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Seok H, Ko SO, Baek JA, Leem DH. Coronoidectomy for reduction of superolateral dislocation of mandible condyle. J Korean Assoc Oral Maxillofac Surg 2022; 48:182-187. [PMID: 35770361 PMCID: PMC9247446 DOI: 10.5125/jkaoms.2022.48.3.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/15/2021] [Accepted: 06/28/2021] [Indexed: 11/07/2022] Open
Abstract
Superolateral dislocation of the condyle is a rare mandibular fracture. The treatment goal is to return the dislocated condyle to its original position to recover normal function. This study reports on superolateral dislocation of the condyle with mandibular body fracture. The mandibular body was completely separated, and the medial pole of the condyle head was fractured. The condyle segment was unstable and easily dislocated after reduction. The temporalis muscle on the condyle segment might have affected the dislocation of the condyle. A coronoidectomy was performed to disrupt the function of the temporalis muscle on the condyle segment in order to successfully reduce the dislocated condyle. Coronoidectomy is a simple procedure with minimal complications. We successfully performed a coronoidectomy to reduce the superolateral displaced condyle to its original position to achieve normal function. Coronoidectomy can be effectively used for reduction of superolaterally displaced condyles combined with severe maxilla-mandibular fractures.
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Affiliation(s)
- Hyun Seok
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Jeonbuk National University, Jeonju, Korea.,Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Seung-O Ko
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Jeonbuk National University, Jeonju, Korea.,Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Jin-A Baek
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Jeonbuk National University, Jeonju, Korea.,Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Dae-Ho Leem
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Jeonbuk National University, Jeonju, Korea.,Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
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Kende P, Wadewale M, Landge J, Desai H, Nadkarni S, Kri M. 'Temporomandibular joint hematoma nerve block'-a new technique in management of mandibular condylar fractures. Oral Maxillofac Surg 2021; 26:247-251. [PMID: 34241723 DOI: 10.1007/s10006-021-00987-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Management of mandibular condylar fracture has invited a great deal of controversy in maxillofacial trauma care. In the orthopaedic literature, surgeons have exhaustively described the use of a 'hematoma block' technique during closed reduction (CR) of the ankle or other long bone fractures. Post-traumatic ankylosis of the temporomandibular joint (TMJ) is due to development and progression of the intra-articular hematoma. We improvised their technique for use during CR of mandibular condylar fractures. The desirable effects which can be achieved with our proposed 'novel TMJ hematoma nerve block' technique are evacuating the accumulated hematoma, blocking auriculotemporal and masseteric nerves which in turn causes relaxation of the lateral pterygoid muscle, all in all, favouring accurate anatomical reduction of the fracture. METHOD Thirteen patients with isolated unilateral condylar fractures were subjected to our new technique. The parameters assessed were the amount of hematoma evacuated, pain in TMJ region during reduction and postoperative anatomic reduction on cone beam computed tomography (CBCT). RESULTS All the patients showed a significant reduction in pain and lowered post-reduction angulation between the proximal condylar and distal ramal segments. CONCLUSION Our technique is minimally invasive, safe, simple to perform, yielding excellent anatomic reduction of the fracture fragments.
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Affiliation(s)
- Prajwalit Kende
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, P D'Mello Road, Near CSMT, Fort, Mumbai, Maharashtra, 400001, India
| | - Maroti Wadewale
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, P D'Mello Road, Near CSMT, Fort, Mumbai, Maharashtra, 400001, India.
| | - Jayant Landge
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, P D'Mello Road, Near CSMT, Fort, Mumbai, Maharashtra, 400001, India
| | - Harsh Desai
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, P D'Mello Road, Near CSMT, Fort, Mumbai, Maharashtra, 400001, India
| | - Shambhavi Nadkarni
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, P D'Mello Road, Near CSMT, Fort, Mumbai, Maharashtra, 400001, India
| | - Mrimingsi Kri
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, P D'Mello Road, Near CSMT, Fort, Mumbai, Maharashtra, 400001, India
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Li MX, Xing X, Li ZB, Li Z. Classification and treatment strategies for condylar fractures in children. Br J Oral Maxillofac Surg 2020; 59:776-782. [PMID: 34127324 DOI: 10.1016/j.bjoms.2020.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 09/04/2020] [Indexed: 11/27/2022]
Abstract
In this study, we aimed to describe a classification method (position and displacement (PD) classification) and the corresponding treatment strategies for condylar fractures in children, based on the anatomical position and displacement of the fractures. Moreover, we aimed to explore the effect of the treatment strategies for condylar fractures in children. Such fractures were classified into the following three types by PD classification: condylar head fracture (type A), mildly displaced condylar neck and base fracture (type B), and severely displaced condylar neck and base fracture (type C). According to this classification, we proposed the corresponding treatment strategy of closed treatment for types A and B fractures and open treatment for type C fractures. Eighty-four patients who had 123 condylar fractures (type A = 97, type B = 16, type C = 10) were included in this study. Type A fractures showed the restoration of normal function with favourable remodelling in the condyles. Types B and C fractures had good function and symmetry in the condylar angle and height of the condylar neck. The PD classification and corresponding treatment strategies may serve as a better option for the clinical treatment of condylar fractures in children.
