Digital diagnosis and treatment of mandibular condylar fractures based on Extensible Neuro imaging Archive Toolkit (XNAT).

Zhongwei Zhou,Yongqing Huang,Wei Tang,Weidong Tian,Mingyun He,Zhang’Ao Li,Jiayin Ren,Carlos M Isales

doi:10.1371/journal.pone.0192831

Abstract

ObjectivesThe treatment of condylar fractures has long been controversial. In this paper, we established a database for accurate measurement, storage, management and analysis of patients’ data, in order to help determine the best treatment plan.MethodsFirst of all, the diagnosis and treatment database was established based on XNAT, including 339 cases of condylar fractures and their related information. Then image segmentation, registration and three-dimensional (3D) measurement were used to measure and analyze the condyle shapes. Statistical analysis was used to analyze the anatomical structure changes of condyle and the surrounding tissues at different stages before and after treatment. The processes of condylar fracture reestablishment at different stages were also dynamically monitored. Finally, based on all these information, the digital diagnosis and treatment plans for condylar fractures were developed.ResultsFor the patients less than 18 years old with no significant dislocation, surgical treatment and conservative treatment were equally effective for intracapsular fracture, and had no significant difference for neck and basal fractures. For patients above 18 years old, there was no significant difference between the two treatment methods for intracapsular fractures; but for condylar neck and basal fractures, surgical treatment was better than conservative treatment. When condylar fracture shift angle was greater than 11 degrees, and mandibular ramus height reduction was greater than 4mm, the patients felt the strongest pain, and their mouths opening was severely restricted. There were 170 surgical cases with condylar fracture shift angel greater than 11 degrees, and 118 of them (69.4%) had good prognosis, 52 of them (30.6%) had complications such as limited mouth opening. There were 173 surgical cases with mandibular ramus height reduction more than 4mm, and 112 of them (64.7%) had good prognosis, 61 of them (35.3%) had complications such as limited mouth opening.ConclusionsThe establishment of XNAT condylar fracture database is helpful for establishing a digital diagnosis and treatment workflow for mandibular condylar fractures, providing new theoretical foundation and application basis for diagnosis and treatment of condylar fractures.

Highlights

Condylar fracture is the most frequent fracture of mandibular fractures, which often causes pain, swelling, fractured end dislocation, occlusal disorder, etc[1, 2]
For the patients less than 18 years old with no significant dislocation, surgical treatment and conservative treatment were effective for intracapsular fracture, and had no significant difference for neck and basal fractures
For patients above 18 years old, there was no significant difference between the two treatment methods for intracapsular fractures; but for condylar neck and basal fractures, surgical treatment was better than conservative treatment

Summary

Introduction

Condylar fracture is the most frequent fracture of mandibular fractures, which often causes pain, swelling, fractured end dislocation, occlusal disorder, etc[1, 2]. It has potential risk for the development of temporomandibular joint and children’s face[3]. Whether to use conservative treatment or surgery to treat condylar fractures has long been controversial[4]. We think that the selection of the treatment plan should base on large amounts of data and accurate measurements. The database can be used as the basis to establish the standardized evaluation system for the prognosis of condylar fractures

Objectives

Methods

Results

Conclusion