Mandibular Function Impairment Research Articles

Temporomandibular dysfunction and functional mandibular limitation

Background: The temporomandibular dysfunction (TMD) is one of the most complex disorders of the body, capable of triggering changes in mandibular function and speech articulation. In the case of teachers, probably due to long periods of speech, since it is known that most of them work in classrooms with too many students, end up making use of the voice incorrectly and may lead to changes in the function of the stomatognathic system. Objective: To investigate the association between TMD and mandibular functional limitation in teachers of an elementary school in the city of Uberlandia. Methods: The study was carried out in 49 teachers. The data were collected through Helkimo’s Clinical Dysfunction Index (IDCCM) and Mandibular Function Impairment Questionnaire (MFIQ). Results: It was observed that all teachers in both genders showed some degree of TMD and, consequently, the higher the TMD degree the greater is the changing the jaw function. Conclusions: Based on the data and through studies carried out with this group of teachers, it is concluded that as the TMD degree increases, it causes alteration of the mandibular function and can lead to a decreased in the mandibular amplitude and to limit movement.

Translation and validation of a Chinese version of the Mandibular Function Impairment Questionnaire.

To adapt the English version of the Mandibular Function Impairment Questionnaire (MFIQ) for Chinese-speaking patients with temporomandibular disorder (TMD) and to evaluate its validity and reliability. In total, 352 patients diagnosed with TMD according to the research diagnostic criteria for TMD (RDC/TMD) Axis I were included in this study. The psychometric evaluation included reliability, which was evaluated by internal consistency (Cronbach's alpha coefficient), and test-retest reliability and validity, which were tested by content and construct validity. Because the content validity of item 11 (kissing) was low (0·12), this item was excluded in subsequent analyses. For exploratory factor analysis, three factors were extracted, accounting for 63·6% of the variance. All items had factor loadings above 0·4. Two models were tested by confirmatory factor analysis, and the two-factor model was adopted (χ(2) /df = 2·279, root mean square error of approximation (RMSEA) = 0·086, comparative fit index (CFI) = 0·910). Internal reliability (coefficient alpha values of 0·925 and 0·720 for each factor) and test-retest reliability (ICCfactor1 = 0·895, 95% CIfactor1 = 0·869-0·918, ICCfactor2 = 0·720, 95% CIfactor2 = 0·645-0·783) of the Chinese MFIQ were excellent. A reliable and valid Chinese version of the MFIQ was constructed for the evaluation of Chinese patients with TMD after some modification of the English version of the MFIQ.

Trismus, xerostomia and nutrition status in nasopharyngeal carcinoma survivors treated with radiation.

The aims of the study were to: (1) examine levels of trismus, xerostomia and nutritional status; (2) compare levels of trismus, xerostomia and nutritional status in patients with nasopharyngeal carcinoma (NPC) receiving different types of radiation modalities; and (3) identify factors related to NPC survivors' risk status for malnutrition and existing malnutrition. A cross-sectional study with consecutive sampling was conducted. NPC survivors were recruited from otolaryngology/oncology outpatient clinics in a medical centre in Northern Taiwan. Study measures included (1) Mandibular Function Impairment Questionnaire, (2) Xerostomia Questionnaire, (3) Mini Nutrition Assessment, (4) Hospital Anxiety and Depression Scale - Depression subscale, and (5) Symptom Severity Scale. A total of 110 subjects were recruited. Those receiving intensity-modulated radiation therapy had less trismus and xerostomia than patients receiving two-dimensional radiation therapy. Patients with female gender, advanced stage, completion of treatments within 1 year, higher levels of depression, more severe trismus and higher symptom severity tended to have malnutrition or were at risk of malnutrition. Trismus and xerostomia are long-term problems in some NPC survivors and may contribute to malnutrition. To better manage a patient's trismus and xerostomia and to enhance nutritional status, clinicians should develop a patient-specific care programme based on careful assessment and targeted measures to improve oral function and insure adequate nutritional intake.

