Mandibular Condylar Fractures Research Articles

A multicenter and epidemiological study of patterns and treatment strategies for mandibular condyle fractures

To evaluate retrospectively the epidemiological characteristics of the prevalence, type and treatment modalities of the condylar mandibular fractures. Data of all patients who underwent surgical or nonsurgical management for condyle mandibular fracture were collected. The study was conducted to assess the trauma etiology, age group, gender, treatment method, anatomic distribution of injury and complications by reviewing patients’ records. There were 139 patients with 171 mandibular condylar fractures. Among these patients, 85% were men, with an overall male-to-female ratio of 5.6:1. The highest occurrence of trauma was in the 21-30 years age group. The most frequently observed etiology was motorcycle traffic accidents and the subcondylar region was the most common location with 109 fractures. There was statistically significant difference between treatments (p < 0,001). In the nonsurgical treatment group, the prevalence of complications was observed compared to the surgical group (p < 0.001). The predominant complications were: mouth opening limitation, mandibular deviation, malocclusion, temporomandibular disorder, paresthesia and facial paralysis. Considering the limitations of this study, subcondylar fractures were the most frequent, especially in men aged 21-30 years, and the surgical treatment showed the fewest complications.

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.

Three-Dimensional Analysis of Bone Remodeling After Closed Treatment for Mandibular Condylar Head Fracture.

Closed treatment of mandibular condylar fractures has been used for its indications based on the fracture site, fracture status, and patient age. Posttreatment mandibular condyle size is associated with mandibular function; however, a few studies have reported bone remodeling patterns and volume changes in the condyle and glenoid fossa after mandibular condylar head fractures (CHFs). Therefore, volumetric changes in the mandibular condyle and glenoid fossa were analyzed in the present study, and bone remodeling patterns were evaluated after mandibular CHFs. The present study included 16 condyles from 12 patients who received closed treatment for CHF. After reconstruction of a 3-dimensional skull model, including the mandible, using computed tomography data taken immediately after injury and 6 months after treatment, volume changes in the mandibular condyle and glenoid fossa were analyzed. The condylar volume increased by 0.32±0.66cm3 during the 6-month healing period without statistical significance (P=0.093). Regarding the glenoid fossa, the fossa showed a statistically significant volume increase of 0.41±0.59cm3 (P=0.021), and 12 glenoid fossae (75%) showed downward bone apposition; however, no change or only mild bone resorption was observed in 4 glenoid fossae (25%). The results of this study indicated that the volume changes in the mandibular condyle after closed treatment of a mandibular CHF are not significant, and the glenoid fossa adapts to the displaced mandibular condyle through downward growth accompanied by volume increase.

Posterior Border Osteosynthesis for Fractures of Mandibular Condyle: A Case Series with Finite Element Model Corroboration

Posterior Border Osteosynthesis for Fractures of Mandibular Condyle: A Case Series with Finite Element Model Corroboration

Application of Crus of Helix Incision Through the Posterior Parotid Gland Approach in the Mid-Level or High-Level Mandibular Condylar Fractures.

This study is to explore the clinical effect of crus of helix incision through the posterior parotid gland approach in the treatment of Mid-or High-Level mandibular condylar fractures. From September 2020 to June 2023, we performed incision reduction internal fixation of 23 patients with mid-level or high-level fractures of the mandibular condylar through the approach of the posterior parotid gland, and observed the effect of the operation. After a follow-up period of 6 to 12 months, all patients showed no signs of postoperative facial paralysis or salivary gland fistula. In addition, satisfactory scars were observed in the operation area, and the occlusion function had recovered well. The approach of using a crus of helix incision through the posterior parotid gland proved to be an effective method for treating mid-level or high-level fractures of the condylar fractures. This technique offers several advantages, including adequate exposure, minimal facial nerve injury, ease of incision and reduction, inconspicuous scarring, and a more concealed incision.

Ultrasound-guided arthrocentesis for condylar head fracture: a technical report.

