Management Of Mandibular Condylar Fractures Research Articles

Two Miniplates Versus Three Dimensional Plate in Management of Mandibular Condylar Fractures: A Systematic Review and Meta-Analysis

Study Design Systematic Review and Meta-analysis. Objective This systematic review and meta-analysis aimed to compare the efficacy of 2 miniplates vs a three-dimensional plate in the management of mandibular condylar fractures. The primary objective was to assess key parameters, including intraoperative time, maximum mouth opening, complications, and functional outcomes, to determine potential differences between the 2 fixation methods. Methods A comprehensive literature search was conducted to identify relevant studies. Inclusion criteria were applied, and the selected studies underwent systematic review. The key parameters were extracted and subjected to meta-analysis to quantify and compare the outcomes associated with the use of 2 miniplates and three-dimensional plates. The methodologies of the included studies were critically evaluated to address potential biases and confounding factors. Results The meta-analysis results indicated that there were no statistically significant differences between the 2 fixation methods in terms of intraoperative time, maximum mouth opening, complications, and functional outcomes. However, concerns were raised regarding the high risk of bias, confounding factors, and considerable heterogeneity observed across the reviewed studies. Conclusions The findings suggest that both 2 miniplates and three-dimensional plates are viable options for the management of mandibular condylar fractures. Despite the lack of statistical significance in the observed differences, the study highlights the need for further prospective research with enhanced methodologies, standardized protocols, larger sample sizes, and reduced bias to refine our understanding and potentially influence clinical management protocols.

Complications of Open Reduction and Internal Fixation of Mandibular Condyle Fractures in Oman

Objectives: The management of mandibular condyle fractures by Open Reduction and Internal Fixation (ORIF) is gaining popularity worldwide. The aim of this study is to report the complication rate associated with ORIF of mandibular condyle fractures in Oman. Methods: A retrospective cohort study was conducted among all patients who underwent ORIF of mandibular condyle fractures at Al-Nahdha Hospital and Sultan Qaboos University Hospital, Muscat, Oman, from January 2008 to December 2020. Data collected included; patient demographics, fracture aetiology, fracture side and type, surgical approach, and recorded complications and outcome. Results: A total of 68 patients (59 males and 9 females, mean age of 30.1 years) with 83 mandibular condyle fractures underwent ORIF during the study period. Subcondylar fracture was the commonest type accounting for 62.7% and bilateral fractures occurred in 21 (30.8%) patients. The most common surgical approach was retromandibular accounting for 42.2%. The overall rate of recorded complications was 42.6% and the commonest reported complications were transient facial nerve palsy (18.1%), followed by malocclusion and restricted mouth opening accounting for 14.7% and 10.3%, respectively. Subsequent surgical intervention to correct malocclusion was performed in six cases. There was no statistically significant difference in overall complications and the patient’s clinical characteristics. Conclusion: Although ORIF of mandibular condyle fractures offers a favourable outcome, it carries a small risk of developing a few complications.
 Keywords: Mandibular Fracture; Mandibular Condyle; Open Fracture Reduction; Complications; Facial Nerve Injuries; Oman.

Comparative Evaluation of Open Reduction with Internal Fixation Against Closed Reduction Methods for Condylar Fracture Management: A Systematic Review and Meta- analysis.

Mandibular fractures are frequent in facial trauma. Management of mandibular condylar fractures (MCF) remains an ongoing matter of controversy in maxillofacial injury. A number of techniques, from closed reduction (CR) to open reduction and internal fixation (ORIF), can be effectively used to manage these fractures. The best treatment strategy, that is, closed reduction or open reduction with internal fixation, remains controversial. The aim of this study is to systematically review the existing scientific literature to determine whether open reduction with internal fixation or closed reduction is a better treatment alternative for the patients with condylar fractures through a meta-analysis. A systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Electronic databases like PubMed, google scholar and Ebsco Host were searched from 2000 to December 2021 for studies reporting management of condylar fractures through open reduction with internal fixation against closed reduction and reporting the outcome in terms of mean and standard deviation (SD). Quality assessment of included case control and cohort studies was performed using Newcastle-Ottawa Scale, and randomized studies were evaluated using Cochrane risk-of-bias (ROB)-2 tool through its domains. The risk of bias summary graph and risk of bias summary applicability concern was plotted using RevMan software version 5.3. The standardized mean difference (SDM) was used as summary statistic measure with random effect model and p value <0.05 as statistically significant. Seventeen studies fulfilled the eligibility criteria and were included in qualitative synthesis, of which only nine studies were suitable for meta-analysis. The pooled estimate through the Standardized Mean Difference (SMD) of 0.80, 0.36 and 0.42 for maximum inter incisal opening, laterotrusion and protrusion favours CR compared to ORIF for condylar fracture management. Also, most results of heterogeneity tests were poor and most of the funnel plots showed asymmetry, indicating the presence of possible publication bias. The results of our meta-analysis suggest that CR provides superior outcomes in terms of maximum inter incisal opening, laterotrusion and protrusion compared to ORIF in condylar fractures management. It is necessary to conduct more prospective randomized studies and properly control confounding factors to achieve effective results and gradually unify clinical guidelines.

