Mandibular Condylar Process Research Articles

Recovery of mandibular motion after closed and open treatment of unilateral mandibular condylar process fractures

The purpose of this study was to determine the rate of recovery of mandibular motion in patients treated for fractures of the mandibular condylar process. One hundred and thirty-six patients (111 men, 25 women), 74 treated by closed and 62 by open methods, were included. They underwent testing of mandibular and condyle mobility at 6 weeks, 6 months, and 1, 2, and 3 years post surgery. Their ranges of motion were compared to those of 52 controls (26 men and 26 women). A jaw-tracking device was used to assess mandibular motion. Multilevel statistical models were used to assess differences between groups, and to estimate rate of recovery in the fracture patients. In general, patients with unilateral fractures of the condylar process had maximum excursions that returned to normal values within 3 years after fracture, regardless of treatment. Patients treated open exhibited a faster rate of improvement in maximum interincisal opening than patients treated closed (0.43 mm/month vs 0.15 mm/month, respectively), but part of the difference was due to a significantly smaller opening after 6 weeks for the patients treated open (38 mm vs 42 mm, respectively). Patients treated open also exhibited a faster rate of improvement in maximum excursion toward the fracture side than patients treated closed (0.10 mm/month vs 0.04 mm/month, respectively). Based upon this study, patients with unilateral fractures of the condylar process, who are treated closed and not put into maxillomandibular fixation but are instructed in physical therapy, can be expected to achieve normal maximum excursions within 3 years after treatment. Patients treated open will have reduced maximum opening initially, but may reach normal levels of opening sooner than patients treated without surgery. Patients treated without surgery may have smaller than normal excursion toward the non-fracture side for at least 3 years after fracture, especially if their fracture was at or above the condylar neck. Improvement rates for other maximum excursions are similar for patients treated with or without surgery.

Recovery of mandibular motion after closed and open treatment of unilateral mandibular condylar process fractures

Recovery of mandibular motion after closed and open treatment of unilateral mandibular condylar process fractures

Surgical complications with open treatment of mandibular condylar process fractures

Purpose: This study assessed the surgical complications after open treatment for fractures of the mandibular condylar process. Patients and Methods: A total of 178 patients with unilateral fractures of the mandibular condylar process, 85 treated closed and 93 treated open, were included in this study. A tabulation of surgical findings and intraoperative and postoperative complications was prospectively performed. Standardized animating facial photographs were obtained at several postsurgical intervals and were examined and scored by a prosthodontist and an orthodontist for signs of facial nerve palsy and the quality of the surgical scar. Standard statistical methods were used to assess differences between open and closed treatment groups. Results: There were very few intraoperative or postoperative complications. At the 6-week point, 17.2% of patients treated open had some weakness of their facial nerve. This had resolved by 6 months. The scars were judged either wide or hypertrophic in 7.5% of cases. Conclusions: Based on this study, surgical complications of open treatment of condylar process fractures that lead to permanent dysfunction or deformity are uncommon. © 2000 American Association of Oral and Maxillofacial Surgeons

Facial symmetry after closed and open treatment of fractures of the mandibular condylar process

Purpose: This study compares vertical measures of mandibular and facial morphology after open or closed treatment for fractures of the mandibular condylar process. Patients and Methods: One hundred forty-six patients (121 male, 25 female), 81 treated by closed and 65 by open methods, were included in this study. Towne's and panoramic radiographs, taken at several intervals, were used to quantify the displacement of the condylar process fractures. Posteroanterior cephalograms taken at 6 weeks, 6 months, 1 year, and 2 to 3 years after treatment were used to assess posterior facial height and bigonial and occlusal plane angles. Additionally, panoramic radiographs were used to assess ramus height at the same periods. Standard statistical methods were used to assess differences between groups. Results: Patients whose condylar process fractures were treated by closed methods had significantly shorter posterior facial and ramus heights on the side of injury, and more tilting of the occlusal and bigonial planes toward the fractured side, than patients whose fractures were treated by open methods. Most of the asymmetry in patients treated by closed methods was present by 6 weeks after injury. Conclusions: Patients treated by closed methods develop asymmetries characterized by shortening of the face on the side of injury. It is likely that loss of posterior facial height on the side of fracture in these patients is an adaptation that helps reestablish a new temporomandibular articulation. © 2000 American Association of Oral and Maxillofacial Surgeons

Occlusal results after open or closed treatment of fractures of the mandibular condylar process

The authors of this study conclude that open reduction and rigid fixation of condylar process fractures yields better occlusal results than closed treatment. I basically agree with this statement; however, I disagree with some points of the study. I doubt the reliability of assessing the occlusion from photographs alone without any clinical observation. Furthermore the classification into just “good” or “poor” is an oversimplification. The “poor” occlusion in Figure 3 may have been changed into “good” by just grinding away an occlusal imbalance.

