Management Of Condylar Fractures Research Articles

Management of condylar fractures – are we compliant with the SORG standard?

Management of condylar fractures – are we compliant with the SORG standard?

Nonsurgical management of condylar fractures in children: A 15-year clinical retrospective study.

To present the 15 years of experience after closed treatment of condylar fractures in children, by evaluating the short- and long-term results and propose treatment modalities. Data were retrieved for all young patients with condylar fractures who were treated from 2000 to 2014. Gender, age of patient, date of injury, type of fracture, treatment provided, and follow-up were registered. A total of 84 patients (mean age: 8.9 years) with 106 condylar fracture sites were included in the study. In 80 cases (95.2%), treatment was nonsurgical, with or without intermaxillary fixation, followed by kinesiotherapy. An intraocclusal block was additionally placed in 19 cases. Open reduction was selected in 4 cases. All condylar fractures healed without functional or esthetic complications, with the exception of 2 patients (2/80, 2.5%). Therefore, in late follow-up, no subjective symptoms were recorded, and a functional well-contoured condylar process was observed in all X-rays. Slight asymptomatic mandibular deviation was recorded in wide mouth opening in 29.1% of the patients. Conservative treatment of condylar fractures is the treatment of choice in children. However, the child's age, adequacy of function of the mandible, degree of displacement or dislocation of the condylar fragment, and need for active kinesiotherapy should be considered in all cases.

Remodeling of Displaced Condylar Fractures with Functional Treatment: High-Quality Radiographic Documentation in Three-Patient Series

Treatment of condylar fractures is variable and controversial. Treatment options for management of condylar fractures include surgical and nonsurgical methods, and if a nonsurgical method is as effective as a surgical method, the former is preferred. Although plain film radiographs and functional outcomes attained through nonsurgical treatment are well established in literature, evidence of the remodeling process through detailed, high-quality imaging is lacking. The purpose of this case series is to describe and illustrate two adults and one pediatric patient with significantly displaced condylar fractures treated nonsurgically with excellent clinical results. It is unique for such patients to have pre- and posttreatment computed tomography scans with high-quality three-dimensional reconstruction as in the case of two adults and to have 3.5-year posttrauma radiographs and 14.5-year follow-up as in the case of the pediatric patient. As such, this report is useful in visually presenting three examples of repositioning and reformation of the temporomandibular joint structures in displaced condylar fractures in a postmenarche 14-year-old female patient, a 21-year-old male patient, and an 18-month-old male patient.

Different patterns of 3D plates of condylar fracture management

Different patterns of 3D plates of condylar fracture management

Temporomandibular joint ankylosis caused by condylar fractures: a retrospective analysis of cases at an urban teaching hospital in Nigeria

Mandibular condylar fractures are common presentations to hospitals across the globe and remain the most important cause of temporomandibular joint (TMJ) ankylosis. This study aimed to analyze cases of mandibular condylar fracture complicated by TMJ ankylosis after treatment. A 16-year retrospective analysis was performed at the dental and maxillofacial surgery clinic of the study institution; patient data were collected from the hospital records and entered into a pro-forma questionnaire. It was found that 56/3596 (1.6%) fractures resulted in TMJ ankylosis. The age of patients with ankylosis ranged from 12 to 47 years. The age (P=0.03) and gender (P=0.01) distributions were significant, with most cases of ankylosis occurring in those aged 11–30 years (n=43/56, 76.8%). Fractures complicated by ankylosis were intracapsular (n=22/56, 39.3%) and extracapsular (n=34/56, 60.7%). Ankylosis increased significantly with the increase in time lag between injury and fracture treatment (P=0.001). Ankylosis was associated with concomitant mandibular (85.7%) and middle third (66.1%) fractures. Treatment methods were not significantly related to ankylosis (P=0.32). All cases of ankylosis were unilateral, and complete (n=36, 64.3%) and incomplete ankylosis (n=20, 35.7%) were diagnosed clinically. The incorporation of computed tomography scans and rigid internal fixation in the management of condylar fractures will reduce ankylosis.

Retromandibular approach in the management of condylar fractures by open reduction and internal fixation a prospective study.