Mandibular condylar fractures: a 5-year retrospective analysis comparing open versus closed reduction.

Mandibular fractures are common facial fractures, and contemporary management of mandibular condylar fractures is controversial. The purpose of this study was to compare the outcomes of patients who sustained a mandibular condylar fracture between 2016 and 2020, who were managed by either open or closed techniques. The outcomes of this study were: post-operative facial nerve function, occlusion, and maximal mouth opening. This study is a retrospective multicentre cohort study which assessed clinical records for 246 patients with mandibular condyle fractures in three hospitals in Perth, Western Australia. The primary outcome measure was changes in post-operative facial nerve function. One hundred and thirty-two patients underwent open reduction and internal fixation (ORIF), and 114 patients had closed management. The overall rate of temporary facial nerve injury following ORIF was 3.28%. The overall rate of permanent facial nerve injury was 0.82%. Sialocoele occurred in 2.46% of all patients who underwent ORIF. 6.14% of patients had persisting malocclusion across both groups. There was a statistically significant association between the degree of fragment shortening and facial nerve injury (P = 0.0063), with more facial nerve changes in the group with 5 mm or greater of fragment shortening. There is still significant debate over the management of mandibular condylar injuries. This study demonstrates a similar rate of temporary and permanent facial nerve injury as previously described, as well as a similar rate of sialocoele occurrence. Further prospective studies may provide clarity about important characteristics that will help guide decision making for mandibular condylar fractures.

Management of Mandibular Condyle Fractures in Paediatric Patients: a Systematic Review.

This systematic review searched three of the most used databases to assess if current evidence suggested a difference between surgical and non-surgical management of mandibular condyle fractures in paediatric patients. An electronic literature search was conducted of three well known databases - Ovid, PubMed and Web of Science. Studies included were conducted paediatric patients, in humans, written in English and published from January 1st 1996 until April 1st 2022. Data collection was carried out by two independent reviewers. Data collated from studies without high risk of bias was pooled for surgical vs non-surgical management and total tallies of all outcomes presented. Presence or absence of complications was recorded in 4 x 4 tables for each outcome and compared using a Chi-Square test. After duplicate records were removed, 182 records were screened. After exclusion of unsuitable reports, 20 were included in the review. Further analysis showed the included studies had high risk of bias. Given this, comparison of this pooled data showed no significant difference between management methods. Presently it appears conservative management is functionally adequate without risks associated with surgical management, even though incidence of these risks was shown to be low in the studies included in this review.

"Cervicomastoid Versus Retromandibular Extension of Pre-Auricular Incision in Transmasseteric Anteroparotid Approach for Condylar Fracture Management-a Prospective Study".

Treating mandibular condylar fractures has always been a matter of debate and controversy. However, there are various approaches, but it is of utmost importance that the surgical procedure must guarantee maximum safety for the facial nerve with best cosmetic outcome and minimizing complications. This prospective study was designed to compare cervicomastoid and retromandibular extension of pre-auricular incision in transmasseteric anteroparotid approach for condylar fractures management. The study was conducted in the Department of Oral and Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere from November 2015 to May 2017, and a total of 16 condylar fractures were surgically accessed for the management and were divided into two groups, cervicomastoid (Group A) and retromandibular extension (Group B) for evaluating parameters such as to assess the access to condylar region, post-operative edema, cosmetic outcome, time taken to access and facial nerve injury. Clinically the time taken was significantly less in the cervicomastoid group even though, there was no statistically significant difference regarding access to the fracture site, post-operative edema, facial nerve injury and cosmetic outcome between two groups. In our opinion the anteroparotid transmasseteric approach is appropriate for surgical management of mandibular condylar fractures as it provides adequate access, ensures safety of the facial nerve and is relatively easy to master. We realize that rather both incisions are good, but cervicomastoid variant is better choice in many aspects one being time taken for the surgery because of better tissue laxity of neck skin when seen in comparison.

