Condylar Base Research Articles

A finite element analysis of the trapezoidal plate. How to get a stable fixation at different fracture lines?

The fractures in the condylar area are a challenge for every surgeon, for the treatment of which trapezoidal condylar plate is used in most cases. However, it is not possible to position the plate in the ideal osteosynthesis lines according to Meyer et. al. in every clinical situation. In many cases, the fracture line is also not in the centre of the trapezoidal plate. The aim of this study is to investigate the osteosynthesis rigidity and the effect of plate localisation relative to the fracture line.In a simulation model in the first group the plate was positioned in the ideal position in the middle of the condylar base, in the second group the plate position was changed - the plate was shifted upwards until the fracture passed underneath the centre of the plate again and in the last group the plate was moved further down so that the fracture passes underneath the middle of the plate. Heterogeneity of the bone was simulated using different sets of biomechanical properties.In the experiment, the joints were fully constrained and a force of 500N was applied to the opposite side. An interaction between bone and plate was completely excluded and the stability of the plates as well as the mobility of the bone fragments was analysed.The results have shown that an inferior position of the fracture line leads to greater mobility of the fragments if the position of the osteosynthesis material is the same. With a deep fracture line, a more cranial positioning of the plate leads to better stabilisation. This study needs to be experimentally validated.

Biomechanical evaluation of various rigid internal fixation modalities for condylar-base-associated multiple mandibular fractures: A finite element analysis.

Condylar-base-associated multiple mandibular fractures are more prevalent than single ones. Direct trauma to mandibular symphysis, body or angle are prone to induce indirect condylar fracture. However, little is known about the effects of various rigid internal fixation modalities in condylar base for relevant multiple mandibular fractures, especially when we are confused in the selection of operative approach. Within the finite element analysis, straight-titanium-plate implanting positions in condylar base contained posterolateral zone (I), anterolateral zone (II), and intermediate zone (III). Von Mises stress (SS) in devices and bone and mandibular displacement (DT) were solved, while maximum values (SSmax and DTmax) were documented. For rigid internal fixation in condylar-base-and-symphysis fractures, I + II modality exhibited least SSmax in screws and cortical bone and least DTmax, I + III modality exhibited least SSmax in plates. For rigid internal fixation in condylar-base-and-contralateral-body fractures, I + III modality exhibited least SSmax in screws and cortical bone, I + II modality exhibited least SSmax in plates and least DTmax. For rigid internal fixation in condylar-base-and-contralateral-angle fractures, I + III modality exhibited least DTmax. The findings suggest that either I + II or I + III modality is a valid guaranty for rigid internal fixation of condylar base fractures concomitant with symphysis, contralateral body or angle fractures.

Which of 51 Plate Designs Can Most Stably Fixate the Fragments in a Fracture of the Mandibular Condyle Base?

In the surgical treatment of the most common fracture of the mandible, which is a fracture of the condylar base, a great choice of different plate shapes is observed. The aim of this study was to determine which shape gives the greatest fixation stiffness. To ensure homogeneity in comparison, tests were performed on polyurethane models divided at the level of the condylar base fracture and each were fixed with 51 plates. The plates were cut from a 1 mm thick grade 23 titanium sheet. The models were then loaded and the force required for 1 mm of fracture displacement was recorded. It was noted that in addition to osteosynthesis from two simple plates, there were also two dedicated single plates with similar rigidity. Among the large number of described designs of plates, there is considerable variation in terms of the stability of the fixation performed with them. The proposed Mechanical Excellence Factor allows a pre-evaluation of the expected rigidity of fixation with a given plate shape without the need for a loading experiment. The authors expect this to be helpful for surgeons in the application of relevant plates, as well for inventors of new plates for the osteosynthesis of basal fractures in mandibular condyle.