Occlusal results after open or closed treatment of fractures of the mandibular condylar process

Purpose: This study compared the occlusal relationships after open or closed treatment for fractures of the mandibular condylar process.Patients and Methods: A total of 137 patients with unilateral fractures of the mandibular condylar process (neck or subcondylar), 77 treated closed and 65 treated open, were included in this study. Standardized occlusal photographs obtained at several postsurgical time intervals were examined and scored by a surgeon and an orthodontist. Standard statistical methods were used to assess differences between groups.Results: Patients treated by closed techniques had a significantly greater percentage of malocclusion compared with patients treated by open reduction, in spite of the fact that the initial displacement of the fractures was greater in patients treated by open reduction.Conclusions: Based on this study, more consistent occlusal results can be expected when fractures of the mandibular condylar process are treated by open reduction.

Further displacement of condylar process fractures after closed treatment

Purpose: This study examined the changes in the position of the fractured condylar process immediately before and immediately after application of arch bars and at 6 weeks after surgery in a group of patients who underwent closed treatment. Patients and Methods: Sixty-five patients over the age of 16 years underwent closed treatment of unilateral mandibular condylar process fractures. Coronal and sagittal displacement of the condylar process was examined using Towne's and panoramic radiographs before treatment, immediately after placement of arch bars, and at 6 weeks. The change in position of the condylar process from one time to the next was analyzed statistically. Results: There was a statistically significant difference (mean, −5.5 °) in the coronal position of the condylar processes from immediately after injury to immediately after placement of arch bars. There was great variability, with some segments becoming more medially displaced and some more laterally displaced. In contrast, mean change in the sagittal position of the condylar process was not statistically significant, although some became more anteriorly and others became more posteriorly displaced. Similarly, from immediately after placement of arch bars to 6 weeks, there was great variability in position of the condylar process, but the overall change was not statistically significant. Conclusions: The results of this study showed that position of the condylar process is not static in patients treated for condylar process fractures by closed means. These results suggest that care must be taken in basing treatment decisions on the degree of displacement or dislocation of the condylar process in presurgical radiographs.

Mandibular motion after closed and open treatment of unilateral mandibular condylar process fractures

Purpose: This study compared mandibular and condylar mobility after open or closed treatment for fractures of the mandibular condylar process. Patients and Methods: One hundred thirty-six patients (111 male, 25 female), 74 treated by closed and 62 by open methods, were included in this study. They underwent testing of mandibular and condyle mobility at 6 weeks, 6 months, and 1, 2, and 3 years postsurgery. A jaw-tracking device was used to assess mandibular motion. Radiographs that were traced and digitized were used to assess condylar displacement and condylar mobility. Standard statistical methods were used to assess differences between groups. Results: Patients treated by open reduction had significantly greater initial displacement of their condylar processes than did the group treated closed. Immediately after treatment and uprighting of the condyles in the open treatment group, patients treated closed had significantly more displacement. At 6 weeks, patients treated closed had some measures of mandibular mobility that were significantly greater than those in patients treated by open reduction. However, after the 6-week period there were minimal differences in mandibular mobility between groups. At 6 weeks, patients treated by open reduction had significantly greater vertical mobility of the condyle than patients treated closed despite less mouth opening. After the 6-week period, patients treated by open reduction continued to have greater condylar mobility on the fractured side than did patients treated by closed methods. No measures of postsurgical displacement correlated with mobility measures in patients treated by open reduction. However, several measures of mandibular displacement correlated with measures of mobility in patients treated closed, indicating that the more displaced the condylar process, the more limited the mobility of the mandible. Conclusions: Based on this study, patients treated for fractures of the mandibular condylar process by open reduction had somewhat greater condylar mobility than patients treated closed, even though the former group had more severely displaced fractures before surgery. Therefore, open reduction may produce functional benefits to patients with severely displaced condylar process fractures.

