Abstract
The objective of rehabilitation after the treatment of a mandibular condyle fracture is to retrieve the effortless, symmetrical opening of the jaws with the preservation of appropriate movements to the sides, and appropriate occlusion without a sense of tension in the mastication muscles or pain sensations. The aim of the article was to establish the conditions of the rehabilitation of temporomandibular joint (TMJ) after the surgical treatment of a fractured condyle. The research featured 46 of patients treated surgically between January 2, 2017 and December 30, 2017. The open reduction and rigid internal fixation (ORIF) was the method mainly applied. Rehabilitation with the use of the Delphi technique was implemented in each patient. The assessment of the mastication organ was mostly performed at 3 and 6 weeks since the beginning of rehabilitation. In every patient, the interincisal distance was measured; in chosen cases, the range and trajectory of the condyle movements, and the trajectory of the secant point during jaw opening were defined with the use of the Zebris® JMA device. In 45 patients, a full reposition and immobilization of 52 bone fragments of fractured mandibular condyles was obtained. The displacement of the midline of the mandible in occlusion or an incorrect occlusion contact determined the decision on the application of intermaxillary fixation in 8 patients for a period of 2 weeks. The minimal jaw opening of 40 mm was achieved in 41 patients after 6 weeks of rehabilitation. In 5 of the rest of the patients, rehabilitation had to be continued. The reassessment of the X-ray images and additional computed tomography (CT) diagnosis in three-dimensional (3D) reconstruction in those patients revealed the possible causes of difficulties in the restoration of the stomatognathic system functions – the injuries of the muscles or ligaments connected with the joint. The extension of radiological diagnostics with a CT examination may improve the assessment of the restored TMJ function after the surgical treatment of a fractured mandibular condyle.
Highlights
The frequency of fractures within the area of the mandibular condyle is assessed to be over 30% of all mandible fractures, and their incidence is in the range of 20–62%.1–3 Mastering the surgical technique and enriching the range of tools with new solutions, including the endoscopic treatment of fractures, have resulted in a more frequent use of open plate osteosynthesis in the fracture treatment as compared to the 20th century
The reassessment of the X-ray images and additional computed tomography (CT) diagnosis in three-dimensional (3D) reconstruction in those patients revealed the possible causes of difficulties in the restoration of the stomatognathic system functions – the injuries of the muscles or ligaments connected with the joint
The extension of radiological diagnostics with a CT examination may improve the assessment of the restored temporomandibular joint (TMJ) function after the surgical treatment of a fractured mandibular condyle
Summary
The frequency of fractures within the area of the mandibular condyle is assessed to be over 30% of all mandible fractures, and their incidence is in the range of 20–62%.1–3 Mastering the surgical technique and enriching the range of tools with new solutions, including the endoscopic treatment of fractures, have resulted in a more frequent use of open plate osteosynthesis in the fracture treatment as compared to the 20th century. The choice of a treatment method depends on the type of fracture, the displacement of the condyle head after the injury, the possibility of the reconstruction of the tooth contact in the opposite arches in habitual occlusion, and the decision of a patient who had been presented with the benefits and possible implications of closed reduction and maxillomandibular fixation (CRMMF) or open reduction and rigid internal fixation (ORIF).[4–7]. Recommended rehabilitation techniques include, in addition to the auto-massage of the muscles involved in chewing, the introduction, at 2–3 days after surgery, of active jaw opening, the extension and mediotrusion of the jaw, performed by patients in front of the mirror to control the range and proper trajectory of movements. The objective of rehabilitation after the treatment of a mandibular condyle fracture is to retrieve the effortless, symmetrical opening of the jaws with the preservation of appropriate movements to the sides, and appropriate occlusion without a sense of tension in the mastication muscles or pain sensations
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