Intracapsular Condylar Fractures Research Articles

Effect of stainless-steel wire internal fixation on intracapsular condylar fracture.

The aim of the study was to investigate the clinical effect of stainless-steel wire fixation on the early mouth-opening movement of an intracapsular fracture involving the condylar process. In this study, patients who underwent mandibular condylar intracapsular fracture surgery in our hospital from 2012 to 2020 were selected as research subjects. A total of 44 patients received steel wire internal fixation treatment, 32 patients received titanium plate-and-nail rigid internal fixation, and 28 patients underwent conservative non-surgical treatment. For the patients in the stainless-steel wire group, the degree of mouth opening reached normal levels of 3.7 cm approximately 10 days after surgery. The recovery time for the patients in the titanium plate-and-nail rigid internal-fixation group was 21 days, while the patients in the conservative treatment group needed 60 days to recover. The treatment of fixation with a stainless-steel wire for intracapsular condylar fracture reduced the time taken to perform mouth-opening exercises and improved the recovery rate of patients.

Conservative versus Surgical Approaches in the Treatment of Intracapsular Condylar Fractures: A Retrospective Study.

The diagnosis and management of intracapsular condylar fractures (ICFs) are crucial, and if left untreated, they can cause facial asymmetry, limited mouth opening, and even temporomandibular joint (TMJ) ankylosis, which may affect the physical function and mental health of patients. Various procedures have been described for the ICFs, but there is no consensus on the therapeutic methods. This study aimed to compare the clinical efficacy of conservative and surgical management of ICFs.

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.

Displaced Mandibular Fracture in an Infant - A Case Report

Introduction: Mandibular fractures in infants are rare. We aim to describe a case of displaced mandibular fracture of an infant who was managed by a combination of treatment modalities to achieve favourable outcome. Case report: A healthy 11 months old girl was referred to the Department of Paediatric Dentistry for management of a mandibular fracture following a fall. Clinical and radiographic examination demonstrated a displaced symphysis fracture of the mandible with concomitant right intra-capsular condylar fracture. Open reduction and internal fixation with titanium miniplate and screws were fixated at the lower border of the mandible with additional immobilisation with cap splint. The cap splint was stabilised with circum-mandibular wirings. The splint and implants were removed after 4 weeks and 3 months, respectively. Post-operative healing was uneventful. The face was symmetrical with the primary teeth erupted into occlusion. Conclusion: The treatment approach should be customised for each case by considering the patient’s age, level of co-operation of the child, degree of fracture displacement, pre-treatment occlusion derangement, and stage of dentition development.

Fracture fragment of the condyle determines the ramus height of the mandible in children with intracapsular condylar fractures treated conservatively

This study aimed to explore and impart understanding of bone remodelling in children with intracapsular fractures treated conservatively. Records of children (less than 12 years), who sustained intracapsular fractures and treated conservatively, were retrieved consecutively for the period of March 2011 to February 2016. Data about age, gender, date of injury, dates of admission and discharge, mechanism of trauma, location and pattern of fracture, other mandibular fractures, treatment methods and time of review were recorded and analysed. Image dates of pre- and post-treatments, including date of review, were also recorded. A total of 22 patients complete their follow-up and show bone remodelling process. During their follow-up, all the displaced condylar fragments fused with the ramus stump at the displaced position. Regardless of the type of conservative procedure, both treatments cannot promote the spontaneous fracture reduction in patients with intracapsular condylar fractures. During follow-up, the absorption of the lateral process of the condyle after the closed treatment becomes close to the ‘horizontal absorption’, until the height (or articular surface) of the lateral condylar process dropped and aligned to the articular surface of the medial process. In children with intracapsular condylar fractures, the fracture fragment of the condyle determines the ramus height of the mandible. Closed treatment cannot restore the fracture fragment. If the height of the fracture fragments dropped remarkably, then open reduction and rigid internal fixation become more suitable.

Serious Condylar Head Absorption in Children With Intracapsular Condylar Fractures Treated Operatively With Long Screws.