Mandibular motion after closed and open treatment of unilateral mandibular condylar process fractures

Mandibular motion after closed and open treatment of unilateral mandibular condylar process fractures

Changes in masticatory patterns after bilateral fracture of the mandibular condylar process

Changes in masticatory patterns after bilateral fracture of the mandibular condylar process

The value of coronal computer tomograms in fractures of the mandibular condylar process

Objective. A prospective investigation designed to compare the diagnostic accuracy of conventional panoramic and pos-teroanterior mandibular radiographs with that of coronal computed tomography scans in cases of fracture of the mandibular condylar process was conducted. Study Design. In all, 182 patients with a total of 249 fractures (some unilateral and some bilateral) of the mandibular condyle received conventional radiographs and coronal computed tomography scans as diagnostic procedures. The ability of these procedures to detect and correctly classify these fractures was determined, and their importance for therapeutic decision-making is described. Results. All clinically identified fractures were detected by means of both conventional and computed tomography imaging. However, only computed tomography scanning could correctly classify high condylar neck fractures. Conclusions. Especially in cases of high condylar neck fracture, coronal computed tomography scans were more useful than conventional radiographs in the determination of type of condylar fracture so that a correct treatment decision could be made. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:632-9)

Changes in masticatory patterns after bilateral fracture of the mandibular condylar process

Purpose: Because the morphology of the temporomandibular joint is thought to control movements of the mandible during mastication, bilateral fractures of the condylar process should disrupt masticatory patterns. The purposes of this study were 1) to document changes in masticatory patterns after such fractures, and 2) to determine whether and when normal masticatory patterns are recovered. Patients and Methods: Twenty-two patients (15 men and 7 women) were examined at 6 weeks, 6 months, 1 year, 2 years, and 3 years after bilateral condylar process fractures. Patients were age and sex matched to a control sample. Incisor movements in three dimensions, along with muscle activity from the anterior temporalis, posterior temporalis, and superficial masseter, were recorded at 500 Hz during mastication of a gummy candy. Results: Although the patients showed no reduction of interincisal opening during mastication, the opening was achieved with reduction of anterior translation of the condyles. Patients had significantly narrower chewing cycles, with significantly lower adductor muscular effort during the closing phases of mastication. Differences from controls were no longer detectable 1 year after the fractures. Conclusion: The amount of opening during mastication may appear clinically normal in patients with bilateral condylar process fractures. However, disruption of controlling structures and lateral pterygoid function appears to reduce the amount of anterior translation and lateral excursion during the chewing cycle. Reduced adductor muscle activity during the closing phases may reduce loads on the fractured condylar processes. In general, these patients recover normal masticatory cycles within 1 year.

Fractures of the condylar process: Surgical versus nonsurgical treatment

Purpose: The purpose of this study was to compare outcomes from surgical and nonsurgical treatment of condylar process fractures. Patients and Methods: Two hundred thirty-four patients with fractures of the mandibular condylar process were treated by open or closed methods. In the follow-up study, 150 patients with a mean follow-up time of 2.5 years were analyzed using radiologic and objective and subjective clinical examinations. Results: No significant difference in mobility, joint problems, occlusion, muscle pain, or nerve disorders were observed when the surgically and nonsurgically treated patients were compared. The only significant difference was in subjective discomfort. Surgically treated patients showed significantly more weather sensitivity and pain on maximum mouth opening. Conclusion: Because of its disadvantages, open surgery is only indicated in patients with severely dislocated condylar process fractures.

Fractures of the condylar process: Surgical versus nonsurgical treatment

Purpose: The purpose of this study was to compare outcomes from surgical and nonsurgical treatment of condylar process fractures. Patients and Methods: Two hundred thirty-four patients with fractures of the mandibular condylar process were treated by open or closed methods. In the follow-up study, 150 patients with a mean follow-up time of 2.5 years were analyzed using radiologic and objective and subjective clinical examinations. Results: No significant difference in mobility, joint problems, occlusion, muscle pain, or nerve disorders were observed when the surgically and nonsurgically treated patients were compared. The only significant difference was in subjective discomfort. Surgically treated patients showed significantly more weather sensitivity and pain on maximum mouth opening. Conclusion: Because of its disadvantages, open surgery is only indicated in patients with severely dislocated condylar process fractures.

Influence of combined mandibular body fractures on clinical dysfunction following fractures of the mandibular condylar process

Influence of combined mandibular body fractures on clinical dysfunction following fractures of the mandibular condylar process

Occlusal results after open or closed treatment of fractures of the mandibular condylar process

Abstract Purpose: This study compared the occlusal relationships after open or closed treatment for fractures of the mandibular condylar process. Patients and Methods: A total of 137 patients with unilateral fractures of the mandibular condylar process (neck or subcondylar), 77 treated closed and 65 treated open, were included in this study. Standardized occlusal photographs obtained at several postsurgical time intervals were examined and scored by a surgeon and an orthodontist. Standard statistical methods were used to assess differences between groups. Results: Patients treated by closed techniques had a significantly greater percentage of malocclusion compared with patients treated by open reduction, in spite of the fact that the initial displacement of the fractures was greater in patients treated by open reduction. Conclusions: ased on this study, more consistent occlusal results can be expected when fractures of the mandibular condylar process are treated by open reduction.