Functional Orthodontic Treatment of Mandibular Condyle Fractures in Children and Adolescent Patients: An MRI Follow-Up.

Background: The purpose of this study was to retrospectively evaluate and follow up a conservative treatment approach with functional orthodontic appliances for the management of mandibular condyle fractures in children and adolescent patients. Methods: Between 2020 and 2022, the treatment records of patients with mandibular condyle fractures receiving a functional orthodontic treatment (FOT) were evaluated. In addition to the clinical and functional findings, magnetic resonance images of the mandibular condyles and surrounding structures were assessed. Results: Out of 61 patients, 8 met the inclusion criteria. The follow-up examination records showed no functional limitations. In 75% of cases, mild midline deviations persisted (mean 1.1 mm) without significant alterations to the occlusal relationships. Magnetic resonance imaging (MRI) showed the remodeling of the condyles and the restitution of the ramus heights, even in dislocated and displaced fractures. In three cases, a partial displacement of the articular disc was observed at the follow-up. No differences in the remodeling patterns were noted depending on age, sex, or fracture location. Conclusions: A FOT led to favorable functional and morphologic outcomes, supporting the concept of a conservative functional approach in children and adolescent patients. Functional adjunctive therapy should be considered in the conservative treatment of mandibular condyle fractures in growing patients.

Intermaxillary fixation with bra hooks

Conservative management of mandibular condylar fractures is frequently employed, particularly when there is minimal displacement at the fracture site. Options include functional therapy without a period of intermaxillary fixation (IMF) versus a short period (approximately two weeks) of IMF followed by functional therapy, soft diet, and pain medication as required.1

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

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

'Temporomandibular joint hematoma nerve block'-a new technique in management of mandibular condylar fractures.

Management of mandibular condylar fracture has invited a great deal of controversy in maxillofacial trauma care. In the orthopaedic literature, surgeons have exhaustively described the use of a 'hematoma block' technique during closed reduction (CR) of the ankle or other long bone fractures. Post-traumatic ankylosis of the temporomandibular joint (TMJ) is due to development and progression of the intra-articular hematoma. We improvised their technique for use during CR of mandibular condylar fractures. The desirable effects which can be achieved with our proposed 'novel TMJ hematoma nerve block' technique are evacuating the accumulated hematoma, blocking auriculotemporal and masseteric nerves which in turn causes relaxation of the lateral pterygoid muscle, all in all, favouring accurate anatomical reduction of the fracture. Thirteen patients with isolated unilateral condylar fractures were subjected to our new technique. The parameters assessed were the amount of hematoma evacuated, pain in TMJ region during reduction and postoperative anatomic reduction on cone beam computed tomography (CBCT). All the patients showed a significant reduction in pain and lowered post-reduction angulation between the proximal condylar and distal ramal segments. Our technique is minimally invasive, safe, simple to perform, yielding excellent anatomic reduction of the fracture fragments.

CLINICAL AND RADIOLOGICAL OUTCOMES OF MANDIBULAR CONDYLAR FRACTURES AFTER CONSERVATIVE TREATMENT

Objective: To assess the clinical as well as radiological outcomes of the conservative management of mandibular condyle fractures.&#x0D; Study Design: Cross-sectional comparative study.&#x0D; Place and Duration of Study: Department of Oral and Maxillofacial Surgery (OMFS), Armed Forces Institute of Dentistry (AFID), Rawalpindi, from Feb 2018 to Aug 2019.&#x0D; Methodology: A total of 60 patients diagnosed as isolated mandible trauma with unilateral condyle fractures were studied. All patients were assessed radiologically on orthopantomogram (OPG) before the start of treatment. They were assessed clinically for maximum mouth opening (MMO), occlusion, pain and masticatory satisfaction before the start of treatment and after conservative management. Conservative Management includes soft diet only or maxillomandibular fixation (MMF) followed by active physical therapy. After 6 months of follow up, pre-treatment and post-treatment clinical parameters and radiological finding were compared.&#x0D; Results: Sixty patients were managed conservatively, among them 37 (62%) were male and 23 (38%) were female with age range of 21-53 years. There was statistically significant decrease in pain (p-value 0.002) and improvement in mastication (pvalue 0.079) before and after the conservative treatment of mandibular condylar fractures. Overall 46 (77%) patients treated with conservative management were satisfied with their mastication and 40 (67%) patients had mild pain on mastication. All the patients showed satisfactory occlusion and had no occlusal discrepancy on last follow up visit. Maximum mouth opening improved from 32.38 ± 4.54 to 40.90 ± 1.75 after treatment. The mean of preoperative ramus length difference of both sides of the mandible was 4.23 ± 2.3 mm............