This study was performed to explore bone remodelling in children with intracapsular condylar fractures after the condylar fracture fragments were fixed using long screws and to offer possible explanations about the underlying mechanism. Records of children (less than 12y old) who sustained intracapsular condylar fractures and fixed with long screws from May 2012 to January 2015 were retrieved. Age, gender, dates of injury, admission, and discharge, mechanism of trauma, location and pattern of fracture, other mandibular fractures, treatment methods, and time of review were recorded and analyzed. Image dates of pretreatments and posttreatments, including the date of review, were also recorded. A total of 8 patients completed their follow-up, and all patients (n=5) who were followed up after more than 3 months showed serious resorption of the condylar head. The condylar head resorbed until the height (or articular surface) dropped and aligned with the surface of the screw. The shortest time of absorption, as shown by the computed tomography scan was 106 days, and the longest time was 171 days (average time of 141.8d). Intracapsular condyle fractures in children should be managed conservatively as much as possible. However, if the height of the fracture fragments drops remarkably, open reduction and rigid internal fixation become possible choices.

Removal of Fracture Fragments in Intracapsular Condylar Fractures: An Alternative Treatment Option.

This study aimed to explore bone remodeling after condylar fracture fragments have been removed from patients with intracapsular condylar fractures. it also evaluated whether condyle fracture removal can be used alternatively when the authors treat patients with comminuted or small pieces of fracture or in extremely difficult operations. Records of patients who sustained intracapsular condylar fractures and treated by removal of fragments for the period of February 2013 to September 2019 were retrieved. Data about age, gender, date of injury, dates of admission and discharge, mechanism of trauma, location and pattern of fracture, other mandibular fracture, treatment methods and time of review were recorded and analyzed. Image dates of pre- and post-treatment (including the time of review) were also recorded. The data of a total of 103 patients ranging from 5 to 84 years old were retrieved during this study. A total of 135 sides of condylar fragments were removed. Almost all of the patients with comminuted condyle head fracture or type A fracture presented apparent shortening of the ramus height, and none of them showed osteogenesis (or new bone formation) during their follow-up. Present study only observed osteogenesis in few patients who sustained type B/C intracapsular condylar fractures during their follow-up. The younger the patient was, the longer the follow-up time was, and the higher the possibility of new bone formation was. No correlation was found between the amount of osteogenesis and follow-up time, the amount of osteogenesis was generally small, and no patient could form a new condyle head similar to the normal (or original) condyle head. Condylar hypertrophy only occurred in children. Four patients developed temporomandibular joint ankylosis. Removal of fracture fragments is an alternative treatment option for patients who sustained comminuted or small pieces of fracture or in extremely difficult operations.

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.

Mini suture anchor: An effective device for reduction and fixation of displaced temporomandibular joint disc with intracapsular condylar fracture

PurposeThe main aim is to provide clinical reference for the application of mini suture anchor in the reduction and fixation of displaced temporomandibular joint (TMJ) disc with intracapsular condylar fracture. MethodsFrom October 2018 to October 2019, 21 patients (31 sides) with intracapsular condylar fractures and articular disc displacement from West China Hospital of Stomatology, Sichuan University were included. The selection criteria were: (1) mandibular condylar fractures accompanied by displacement of the TMJ disc, confirmed by clinical examination, CT scan and other auxiliary examinations; (2) indication for surgical treatment; (3) no surgical contraindications; (4) no previous history of surgery in the operative area; (5) no facial nerve injury before the surgery; (6) informed consent to participate in the research program and (7) complete data. Patients without surgical treatment were excluded. The employed patients were followed up at 1, 3, 6 and 12 months after operation. Outcomes were assessed by success rate of operation, TMJ function and radiological examination results at 3 months after operation. Data were expressed as number and percent and analyzed using SPSS 19.0. ResultsAll the surgical procedures were completed successfully and all the articular discs were firmly attached to the condyles. The articular disc sufficiently covered the condylar head after the fixation. The fixation remained stable when the mandible was moved in each direction by the surgeons. No complications occurred. The functions of the TMJ were well-recovered postoperatively in most cases. CT scan revealed that the screws were completely embedded in the bone without loosening or displacement. ConclusionMini suture anchor can provide satisfactory stabilization for the reduced articular disc and also promote the recovery of TMJ functions.