Aim:To evaluate the efficacy and safety of the retromandibular approach in the management of condylar fractures by open reduction and internal fixation (ORIF).Materials and Methods:A total of 20 patients with unilateral mandibular condylar fractures underwent ORIF using retromandibular approach. Pertinent data were collected and subjected to evaluation.Results:The retromandibular approach was found to be expeditious in adequately exposing the fracture site and enabling ORIF. The anatomic reduction of the fractured segments and the fixation was satisfactory in all the cases. Average duration of surgery was 39 min (range: 17-56 min) for satisfactory exposure, reduction, and fixation of each condylar fracture.Conclusion:The retromandibular approach provides adequate exposure of the subcondylar region and should be considered as commendable alternative in the management of condylar fractures.

Functional Outcomes of Preauricular Underparotid Retrograde Approach for Mandibular Condyle Fractures

Management of condyle fractures includes a wide spectrum of alternatives including analgesia alone, physiotherapy, intermaxillary fixation, and open reduction and internal fixation. Various approaches have been previously mentioned for the access to the mandibular condyle. The aim of this retrospective clinical study was to evaluate our clinical results on preauricular underparotid retrograde approach for condylar fractures. This retrospective study included 20 condylar fractures in 16 patients who were treated surgically using a preauricular transparotid retrograde approach between 2010 and 2013. Functional outcomes with this method were addressed in light of the results obtained in this clinical series. We suggest this method in the management of condylar fractures.

Position paper from the IBRA Symposium on Surgery of the Head – The 2nd International Symposium for Condylar Fracture Osteosynthesis, Marseille, France 2012

BackgroundThis is a position paper from the 2nd International Bone Research Association (IBRA) Symposium for Condylar Fracture Osteosynthesis 2012 was held at Marseille, succeeding the first congress in Strasbourg, France, in 2007. The goal of this IBRA symposium and this paper was to evaluate current trends and potential changes of treatment strategies for mandibular condylar fractures, which remain controversial over the past decades. MethodsUsing a cross-sectional study design, we enrolled the consensus based on the panel of experts and participants in the IBRA Symposium 2012. The outcomes of interest were the panel and electronic votes on management of condylar base, neck and head fractures, and panel votes on endoscopic and paediatric condylar fractures. Appropriate descriptive and univariate statistics were used. ResultsThe consensus derived from 14 experts and 41 participant surgeons, using 12 case scenarios and 27 statements. The experts and participants had similar decision on the treatment of condylar base, neck and head fractures, as well as similar opinion on complications of condylar fracture osteosynthesis. They had a parallel agreement on using open reduction with internal fixation (ORIF) as treatment of choice for condylar base and neck fractures in adults. Endoscopic approaches should be considered for selected cases, such as condylar base fractures with lateral displacement. There was also a growing tendency to perform ORIF in condylar head fractures. The experts also agreed to treat children (>12 years old) in the same way as adults and to consider open reduction in severely displaced and dislocated fractures even in younger children. Nevertheless, non-surgical treatment should be the first choice for children <6 years of age. The decision to perform surgery in children was based on factors influencing facial growth, appropriate age for ORIF, and disagreement to use resorbable materials in children. ConclusionsThe experts and participating surgeons had comparable opinion on management of condylar fractures and complications of ORIF. Compared to the first Condylar Fracture Symposium 2007 in Strasbourg, ORIF may now be considered as the gold standard for both condylar base and neck fractures with displacement and dislocation. Although ORIF in condylar head fractures in adults and condylar fractures in children with mixed dentition is highly recommended, but this recommendation requires further investigations.

