Reliability of a Trapezium Miniplate with Endoscope-Assisted Internal Fixation in Mandibular Subcondylar Fractures: A Three-Dimensional Analysis.

Seungwook Jung,Ok Hyung Nam,Shavkat Dusmukhamedov,Chunui Lee,Yi-Qin Fang

doi:10.3390/jcm11010207

Seungwook Jung, Ok Hyung Nam + Show 3 more

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https://doi.org/10.3390/jcm11010207

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Abstract

This study aimed to evaluate the reliability of a trapezium plate for open reduction and internal fixation (ORIF) of mandibular subcondylar fractures with the simultaneous use of an endoscope. We selected and retrospectively studied 18 patients (12 males and 6 females) with unilateral mandibular subcondylar fractures who visited the Wonju Severance Christian Hospital. The mean age of the patients was 43.43 ± 15.76 years. Patients underwent ORIF with trapezium miniplate application through an intraoral incision under general anesthesia. The clinical and radiographic findings of the fractured side were compared with those of the non-operated side at 6 months follow-up. All occlusions became stable, and transient functional disturbances disappeared within 6 months of periodic follow-up. Functional mandibular movement recovered within the normal range, with an average mouth opening of 41.5 mm, protrusion of 7.5 mm, and lateral excursion of 7 mm at 6 months. Radiographic controls and statistical analysis confirmed a decent anatomical reduction in all 18 cases. In conclusion, the use of a trapezium miniplate with endoscope-assisted ORIF in mandibular subcondylar fractures can be useful for fixation and functional recovery.

Highlights

The optimal treatment protocol for open reduction and internal fixation (ORIF) of mandibular condylar and subcondylar fractures has been debated over decades
The plates were removed in all 18 patients, and no loose screws were found during removal; many of the patients had bone accumulation over the trapezium plate. 3.2
Radiographic findings confirmed proper anatomical reduction, and no permanent functional complications occurred in our patient cohort

Summary

Introduction

The optimal treatment protocol for open reduction and internal fixation (ORIF) of mandibular condylar and subcondylar fractures has been debated over decades. Many studies on condylar fracture surgery have introduced various surgical approaches to the condylar region, and verified that the intraoral approach has the least postoperative morbidity [1–3]. The application of miniplates fixed with screws is considered the gold standard for ORIF in mandibular surgery [4,5]. Numerous miniplate designs have been introduced during the past decades, and recently, their efficacies have been studied to examine biomechanical stability and surgical simplicity [6–9]. Previous biomechanical studies have confirmed the reliability of condyle fixation via two miniplates for subcondylar fractures for withstanding the compression and tension forces within physiological limitations. [12] demonstrated that the trapezoidal plate provided sufficient rigidity for the fixation of subcondylar fractures. Darwich et al [13] claimed that trapezoidal plates are superior to two miniplates

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