Double puncture arthrocentesis (DPA) of the temporomandibular joint (TMD) is considered an effective preservative option for managing mandibular condylar head fractures. However, the procedure is commonly performed by a traditional "blind" method using anatomical characteristics. In the present study, an ultrasonography (US) device was applied for the treatment of a case with a fractured mandibular condyle. A 79-year-old female was diagnosed right side condylar head fracture complaining pain of right TMD and reduced mouth opening range: inter-incisor distance of 20mm. Since the fracture position was high and inoperable, the decision was made to perform DPA of the TMD. The US probe was positioned parallel and slightly oblique to the major axis of the mandibular ramus. Both the posterior and anterior insertions into the joint space were performed according to the axis mentioned above, which enabled the operator to visualize the entirety of the needle. The device offered safety and ensured accuracy by providing real-time visual aid to the surgeon. The procedure provided an early increase in the inter-incisor distance (31mm) and pain relief. Hence, for the preservative treatment of mandibular condylar head fractures, based on the present study, we recommend US-guided arthrocentesis as a safe, feasible, and effective therapeutic option instead of the conventional "blind" method.

Management of Mandibular Condylar Sagittal Fracture Accompanied by Lateral Condylar Crest Defect.

The sagittal fracture of the mandibular condyle can be fixed with absorbable long screws. Absorbable long screws are generally inserted from the lateral crest of the condyle and are as close as possible to the medial pole of the condyle to obtain sufficient retention force. However, in clinical practice, patients with locally comminuted condylar fractures and partial defects in the lateral crest are often encountered. We validated the use of absorbable plates and long screws to fix mandibular condylar fractures with lateral crest defects, and postoperative follow-up showed good results. The preoperative design indicated that if conventional long screws were used, more soft tissue need to be pulled downward to achieve the appropriate drilling angle. If an absorbable plate was used, the degree of downward pulling of soft tissue was smaller, which can better protect the parotid gland tissue and facial nerve. The surgery was performed according to the preoperative design, using an absorbable plate scheme. Postoperative CT confirmed a stable anatomical reduction of condyle. Four-month follow-up showed that the patient's facial shape, occlusion, and mouth opening were all good. Follow-up CT showed good fracture healing. It is feasible to use absorbable plates and long absorbable screws to fix mandibular condylar sagittal fracture accompanied by lateral condylar crest defect.

Effect of tranexamic acid on postoperative blood loss

The aim of this article was to evaluate the efficacy of tranexamic acid (TXA) to reduce blood loss after maxillofacial fracture surgery. Clinical data were collected retrospectively on patients with unilateral fractures of the zygomaticomaxillary complex (ZMC) or mandibular condyle. Patients were then further divided into TXA and control groups according to whether or not TXA was used after surgery. The amount of postoperative blood loss was evaluated by negative pressure drainage volume. Data were statistically analysed. In patients with unilateral ZMC fractures, total postoperative blood loss in the TXA group was about 30 ml less than that in the control group (p = 0.006). It was significantly less on the first and second postoperative days. However, in patients with unilateral mandibular condylar fractures, there was no significant difference between the TXA and control groups (p = 0.917). TXA can reduce postoperative bleeding in patients with ZMC fractures, and the optimal usage time is on the first and second postoperative days. For patients with mandibular condylar fractures, TXA may not be used.

Transoral endoscopic-assisted VS external approach for performing ORIF in mandibular condyle fractures: A case-series study

ObjectiveThe treatment of condylar fractures can have significant morbidity. The purpose of this study is to suggest the safest approach by comparing endoscope-assisted and open surgery. MethodsA case-series study was conducted in the Maxillo-Facial Surgery Unit of the Federico II University of Naples from January 2016 to January 2022 on 34 patients who underwent surgery for condylar fracture. Thirty patients met the inclusion criteria. They were divided into two groups according to the surgical technique used: Group A, made up of 15 patients treated by endoscope-assisted surgery; Group B made up of 15 patients treated by traditional non-endoscope-assisted surgery. ResultsThe most common complication was transient facial nerve palsy, observed in group B in 4 patients (26%) and in only 2 patients in Group A (13%). Permanent facial nerve palsy occurred in 2 patients (13%) in Group B. No permanent facial nerve palsy was observed in Group A. No plates infection occurred in Group A, 1 case (7%) was recorded in Group B. ConclusionsFrom our experience we can consider endoscope-assisted surgery a favorable option for treating condyle fractures. Patients’ selection for transoral endoscope-assisted surgery is extremely important to ensure the best surgical results with the less complications score.