Innsbruck-style Retromandibular Anterior Trans-parotid Approach for Condylar Fractures: A Retrospective Review of 39 Fractures

Background:The retromandibular anterior trans-parotid (RAT) approach and a triangular-positioned double mini-plate osteosynthesis (TDO) technique have been reported from Innsbruck Medical University. This minimally invasive technique involves direct visualization of the condyle and is associated with lower incidence of facial palsy.Methods:A retrospective review was performed on the RAT approach and TDO technique conducted by a surgeon and team at two hospitals in Tokyo during a period of 3 years and 10 months.Results:This technique was performed on 35 patients with 39 condylar fractures. Sixty-nine percent of cases were due to accidental fall, 17% to traffic accidents, and 9% to sports. Furthermore, 92% cases were condylar base fractures. Nighty-seven percent of cases achieved good occlusion. The mean maximum mouth opening was 49 ± 1.3 mm. Postoperatively, facial palsy developed in three patients (7.7%), and two of them developed Frey syndrome at approximately 2.5 years postoperatively (5.1%). All patients completely recovered within 3 months postoperatively. One case each of salivary fistula, visible scar, and condylar resorption was found (2.6%). No case of massive bleeding during surgery, hematoma, or TMJ pain after surgery was found.Conclusion:This technique could achieve good occlusion with low incidence of complications and could contribute to early social reintegration among patients.

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.

Infinitesimal Periangular Pterygomasseteric Transectioning Approach for the Base Fractures of the Mandibular Condyle: A Technical Note and Quality of Life Outcome.

Purpose Infinitesimal Periangular Pterygomasseteric Transectioning Approach (IPPTA) is a minimal access surgical approach utilized for the management of base fractures of the mandibular condyle. The aim of the study was to evaluate and report the long-term post-operative functional outcomeusing this surgical access approach. Materials and method A prospective clinical study involving 20 patients was undertaken to evaluate the post-operative functional and aesthetic outcome for the patients that underwent surgery for base fractures of the mandibular condyle using IPPTA. The various parameters assessed were wound healing, marginal mandibular nerve injury, diet intake, mandibular function, and any other complications at twelfth post-operative month. Results IPPTA provided adequate exposure to the condylar base fracture for open reduction and internal fixation (ORIF) and was found to have an uneventful post-operative recovery phase in terms of functional and aesthetic outcomes. Conclusion IPPTA involves utilizing a smaller incision and provides adequate exposure to the condylar base region for ORIF to establish a satisfactory form and function with a predictable outcome.

Biomechanical evaluation of various internal fixation patterns for unilateral mandibular condylar base fractures: A three-dimensional finite element analysis

Finite element analysis (FEA) could efficiently simplify the mechanical behaviors of complex loaded constructions. Condylar base fracture related FEAs have been always published, but it is absent for the therapeutic effects of diverse implanting devices’ locations and materials on osteosynthesis. The current FEA aimed to elucidate the biomechanical effects of unilateral mandibular condylar base fractures with open reduction and internal fixation (ORIF) of different locations and materials. The implanting positions included posterolateral border of ramus (A), anterolateral border along sigmoid notch (B), and lateral border in the middle area (C). Two different materials were presented, titanium and u-HA/PLLA (Poly-L-lactic acid combined with uncalcined and unsintered hydroxyapatite). For titanium, A + B presented lowest values of maximum von Mises stress in plates (198.66 MPa) and screws (237.39 MPa), and lowest value of peak displacement in the whole mandible (260.35 μm), while A + C presented lowest value of maximum von Mises stress in cortical bone surrounding screws (65.96 MPa). For u-HA/PLLA, A + B presented lowest value of maximum von Mises stress in screws (134.15 MPa), and lowest value of peak displacement in the whole mandible (374.43 μm), while A + C presented highest value of maximum von Mises stress in cortical bone surrounding screws (166.41 MPa). The findings suggest that both posterolateral border of mandibular ramus and anterolateral border along sigmoid notch are crucial for ORIF of unilateral mandibular condylar base fractures, whatever titanium or u-HA/PLLA devices. In addition, we speculate that titanium devices of position B could be adjusted backward and downward appropriately, but not for u-HA/PLLA device.

Mandibular condyle changes in rats with unilateral masticatory function.