Évolution du traitement chirurgical des fractures du condyle mandibulaire en France entre 2005 et 2012

The surgical treatment of mandibular condylar fractures is commonly performed. We had for aim to present the latest trends in the surgical management of condylar fractures in France, between 2005 and 2012. A survey was performed among the 49 members of the French college of oral and maxillofacial surgeons between January and September 2012, with a questionnaire sent by email. We analyzed the therapeutic management, the surgical indications; the techniques used according to the fracture, and the postoperative treatment protocols. The data was compared to that of a similar study performed in 2005. The overall reply rate was 86%. Low subcondylar fractures were operated on in all institutions (100%), compared to 76% in 2005. The most popular technique was the high submandibular approach with intraoral miniplate fixation osteosynthesis. High subcondylar and diacapitular fractures were operated on in respectively 82% and 35% of the cases compared to 29% and 10% in 2005 with various surgical techniques and postoperative management. French maxillofacial surgeons operated on more mandibular condylar fractures in 2012 than in 2005. As observed in 2005, the lower and the more dislocated the fractures were, the more they were operated on. The high submandibular approach has become the most popular approach. The use of miniplates for bone fixation has become common. Diacapitular fractures were usually treated functionally. The postoperative management varied greatly from one team to the other.

Comparison of Preauricular Approach Versus Retromandibular Approach in Management of Condylar Fractures

The aim of the study is to compare the two extra oral approaches to the TMJ viz preauricular and retromandibular approach in management of condylar fractures of mandible. Patients with fractured dislocation and displacement of mandible condyle in medial direction were managed by preauricular approach. Patients with lateral displacement of mandibular condyle were managed by retromandibular approach. OPG, Reverse towne's, and C.T. scan were taken in all the cases prior to surgery to assess the pattern of displacement. In our study both approaches have given excellent access and visibility to the condylar fractures but with limitations in each technique. Minimal intraoperative and postoperative complications were encountered in both approaches. The duration of the procedure for preauricular approach was much longer when compared with retromandibular approach. Facial nerve weakness was common in patients treated with preauricular approach, which they improved over a period of time and had complete recovery. Postoperative scar was imperceptible in all cases and good cosmetic results were seen with both approaches. Mouth opening, mandibular movements and occlusion were more or less same in both the approaches while pain and clicking was common in preauricular approach. Both approaches have good results in managing condylar fractures with retromandibular approach having ease of access and ease of fixation. So one can always give preference to retromandibular approach over preauricular approach in managing the condylar fracture except in some cases where preauricular approach is the only option like anteromedial dislocation or complete medial dislocation of condylar segment. Situations, where patients who reported very late for the surgery with resultant scarring of the tissue, in those cases preauricular approach is the only option.

Changing trends in the management of condylar fractures

Aims: In this study we evaluated the functional outcomes and complications in 205 fractures of the mandibular condyle.

Setbacks of Bio-Resorbable Plates and Screws in the Management of Condylar Fractures: Our Experience

Fractures of the condyle can be managed by open or by closed reduction. This study was designed to mention the complications of the bio-resorbable material we had experienced while using them in the management of condylar fractures. Fifteen (11 men and four women) patients with subcondylar fractures were included in the study. Resorbable poly-l-lactide plates and screws were used for the fracture fixation. Patients were followed up clinically and radiographically for a period of 2years. Seven patients had a satisfactory reduction following the placement of bio-resorbable plates. Three patients had developed a swelling in the pre-auricular region, extending till the angle. Two patients had a screw breakage whereby leading to malunion and three other patients had bone resorption, at the fractured site that was appreciated radiographically. Inspite of the advantages of these materials, certain complications has been experienced in our study with regard to the resorption and degradation of the material which has been mentioned and explained in our article.

Results of Transmasseteric Anteroparotid Approach for Mandibular Condylar Fractures

Management of condylar fractures has been the subject of much disagreement and debate. There is no general consensus for definitive treatment. Although there is a growing tendency for open reduction and internal fixation technique, risks and morbidity of the surgical procedure are still a point of concern for maxillofacial surgeons. To reduce potential complications and improve surgical exposure, the transmasseteric anteroparotid approach was introduced. Since 2008, we have operated on 6 patients (7 fractures) using this approach. The technique is easy to learn, provides adequate surgical exposure for open reduction internal fixation, and has few complication rates.