Biomechanical Loading Comparison between Titanium and Bioactive Resorbable Screw Systems for Fixation of Intracapsular Condylar Head Fractures.

Osteosynthesis resorbable materials made of uncalcined and unsintered hydroxyapatite (u-HA) particles, poly-L-lactide (PLLA), are bioresorbable, and these materials have feasible bioactive/osteoconductive capacities. However, their strength and stability for fixation in mandibular condylar head fractures remain unclear. This in vitro study aimed to assess the biomechanical strength of u-HA/PLLA screws after the internal fixation of condylar head fractures. To evaluate their biomechanical behavior, 32 hemimandible replicas were divided into eight groups, each consisting of single-screw and double-screw fixations with titanium or u-HA/PLLA screws. A linear load was applied as vertical and horizontal load to each group to simulate the muscular forces in condylar head fractures. Samples were examined for 0.5, 1, 2, and 3-mm displacement loads. Two screws were needed for stable fixation of the mandibular condylar head fracture during biomechanical evaluation. After screw fixation for condylar head fractures, the titanium screws model was slightly more resistant to vertical and horizontal movement with a load for a small displacement than the u-HA/PLLA screws model. There was no statistically significant difference with load for large displacements. The u-HA/PLLA screw has a low mechanical resistance under small displacement loading compared with titanium within the limits of the mandibular head fracture model study.

Three-dimensional evaluation of condylar morphology after closed treatment of unilateral intracapsular condylar fracture in children and adolescents

PurposeTo investigate the condylar morphology after closed treatment of unilateral intracapsular condylar fracture in children and adolescents through three-dimensional evaluation and to explore the influence of age, types of fracture, follow-up period, treatment methods, and concomitant fractures on the treatment effectiveness. Materials and methodsThe medical records of patients who underwent closed treatment for condylar fractures from January 2006 to December 2018 were reviewed. The fractured sides were included in the study group and the opposite healthy joints were included in the control group. The height of articular eminence, depth of glenoid fossa, length & width & thickness of condylar process, length & width of the ramus, and deviation of pogonion were measured three-dimensionally. Results31 participants were included in the study. The length of condylar process was 2.10 ± 3.77 mm (P = 0.004) shorter, the depth of glenoid fossa was 1.09 ± 2.13 mm (P = 0.040) shallower, and the length of ramus was 1.55 ± 2.49 mm (P = 0.002) longer in fractured side than the ones in healthy side after closed treatment. The pogonion deviated 0.48 ± 1.7 mm to the fractured side, but no statistical significance was found (P = 0.129). ConclusionsChildren had great growth potential to compensate the shortening of condylar process after intracapsular condylar fracture, so closed treatment could be an effective therapy for young children and adolescents.

Acute Intra-Articular Soft Tissue Injury as Seen on Magnetic Resonance Imaging and Its Association With Condylar Fracture Dislocation in Children

An intra-articular injury in growing patients should be well understood because it can interfere with normal temporomandibular joint (TMJ) function and even mandibular growth. The present study evaluated TMJ soft tissue injury after acute nondislocated and dislocated intracapsular condylar fractures (ICFs) in children. In the present cross-sectional study, we enrolled a sample of children younger than 12years old with acute ICFs. The predictor variable was the position of the ICF in relationship to the articular fossa, grouped as nondislocated and dislocated. The primary outcome variable was the injury type, including anterior displacement and deformity of the disc, joint effusion, and retrodiscal attachment tear. The second outcome variable was the injury score classified according to the injury type. Other study variables included age, gender, laterality, and the presence of concomitant fractures. The data were analyzed using the χ2 test and logistic regression analysis. P values<.05 were considered to indicate statistical significance. A total of 44 children with 63 ICFs were included, of which 28 and 35 were nondislocated and dislocated fractures, respectively. Of the 63 ICFs, 56 (88.9%) had anterior disc displacement, 2 (3.2%) had disc deformity, 59 (93.7%) had joint effusion, and 11 (17.5%) had a retrodiscal attachment tear. According to the injury type, 4 joints were given a score of as 0, 3 a score of 1, 45 a score of 2, and 11 a score of 3. The injury type and score were significantly associated with fracture dislocation (P<.05). In children with ICF, the presence of a retrodiscal attachment tear and disc deformity were less frequent. The type and severity of the soft tissue injury were associated with fracture dislocation. Additional studies are warranted to evaluate how soft tissue injuries affect TMJ function and fracture healing.