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.

A single-centre retrospective 10-year experience of the rhombic 3D condylar fracture plate for open reduction and internal fixation of condylar neck and base fractures

Fractures of the mandibular condyle account for a significant proportion of mandibular fractures. The specific functional loads require particular specifications for the implant design used for open reduction and internal fixation of such fractures. The clinical and radiographic outcomes in patients treated using a single rhombic 3D condylar fracture plate for open reduction and internal fixation at a single institution, and who fulfilled the inclusion and exclusion criteria, are presented.The primary outcome variables were: occlusion, maximum interincisal distance and mandibular excursion at 1, 3, and 6 months postoperatively, and radiographic measurements for mandibular height and gonion angle.In total, 263 patients were included, of whom 173 (65.8%) were male and 90 (34.2%) female. The mean age was 40.4 ± 18.9 years. There was satisfactory occlusion in 98.9% of patients at the 6-month follow-up, and a significant improvement in all parameters for mandibular excursion (p < 0.001), with a reduced ramus height and an increase in the gonion angle on the fractured side.Excellent clinical and radiographic results were achieved using the rhombic-shaped implant, deeming it appropriate for the osteosynthesis of mandibular condyle fractures.

Two pediatric cases of bilateral mandibular condylar fracture with follow-up of morphological recovery process of the condyles

Two pediatric cases of bilateral mandibular condylar fracture with follow-up of morphological recovery process of the condyles

Optimal Plate Choice for High-Neck Mandibular Condyle Fracture: A Mechanistic Analysis of 16 Options

(1) Background: Mandibular fractures are common, with the condylar process being a frequent site of injury, accounting for 25–45% of cases. This research aims to assess the mechanical suitability of various plates for high-neck condyle fractures. (2) Methods: Polyurethane models mimicking high-neck condyle fractures were utilized in this study. Sixteen distinct plate designs, constructed from titanium sheets, were tested. The figures underwent force assessments on a durability testing apparatus, and the relationship between used force and fracture movement was documented. (3) Results: For high-neck breaking, the two straight plates emerged as the most effective, aligning with established osteosynthesis standards. The second-best plate exhibited nearly half the strength of the gold standard. (4) Conclusions: In response to the aim of this study, considering the mechanical aspects, the double plain plate stands out as the optimal choice for osteosynthesis in cases of high-neck fractures of the mandibular condylar process. In addition, the authors propose the Mechanical Excellence Factor (MEF) as a superior metric for appraising a plate’s mechanical force, surpassing the conventional Plate Design Factor (PDF).

Characteristics of pediatric mandibular condylar fractures in Southwest China: A single-center and 12-year retrospective study.

