Dislocation Of Condyle Research Articles

Analysis of condylar positioning in the temporomandibular joint following mandibular reconstruction: Introduction of a new classification system and assessment of influencing factors on displacement.

This study investigates the unsatisfactory outcomes observed in mandibular reconstruction procedures attributed to improper condylar positioning in the Temporomandibular Joint. It also proposes a systematic classification for post-reconstruction condylar positioning dissatisfaction. A retrospective analysis was conducted on 337 patients who underwent tumor removal and mandibular reconstruction with vascularized osteocutaneous flaps. Reconstruction techniques included conventional surgery (43.3%) and 3D technology-guided procedures (56.7%). Evaluation utilized preoperative and postoperative CT scans to assess mandibular vertical ramus length (V) and condylar alignment in both sagittal (S) and coronal (C) planes. Accordingly, a classification system for condylar positioning was developed and abbreviated as VSC. It includes four classes: Class I, proper condylar reconstruction; Class II, short ramus length; Class III, one or two aspects of sagittal/coronal condylar positions dissatisfaction; and Class IV, two or three aspects dissatisfaction. The overall success rate for condylar reconstruction was 85.16%. Though not statistically significant, the success rate was marginally higher in the 3D-assisted group (85.86%) compared to the conventional group (84.25%). In terms of the VSC classification, the distribution of cases across Class I, II, III, and IV were 287, 4, 9, and 37 cases, respectively. Notably, condylar dislocation was significantly associated with the defect site, particularly the body and condyle (p < 0.001, OR = 49.734, 95% CI 12.995-190.342), and the number of reconstructed segments (p = 0.025, OR = 3.480, 95% CI 1.173-10.328). The findings highlight the importance of accurate reconstruction methods and reveal implications of the defect site and the number of reconstructed segments in condylar dislocation. Consequently, we propose a classification system to refine condylar positioning assessment and enhance surgical outcomes in mandibular reconstruction.

Improvement of the temporomandibular joint symptoms due to the condylar position change following modified L-shaped intraoral vertico-sagittal ramus osteotomy: a single-center, retrospective study.

Intraoral vertico-sagittal ramus osteotomy (IVSRO) was first reported by Choung in 1992 as a surgical procedure to decrease postoperative condylar dislocation. In 2017, Iwanaga et al. developed modified L-shaped IVSRO (mIVSRO) to reduce postoperative nerve dysfunction and achieved favorable outcomes. This study aimed to clarify the effect of mIVSRO on changes in temporomandibular joint (TMJ) symptoms and three-dimensional condylar position. We conducted a retrospective study of thirty sides in fifteen Japanese adults diagnosed with jaw deformities who underwent mIVSRO and sagittal split ramus osteotomy (SSRO). TMJ symptoms were assessed chronologically, and the condylar long axis and the condylar position were analyzed two- and three-dimensionally using axial cephalograms and cone-beam computed tomography. Postoperative TMJ symptoms improved by 90% (9/10 sides) in the mIVSRO group and by 50% (7/14 sides) in the SSRO group. The mIVSRO group exhibited outward rotation of the condylar long axis, while the SSRO group exhibited inward rotation. Moreover, mIVSRO induced residual anteromedial-inferior deviation of the condyle. The inclination angle of the condylar process was not significantly different between the two procedures pre- and postoperatively. These results clearly demonstrated the effect of mIVSRO on symptomatic TMJ. Residual changes in the position of the condyle following mIVSRO may not affect jaw function.

Management of Unilateral TMJ Dislocated Facial Bone Fracture due to an rarely Industrial Accident

Introduction: Traffic accidents commonly cause maxillofacial trauma but rarely industrial accidents. Treatment of multiple maxillofacial traumas needs comprehensive and immediate care to prevent further complications. Objective: Management of a maxillofacial fracture accompanied by dislocation of the right temporomandibular joint due to a fall in a rice mill. Case report: A 20-year-old male patient complained of bleeding and facial fractures due to a rice milling accident approximately one day before admission. The case diagnosis was multiple maxillofacial fractures with condyle dislocation. Emergency oral and maxillofacial surgery was performed immediately and quickly with minimal intervention on the upper jaw to prevent persistent cerebrospinal fluid leakage and prevent infection. Definitive treatment was soft tissue reconstruction, ORIF of the maxillary and mandibular fractures, and repositioning of the condyle dislocation. Conclusion: Multiple facial bone fractures accompanied by TMJ dislocation can result in deformity and loss of facial function affecting the patient's social life. Immediate action and open reduction internal fixation (ORIF) procedure performed in this case were able to restore stomatognathic and facial function. Keywords: Industrial accident, maxillofacial trauma, open reduction internal fixation, temporal mandibular joint dislocation Introduction: Traffic accidents commonly cause maxillofacial trauma but rarely industrial accidents. Treatment of multiple maxillofacial traumas needs comprehensive and immediate care to prevent further complications. Objective: Management of a maxillofacial fracture accompanied by dislocation of the right temporomandibular joint due to a fall in a rice mill. Case report: A 20-year-old male patient complained of bleeding and facial fractures due to a rice milling accident approximately one day before admission. The case diagnosis was multiple maxillofacial fractures with condyle dislocation. Emergency oral and maxillofacial surgery was performed immediately and quickly with minimal intervention on the upper jaw to prevent persistent cerebrospinal fluid leakage and prevent infection. Definitive treatment was soft tissue reconstruction, ORIF of the maxillary and mandibular fractures, and repositioning of the condyle dislocation. Conclusion: Multiple facial bone fractures accompanied by TMJ dislocation can result in deformity and loss of facial function affecting the patient's social life. Immediate action and open reduction internal fixation (ORIF) procedure performed in this case were able to restore stomatognathic and facial function. Keywords: Industrial accident, maxillofacial trauma, open reduction internal fixation, temporal mandibular joint dislocation