Certain malocclusions or unilateral tooth loss can lead to asymmetric functional load of the two mandibular sides during mastication and induce skeletal asymmetries to the condylar process of growing individuals. However, in adults, asymmetric function may have a different impact. The aim of the present study was to investigate three-dimensionally the effects of unilateral masticatory function on the condylar process morphology in growing and adult rats and the adaptive processes to differential condylar loading. Fifty-six growing and adult Wistar rats aged 4 and 26 weeks respectively were obtained. The maxillary right molars of the experimental animals were extracted and all animals were followed for 12 weeks. Three-dimensional images were obtained by an in-vivo microcomputed tomography (micro-CT) examination. The following measurements were studied: condylar process height, condylar base width, and condylar cross-sectional surface. While no differences were found with regards to condylar process height and base width, the cross-section of the condyle on the extraction side did not increase during growth in the young rats. No such differences were found in adults. Young rats had statistically significantly shorter condylar height, base width and cross-sectional surface than the adult rats and showed significant growth of these structures during the experimental period. Condylar height and base width growth are not hindered by reduced occlusal function, contrary to the average cross-sectional surface, which implies that the condyle form of growing individuals becomes thinner while maintaining its length, in the absence of occlusal stimuli. The condyle of adult rats with extractions is less affected by occlusion changes.

Impact of Diet Consistency on the Mandibular Morphology: A Systematic Review of Studies on Rat Models.

Apart from genetics, environmental factors, such as food consistency, may affect craniofacial morphology and development. The present systematic review aims to systematically investigate and appraise the available evidence regarding the effect of diet consistency on the anatomical structures of the basal bone of the rat mandible. The search was performed without restrictions in five databases (PubMed, Scopus, Web of Science, ProQuest Dissertations and Theses Global, including grey literature) and hand searching through January 2022. A total of 14,904 references were initially identified, and 16 articles were finally included in the systematic review. Rats that consumed hard diets were found to exhibit an increase inbigonial width, corpus height, condylar depth, condylar base inclination, condylar process inclination, mandibular plane inclination, height and length of angular process, mandibular body height, depth of antegonial notch, growth rate in the gonial angle, angular process convexity and height of condylar process. It was also noted that mandibular depth, mandibular height, ramus angle and angle between the angular process and mandibular plane were decreased in rats that were fed with a hard diet. On the other hand, there were conflicting results about the growth of mandibular length and width, corpus length, mandibular body length, ramus height, condylar length and width, gonial angle and height of coronoid process. From the abovementioned results, it can be concluded that food consistency may affect the morphology of anatomical structures and the overall growth and development of rat mandibles in various ways.

Application of the lambda plate on condylar fractures: Finite element evaluation of the fixation rigidity for different fracture patterns and plate placements

Purpose: The treatment challenges of condylar fractures necessitated the production of several plate designs. Among the relatively new plate designs is the lambda plate, for which biomechanical and clinical data are lacking. The purpose of this study is to examine the rigidity of fixation achieved when the lambda plate is applied to different fractures of the condylar neck and base.Methods: Five fractures of the condylar area were designed on a virtual model of a healthy mandible obtained from a CT scan. The fractures were reduced using the lambda plate. For the same fractures, alternative placements of the plate were simulated. The generated models were analysed using the finite element analysis for a 500 N bite load. The displacement of the two condylar fragments along the fracture line was calculated as an indicator of the rigidity of the fixation.Results: The displacement along the fracture was less than 0.144 mm for the neck fractures and greater than 0.165 mm for the fractures of the condylar base. A more cranial placement of the plate for the neck fractures further reduced the displacement, while a more anterior placement of the plate for the base fractures resulted in displacements greater than 0.330 mm.Conclusion: According to our study, the lambda plate offers better rigidity when applied as cranially as possible for condylar neck fractures. The lambda plate did not provide adequate fixation for base fractures. A second plate at the sigmoid notch should be considered to achieve better stabilization along the fracture if the lambda plate is eventually used.