A comparative biomechanical evaluation of different osteosynthesis techniques used for intracapsular condylar head fractures

PurposeThe aim of the present experimental study was to evaluate the biomechanical behavior in different types of osteosynthesis (titanium screws, bioresorbable pins and miniplates) used in management of intracapsular condylar head fractures. MethodExperimental models of the condylar head fractures were simulated on 15 dry human cadaveric mandibles. Osteotomized mandibles were randomly divided into three groups with different fixation systems used: 1) 15 mm long titanium screws, 2) 15 mm long bioresorbable pins Sonic Pins Rx, 3) T-shaped titanium miniplate and 7 mm long titanium screws. Mandibles were loaded in TIRAtest testing machine (Germany). The main types of deformations, including torsion, bending and shearing, were simulated to study the biomechanical characteristics of the fixation systems. ResultsTitanium bicortical screws demonstrated the highest stiffness in standard loading conditions. The fixation with bioresorbable pins showed lower stiffness in both frontal and sagittal loads. This is indicative of the fact that resorbable pins, which have numerous advantages for clinical usage, cannot provide adequately stable fixation in maximal masticatory loads. The mandibles fixed with T-shaped plate had the lowest stiffness. ConclusionScrew or pin fixation, regardless of the material used, was not resistant to rotational loads. On the contrary, the stiffness of T-shaped plates was quite significant. In real clinical conditions, if rotational displacements are not effectively compensated by irregularities in the fracture surface and precise repositioning of the bone fragments, combined use of miniplates and bicortical titanium screws or two screws can be beneficial.

Surgical Treatment of Intracapsular Condylar Head Fracture with Lag Screw Technique. A Case Report

Intracapsular condylar fractures may account for 65% of all condylar fractures. This diversity of classifications makes epidemiological data collection challenging. Historically, intracapsular condylar fractures were treated in a closed or conservative manner, without open surgery and fixation of the bone fragments. Closed treatment has been described with acceptable outcomes without the risk of complications associated with the surgical treatment, that is, infection, damage to the facial nerve, and unaesthetic extra-oral scar. Recently, studies reporting the surgical treatment of condylar head fractures have reported better results regarding mandibular functional aspects, dental, and aesthetic results. It is also suggested that the repositioning of the articular disc during the surgical procedure, could prevent the consequences of its displacement in possible temporomandibular joint dysfunctions. The objective of this study is to report a clinical case of intracapsular condylar head fracture with open treatment, using lag screw fixation according to AO/ASSIF (Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation) protocols and recommendations.

Does Intraoperative Navigation Improve the Anatomical Reduction of Intracapsular Condylar Fractures?