An investigation of current consensus on the management of condylar fractures among Chinese senior maxillofacial surgeons

To determine the current consensus in the management of condylar fractures among Chinese senior oral and maxillofacial (OM) surgeons and the difference between domestic and international. Forty-six senior OM surgeons, who were considered to be expert in management of maxillofacial trauma, were invited to participate in this investigation. A questionnaire was designed to appraise management strategies of surgical and non-surgical treatment on the 18 fractures of condylar process of mandible, which varied in fracture patterns, the degree of fragment displacement, uni-and bi-lateral involved and the age range of patients. The consensus was analyzed and then compared with the current international practice based on Baker's survey. Three fracture situations obtained a uniform opinion, 9 situations had tendency in the alternative of surgical and non-surgical approach, 6 situations had no preference. Of 18 fractures, 8 were advised to receive an open procedure in management of the condylar fracture compared with 4 which was considered to be in a close procedure. Others were obscure in the preference of treatment decision. Consensus was achieved in non-surgical treatment for the patients younger than 12 years in age, and the teenager patients were considered for an open treatment when fracture occurred at the base of condyle and the fragment located out of fossa. It was controversial over the treatment of sagittal or comminuted fracture and subcondylar fracture with slight displacement in the adults. The panel of surgeons admitted a practice that bilateral subcondylar dislocated fractures were indicated for open reduction and internal fixation. If the similar case occurred on the unilateral joint, most of the Chinese surgeon preferred a surgical intervention which was adverse opinion from international. In regard to the decision of surgical and non-surgical treatment for condylar fracture of the mandible, much controversy remained in one third of the investigated cases. The shared opinion was that the children patients should be treated by the closed methods for the condylar fracture and the bilateral subcondylar dislocated fractures were identically indicated for surgical reduction. The domestic OM surgeons seem to have a more tendency to surgery compared with their international counterparts.

Results of functional management of condylar fracture in 3 to 16 years old children

To investigate the effect of soft occlusal splint in the treatment of condylar fracture in children and adolescents. Twenty-three children with condylar fracture aged from 3 to 16 were included in this study. Impressions of both jaws were taken and stone working models poured. After occlusion was recovered by mounting on a bionic articulator, a soft occlusal splint was fabricated. The occlusal splint was worn for 1 to 3 months accompanied with functional exercise. Follow-up was carried out by clinical observation and panoramic image. Clinical satisfactory results were obtained in all the patients with good occlusion, unimpaired function and normal growth and development of the mandibles. Panoramic image showed reconstruction of the fractured condyles, which were flattened and short. Soft occlusal splint is a promising approach for treating condylar fracture in children.

Transmasseter Approach to Condylar Fractures by Mini-Retromandibular Access

The published data are full of evidence that surgical treatment of condylar fractures, performed through an intraoral or extraoral approach, leads to better results than nonoperative treatment. Intraoral surgery can be technically demanding, and an extraoral approach presents risks of facial nerve injuries and visible scarring. The mini-retromandibular approach we have described allows the treatment of condylar fractures at any level in a simplified and rapid manner while reducing the risk of complications common to the other techniques. A total of 33 patients with 38 condylar fractures were treated with a 20-mm mini-retromandibular approach. The mean operative time was 33 minutes (range 17 to 56). One patient in the present study was only 14 years old at surgery, which was performed 25 days after the associated trauma. Correct anatomic reduction and occlusion were achieved in all cases. Additionally, all patients showed normal articular function. Infection of the surgical site occurred in the first 2 surgical cases. In another patient, an additional operation was necessary to fix an erroneously reduced fracture, which had occurred because of insufficient surgical access (15 mm). No facial nerve injury was observed, and all surgical scars were barely visible. We suggest that the mini-retromandibular approach outlined in the present study should be the technique of choice for condylar fracture management, because it allows for easy, fast reduction and synthesis while minimizing the risk of facial nerve injury and visible scars.