Associations between condylar fractures and external auditory canal fracture: A 7-year retrospective study

The study aimed to investigate whether the incidence rate of external auditory canal (EAC) fracture varies among different clinical types of condylar fracture. A retrospective cohort study was conducted in single hospital of China. Eligible patients diagnosed with mandibular condylar fractures were retrospectively reviewed. Among all patients with condylar fractures (318 cases and 437 sides), 45 cases and 59 sides (59/437 sides, 13.5%) were found with EAC fracture, including 17(17/38, 44.7%) sides of sagittal fracture of condyle (Type I), 21(21/59, 35.6%) sides of intracapsular condylar fracture (Type II), 8 (8/306, 2.6%) sides of condylar neck fracture (Type III), and 6 (6/34, 17.7%) sides of condylar base fracture (Type IV). Type III condylar fracture had a significant lower rate of EAC fracture than all other three types (all p<0.001). Type I condylar fracture had a higher rate of EAC fracture compared to Type IV (p=0.014). The incidence rates of EAC fracture in combined Type I+Type II group (38/97, 39.2%) was significantly higher than Type III (8/306,2.6%, p<0.001) and Type IV (6/34,17.7%, p=0.002). A total of 35 sides (27 patients) with combined fractures were followed up for 6 months after treatment, among whom 11 sides (7 patients) were operated for both fractures simultaneously. Neither EAC stenosis nor hearing loss was observed. Meanwhile, for 24 non-operated ears from 20 patients, all EACs showed different degrees of stenosis. In conclusion, oral and maxillofacial surgeons should pay more attention to EAC fracture combined with condylar fracture, especially for patients diagnosed with condylar head fracture. Maxillofacial fractures should be accompanied by early treatment of EAC fractures, in order to prevent EAC stenosis, hearing loss, and other complications.

Choice of Screws for Fixation of Mandibular Condyle Fractures Guided by Anthropometric Data

Open reduction and internal fixation (ORIF) is becoming increasingly common in treatment of the condylar process, including mandible head fractures. This approach significantly improves the results in terms of anatomical reduction of bone fragments, and shortens the treatment time, allowing for early functional recovery. The success of ORIF is largely determined by the stability of the osteosynthesis. The stabilization effect depends on the screw type and length of the plate used, in addition to the diameter and length of the screws used. The aim of this study was to determine the largest possible screw length that can be used in ORIF of the mandibular condyle considering the variable bone thickness. A total of 500 condyles were examined using computer tomography (CT)-based 3D models in Caucasians. For all models, three measurements were made in the frontal projection in places typical for the stabilization of osteosynthesis plates in the fractures of the condylar process: the base, the top, and the sigmoid notch. In addition, one measurement of the mandible head was made in the place of the greatest width. The results showed that 8 mm screws should be used in the region of the condylar base as the longest anatomically justified screw, whereas in the area of a sigmoid notch only 1.5–2 mm screws should be used. Measurements in the area of the neck top revealed statistically significant differences in the measurements between the sex of patients, with average differences below 1 mm (p &lt; 0.05). In this area, the maximal length of the screw was found to be 10 mm. In mandibular head fractures, the use of long screws is extremely important due to the desired effect of fragment compression. Statistically significant differences were found in the measurement results between women and men. The maximal screw length for bicortical fixation was found to be 22 mm in men and 20 mm in women. In post-traumatic patients, the ability to obtain a clear measurement is often limited by a deformed anatomy. Taking into account the fact that the fracture stability is influenced by both the plate length and the length of the fixation screws, an assessment of the standard measurement values in a cohort group will improve the quality of the surgical fixations of the fractures.

The retromandibular transparotid approach vs. retromandibular retroparotid approach for the mandibular condyle