Superior Dislocation of the Mandibular Condyle into the Middle Cranial Fossa: A Comprehensive Review of the Literature.

The superior dislocation of the condyle into the cranium occasionally requires invasive procedures due to the absence of a timely diagnosis. This review analyzed the available clinical data to provide information on treatment decisions. The reports were assessed using electronic medical databases from inception to 31 October 2022. A total of 116 cases from 104 studies were assessed; among the patients, 60% and 87.5% of the affected women and men required open reduction, respectively. The ratio of closed to open procedures within 7 days after injury was maintained; however, closed reduction decreased over time, and all cases required open reduction after 22 days. Eighty percent of the patients with a total intrusion of the condyle required open reduction, whereas the frequency for both procedures was comparable in the remaining patients. Open reduction was significantly more frequently performed for men (p = 0.026, odds ratio; 4.959, 95% confidence interval; 1.208-20.365) and less frequently performed in cases with partial intrusion (p = 0.011; odds ratio: 0.186; 95% confidence interval: 0.051-0.684); the frequency varied according to the time until treatment (p = 0.027, odds ratio; 1.124, 95% confidence interval; 1.013-1.246). Appropriate diagnostic imaging and prompt diagnosis are indispensable for minimally invasive treatment of this condition.

Total temporomandibular mandibular joint alloplastic replacement as first line treatment for condylar fracture

The treatment of condylar fractures has been the subject of debate and controversy. Open reduction and internal fixation, along with closed reduction, are the 2 main treatment modalities when well indicated and performed. In specific situations, however, the success of both treatment modalities can be challenged by local or systemic conditions. Alloplastic total temporomandibular joint replacement (TMJR) with the current systems, Biomet and Stryker, has proven to be successful in the long-term. The authors present 2 cases and propose the consideration of TMJR as a first-line treatment for condylar fractures in the following situations: fractures older than 4 weeks; 2) elderly patients with severely dislocated or displaced condyles; 3) condylar dislocation into the cranial fossa; 4) maxillomandibular fixation is not a viable option.

Mandibular condyle dislocation into the middle cranial fossa with open reduction and reconstruction with glenoid fossa prosthesis. Unusual case report and literature review.

Mandibular condyle dislocation into the middle cranial fossa with open reduction and reconstruction with glenoid fossa prosthesis. Unusual case report and literature review.. DOI: 10.20986/recom.2023.1392/2022

Management of chronic long standing condyle dislocation

Condyle dislocation accounts for 3% of all the dislocations of different joints in the body. They are basically classified based on duration as acute, chronic and recurrent, the most difficult to manage being chronic longstanding. This study of case series was carried out to enunciate and discuss optimal treatment protocols to enhance the postoperative result and functionally rehabilitate the patient. Data were recorded of patients of chronic long standing condyle dislocation (CLSCD) between 2012 to 2019. Predictor variables were drawn from demographics age, gender, aetiology, duration of dislocation status. The outcome variables were surgical success rate and complications. Surgical treatment included endaural pre auricular approach, high condylar shave with eminoplasty, elastic traction for a period of 5-7 days and mouth opening exercises. 15 patients with CLSCD of more than a month duration were identified out of 65 reported with other forms of acute and recurrent dislocation. The 12 (80%) were bilateral and 3 (20%) were unilateral. Three (20%) were of interpersonal violence, 3 (20%) had cerebrovascular accident, 3 (20%) following RTA with other major injuries, and 1 patient (6.6%) very rare unusual history of dislocation during labor pain reporting after six months. All patients had unsuccessful attempted conservative management. Surgical intervention and outcome were excellent. Complications recorded were 3 patients (20%) had transient facial nerve weakness, 2 (13.3%) infection. Conservative manipulation has definitive role in acute and recurrent cases but surgical approach or open procedure in chronic long-standing cases is the choice with duration of condylar dislocation being the decisive factor for difficulty index.

