Bilateral Condylar Fractures Research Articles

The Periarticular Pelvic Clamp: An Indispensable Aid to Assist in the Narrowing of Facial Width in Mandibular Trauma.

Symphyseal fractures of the mandible with concomitant bilateral condylar fractures can often be a particularly challenging fracture pattern for the facial surgeon. Improper reduction of these fractures may lead to facial widening that proves difficult to correct secondarily. Here the authors describe a method to prevent this unwanted facial widening with the use of an orthopedic periarticular reduction clamp. This method allows for not only increased ease of reduction but also reduces the burden of assistance in manual reduction of the fracture.

Electromyographic Study of Facial Nerve Function Using Two Different Surgical Approaches in Low Condylar Fractures of the Mandible: A Randomized Controlled Clinical Trial

Facial nerve (FN) dysfunction is a potential complication during open reduction of mandibular condylar fractures. The purpose of this study was to measure and compare the postoperative FN function following transparotid (TP) and transmasseteric anterior parotid (TMAP) operative approaches in open reduction and internal fixation of condylar fractures using electromyogram. A randomized controlled clinical trial was designed. The study was conducted in a single tertiary-care hospital in the inpatient setting. Patients aged above 18years with unilateral condylar fracture of the jaw or bilateral condylar fractures undergoing surgery on only 1 side were included. Patients were excluded if they had fractures of the head, bilateral condylar fractures with surgery planned on both sides, a previous history of surgery in the retromandibular area, existing lacerations to approach condyle, preoperative signs of FN weakness, or a history of parotid surgery. The predictor variable was the operative approach and the subjects were allocated randomly to TMAP and TP. The primary outcome variable was postoperative FN function in the surgical approach employed using the House-Brackmann scale and electromyography (EMG) to record any subtle weakness in nerve function. The FN function is recorded at 3 time intervals postoperatively 1week (T1), 1month (T2), and 3months (T3). The secondary outcomes studied were operating time and any other complications recorded. Age, sex, fracture pattern with classification of condylar fractures into condylar neck or base fractures according to Loukata etal.4 Any associated fracture of mandible describing the anatomical location viz symphysis and parasymphysis (anterior mandible), body, contralateral condyle or greater than 1 associated fracture were recorded. Similarly, the presence or absence of any associated midface fracture was also recorded to suggest that the study participants were homogenous in all aspects. Analytical statistics included χ2 test, t-test, and repeated measures ANOVA followed by post hoc test to compare EMG data (mean power and mean amplitude) between 2 operative approaches (TP vs TMAP) for facial muscles including frontalis, oculi, and buccinator at different time intervals (T0, T1, T2, T3). Patients within each group were also analyzed to check for nerve recovery occurring during the follow-up period. The level of significance was set at P<.05. The study sample was composed of 22 patients with a mean age of 32.82±11.21years in TMAP and 27.82±8.54years in the TP group respectively (P=.26); male predominance of 81.8 and 90.9% in TMAP and TP group respectively (P=.53) was noted. The FN deficit as assessed by the House-Brackmann scale clinically, was at 54% (T1), 36.4% (T2), and 9.1% (T3) for the TP group and 27% (T1),9% (T2), and 0% (T3) for TMAP group; however, the results were statistically insignificant (P=.31). In surface EMG evaluation, the mean power for the frontalis muscle was significantly higher in the TMAP approach at the T3 time (105.03±9.7 vs 89.56±10; 95% confidence interval -24.28 to -6.65 with P value=.002). TP approach was faster with a mean exposure time of 9.9minutes. The results show that both approaches give comparable long-term results with the TMAP group showing better frontalis muscle activity.