Mandibular condylar fractures in pediatric patients may exhibit distinct epidemiological characteristics attributed to their unique growth and development phase, as well as various anatomical, physiological, biomechanical, and behavioral factors that differentiate them from adults. This study aimed to investigate the demographics, injurious factors, classifications, clinical manifestations, and treatments of pediatric mandibular condylar fractures, as well as the concomitant injuries in maxillofacial and other body parts. This retrospective study analyzed the clinical data of 189 pediatric patients with mandibular condylar fractures between 2011 and 2022. Variables investigated included age, gender, timing of onset, causes, classification of condylar fracture, concomitant injuries, clinical manifestations, and treatment modalities. A total of 189 patients, a higher proportion of boys compared to girls was observed, with the highest incidence rate in children aged 1-3 years. They occurred primarily in July, June, and September as well as on Saturdays and Sundays. The most prevalent cause of mandibular condylar fractures was falls from heights in 73 patients (38.62%). Pediatric patients exhibited a higher susceptibility to condylar head fractures. A significant majority (81.48%) of these fractures were accompanied by soft tissue injuries in the maxillofacial region, with the chin being particularly vulnerable to injury. In addition, 61.90% of pediatric patients experienced fractures in other areas of the maxillofacial region, with the mandibular symphysis being the most commonly affected site. Dental trauma predominantly occurred in the anterior region (44.97%). Notably, a substantial proportion (28.04%) of cases also presented with multiple systemic injuries. The characteristics of pediatric mandibular condylar fractures exhibit distinct features in terms of age, gender, timing of onset, etiology, location and type, the presence of concomitant maxillofacial soft/hard tissue injuries and multiple systemic injuries, as well as clinical manifestations and treatment modalities. Therefore, clinicians should pay special attention to the diagnosis and treatment of pediatric condylar fractures.

Risk factors for postoperative facial nerve injury in retromandibular-approach surgery: A retrospective study including CT measurements of maxillofacial bone structure

The purpose of this retrospective study was to identify risks of postoperative facial nerve injury (FNI) in mandibular condylar fractures. A total of 59 consecutive cases of condyle fracture or plate removal with a retromandibular transparotid approach (RMTA) were divided into FNI and non-FNI groups that were evaluated for associations with age, sex, laterality, fracture type, height, weight, body mass index (BMI), and maxillofacial bone height and width diameters on computed tomography (CT).FNI occurred in 11 of 59 patients (18.64%), all of them female (p = 0.0011). Other statistically significant factors on univariate analysis for FNI included a short height (156.95 ± 8.16 cm vs. 164.29 ± 9.89 cm, p = 0.04), low weight (46.08 ± 8.03 kg vs. 58.94 ± 11.79 kg, p = 0.003), low BMI (18.64 ± 2.63 kg/m2 21.68 ± 3.02 kg/m2, p = 0.007), short condylion–anterior fracture distance (19.34 ± 3.15 mm vs. 22.26 ± 3.96 mm, p = 0.04) and short condylion–posterior fracture distance (20.12 ± 3.98 mm vs. 25.45 ± 5.02 mm, p = 0.009).Our retrospective study suggested that FNI with RMTA surgery occurs particularly in female patients and may occur more frequently in patients who are short, lean or have high condyle fractures.

Correlating assessment between clinical features and morphologies on CT scan of mandibular condyle fracture

Background: Among mandibular fractures, condyle fractures are common injuries which directly affect the occlusal function and aesthetics of the patients. Accurate diagnosis based on clinical and radiographic features helps to choose the appropriate treatment. This study aims to evaluate clinical features, morphologies on CT Scan of mandibular condyle fractures and analyze the relationship between these characteristics. Materials and methods: A cross-sectional study on 30 patients with mandibular condyle fractures were conducted at Department of ENT - Ophthalmology - Odonto Stomatology in the Hospital of Hue University of Medicine and Pharmacy, from December 2021 to June 2023. Results: The male:female ratio was about 2:1, the main cause of fractures was traffic accidents (73.4%). The common clinical symptoms were malocclusion (96.7%) with occlusal interferences on posterior teeth and limited mouth opening (83.3%). On CT Scan, condylar neck fractures were the most common position (58.8%). There was a relationship between the side of deviated mouth opening and the affected sides (p &lt; 0.05). In cases of unilateral condyle fractures, there was a relation between the side of premature contact on posterior teeth and the affected sides (p &lt; 0.05). Conclusions: Fractures of condylar neck was the most common fractures in the mandibular condyle, which resulted in malocclusion, interferences on posterior teeth, limited and deviated mouth opening. There was a relationship between deviated mouth opening and premature contacts on posterior teeth with the fractured side. Key words: Mandibular condyle fracture, clinical features, CT Scan.