Aim: The mandible is regarded as a frequently fractured bone in patients who present with maxillofacial trauma accounting for almost 15.5% to 59% of all facial fractures. Managing condylar trauma has remained to be a point of contention amongst experts, regardless of the advances in surgical modalities and methodologies, and the treatment plan is often determined by the preference and the experience of the surgeon. There exist various approaches in the literature, each with its own specific benefits and drawbacks. With this study, we aimed to evaluate the prevalence of post-operative complications in patients who experienced ORIF by means of the retromandibular approach, by comparing the outcomes of one group having undergone transparotid surgery, with another that underwent retroparotid surgery. Methods: An experimental trial was undertaken. Convenience sampling was done from among the cases of condylar neck and base fracture visiting the department of OMFS, Dow University of Health Sciences from January 2017 to December 2019. An overall 26 patients were divided into 2 groups of 13 members each; one was managed using Open Reduction Internal Fixation (ORIF) by means of a retromandibular transparotid approach while the other group was treated with ORIF by means of a retromandibular retroparotid approach. A 6 month follow-up was done to assess range of active motion, occlusion, and complications such as deviation/deflection, neural injury, infections, sialocele, salivary fistulae and Frey’s syndrome in both groups. Results: There was no statistically significant difference between the two groups in terms of inter-incisal opening, right and left lateral movements, or protrusion. One patient in the retroparotid group had deviation on mouth opening (7.69%), while one in the transparotid group reported with infection (7.69%), and 2 developed post operative seromas (15.38%). None had persisting facial nerve palsy at 6 months. Conclusion: We find no significant disparity between the 2 approaches at a follow-up of 6 months; therefore, the primary determining factor for selection of either technique is surgeon preference and appropriate case selection.

Noninvasive Management of Pediatric Isolated, Condylar Fractures: Less Is More?

The purpose of this study was to examine injury patterns in pediatric mandibular condylar fractures and to propose and evaluate the validity of an institutional treatment algorithm for such fractures. A retrospective chart review was conducted on pediatric patients who presented to the authors' institution with isolated mandibular condylar fractures between 1990 and 2016. Patients were categorized by dentition, and information regarding demographics, injury characteristics, management, and complications was compiled. Forty-three patients with 50 mandibular condylar fractures were identified. Twelve patients (27.9 percent) had deciduous dentition, 15 (34.9 percent) had mixed dentition, and 16 (37.2 percent) had permanent dentition. The most common fracture pattern in all groups was diacapitular [n = 30 (60 percent)]; however, older groups showed higher rates of condylar base fractures and bilateral fractures (p = 0.029 and p = 0.011, respectively). Thirty-one patients (72.1 percent) were treated with nonoperative management, 10 (23.2 percent) with closed treatment and mandibulomaxillary fixation, and two (4.7 percent) with open treatment and mandibulomaxillary fixation; nonoperative treatment was more common in younger patients (p = 0.008). Management for 10 patients (23.2 percent) was nonadherent to the treatment algorithm. Eight patients had complications (18.6 percent). Common complications included temporomandibular joint ankylosis (n = 2) and malocclusion (n = 2). Although complications were seen in all groups, adherence to the algorithm was associated with an 81.8 percent reduction in odds of complications (p = 0.032). Nonoperative management has a low complication rate in deciduous children. Children with permanent/mixed dentition may undergo closed treatment and mandibulomaxillary fixation if they have malocclusion/contralateral open bite, significant condylar dislocation, and ramus height loss greater than 2 mm. Therapeutic, III.

Mandibular Condylar Fracture in a Professional Soccer Goalkeeper: How to Achieve Early Return-to-Play—A Case Report

Sport-related mandibular fracture is a common injury in the field of maxillofacial surgery. However, the treatment of mandibular condylar fractures in professional soccer goalkeepers is rarely reported. A 32-year-old male professional soccer goalkeeper was referred for malocclusion after collision with an opponent player during a game. The patient’s mandible was displaced between the left lower lateral incisor and left lower canine. Computed tomography showed right condylar base fracture with medial displacement and left para-symphysis fracture. Internal fixation using retromandibular anterior trans-parotid approach via 25-mm skin incision immediately below the earlobe and intraoral vestibular approach were performed under general anesthesia 2 days after the injury. The patient was discharged without complications 3 days after surgery, with mandibular protrusion and diduction exercises with limitation of mouth opening. Soft diet and limitation of mouth opening was performed for 4 weeks after surgery. To achieve early return-to-play, rehabilitation based on Fowell and Earls’ return-to-play guidelines following facial fractures was started, with moderate exercise 5 days after surgery, and progressively full exercise without contact 8 days after surgery. He started normal team training with individualized jaw-guard 4 weeks after surgery. His body weight decreased by 2.2 Kg 1 week after surgery, gradually recovered, and became normal 4 weeks after surgery. The patient returned to a game 2 months after surgery. This case report can be a reference case in condylar fractures of professional soccer players, as the available scientific literature is limited with regard to return-to-play after maxillofacial fracture in professional athletes.