RE-TREATMENT OF MISMANAGED BILATERAL CONDYLAR FRACTURE AND POST-SURGICAL COMPLICATION

Introduction: Improper management of condyle fractures can lead to changes in the structure of the temporomandibular joint, which can impact the patient's oral function. Corrective surgery is necessary to restore the patient's function and quality of life. This case report aims to discuss the procedure of bilateral condylectomy in neglected condylar fracture, as well as the risks and post-operative complication management. Case: A 26-year-old female patient presented with mandibular hypomobility and occasional temporomandibular pain. The patient had history of a traffic accident around four months ago, and was managed in a public hospital but symptoms persisted. Case Treatment: After thorough examinations, the patient was diagnosed with neglected complete bilateral condylar fracture with displacement and managed via bilateral condylectomy. Post-operative, the patient presented with anterior open-bite and facial paralysis on the right side, and was treated accordingly. During 4-month follow-up, complications and chief complaints had all subsided. Discussions: Mismanagement of condylar fracture could result in malunion of fragments, which is difficult to reposition due to the changes that have already occurred in the temporomandibular structure. Condylectomy is often necessary to relieve symptoms, although bilateral condylectomy poses certain neurological risks. Prompt recognition and intervention of nerve injury is important to prevent permanent complication. Conclusion and Suggestions: Condylectomy could properly treat neglected bilateral condylar fracture in adult patients. Operators must know the associated risk and management of post-operative complications.

The use of orthodontics in the management of a bilateral condylar fracture in a child

Mandibular fractures in children are different to those in adults. Greenstick fractures are more commonplace, and displacement less frequently encountered. They are mostly treated conservatively; however, if the occlusion is altered, then reduction will be required. Closed reduction is normally favoured in children because open surgical reduction and internal fixation may impair future growth. Closed reduction is often carried out with arch bars or splints. These may be traumatic and painful for the child. This case report describes the case of a 12-year-old boy who presented with bilateral condylar fractures with displacement and deranged occlusion. Minimal fixed appliance treatment was used to reduce the fractures and restore him to his pre-injury occlusion. CPD/Clinical Relevance: Minimal orthodontic treatment can be used to reduce a bilateral condylar fracture with displacement in paediatric mandibular fractures.

Five-Segment Mandibular Osteotomy: A Novel Approach to the Correction of Complex Post-Traumatic Mandibular Deformities.

Post-traumatic mandibular malocclusion is a complex condition that poses a significant challenge to reconstructive surgeons. The malocclusion that ensues from bilateral condylar and parasymphseal fractures presents a particular challenge as it leads to bilateral posterior shortening and lingual tilting of dental arch leading to a combination of open anterior bite, crossbite, overbite, underbite, and/or facial asymmetry. The complexity of such malocclusion requires intricate freedom of movement of the mandibular arch that can be achieved by performing a 5-segment mandibular osteotomy. This is a case series of 9 adult patients with significant post-traumatic mandibular malocclusion who were treated with 5-segment mandibular osteotomy technique. This article details the demographics, surgical technique and outcomes in this cohort of patients. All 9 patients in this series had condylar fracture as part of the index mandibular trauma. They have a common post-traumatic deformity of the mandibular arch due to shortening of the vertical mandibular height in the fracture site and variable degrees of lingual tilting leading to crossbite. The 5-segment mandibular osteotomy provided an adequate correction of dental and facial deformities in all 9 patients. One patient had a relapse of the dental malocclusion that required postoperative rescue orthodontics. Furthermore, one patient had a significant postoperative hemorrhage that required a facial artery ligation. Post-traumatic mandibular malocclusion is a complex deformity that poses a great challenge to practicing surgeons. Five-segment mandibular osteotomy is a technique that provides ample degrees of movement of mandibular segments that is necessary to correct such deformity.

The “low preauricular” transmasseteric anteroparotid (TMAP) technique as a standard way to treat extracapsular condylar fractures

Condylar fracture treatment is a debated topic among maxillofacial surgeons. Various surgical techniques are used today, each one with advantages and disadvantages. The aim of this study is to present and evaluate our technique adopted for treatment of any type of extracapsular condylar fractures.Between 2020 and 2022, 16 condylar fractures were treated. In two patients with bilateral condylar fractures, the present technique was compared to the mini-retromandibular approach. All the patients were checked for clinical and radiological outcomes, facial nerve injury, scar visibility and presence of salivary complications.Dental occlusion was always restored, and facial nerve damage or salivary disorders were not observed. The skin incision, limited to the caudal two-thirds of the auricle, made the scar almost invisible and greatly improved the surgical field in the condylar neck area, facilitating the treatment.The proposed technique provides easier internal fixation for both neck and base condylar fractures with good cosmetic results, ensuring better protection of the facial nerve and parotid gland.The surgical technique described has not shown disadvantages in terms of operational difficulty, results, and complications. This novel surgical technique could represent a new choice in the treatment of extracapsular condylar fractures, although further studies are needed to support this new proposal.