Assessment of Maximal Incisal opening using autogenous Inlay Assessment of Maximal Incisal opening using autogenous Inlay Eminoplasty Technique For Treatment Of chronic recurrent Eminoplasty Technique For Treatment Of chronic recurrent temporo mandibular joint Dislocation

Purpose: Different surgical protocols have been introduced for eminence augmentation for treatment of recurrent temporomandibular joint dislocation, The aim of this study is to assess maximal incisal opening (MIO) using inlay (sandwich osteotomy) autogenous block augmentation harvested from patient’s symphesis for more stable condylar movements . Methods: five patients were treated in this study (10 joints) with bilateral autogenous inlay block bone grafting technique, each autogenous cortico-cancellous bone block was harvested from chin and wedged at the created defect of the eminence through a green stick fracture to increase its height . Results: The follow up period ranged from six months to two years to access the maximal incisal opening (MIO). the mean preoperative maximal incisal opening was 45.8mm and that of the postoperative was 32.3 mm . One patient reported postoperative slight unilateral edema and pain that gradually diminishes after one month postoperative.another patient showed intraoperative condylar dislocation that was treated with masseter scarification. Conclusion: autogenous block interpositional eminoplasty technique is a reliable procedure for management of antero-medial recurrent condylar dislocation.

Camouflage orthodontic treatment combined with genioplasty distraction osteogenesis for skeletal class II relationship secondary to osteosarcoma excision surgery

The treatment of orthodontic patients who survive head and neck tumors is challenging because of dentoskeletal deformities and other unexpected dental and facial complications. This case report describes the case of a 26-year-old woman who presented with mandibular retrognathia after survival from osteosarcoma. Camouflage orthodontic treatment was chosen instead of combined orthodontic-orthognathic surgery after primary reconstructive surgery with an iliac bone graft. Genioplasty distraction osteogenesis (DO) was performed to achieve an optimal facial profile. Although unexpected condyle dislocation and epithelial hyperplasia occurred during treatment, a favorable facial profile and optimal skeletal and dental relationships were accomplished after 32 months of treatment. The patient underwent genioplasty DO and experienced unexpected left condyle dislocation. However, the treatment achieved esthetic goals after intermaxillary elastics were applied.

The rationale for the algorithm of comprehensive digital diagnosis of patients with temporomandibular disorders using an intraoral occlusal appliance

Relevance. The study aimed to increase the effectiveness of comprehensive diagnosis and treatment of patients with TMD using an intraoral occlusal appliance.Materials and methods. All patients of the main group underwent a digital comprehensive functional examination, including TMJ magnetic resonance imaging, kinesiography, joint vibration analysis, surface myography and electrical stimulation of the masticatory muscles, followed by a bite registration of the optimal mandible position. According to the bite recorder, the models were mounted in the articulator and the intraoral occlusal appliance was fabricated. This occlusal appliance used the first-class lever principle, which acts on the condyle using a force applied to the mesial part of the canine and rests on the distal part of the upper second molar. After the diagnosis and treatment stage using an occlusal appliance, a digital comprehensive functional examinatio n was performed again.Results. Analysis of the digital comprehensive diagnosis data evidenced the restoration of the lower jaw movement, the elimination of intra-articular disorder and the normalization of the dentition functioning as a whole, using TENS appliance and an improved intraoral occlusal appliance (Patent # 273 0995, 26.08.2020) in patients with TMD.Conclusion. Treatment of patients with TMD using an intraoral occlusal appliance, which eliminates condyle compression and dislocation of the articular disc, allows restoring the lower jaw movement and the functioning of the dentition as a whole. Kinesiography at all stages of the prosthodontic treatment allows objectively monitoring the restoration of the mandibular movement pathways, taking into account time inte rvals.

MANAGEMENT OF AN UNRECOGNIZED AND DELAYED DIAGNOSED CASE OF BILATERAL CONDYLAR DISLOCATION FOLLOWING ORAL CANCER SURGERY - A CASE REPORT

Temporomandibular joint (TMJ) dislocation is characterized by displacement of the mandibular condyle from the glenoid fossa. There are various reasons for the dislocation of TMJ, among which iatrogenic dislocation is one of the cause which is generally overlooked. Acute dislocations can be corrected by various conservative methods like manual reduction, but long standing chronic dislocation requires surgical management. Here we present a case report of an unrecognized and delayed diagnosed case of bilateral condylar dislocation following oral cancer surgery under general anaesthesia with iatrogenic fracture of ramus of mandible which was managed surgically by vertical ramus osteotomy and ORIF.

Eminectomy for recurrent condylar dislocation with Ehlers-Danlos syndrome: A case report

Eminectomy for recurrent condylar dislocation with Ehlers-Danlos syndrome: A case report

The ESTMJS (European Society of Temporomandibular Joint Surgeons) Consensus and Evidence-Based Recommendations on Management of Condylar Dislocation.