Extracapsular Condylar Fractures Treated Conservatively in Children: Mechanism of Bone Remodelling.

This study aims to reveal the reconstruction process in pediatric patients with extracapsular condylar fractures after conservative treatment. We clarify that the "upright" position (or "recontouring" or favorable prognosis) of condyles is not a result of the anatomical reduction of the deviated condylar processes but originates from the remodeling of the skeleton. We also explore the related mechanism. The sample consisted of 27 pediatric patients aged less than 12 years who presented with extracapsular condylar fractures and were treated conservatively within an 8-year period (June 2011-April 2019). Data on the age, gender, date of injury, mechanism of trauma, location and pattern of mandibular condylar fracture and associated injuries and treatment methods of the patients were obtained. The process of bone remodeling in condyles was also recorded and analyzed. The 27 children in this study sustained 33 extracapsular condylar fractures over the 8-year period of record retrieval. Amongst these fractures, 8 (24.2%) and 25 (75.8%) were condylar neck and condylar base fractures, respectively. Deviation and green-stick fractures were the predominant types and accounted for over 3 quarters of the condylar neck and base fractures (28, 84.8%), followed by dislocation fracture (3, 9.1%), displacement fracture (1, 3.0%), and non-displaced fracture (1, 3.0%). The period of follow-up ranged from 2 days to 257 days (average, 58.78 days). Only 1 patient with bilateral extracapsular condylar fractures showed vertically reconstructed condyles, which indicates an upright position of the condylar processes. One patient showed less angulation after treatment than before treatment, 1 patient revealed greater angulation after treatment than before treatment and all other patients (20 patients) showed the same angulation pre- and post-treatment. Both patients with only extracapsular condylar fractures showed no obvious deviations in dentition and facial asymmetry after their injury and treatment. The shortest and longest times observed for bone remodeling were 33 and 256 days, respectively. Children whose condylar head remained completely or at least partly inside the glenoid fossa showed satisfactory remodeling results during follow-up. Computed tomography scan during follow-up generally showed bone regeneration in the lateral condyle articular surface and the medial portion of the ascending ramus and bone resorption in the displaced direction (ie, the medial condyle head became sharp). Condylar heads displaced completely outside of the glenoid fossa showed serious shortening of the ascending ramus, and no obvious bone remodeling was observed. Only 1 patient with bilateral extracapsular condylar fractures showed a normal contour (ie, a vertically reconstructed condyle reflecting the upright position of the condylar processes) after 8 months. Stress stimulation originating from the glenoid fossa and ascending ramus of the mandible is a prerequisite for good condylar reconstruction. Conservative treatment could be carried out if the condylar head remains completely or at least partly inside the glenoid fossa. When the condylar head is dislocated completely outside the glenoid fossa, the glenoid-condylar relationship ceases to exist, joint function is lost and the height of the ascending ramus is significantly reduced. In this case, open reduction may be suitable.

Infinitesimal Peri-angular Pterygomasseteric Transectioning Approach (IPPTA) for the Base Fractures of the Mandibular Condyle: A Preliminary Study.

To investigate a reliable and safe surgical access to the condylar base region with minimal surgical trauma to the surrounding anatomic structures. In an attempt to do so, to describe Infinitesimal Peri-angular Pterygomasseteric Transectioning Approach (IPPTA) for the management of base fractures of the mandibular condyle. A preliminary clinical study involving 20 patients was undertaken to treat patients with unilateral condylar base fracture of the mandible using IPPTA under general anaesthesia (GA). Various parameters assessed were adequacy of surgical access, wound healing at the incision site, marginal mandibular nerve injury, diet intake and complications post-operatively. This method provided adequate exposure to fractured condylar base for open reduction and internal fixation (ORIF) with uneventful post-operative recovery phase. There was no limitation to function which was identified by restoration of normal pre-trauma diet intake by 14th post-operative day in more than 50% of the study patients. No complications were observed in any patients among the study population. The peri-angular approach has been discussed in the literature. The IPPTA highlights the use of a smaller incision providing an adequate exposure to the condylar base region for ORIF.