Conservative management of mandibular fractures in pediatric patients during the growing phase with splint fiber and ligature arch wire

PurposeThe purpose of this article is to discuss the effective management of mandibular fractures in pediatric patients during the growing phase of the mandible using splint fiber and ligature wire.MethodsA retrospective study examined pediatric patients with mandibular fractures who were treated using the splint (Quartz) fiber and ligature wire technique at the Stomatology Hospital of Xi’an Jiaotong University from August 2021 to January 2023. Data on gender, age, location or site of the fracture, and development of tooth stage were collected from the patient’s medical records. Descriptive statistics were used to analyze the data and evaluate the effectiveness of the splint (Quartz) fiber technique for treating mandibular fractures in pediatric patients.ResultsOut of 256 subjects, 6 pediatric patients with mandibular fractures were selected, resulting in an incidence rate of 2.34% with an equal sex ratio. Mental or symphysis fracture was the most common site for fracture in children, accounting for 100% of cases. Right mandibular angle fracture was observed in 16.7% of patients, while 50% of the group (3 individuals) suffered from left condylar fracture and 16.7% had a bilateral condylar fracture. Treatment with Quartz splint fiber and circumdental arch wiring using ligature wire was successful with no observed post-treatment complications or malocclusion. The splint fiber was worn for 30 days and the circumdental arch wiring was for the same. Healing of bone fracture yields good results after 12 weeks. Follow-up care is crucial to monitor for complications, in this study, no post-treatment complications were observed.ConclusionThe treatment of pediatric mandibular fractures is complex and requires careful consideration of various factors. Conservative management should be the first choice, with open reduction and internal fixation reserved for specific cases. The use of quartz splint fiber and ligature wire is an effective treatment option for stabilizing the mandible and providing occlusal stability in growing children. A fiber splint along with ligature wire can also be used as an alternative treatment to avoid any adverse effects on the growth and development of the mandible and permanent teeth. A multidisciplinary approach is essential to achieving the best outcomes for pediatric patients with mandibular fractures.

Control of Mandibular Width With 3D Printed Occlusal Splint in Children With Multiple Mandibular Fractures.

The fracture of mandibular symphysis combined with bilateral condylar fractures often leads to changes in the width of the mandible, which significantly widens the face of the child. Therefore, it is necessary to reposition the mandible through accurate adduction. To ensure that the mandible can be accurately repositioned, a 3D printed occlusal splint was used. Bilateral maxillomandibular fixation screws were implanted. The 3D printed occlusal splint was located on the maxillary dentition and fixed to the maxillomandibular fixation screws with wire loops. The reference basis for adduction is to make the mandibular dentition located in the occlusal splint. The absorbable plate was contoured according to the restored model and fixed at the fracture site. The 3D printed occlusal splint was retained in the maxillary dentition for two months. Postoperative computed tomography showed that the mandible had been adducted according to the preoperative design. Two months of follow-up showed that the child's facial development, mouth opening type, occlusion, and range of motion were good. It is especially suitable for children with mandibular symphyseal fractures accompanied by bilateral condylar fractures.

Unilateral Severe Condylar Resorption Following Internal Fixation in Bilateral Mandibular Condylar Fracture

Study Design Case Report Objective: A severe condylar resorption following internal fixation of the mandibular condylar fracture is rarely reported. Methods A 35-year-old female caused bilateral condylar base fracture due to fall. She had no connective tissue autoimmune disease, no temporomandibular joint (TMJ) problems, and no history of the orthodontic treatment. Each fractures of condyles were fixed by 2 none-locking titanium miniplates on ideal lines of the osteosynthesis. Results: 6 months after surgery, although patient showed no malocclusion and no TMJ pain, panoramic X-ray showed left side condylar head resorption. Twelve months after surgery, bilateral plate removal was performed. Twenty-six months after internal fixation, panoramic X-ray showed bone formation at the left side of the condylar head. Magnetic resonance imaging of the TMJ showed left TMJ disc displacement without reduction and severe deformity of the left condylar head. Conclusions The condylar resorption might be caused by increasing functional loading due to new position of the condyle following osteosynthesis. Possible contributors for condylar resorption following osteosynthesis were: (1) internal fixation in bilateral condylar fracture, (2) disc displacement without reduction, and (3) female patient (hormonally-mediated theory, eg estrogen). However, the mechanize of condylar resorption was unclear and the further studies were necessary.

The Comparison of Functional Outcomes in Patients With Unilateral or Bilateral Intracapsular Mandibular Condylar Fractures After Closed or Open Treatment: A 10-Year Retrospective Study.