Comparison between endoscopically assisted transoral and high perimandibular approaches for the surgical management of condylar fractures: A retrospective study

ObjectiveThis study aimed to compare the endoscopically assisted transoral approach (EATA) and high perimandibular approach (HPMA) for mandibular condylar fractures. MethodsWe conducted a retrospective study on patients who underwent open reduction and internal fixation using the EATA or HPMA between March 2013 and February 2023 and were followed up for > 6 months. The primary predictor variables were the surgical approach, including the EATA and HPMA. The outcome variables were postoperative mandibular condition, including maximum interincisal opening, occlusion and condylar pain, anatomical reduction, and complications. Other predictive variables were patient characteristics and perioperative fracture conditions. Statistical analyses were performed by comparing patients treated with the EATA and HPMA. ResultsSeventeen and 14 patients who were treated with the EATA and HPMA, respectively, were eligible for this study. Radiological assessments showed that the anatomical reduction in patients treated with the HPMA was significantly better than in those treated with the EATA. Notably, four patients experienced trismus after the EATA and none after the HPMA. One patient experienced malocclusion after the EATA; however, none experienced malocclusion after the HPMA. However, the differences in these mandibular condition between the EATA and HPMA groups were not significant. None of the patients experienced transient or permanent facial nerve palsy. ConclusionsSignificant differences in anatomical reduction between patients treated with the EATA and HPMA are observed; however, the difference in postoperative mandibular condition is not significant between the two approaches. It is essential to choose the appropriate approach based on a thorough preoperative evaluation.

Factors Affecting the Duration of Surgery in the Management of Condylar Head Fractures.

Prolonged operation times should be avoided due to the associated complications and negative effects on the efficiency of the use of operating room resources. Surgical treatment of mandibular condylar head fractures is a well-established routine procedure at our department, nevertheless, we recognized fluctuating operating times. This study aims to pinpoint the influencing factors, in particular the hypothesis whether the efficiency of intraoperative muscle relaxation may decisively affect the duration of surgery. It analyses 168 mandibular condylar head fractures that were surgically treated in the period from 2007 to 2022 regarding the duration of the surgery and potential factors affecting it. The potential predictors' influence on the dependent variable operation time was mainly calculated as a bivariate analysis or linear regression. Efficiency of relaxation (p ≤ 0.001), fragmentation type (p = 0.031), and fracture age (p = 0.003) could be identified as decisive factors affecting the duration of surgery, as the first surgeon was a constant. In conclusion, surgical intervention should start as soon as possible after a traumatic incident. In addition, a dosage regimen to optimize the efficiency of relaxation should be established in future studies. Fragmentation type and concomitant fractures should also be considered for a more accurate estimation of the operating time.

ASSESSMENT OF PRESENCE AND ABSENSE OF IMPACTED MANDIBULAR THIRD MOLAR ON ANGLE AND CONDYLE FRACTURE

Background: Various studies in the past have proven that impacted mandibular third molars increase the risk of angle fractures and decrease the risk of concomitant fractures of the condyle. The present study aimed to assess the effect of presence of mandibular third molars on mandibular angle and condyle fracture. Methods: A retrospective study was conducted in Department of Oral and Maxillofacial Surgery, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal between September 2016 to July 2020 after obtaining ethical approval. Hospital case records and panoramic radiographs were used to assess the presence, position and angulation of impacted mandibular third molar and the incidence of mandibular angle and condyle fractures were determined. Data were analyzed by using descriptive statistics. The frequency, percentage, means and standard deviation were calculated. Results: A total of 78 cases with 103 angle and condyle fractures were included in this study. Sixty two cases of angle fracture had presence of mandibular third molars. Among 25 condyle fracture 16 cases had either fully erupted or missing mandibular third molars. Conclusions: The presence of impacted mandibular third molar makes the angle region more vulnerable to fracture while presence of erupted third molar or its absence increases the risk of condylar fracture.

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.