Accurate reduction of intracapsular condylar fractures is the key to successful reconstruction of the temporomandibular joint and remains a challenge for oral and maxillofacial surgeons. The aim of thestudy was to evaluate quantitatively the effect of surgical navigation on the accuracy of reduction of intracapsular fractures. In this prospective randomized nonblinded controlled clinical trial, patients diagnosed with intracapsular condylar fractures who were scheduled for surgical treatment were included and randomized to open treatment with or without surgical navigation. The primary predictor variable was surgical navigation. The primary outcome variable was the average distance (AD) between preoperative and postoperative computed tomographic measurements. The second outcome variable was the rate of anatomic reduction. The χ2 test and independent-samples t test were used for statisticalanalyses. Twenty patients (33 sides) with intracapsular condylar fractures were enrolled and treated with open surgery (13 male, 7 female; mean age, 28.65yr; range, 13 to 54yr). Of these, 10 patients (16 sides) and 10 patients (17 sides) were treated, respectively, with and without surgical navigation technology. All patients underwent follow-up at 1, 3, 6, and 12months. The mean AD was 0.5235mm in the navigation group and 1.170mm in the control group (P<.001). The rate of anatomic reduction was 93.8% in the navigation group and 88.2% in the control group (P=.58). The results indicated that a more precise reduction was achieved in the navigation group than in the control group. According to the study results, the rate of anatomic reduction increased and the ADs decreased in the navigation group compared with the control group. Therefore, surgical navigation could increase the accuracy of reduction during the surgical treatment of intracapsular condylar fractures.

Preserving the Fibrous Layer of the Mandibular Condyle Reduces the Risk of Ankylosis in a Sheep Model of Intracapsular Condylar Fracture

The aim of this experimental study was to investigate the role of the fibrous layer of the condylar head in the formation of temporomandibular joint (TMJ) ankylosis in a sheep model of intracapsular condylar fracture. Six growing Xiao-wei Han sheep were used in the study, and bilateral TMJ surgery was performed in each sheep. In the left TMJ, sagittal fracture of the condyle, removal of the fibrous layer of the condylar head, excision of two thirds of the disc, and removal of the fibrous zone of the glenoid fossa were performed. In the right TMJ, the same surgical management was performed, except that in each sheep, the fibrous layer of the condylar head was preserved. Three sheep were killed humanely at 1month postoperatively, and the other 3 sheep were killed humanely at 3months postoperatively.The TMJ complexes were examined by histologic evaluation. Fibrous ankylosis was observed on the left side in 3 sheep at 1month postoperatively and in 2 of 3 sheep at 3months postoperatively. Fibro-osseous ankylosis was achieved on the left side in 1 sheep at 3months postoperatively. In the right TMJ, the main postoperative histologic findings included condylar fracture healing, topical rupture or exfoliation of the fibrous layer of the condyle, and fissure between the fibrous layer and the proliferative zone of the condyle. However, no evidence of ankylosis was observed. The TMJ ankylosis scores on the right side were significantly lower than those on the left side at different time points (P<.05). This study showed that the presence of the fibrous layer of the condylar head prevented the development of TMJ ankylosis in a sheep model of intracapsular condylar fracture.

Relationship Between Intracapsular Fracture Patterns and Arthroscopic Findings

To observe the superior joint compartment (SJC) using ultrathin arthroscopy in intracapsular condylar fracture (ICF) of the temporomandibular joint, describe the changes, and evaluate the relations among fracture pattern, arthroscopic findings, and clinical outcome. Twenty patients with 27 ICFs were the subject group. Thirteen patients had unilateral ICFs and 7 had bilateral ICF. The fracture patterns were classified into 9 categories, and all patients had arthroscopic examination of the traumatized joint at the time of definitive treatment. At 4months after treatment of the injury, all patients had a secondary arthroscopy ofthe ICF joint. In all patients, range of motion (ROM) was measured as the interincisal distance (millimeters) at the first visit to 12months after the first treatment, and the data were statistically evaluated. Intra-articular hyperemia, hypervascularity, and temporal bone damage were found, and 4 patients had disc perforations at the first examination. At the second arthroscopy 4months later, normal healing occurred in 11 joints, all of which had minimally displaced fractures. Fifteen joints showed complete filling of the SJC, all of which had a displaced minor fragment from the fossa. Comparison of the effect of the presence versus absence of SJC fibrosis on ROM showed marked differences from 1 to 12months. The effect of early versus delayed definitive treatment showed marked differences at 4 and 12months. The intra-articular condition at 4months after ICF as observed arthroscopically was related to the minor fragment position. If the minor fragment is nondisplaced, then it will heal to a normal state; however, if the minor fragment is displaced from the fossa, then the SJC shows disc damage and fibrosis. This could lead to fibrous ankylosis.