The treatment strategies for mandibular condylar head fractures, also known as intracapsular condylar fractures (ICFs), have not been concluded. We humbly present our treatment outcomes and share our experience in our department. The aim of this study was to compare the functional outcomes between closed reduction (CR) and open reduction and internal fixation (ORIF) for management of unilateral or bilateral ICFs. This 10-year retrospective cohort study included 71 patients with 102 ICFs who were treated in our department from May 2007 to August 2017. Nine patients mixed with extracapsular fractures were excluded; thus, 62 patients with 93 ICFs were included. All patients received treatment by the senior surgeon in Chang Gung Memorial Hospital, Linkou Branch, Taiwan. The patient's basic data, fracture morphologies, associated injuries, managements, complications, and maximal mouth opening (MMO) measurement at 1, 3, 6, and 12 months postoperative were reviewed for analysis. Among the 93 fractures, 31 (50%) were bilateral and 31 were unilateral (50%). Based on He's classification, 45 (48%) had type A fracture, 13 (14%) had type B, 5 (5%) had type C, 20 (22%) had type M, and 10 (11%) had no displacement. Maximal mouth opening of 37 mm in unilateral cases after 6 months was significantly higher than the 33-mm MMO in bilateral cases. In addition, the MMO in the ORIF group was significantly higher than that of the CR group in 3 months postoperative. Univariate (odds ratio, 4.92; P = 0.01) and multivariate (odds ratio, 4.76; P = 0.027) analyses revealed CR as an independent risk factor for trismus development compared with ORIF. Malocclusion was observed in 5 patients in both CR and ORIF groups. In addition, 1 patient developed temporomandibular joint osteoarthritis in the CR group. No surgical-related temporary or permanent facial nerve palsy was observed. Open reduction and internal fixation for condylar head fracture provided better recovery in MMO than CR, and the MMO recovery was less in bilateral condylar head fracture than unilateral condylar head fracture. Open reduction and internal fixation in ICFs have a lower risk for trismus development and should be the treatment of choice in selected cases.

A Case of Conservative Treatment for Bilateral Condylar Process Fractures with Good Remodeling in an 11 Year 9 Month Old Girl

A Case of Conservative Treatment for Bilateral Condylar Process Fractures with Good Remodeling in an 11 Year 9 Month Old Girl

CONTRECOUP INJURY TO THE MANDIBLE – A CASE REPORT

Direct blow to the chin causes the hunting bow effect and transmits the blow to the condyle causing them to fracture. This is called as the contrecoup injury of the mandible. This report presents a case of 26-year-old male with left parasymphysis and bilateral condylar fracture. The treatment protocol followed was open reduction and internal fixation of left parasymphysis &amp; right condylar fracture and closed reduction of left condylar fracture. In post-operative period, the patient did not experience any trismus, infection, sialocoele or wound dehiscence.

Treatment of pediatric bilateral condylar fractures: A comprehensive analysis

Pediatric bilateral condylar fractures (PBCF) is a rare clinical pathology, where the management is carried out with both conservative and surgical approaches. The purpose of this study was to analyze and compare these two treatment approaches and their associated long term complications in PBCF. An extensive literature review- through the search of online databases- was conducted to survey, collect, analyze and compare the reported outcomes of different treatment modalities for PBCF. The number of studies presenting PBCF case reports was 16, while the number of such retrospective studies included here was 19. Analyses of these studies revealed that the conservative treatment is preferred in PBCF patients younger than 12 years of age. Moreover, a composite approach where the open reduction and internal fixation (ORIF) is carried out for one side while the intermaxillary fixation (IMF) for the contralateral side is frequently reported for the management of PBCF cases; this approach appears effective in improving daily functioning of temporomandibular joint and reducing long term complications. Performing ORIF for one side while IMF for the contralateral side seems the most common treatment approach in PBCF. This study may help in rapid decision making for treatment selection of PBCF patients while minimizing the risk for late complications.