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Affiliation(s)
- M-X Li
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and the Key Laboratory of Oral Biomedicine Ministry of Education, Wuhan, China; The Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - X Xing
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and the Key Laboratory of Oral Biomedicine Ministry of Education, Wuhan, China; The Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Z-B Li
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and the Key Laboratory of Oral Biomedicine Ministry of Education, Wuhan, China; The Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Z Li
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and the Key Laboratory of Oral Biomedicine Ministry of Education, Wuhan, China; The Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China.
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Sridharan G, Panneerselvam E, Ponvel K, Tarun S, Krishna Kumar Raja VB. Maxillofacial trauma in a pregnant patient: Contemporary management principles with a case report & review of literature. Chin J Traumatol 2020; 23:78-83. [PMID: 32178998 PMCID: PMC7156954 DOI: 10.1016/j.cjtee.2020.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/21/2020] [Accepted: 02/03/2020] [Indexed: 02/04/2023] Open
Abstract
Trauma during pregnancy deserves special attention because of its management objectives, i.e. well-being of both pregnant woman and foetus. Maxillofacial trauma directly affects the nutrition of foetus by interfering with the normal functions in a pregnant woman such as mouth opening, mastication and breathing. Hence early restitution of form and function of maxillofacial skeleton is essential. However, the gravid status is associated with numerous anatomical and physiological changes which present with clinical dilemma related to imaging and treatment. A careful scrutiny of the patient's systemic and gestational status is absolutely essential before, during and after instituting any interventional procedures. We present a case of bilateral condyle fracture in a 30-year-old pregnant woman in the third trimester (32 weeks). She was treated with inter maxillary fixation using orthodontic brackets & elastics. After successful restitution of occlusion, the patient was advised aggressive physiotherapy which ensured normal mouth opening. Two weeks later, the patient delivered uneventfully. The patient was followed up at one month and 3 month and demonstrated restitution of normal occlusion, mouth opening and lower facial height. This article aims at analyzing the contemporary principles in management of maxillofacial trauma in a pregnant woman and clarifying the common misconceptions.
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Affiliation(s)
- Geetha Sridharan
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai 600089, Tamil Nadu, India
| | - Elavenil Panneerselvam
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai 600089, Tamil Nadu, India.
| | - Keerthana Ponvel
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai 600089, Tamil Nadu, India
| | - Swetha Tarun
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai 600089, Tamil Nadu, India
| | - V B Krishna Kumar Raja
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai 600089, Tamil Nadu, India
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Revanth Kumar S, Sinha R, Uppada UK, Ramakrishna Reddy BV, Paul D. Mandibular Third Molar Position Influencing the Condylar and Angular Fracture Patterns. J Maxillofac Oral Surg 2015; 14:956-61. [PMID: 26604470 DOI: 10.1007/s12663-015-0777-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 02/28/2015] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The aim of this study was to assess the influence of position of mandibular 3rd molar on angle and condylar fractures. MATERIALS AND METHODS Panoramic radiographs were used to determine the mandibular fracture patterns based on the presence or absence of the third molar. RESULTS Of the 64 patients with mandibular fractures, condyle and angle fractures were found to be 67 and 33 % respectively. The greatest percentage (75 %) of condylar fractures were associated with erupted third molar teeth, and 25 % had impacted teeth. Subcondylar region was found to be the most common site that predisposes to fracture. Moderate force lead to condylar fracture when third molar is erupted or absent and mild force showed angle fracture when third molar is impacted. Increased incidence of angle fracture was observed when tooth is in mesioangular and distoangular position. CONCLUSION Impacted mandibular 3rd molar leads to an increased risk of angle fracture and decreased risk of condylar fracture especially when they are more deeply seated.
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Affiliation(s)
- S Revanth Kumar
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana India
| | - Ramen Sinha
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana India
| | - Uday Kiran Uppada
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana India
| | - B V Ramakrishna Reddy
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana India
| | - Dushyanth Paul
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana India
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Abstract
Condyle fractures are a common injury, but only a few of these injuries require immediate or late reconstruction. The complications that most frequently necessitate condylar reconstruction include proximal segment degeneration, malunion, and ankylosis. Costochondral grafts and total joint prostheses, both stock and custom, remain the most common methods of reconstruction. Reconstruction plates with condylar extensions should only be used temporarily as an unacceptable number cause serious complications. Distraction osteogenesis may have an occasional role in reconstructing the posttraumatic condyle.
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Affiliation(s)
- Ben Davis
- Department of Oral and Maxillofacial Sciences, Dalhousie University, Halifax, NS B3H 1W2, Canada.
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