P.282 Fractures of orbito-zygomatic region

Twenty-five patients with 28 condylar or subcondylar fractures, sustained during their growth period and treated nonsurgically, have been followed for an average period of 15 years. The fractures were classified as intracapsular, high condylar neck and low condylar neck fractures. In 5 patients, two weeks of intermaxillary fixation, followed by elastic traction in order to achieve a proper occlusion, was applied. All the other patients were treated by instruction, exercises and observation. In 4 patients, subsequent orthodontic treatment was provided. It is not advocated to perform orthodontic aftercare as a routine action in all patients. Satisfaction with the treatment results, as measured on a visual analogue scale (VAS), was very high. The masticatory function of all patients at last follow-up was good to excellent. From this study, it appears that especially the commonly occurring high condylar fractures (64%) show good regeneration tendency as observed on radiographs. Low condylar and intracapsular fractures may give rise to some asymmetry. In 4 cases this asymmetry was clearly visible to the experienced observed, but did not concern the patient. One patient (low condylar neck fracture) showed obvious malocclusion and facial asymmetry, which needed to be corrected by orthognathic surgery. Unfortunately, it is impossible to predict which type of fracture is at risk of facial asymmetry. It is concluded that nonsurgical management of condylar fractures of the mandible in children is still the method of choice.

Mini-retromandibular approach to condylar fractures

Among maxillofacial surgeons, a general agreement exists that the therapeutic strategy for intracapsular condylar fractures is conservative, while the treatment of extracapsular fractures of the mandibular condyle is extremely controversial. The indications and choice of treatment are less than uniform, often relying on the surgeon's personal experience and beliefs. The literature increasingly suggests that the surgical management of these fractures is superior to conservative management in functional terms. Nonetheless, the indications for surgically treating condylar fractures are limited by fear of potential pitfalls related to the access. Extraoral routes to the condyle involve the risk of facial nerve injuries or visible scars; transoral access is free from these pitfalls but is demanding technically, especially for higher neck fractures. In our experience, a 2-cm-long retromandibular access allows straightforward management of condylar fractures, providing as a result a well concealed scar. From 2006 to 2007, 21 patients with 25 condylar fractures were treated surgically using the mini-retromandibular access. The mean operating time was 32 min (range 17-55 min). No facial nerve injuries were observed. The first two patients developed postoperative infections. One patient, in whom the first intervention resulted in malreduction of the fracture because the access was insufficient (15 mm incision), required a second operation to achieve correct reduction and rigid fixation of the condyle. In all cases, good anatomical stump reduction was achieved. All the patients obtained good articular function, since the access was exclusively extra-articular. Condylar fracture reduction, fixation and healing can be managed comfortably using a limited retromandibular approach. Moreover, the risk of facial nerve injury is limited as the nerve fibres are viewed directly.

Open reduction of condylar fractures—A right treatment perspective?

The aim of this study was to evaluate the outcome of open reduction of condylar fractures. Seventy-three patients having 84 condylar fractures of various types operated by a single surgeon between 1991 and 2007 were analysed retrospectively. Rigid fixation was done in 70 cases by using plates and screws whilst condylectomy was done in 14 cases. Explorations were done either by an extended Risdons or by preauricular approach. No immobilisation was done. Results were analysed immediately, after 3 months and over long-term with respect to occlusal status, mouth opening and deviation, TMJ pain, facial nerve function and chewing efficiency. Suitability of approach with respect to access, ease, safety, duration and aesthetics was also analysed. In no case, malocclusion was noted. Facial paralysis occurred in one case (1.2%). Temporary Temporal branch weakness associated with preauricular approach was seen in 20 cases (34.4%), while Mandibular branch weakness associated with the extended Risdons approach was seen in eight cases (30%). Two wounds (2.4%) got infected requiring plate removal. Mouth opening and chewing efficiency could be restored to normal within 3 months. No TMJ pain noted after 3 months. No case showed healing problem. Preauricular approach was superior to extended Risdons approach. Considering the outcome, extra oral open reduction should be the treatment of choice in the management of condylar fractures.

Traitement chirurgical des fractures du condyle mandibulaire de l'adulte en France en 2005

The authors had for aim to present the latest trends in the surgical management of mandibular condylar fractures in France, in 2005. One hundred maxillofacial surgeons were questioned on the surgical management of condylar fractures and indications. Results were presented at the 41st Congress of Stomatology and Maxillofacial surgery. The overall reply rate was 70%. Condylar fractures are generally managed in teaching hospitals. Open reduction and fixation was deemed appropriate in low subcondylar fractures in 76% of the cases, in 10% for diacapitular fractures. Therapeutic details and indications were a matter of huge variability. This survey highlighted the absence of any consensus as far as condylar fractures are concerned. It seems that the higher the fractures are, the lesser they are approached.