Retrospective clinical study of mandible fractures

BackgroundAs society becomes more complex, the incidence of mandibular fractures is increasing. This study aimed to analyze the incidence and type and identify etiological factors of mandibular fractures to use them in future treatments.Material and methodsData were collected from 224 patients who visited the department of oral and maxillofacial surgery at the Kyung Hee Medical Center dental hospital during a 6-year period (2016 to 2021). A logistic regression model was used for data analysis.ResultsIn a total of 224 patients, 362 fractures were appeared. The average age of the patients was 34.1 years, with the highest incidence in the 20s. And the ratio between male and female was 4.09:1. Symphysis fractures were the most prevalent of all patients (52.7%), followed by unilateral condyle (37.1%), angle (36.2%), bilateral condyle (9.4%), body (8%), and coronoid (2.2%). The most common cause of fracture was daily-life activity (57.6%), followed by violence (30.4%), traffic accidents (8.5%), and syncope (3.6%). Patients with symphysis fracture were at low risk (OR < 1) of angle, body, and unilateral condyle fractures. Similarly, patients with unilateral fracture were at low risk (OR < 1) of symphysis, angle, body, and others site fractures. In contrast, patient with bilateral condyle fracture were at high risk (OR > 1) of coronoid fractures. And younger patients were high risk of mandibular angle fractures.ConclusionThrough this study, it was confirmed that etiological factors of mandibular fractures were like those of previous studies.

Considering guardsman fracture as a differential in mandibular injuries

A guardsman fracture is characterized by bilateral condylar fractures in combination with a parasymphyseal fracture and is usually seen in epileptics and elderly patients due to fall on the chin. The utility of plain radiographs in identification of guardsman fracture is limited. Computed tomography scan, including three-dimensional reconstruction, allows better visualization of the temporomandibular joint (TMJ) without superimposition of the bony structures as well as assessment of condylar fracture position, angulation, and any fractured dislocation of the condylar head. Early identification and appropriate evaluation of this condition by the emergency physicians and trauma surgeons is important to guide the maxillo-facial surgeons to determine the appropriate treatment modality and timing of surgery and to avoid subsequent complications from an injury to the TMJ complex.

Clinical comparison between bilateral and unilateral mandibular condyle fractures combined with symphysis fractures – A retrospective study

ObjectiveEffective treatment strategies for a mandibular fracture, especially a condylar fracture, have yet to be established. The purpose of the present study was to examine characteristics and treatment management practices to compare between bilateral and unilateral condyle fractures combined with a symphysis fracture. MethodsThis retrospective study included 30 patients with a mandibular condyle fracture combined with a symphysis fracture. They were divided into the unilateral and bilateral condyle fracture groups. Variables noted included fracture etiology, fracture sites, treatment methods, and functional evaluations. ResultsIn patients with a mandibular condyle fracture combined with a symphysis fracture, the most common cause of injury was a fall. High condyle fractures accounted for the majority of bilateral fracture cases, with low condyle fractures seen in the majority of those with a unilateral fracture. Moreover, in the bilateral fracture group, in not only patients with a low condyle fracture but also those with a high condyle fracture, ORIF was performed on at least one side, with IR used for the other side, resulting in early postoperative recovery of range of mouth opening and reduction in temporomandibular joint pain. ConclusionThe results of the present study indicated that while the causes were common, condyle fracture sites differed between cases with a bilateral and those with a unilateral condyle fracture when combined with a symphysis fracture. The findings in the present study suggest that treatment with a combination of ORIF and IR may be better for obtaining good functional recovery in the bilateral fractures pattern.

Virtual surgical planning is a useful tool in the surgical management of mandibular condylar fractures

PurposeThe aim of this study is to evaluate the application value of virtual surgical planning in the management of mandibular condylar fractures and to provide a reliable reference. MethodsThis was a prospective randomized controlled study and recruited 50 patients requiring surgical treatment for their mandibular condylar fractures. The inclusion criteria were patients (1) diagnosed with a condylar fracture by two clinically experienced doctors and required surgical treatment; (2) have given consent for the surgical treatment; and (3) had no contraindications to the surgery. Patients were excluded from this study if: (1) they were diagnosed with a non-dislocated or only slightly dislocated condylar fracture; (2) the comminuted condylar fracture was too severe to be treated with internal reduction and fixation; or (3) patients could not complete follow-up for 3 months. There were 33 male and 17 female patients with 33 unilateral condylar fractures and 17 bilateral condylar fractures included. The 50 patients were randomly (random number) divided into control group (25 patients with 35 sides of condylar fractures) and experimental group (25 patients with 32 sides of condylar fractures). Virtual surgical planning was used in the experimental group, but only clinical experience was used in the control group. The patients were followed up for 1, 3, 6 and 12 months after operation. Variables including the rate of perfect reduction by radiological analysis, the average distance of deviation between preoperative and postoperative CT measurements using Geomagic software and postoperative clinical examinations (e.g., mouth opening, occlusion) were investigated for outcome measurement. SPSS 19 was adopted for data analysis. ResultsThe average operation time was 180.60 min in the experimental group and 223.2 min in the control group. One week postoperatively, CT images showed that the anatomic reduction rate was 90.63% (29/32) in the experimental group and 68.57% (24/35) in the control group, revealing significant difference (X2 = 4.919, p = 0.027). Geomagic comparative analysis revealed that the average distance of deviation was also much smaller in the experimental group than that in the control group (0.639 mm vs. 0.995 mm; t = 3.824, p < 0.001). ConclusionThese findings suggest that virtual surgical planning can assist surgeons in surgical procedures, reduce operative time, and improve the anatomic reduction rate & accuracy, and thus of value in the diagnosis and treatment of condylar fractures.