Outcomes of treatment for intracapsular fractures of the mandibular condyle: recommendation for a new classification

We know of no universally accepted classification for intracapsular condylar fractures. We propose here a new classification based on the concept of a “disc-condyle” unit, and validate the classification based on outcomes of treatment. From 1 January 2010 - 31 December 2014, 55 patients with unilateral intracapsular condylar fractures were classified into three types: type A has no reduction in mandibular height or displacement of the disc (n=7); type B has displacement of the disc with no reduction in mandibular height (n=17); and type C has reduced mandibular height with or without displacement of the disc (n=31). We treated types B and C by open reduction and fixation, while type A fractures were managed non-surgically. At six month follow-up, we found no significant differences in the vertical height of the ramus, mandibular deviation, protrusion, or lateral protrusion between the fractured and healthy sides. All patients had normal occlusion postoperatively and only one patient (type C) reported pain. Magnetic resonance imaging and computed tomography showed good osseous healing and disc-condylar relations in all cases. Our results show that this new classification of intracapsular condylar fractures is a safe and easy way to obtain satisfactory outcomes of treatment. However, it needs further independent validation.

Do Open Reduction and Internal Fixation With Articular Disc Anatomical Reduction and Rigid Anchorage Manifest a Promising Prospect in the Treatment of Intracapsular Fractures?

In response to the increased attention to soft tissue reduction in the treatment of intracapsular condylar fractures (ICFs), a modified open reduction technique is proposed and its functional and radiographic outcomes were evaluated in this study. This is a retrospective case series study of patients with all ICF types that were treated with open reduction and internal fixation (ORIF) with articular disc anatomic reduction and rigid anchorage. Inclusion and exclusion criteria were strictly applied. Preoperative and postoperative clinical examinations of malocclusion, maximum incisor opening (MIO), laterotrusion, and temporomandibular disorder symptoms were recorded and analyzed. Computed tomography (CT) and magnetic resonance imaging (MRI) were used to assess articular position and condylar morphology and position. Thirty-four patients with ICFs (47 sides) were treated with the modified ORIF technique. At 6months of follow-up, no malocclusion was found and the MIO considerably expanded to 3.56±0.13cm. Only 4 patients (12%) had temporomandibular joint discomfort with mouth opening. Interestingly, for unilateral type B ICFs, the laterotrusion distance to the ORIF sides was notably longer than to the non-ORIF sides. Postoperative CT and MRI showed that all fragments were properly reduced and the condyles were in the normal position. Postoperative anterior disc displacement occurred in 4 sides and condylar morphologic abnormalities (slight surface roughening and articular cartilage absorption) occurred in 3 sides (6.4%). This modified ORIF technique, which achieved good outcomes after treatment of all ICF types, shows promise for the treatment of ICFs.

A Comparative evaluation of CBCT outcomes of two closed treatment methods in intracapsular condylar fractures

The cone beam computed tomography (CBCT) images of 2 closed treatments are compared for intracapsular condylar fractures (ICFs) to learn whether splint treatment could promote better radiologic outcomes. Fifty-four patients with 60 sides of ICF were divided into 2 groups. In the control group (C-group), patients had a liquid diet for 1month. In the trial group (T-group), patients wore splints with anterior elastic traction. Local CBCT images of the temporomandibular joint were obtained at T0 (mean 8.8days), T1 (mean 37.4days), and T3 (mean 3.3months) after trauma. Six parameters, including 2 horizontal, 1 sagittal, and 3 vertical distances, were calculated using the coordinates of 10 points marked on CBCT sections. Statistical analysis included intragroup comparison at T0, T1, and T3, and intergroup comparison among subgroups classified by age and ICF types. Compared to C-group, vertical distances were significantly changed in T-group, specifically in adults and patients with ICF type B. Significant changes at stage T1 were also observed in T-group. During the natural healing process, ICF healed in the displaced position and the stump tended to move closer to the joint fossa in the vertical dimension. Splint treatment with elastic traction was helpful to increase joint space and promote better radiologic healing shape.