Although condylar dislocation is not uncommon, terminology, diagnostics, and treatment concepts vary considerably worldwide. This study aims to present a consensus recommendation based on systematically reviewed literature and approved by the European Society of TMJ Surgeons (ESTMJS). Based on the template of the evidence-based German guideline (register # 007-063) the ESTMJS members voted on 30 draft recommendations regarding terminology, diagnostics, and treatment initially via a blinded modified Delphi procedure. After unblinding, a discussion and voting followed, using a structured consensus process in 2019. An independent moderator documented and evaluated voting results and alterations from the original draft. Although the results of the preliminary voting were very heterogenous and differed significantly from the German S3 guideline (p < 0.0005), a strong consensus was achieved in the final voting on terminology, diagnostics, and treatment. In this voting, multiple alterations, including adding and discarding recommendations, led to 24 final recommendations on assessment and management of TMJ dislocation. To our knowledge, the ESTMJS condylar dislocation recommendations are the first both evidence and consensus-based international recommendations in the field of TMJ surgery. We recommend they form the basis for clinical practice guidelines for the management of dislocations of the mandibular condyle.

Mandibular Reconstruction with Scapular Systems: A Single-Center Case Series Involving 208 Flaps.

The scapular flap is the most versatile composite flap used for mandibular reconstruction. The purpose of this study was to review and summarize findings of cases of mandibular reconstruction with a scapular flap and describe associated outcomes and complications. A total of 208 microvascular scapular free flaps were performed for mandibular reconstruction in a total of 205 patients from 2003 to 2018. This study involved a retrospective review of all eligible patients' medical records. There were seven cases (3.4 percent) of microvascular thrombosis. Postoperative bone union was achieved by 201 patients, except for five with total flap necrosis and two with partial flap necrosis. There were four cases (1.9 percent) of mandibular condyle dislocation. Two major types of complications were observed at the donor site, including four cases of infection and six cases of scapular body fracture. Postoperative denture prosthesis was introduced to 97 patients (47.3 percent). Implant treatment was performed in 10 patients (4.9 percent). Functional and aesthetic outcomes were good to excellent. The scapular composite free flap for mandibular reconstruction was associated with favorable outcomes and demonstrated satisfactory results. Although scapular bone fracture is rare, patients who have undergone mandibular reconstruction using a scapular flap should be monitored for its presence. . Therapeutic, IV.

Fixation of Ramus of the Mandible to the Zygomatic Buttress to Prevent Condylar Dislocation in a Case of Mandibular Reconstruction Using a Fibula-Free Flap: A Technical Note

Fixation of Ramus of the Mandible to the Zygomatic Buttress to Prevent Condylar Dislocation in a Case of Mandibular Reconstruction Using a Fibula-Free Flap: A Technical Note

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.

Postero-supero-lateral dislocation of condyle: A case report

Condylar dislocation involves a non- self limiting displacement of the condyle, outside of its functional position. The most common condylar dislocation is anterior to the articular eminence. There may be medial, lateral, posterior, intracranial dislocations. Condylar dislocations constitutes only 3% of all the dislocations of joint in the body. Dislocations along with a fracture is very rare. This is a case report reviewing a postero-supero-lateral dislocation of condyle into the external acoustic meatus and perforating it without corporation of other fractures.

Traumatic Posterior Dislocation of Bilateral Mandible Condyles into External Auditory Canal Treated with Midline Mandibulotomy: A Rare Case Report and Review of Literature.

Posterior dislocation of the condyle from the glenoid fossa fracturing the anterior wall of the canal and ultimately restricting lower jaw movements is a rare condition. It may occur due to lax intra-articular ligaments or periarticular tissue or as a result of injury to the chin region. Very few cases of this condition are reported in the literature. The purpose of this article is to present a rare case report and review of literature related to posterior dislocation of bilateral mandible condyles to the external auditory canal, its diagnosis, and treatment with midline mandibulotomy. We used conservation methods to reduce it initially but not succeeded. Then we used midline mandibulectomy to reduce the individual condyle to its original position without opening the condyle region. We achieved a successful reduction of the dislocation and achieved with good occlusion and postoperative mouth opening. No complications like recurrence and TMJ ankylosis occurred. Bilateral posterior dislocation is a rare condition; proper clinical, radiographic diagnosis, and early treatment with manual or surgical intervention are required to avoid complications.

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.

A case of recurrent condylar dislocation treated with eminectomy and a headgear device specialized for condylar dislocation in a middle-aged patient with Down&apos;s syndrome

A case of recurrent condylar dislocation treated with eminectomy and a headgear device specialized for condylar dislocation in a middle-aged patient with Down&apos;s syndrome