Assessment of Clinical Outcomes in Open Reduction and Internal Fixation of Mandibular Condyle Fractures Compared to Closed Treatment

Statement of the problemThe clinical decision to pursue open reduction and internal fixation (ORIF) vs. closed treatment (CT) to treat mandibular condyle fractures has been long contested but predicated on understanding of absolute and relative indications and contraindications. This meta-analysis critically appraised the literature to compare and contrast clinical outcomes following these interventions. Materials and methodsA systematic review and meta-analysis were performed to test the null hypothesis of no difference in clinical outcomes in ORIF vs. CT of mandibular condyle fractures. ORIF also was compared to endoscopically assisted open treatment. The PubMed, EMBASE, Cochrane Library, Elsevier text mining tool database and ClinicalTrials.gov trial registries were accessed from 1946 to 2020. The quality of evidence was determined using Grading of Recommendations Assessment, Development and Evaluation methodology. No pediatric studies were included. The quality of evidence was downgraded due to risk of bias and imprecision in specific outcomes in observational studies. Data analysisTwo authors extracted the following data from included studies: country of origin, study design, study period, number of patients, patient characteristics (i.e., age range, gender, ethnicity), fracture laterality (unilateral vs. bilateral), treatment used (CT vs. ORIF), and clinical outcomes. The study analyzed the data separately according to fracture location and study design (e.g., RCTs and observational studies). An experienced medical librarian was consulted on methodology and ran a medical subject heading (MeSH) analysis of known key articles provided by the research team to ensure complete capture of all articles pertaining to management of condylar fractures. In each database, the study ran scoping searches and used an iterative process to translate and refine the searches. Results and outcomes dataOf 1507 screened articles, 14 met the inclusion criteria. There were 4 meta-analyses that were included, examining 7 randomized controlled (RCTs) trials and 31 non-randomized studies. Primary studies enrolled adults with displaced uni- or bilateral condylar fractures and did not report the results by fracture location (e.g., subcondylar or condylar) except with 2 RCTs that included all adults with subcondylar fractures. Primary studies compared the outcomes after open surgical procedure with those of fixation using 1 or 2 miniplates with various diameters. Open reduction and internal fixation were favored significantly when evaluating temporomandibular joint pain (RR 0.3; 95% CI 0.1-0.7) (NNTp 3; 2-6), laterotrusive movements of the mandible (MD 2.3; 1.7-3.0) (SMD 0.9; 0.4-1.3), and malocclusion (RR 0.5; 0.4-0.7) (NNTp 19; 10-200). However, open treatment yielded higher incidence of postoperative infection (RR 3.6; 95% CI 0.9-13.8). With respect to ORIF versus endoscopically assisted open treatment, no difference was seen in overall patient satisfaction with postoperative mandibular movement, disturbance to articulation, or occlusion. ConclusionMeta-analysis of high-level evidence in randomized controlled trial data suggests ORIF yields significantly superior clinical outcomes when evaluating restoration of translational and rotational mandibular movement, alleviation of pain, and restoration of occlusion and symmetry, although it is associated with higher risk of postoperative infection and facial nerve injury. These long-term benefits must be weighed against the increased risk of postoperative infection in ORIF; thus, treatment should be patient-specific. Future investigations with high-level evidence may further elucidate the relative effectiveness and safety of various open, endoscopic, and closed techniques in patients with facial trauma.