Pre-auricular Transparotid Approach for the Management of Mandibular Condylar Fracture: An Experience of 82 Cases.

This paper retrospectively analyses the functional outcomes and complications associated with pre-auricular transparotid approach for the management of mandibular condylar fractures. The retrospective data of 82 condylar fractures were analysing in 73 patients who underwent open reduction and internal fixation with pre-auricular transparotid approach. Evaluation of post-operative complications and the post-operative occlusion status, maximal inter-incise opening, adequacy of reduction and stability of fixation were assessed clinically and radiographically. The exposure of fracture segment was adequate in all the cases, and fixation was easy with 2mm delta miniplate. Transient facial nerve palsy occurred in 2 patients (2.43%). 1 patient developed sialocele which was managed conservatively. There were slight occlusal discrepancies in 10 patients at the end of 1-week follow-up which was corrected with guiding elastics at the end of 1-month follow-up. The reduction was adequate, and fixation was stable. The functional outcomes were satisfactory in term of mouth-opening and range of motion. The pre-auricular transparotid approach provides direct access to the fracture site resulting in less retraction of the tissue containing facial nerve and also less amount of periosteal stripping is required, thus it maintains good vascularity to the fracture segments. It provides direct visualization of the fracture without much retraction of the tissue containing facial nerve branches. It allows better fixation of the fracture with very less complication which results in good functional outcomes.

Management of mandibular condylar fractures by the retromandibular approach – An evaluation of its complications

Background: Mandibular condyle fractures are commonly encountered in the practice of maxillofacial surgeon. Even though being a commonly seen fracture, the fracture condyle of the mandible demands meticulous diagnosis and a tailor made treatment plan for each and every patient. The treatment plan largely depends on the age of the patient and the displacement of the fractured fragment. This retrospective study provides an insight in to the management of fracture mandibular condyle by retromandibular approach.&#x0D; Aims and Objectives: The aim of this study was to evaluate the complications of the retromandibular transparotid approach in surgically operated patients with mandibular condylar fractures.&#x0D; Materials and Methods: A retrospective study was performed by analyzing the treatment records of patients who underwent open reduction and internal fixation (ORIF) by the retromandibular transparotid approach for seven years. Thirty-five patients who fulfilled the criteria were included in the study. Clinical parameters such as marginal mandibular nerve weakness, sialocele, occlusal derangement and decreased mouth opening were recorded during the first, fourth and twelfth weeks postoperatively. The retrieved data were analyzed for complications of the retromandibular approach in the management of mandibular condylar fractures.&#x0D; Results: In patients (N= 35) who underwent ORIF by the retromandibular transparotid approach, findings recorded at the end of the first week included 5 patients with sialocele, 2 patients with derangement of occlusion, 6 patients with restricted mouth opening and 1 patient with marginal mandibular nerve weakness. However, postoperatively, at the end of 4 weeks, the only complication observed was sialocele in 3 patients. Furthermore, at the end of 12 weeks, sialocele had completely resolved in all 3 patients, and they were free of complications.&#x0D; Conclusion: The retromandibular transparotid approach is a reliable and straightforward technique with manageable complications.

Can Condylar Fracture Still Be Treated with Conservative Approach?? – A Retrospective Study

Background: Ideal management of mandibular condylar fractures remains controversial in maxillofacial trauma. Traditionally, conservative approach was implemented but recently ORIF (Open Reduction with Internal Fixation) has become prevalent. A difference of opinion has been acknowledged in the review of literature concerning the results achieved by open/closed reduction of fractures of the condyle in mandible. Research Objectives: To assess the preference of treatment for fractures of condyle and their indications, advantages, disadvantages and complications for open/closed reduction of fractures of condyle. Methodology: A 13-year retrospective study involving 56 patients who reported with fractures of condylar region were selected from 264 patients who experienced maxillofacial fractures. Out of them, seven were treated with ORIF, while 49 underwent closed reduction. Every patient was critically evaluated for identifying their indications, advantages, disadvantages, their effectiveness and complications of chosen interventions used in the management of condylar fractures. Findings: A male predominance was observed. Closed reduction with concomitant active physical therapy after inter-maxillary fixation gave similar results to that of open method. Conclusion: This study manifested that an appropriately followed conservative treatment provided similar clinical results when compared to ORIF for the management of condylar fractures. In cases with severe loss of height of mandible, surgical intervention is to be preferred to restore it. Further prospective randomized controlled trials with larger sample size are required to come to a decisive conclusion.

