures, bone fragments may heal improperly. This study aimed to investigate the healing morphology of unilateral condylar fractures. We retrospectively investigated 70 patients with unilateral condylar fractures. Clinico-statistical analyses were performed on the whole-condylar fracture, closed reduction, and observation/functional therapy groups. Among these patients, 52 patients aged older than 16 years underwent closed reduction. The extent of maximum mouth opening, the incidence of malocclusion, and the relationship between healing morphology and Arbeitsgemeinschaft für Osteosynthesefragen classification or trismus were analyzed in the closed reduction group. There were significant differences in age (P=0.008) and sex (P=0.025) between the closed reduction and observation/functional therapy groups. However, there were no significant differences in trauma etiologies and concomitant fractures between the 2 groups. The average maximum mouth opening extent for unilateral fractures after closed reduction was 42.6±6.1 mm. Only 1 case (2.1%) of post-treatment malocclusion was observed. In all the MacLennan classification of deviation or more, regardless of the classification, upper fractures (head and upper neck) tended to heal through a spherical (P<0.001) morphology, whereas lower fractures (lower neck and subcondylar) tended to heal through an L-shaped and lateral fusion (P<0.001). There was no significant difference in the incidence of trismus between the healing morphology of unchanged type and others (P=0.690). Our results elucidated the etiology, dysfunction, and healing morphology classification of unilateral mandibular condyle fractures treated with closed reduction.