The Use of Titanium 3D Mini-Plates in the Surgical Treatment of Fractures of the Mandibular Condyle: A Systematic Review and Meta-Analysis of Clinical Trials.

Introduction: Fixing fractures of the base and neck of mandibular condyles is demanding due to the difficulties in surgical access and the various shapes of bone fragments. Classic fixation techniques assume the use of straight mini-plates, utilized for other craniofacial bone fractures. Three dimensional mini-plates may provide a reasonable alternative due to their ease of use and steadily improved mechanical properties. The multitude of different shapes of 3D mini-plates proves the need for their evaluation. Aim: This paper aims to summarize the clinical trials regarding the use of various types of 3D condylar mini-plates in terms of need for reoperation and the incidence of loosening and damage to the osteosynthetic material. Materials and Methods: A systematic review was conducted in accordance with PICOS criteria and PRISMA protocol. The risk of bias was assessed using ROBINS-I and RoB 2 Cochrane protocols. The obtained data series was analyzed for correlations (Pearson’s r) respecting statistical significance (Student’s t-test p > 0.05) and visualized using OriginLab. Results: 13 clinical trials with low overall risk of bias regarding 6 shapes of 3D mini-plates were included in the synthesis. The number of reoperations correlates with the number of fixations (r = 0.53; p = 0.015) and the total number of screw holes in the mini-plate (r = −0.45; p = 0.006). There is a strong correlation between the number of loosened osteosynthetic screws and the total number of fractures treated with 3D mini-plates (r = 0.79; p = 0.001 for each study and r = 0.99; p = 0.015 for each mini-plate shape). A correlation between the percentage of lost screws and the number of distal screw holes is weak regarding individual studies (r = −0.27; p = 0.000) and strong regarding individual mini-plate shape (r = −0.82; p = 0.001). Three cases of 3D mini-plate fractures are noted, which account for 0.7% of all analyzed fixation cases. Discussion: The reasons for reoperations indicated by the authors of the analyzed articles were: mispositioning of the bone fragments, lack of bone fragment union, secondary dislocation, and hematoma. The known screw loosening factors were poor bone quality, bilateral condylar fractures, difficulties in the correct positioning of the osteosynthetic material due to the limitations of the surgical approach, fracture line pattern, including the presence of intermediate fragments, and mechanical overload. Fractures of the straight mini-plates fixing the mandibular condyles amounts for up to 16% of cases in the reference articles. Conclusions: There is no convincing data that the number of reoperations depends on the type of 3D mini-plate used. The frequency of osteosynthetic screw loosening does not seem to depend on the 3D mini-plate’s shape. Clinical fractures of 3D mini-plates are extremely rare.

Long-term Complications of Isolated and Combined Condylar Fractures: A Retrospective Study.

Fractures of the mandibular condyle are a common injury in maxillofacial trauma. Both conservative treatment (i.e., analgesic therapy and soft diet) and intermaxillary fixation (IMF) or open reduction internal fixation (ORIF) have satisfactory and functional outcomes, though severe late-onset complications have been reported. We compared the long-term complications of patients with condylar fractures treated conservatively, with IMF, or with combined ORIF and IMF. We retrospectively analyzed all patients diagnosed with unilateral or bilateral condylar fracture, isolated or combined with a fracture of the mandibular body, admitted to the Department of Maxillofacial Surgery at UZ Leuven between January 2013 and January 2020. We collected data on age, gender, side of condylar fracture, presence of associated fracture of the mandibular body, referrals, initial treatment, long-term complications and secondary treatment. Long-term complications were defined as sequelae still present 6 weeks after initial treatment. Among 192 patients, 68.8% had unilateral and 31.2% bilateral condylar fractures; an associated fracture of the mandibular body was seen in 45.8%, 31% received conservative treatment, 51% IMF only, and 18% combined ORIF and IMF. Forty-eight percent of all patients suffered from 1 or more long-term complications, most frequently malocclusion (24%), reduced mouth opening (15.1%), nerve disturbances (13.5%), pain (8.9%), and facial asymmetry (2.6%). Surgery as a secondary treatment was necessary in 25% of all cases. The presence of bilateral condylar fractures or associated fracture of the mandibular body is a risk factor for developing long-term complications. Most patients with long-term complications were initially treated with combined ORIF and IMF, but long-term complications after initial conservative or IMF treatment were treated with secondary surgery.