A surgical procedure for treatment of mandibular condylar process fractures via a retromandibular approach

A surgical procedure for treatment of mandibular condylar process fractures via a retromandibular approach

Adaptations of the masticatory system after bilateral fractures of the mandibular condylar process.

The objective of this investigation was to evaluate the adaptations that occur in the masticatory system after treatment of bilateral fractures of the mandibular condylar process. Twenty-two patients (15 men and seven women) with bilateral condylar process fractures treated by open reduction and rigid internal fixation (n = 6), closed therapy (n = 14), or a combination of these techniques (n = 2) were compared with 22 sex- and age-matched controls. Measures of mandibular range of motion, bite force, muscle activity, estimated joint forces, and skeletal morphology were determined at 6 weeks, 6 months, and 1, 2, and 3 years after treatment in all subjects. Various statistical tests were used for comparing differences between patients and controls. There was no significant difference in the patients' morphologic measures for the open and closed reduction procedures; therefore, all of these patients were tested as a single group. After treatment, patients had significantly increased mandibular plane and gonial angles and decreased facial axis angles. They also showed a significant reduction in posterior facial height and moment arm length for the masseter and pterygoid muscles. Anterior and posterior temporalis muscle direction also was significantly different between patients and controls. Patients had significantly limited mobility during the first year after fracture. Bite forces were lower for patients at all times and tooth positions, with a significant difference at 6 weeks after treatment. Patients had a tendency to use proportionally higher temporalis muscle activity during maximum biting; however, the differences were not statistically significant, probably because of the small sample size. The estimated joint force magnitudes were essentially identical between patients and controls; however, the direction of the patients' joint forces were more posteriorly directed for both incisor and molar bites. The results of this study suggest that early reduction in mandibular range of motion, bite force, and the distribution of masticatory muscle activity assist in preventing overloading of the bilaterally fractured mandibular condylar processes.

Effect of Freezing Damage of the Periosteum on the Growth of the Mandibular Condylar Process in the Rat

The regulatory effect of the periosteum on the growth of the mandibular condylar process has previously been investigated by relieving the periosteal tension, e.g. by dividing the periosteum, but no unanimous conclusion has been reached. In the present investigation, a different experimental design was applied in that the growth of the condylar process was observed following a provoked periosteal damage. Using 15-day-old rats, the mandibular ramus on the right side was exposed, and the periosteum subjacent to the condylar cartilage was frozen by a cryotechnique. Controls were treated similarly, with the exception of the freezing. The height of the ramus and the length of the mandibular corpus were measured on separated dry mandibular halves 15 or 30 days postoperatively. The measurements showed that the mandibular halves on which the periosteum had been frozen were significantly smaller than the contralateral ones. A tendency in the same direction was also found in the sham-operated animals. It can be concluded that the presumably increased restriction following damage to the periosteum, and evidently also scarring resulting from the operation, has an inhibitory effect on the growth of the condylar process. However, it is still open to discussion whether the reduced growth is transmitted by mechanical means according to the periosteal-tension hypothesis and/or by here unspecified mitogenic factors.

Computerized axiographic evaluation of condylar movements in cases with fractures of the condylar process: a follow-up over 19 years

The treatment of fractures of the mandibular condylar process(es) can be conservative or surgical. However, in many cases, a definitive judgment on the functional long-term outcome of the chosen therapy can only be given many years after the intervention. As a result, it is clearly useful to be able to review the effects of treatment undertaken at least 15 years previously. Even so, only two such studies have been identified. Therefore, the aim of the present study is to evaluate the current functional capacity of the mandibular condyles of 20 subjects who had had an uni- or bilateral fracture of the condylar process, on average 19 years ago. The individuals, who all had been treated conservatively, were compared with a control group of healthy volunteers matched for gender and age. Besides measuring maximum mouth opening (MMO), computerized axiographies in the sagittal plane were made for each condyle during MMO, maximum protrusion and maximum mediotrusion. In spite of the high degree of inter-individual variability in both groups, the data showed that the amount of condylar movement was in most cases greater in the control group. In general, it appears that the risk of developing functional problems after conservative treatment is highest in the case of a fracture of the condylar process accompanied by condylar luxation, rather than by a condylar dislocation or without it.