Retrospective analysis on the outcome of open and closed reduction of mandibular condylar fractures at tertiary centre of Gujarat

AimAim of this study is to analyse the epidemiology, treatment modalities and complications faced in management of mandibular condylar fractures by surgical and conservative treatment, over period of five years at our centre. Material and methodData of patients who were diagnosed with condylar fractures of mandible from 2013 to 2018 was collected, and were evaluated on the basis of Etiology, fracture pattern, age, sex, associated injuries, treatment modalities and complications. ResultsThe sample size of 82 patients (total 204), 67 male (81.71%) and 15 female (18.29%) (Male: female = 4.5:1), commonly affected 21–40 years age group. RTA is the most common cause (67.07). Subcondylar fractures were significantly related to RTA under influence of alcohol (48.5%). Total 55 (67%) were treated conservatively and (30.59%) of this belonged to MacLennan I. MacLennan II and III were mostly treated surgically with retromandibular approach being the most common. ConclusionThe principal factors which determine the treatment plan are the level of the fracture and the degree of displacement. Most of undisplaced fractures can be managed by closed non surgical treatment. Open reduction is justified mostly in adults with undisplaced or displaced fractures associated with Malocclusion and patients requiring immediate function. Even after these guidelines many other factors like Medical condition, Patient acceptance & Cost can be a deciding factor.

Non-surgical management of paediatric and adolescent mandibular condyles: A retrospective review of 49 consecutive cases treated at a tertiary referral centre

IntroductionMandibular fractures account for over 50% of all facial fractures in children, with the majority of these occurring at the condyle. There is currently no consensus on the management of mandibular condyle fractures in the paediatric population. Treatment options range from conservative management, with or without maxillomandibular fixation (MMF) and physiotherapy, to open reduction and internal fixation (ORIF). MethodsThis was a retrospective review of all patients who attended Alder Hey Children's Hospital with fractured condyle(s) between the years 2000 and 2015. All patients were managed non-surgically and included those managed conservatively and/or with MMF. The following variables were recorded: age, sex, mechanism of injury, concomitant mandibular fractures, imaging, SORG classification, complications and follow-up intervals. The following exclusion criteria applied: patients who underwent open reduction internal fixation of their condylar fracture and patients aged 16 years or over. ResultsForty-nine patients (38 male, 11 female) underwent non-surgical management of condylar fractures during the 15-year study period. The mean age at time of injury was 12 years (range 2–15 years).The etiology of fractures comprised mechanical falls (n = 22), assault (n = 14), sport (n = 5), road traffic accident (n = 3), epileptic fit (n = 1), and unknown mechanism (n = 4). The mean length of hospital stay was 3 days, ranging from 0 to 14 days. Thirty-seven patients had a concomitant mandibular fracture and 12 had an isolated unilateral condylar fracture. Follow-up intervals ranged from 1 to 133 weeks, with a median length of 12 weeks. Fifteen patients underwent MMF, while 34 had soft diet and physiotherapy only. Ninety-two per cent of patients had no complications. No patient had failure of treatment requiring a return to theatre and/or ORIF. Occlusion, interincisal distance, asymmetry and TMJ symptoms were examined in 43/49 patients who attended their postoperative appointments. Four patients (8%) had complications in the postoperative period, namely: lateral open bite (n = 2), deviation to the affected side on wide opening (n = 1), and non-specific TMJ dysfunction (n = 1). None of these patients presented with any subjective symptoms and none developed asymmetry or needed any further surgical intervention. ConclusionPaediatric and adolescent mandibular condyle fractures can be safely and predictably managed using conservative methods. In our, albeit small, study cohort all patients were managed conservatively, and all had a satisfactory outcome with no requirement for further operative intervention.