Management of Medially Displaced Sub-Condylar Mandibular Fractures in Pediatric Population Using Novel Atraumatic Approach.

The appropriate treatment of pediatric mandibular condyle fractures is subject to much debate and concern among surgeons, with improper treatment potentially resulting in a number of adverse outcomes. Such outcomes include the disruption of mandible growth, decreased posterior facial height, facial asymmetry, and temporomandibular joint ankylosis. Several surgical and nonsurgical approaches to these fractures have been described in the literature; however, each one carries its own risk of various complications. In this study, the authors illustrate a new atraumatic approach for mild to moderately displaced subcondylar fractures, with least possible complications and unexpected outcomes. In this study, 6 patients (2 female and 4 male) with unilateral medially displaced condylar base and neck fractures, angulated between 30 and 45 degrees, were treated using a novel intraoral approach. The follow-up period varied from 12 to 18 months. All patients achieved normal occlusion and had painless functioning of the temporomandibular joint with proper mouth opening (>35 mm) without any recurrence at long term follow up. This minimally invasive approach could eliminate the possibility of major complications and be considered a safe and feasible surgical technique for certain cases of pediatric mandibular condyle fracture.

Algorithm for Management of Mandibular Condylar Base Fractures.

Increasing evidence suggests that open reduction and internal fixation of condylar base fractures in adults results in improved outcomes in regard to interincisal opening, jaw movement, pain, and malocclusion. However, most of the condylar fractures are managed by maxillomandibular fixation alone due to the need for specialized training and equipment. Our aim was to present an algorithm for condylar base fractures to simplify surgical management. A retrospective review was performed of patients (n = 22) with condylar base fractures treated from 2016 to 2020. Patients who presented with operative fractures that require open treatment underwent 1 of 2 different techniques depending on the fracture type: a preauricular approach with a transoral approach if the condyle was dislocated (n = 2) or a transoral only approach (n = 20) in nondislocated cases. Operative time, occlusion, range of motion, and postoperative complications were assessed. Condylar base fractures were combined with other mandibular fractures in 16 of 22 patients. Patients with condylar dislocation were managed with a preauricular approach with a secondary transoral incision (n = 2, median 147 minutes). Those without dislocation were treated with a transoral approach (n = 20, median 159 minutes). Most patients were restored to their preoperative occlusion without long-term complications. We present a simplified algorithm for treating condylar base fractures. Our case series suggests that reduction in operative time and clinical success can be achieved with open reduction and internal fixation using a transoral approach alone or in combination with a preauricular approach for dislocated fractures.

Endoscopically Assisted Treatment of Condylar Base and Neck Fractures: A Single Institution Analysis of Outcomes and Complications.

Conservative treatment, including observation and closed treatment, as well as open reduction and internal fixationare existing options for treating condylar process fractures. Extraoral approaches are widely preferred for open reduction and internal fixation. Transoral access for condylar base and neck fractures is not yet commonly used as it is technically demanding and requires special equipment. In this study, the transoral endoscopically assisted approach is described, and its outcomes and complications were investigated. Imaging data and clinical records of 187 patients with condylar process fractures, treated via endoscopically assisted transoral approach between 2007 and 2017 were analyzed. Parameters included diagnosis and fracture classification, treatment, osteosynthesis configuration and postoperative complications. Early complications, including infection, transient postoperative malocclusion, pain and limited mouth opening, occurred in 35 patients (18.7%). Late onset complications, such as screw loosening were documented in only 4 patients (2.1%). Revision surgery following postoperative 3D imaging was required in only 3 cases (1.6%). Fragment length ranged from 15.5 to 38.3mm. In 57.7% of patients with condylar fragment length < 20mm, a single osteosynthesis plate was used, with no elevated complication rate. Two osteosynthesis plates with 4 screws each was used as standard in longer fragments. Endoscopically assisted transoral treatment of condylar process fractures is a reliable, yet technical demanding technique. It allows for reduction and fixation of fractures with a condylar fragment length of > 15mm with low postoperative complication and revision rates.