Management of Bilateral Head-Condyle Fractures and Chronic Dislocation In Children: Case Report

Introduction : Mandibular condyle fracture in children which is late to be treated can cause complications. The management of mandibular condyle fractures in children still controversial between open reduction and closed reduction. The management of maxillofacial fractures in children need to be considered properly due to the growth period in maxillofacial bone. Case Report : A 7-year-old girl patient came with complained her mouth couldn’t close tightly. Patient fell from a motorcycle about 2 months ago. A month after the accident, patient has been treated in private hospital but was unsuccessful. Patient’s mouth still couldn’t close tightly. Intraoral examination shown open bite in patient’s bite relation. Radiographic examination shown discontinuity in bilateral mandibular head-condyle. Patient has been diagnosed with temporomandibular joint dislocation and bilateral head-condyle fracture, then treated with condylectomy. Result : At sixth month control, the opening of patient’s mouth was 3 cm and the occlusion was normal. Discussion: The late management in children’s mandibular fracture can cause complications, such as ankylosis. If it was not treated immediately, it may be impaired the growth of jaw. Surgery or open reduction is the best choice of treatment when long-standing fracture has persisted and ankylosis occurred. Conclusion : The management of mandibular condyle fracture must be treated immediately and based on the accurate diagnosis, it can reduce and eliminate the possible complications. In this case, the treatment was late to be performed so the surgical intervention was necessary due to fibrous tissue that has been formed in temporomandibular joint and interfered the mandibular movement.

Surgical management of mandibular condyle fractures

Background: There is much debate amongst the Oral and Maxillofacial Surgery (OMFS) community about appropriate management of condylar fractures: should they be treated with surgery or more conservatively?

Transmasseteric antero-parotid approach through modified preauricular lazy ‘S’ incision for management of mandible condylar fractures: a prospective study

To report the surgical details and results of our technique of Transmasseteric antero-parotid approach (TMAP) through modified preauricular lazy ‘S’ incision for management of mandibular condylar fractures. This was an observational analysis of 65 patients where 25 patients were treated with conventional preauricular approach, 25 patients with closed reduction and 15 patients with a mean age of 29.4 years with condylar fractures were treated by TMAP technique between September 2016 to June 2018. Aim of the study was to evaluate the proficiency of TMAP approach for open reduction and internal fixation (ORIF) of condylar fracture. The only complication which was noticed was sialocele formation and managed by drainage. TMAP is versatile since it avoids facial nerve damage as it involves identification and preservation of facial nerve and has less chances of post-operative complications related to facial nerve injury. The accessibility achieved by this approach is fair enough to facilitate anatomic reduction and fixation of condyle.

Application of cone-beam computed tomography (CBCT) for diagnosis and management of mandibular condyle fractures

Background: Cone beam computed tomography (CBCT) provides precise imaging of temporomandibular joint anatomy without superimposition and distortion. CBCT is relatively a new imaging modality and used commonly in dental practice.Objective: The aim of this study is to present detailed imaging of emporomandibular joint in case of condyle fracture using CBCT for its use in diagnosis, surgical planning and evaluation of treatment.Method: In our study, we evaluated 3D - CBCT (three dimensional Cone beam computed tomography) examinations of 18 patients with mandibular condyle fractures. All of the fractures in our cases were overlooked on CBCT, thus providing axial, coronal and para-sagittal imaging of condylar head including 3D dimensional volumetric images of the condyle and surrounding structures.Result: Out of 18 condylar fracture patient’s CBCT, 8 radiographs showed condylar head (intracapsular) fracture, 2 condylar neck, 8 subcondylar fracture. 13 condylar fractures were unilateral and 5 were bilateral fracture. 9 of the condylar fractures were not associated with the mandible fracture. Out of the 9 associated condylar fractures; 3 were associated with symphysis fracture, 4 associated with parasymphysis fracture, 1 associated with body fracture and remaining 1 associated with mandibular angle fracture. 6 of the condylar fracture showed no signs of displacement of the fractured part and among 12 displaced condylar fracture parts 8 medially and 4 laterally displaced recorded in CBCT. All of the patients were given treatment on the basis of CBCT diagnosis and the results obtained from it was clinical satisfactory without complaints.Conclusion: We concluded that CBCT is the latest sophisticated technology which provides clear image of condylar head without superimposition of other structures, presented supplementary information for a more effective diagnosis and management of mandibular condyle fractures. Health Renaissance 2015;13 (3): 73-81