Risk of Headache, Temporomandibular Dysfunction, and Local Sensitization in Male Professional Boxers: A Case-Control Study

ObjectiveTo evaluate differences in the incidence of headache, trigeminal nerve mechanosensitivity, and temporomandibular functionality in professional male boxers (exposed to repetitive craniofacial trauma) who were actively training and without severe previous injuries compared with handball players. DesignCase-control study. SettingUniversity-based physical therapy research clinic. ParticipantsEighteen boxers (mean age, 23±4.61y) as the cases group, and 20 handball players as the comparison group (mean age, ±2y, and sex matched), were included. All participants (N=38) completed the assessment protocol. InterventionsNot applicable. Main Outcome MeasuresMeasurements were taken of the headache impact (Headache Impact Test-6) and the pressure pain threshold over the trigeminal nerve sensory branches, the masseter muscle, and the tibialis anterior muscle. The secondary outcome measure included the temporomandibular function (Helkimo Clinic Index). ResultsThe boxers showed slight mandibular function impairment, local muscular and neural sensitization, and a higher impact from headaches than did the handball players. The between-group comparison found significant differences in all outcome measures (P<.05), except in the tibialis anterior muscle pressure pain threshold on the dominant (P=.958) and the nondominant (P=.453) sides. ConclusionsProfessional male boxers seem to suffer a greater headache impact and local sensitization of the craniomandibular region than do professional handball players. It cannot be determined whether these findings are short-lasting, as a result of the training activity, or long-lasting.

Assessment of cross-cultural adaptations and measurement properties of self-report outcome measures in Portuguese relevant to temporomandibular disorders: a systematic review

The aim of this study was to identify, through a systematic review, which questionnaires used to assess temporomandibular (TMD) disorders are available in the Portuguese language, describing and analyzing the procedures used to translate and adapt the questionnaire into Portuguese, as well their measurement properties. Systematic searches were performed in five electronic databases (MEDLINE by PubMed, Embase, CINAHL by EBSCO, SciELO and LILACS). All studies were analyzed according to the criteria of quality guidelines for the procedures for cross-cultural adaptation and measurement properties. There were 1.418, of which only six were eligible. Manual search retrieved two additional articles and a book chapter, totaling nine eligible studies. Four instruments were translated/adapted into Portuguese: The Research Diagnostic Criteria for Temporomandibular Disorders: Axis II (RDC/TMD); the Fonseca Questionnaire and Anamnestic Index; the Questionnaire from the American Academy of Orofacial Pain (QAADO); and Mandibular Function Impairment Questionnaire (MFIQ), but none of these questionnaires where fully submitted to the steps for translation and adaptation recommended by the followed guidelines and none of the questionnaires had all measurement properties tested. The RDC/TMD and tehe MFIQ are the best available questionnaires in Portuguese to assess TMD, as were those with the most measurement properties acceptable results tested.

Epidemiology of severity of temporomandibular disorders in Brazilian women.

To evaluate the severity of temporomandibular disorders (TMD) of women in the municipality of Araraquara (Brazil) as well as the contribution of the perception of oral health, mandibular functional limitation, and sociodemographic variables on the severity of TMD. The participants were interviewed by telephone. Information regarding age, marital status, economic level, education, and use and type of dental prostheses was surveyed. To evaluate TMD severity, mandibular functional limitation and perception of oral health, Fonseca's Anamnesic Index (IAF), the Mandibular Function Impairment Questionnaire (MFIQ), and the General Oral Health Assessment Index (GOHAI) were used. To evaluate the contribution of these variables on TMD severity, a structural equation model (SEM) was fitted to the data and assessed by usual goodness-of- fit indices. A total of 701 women with a mean age of 44.36 years (SD = 16.31) participated. According to the IAF, 59.6% (95% confidence interval = 56.0%-63.2%) of the women were classified as having TMD, of which 63.9% presented light, 26.8% moderate, and 9.3% severe TMD. Mandibular functional limitation was low in 91.0% of the women, moderate in 7.1%, and severe in 1.9%. Goodness-of-fit for the structural model was adequate. The predictors explained 43% of the variation in the TMD severity, with significant contributions of the variables dental prostheses (β = -.008; P = .006), perception of oral health (β = -.43; P < .001), and mandibular functional limitation (β = .014; P = 014). The severity of TMD among Brazilian women was greater in nonusers of dental prostheses and was also associated with greater mandibular functional limitation and poor perception of oral health.

Modified Extracorporeal Reduction of the Mandibular Condylar Neck Fracture

There are many treatment options in management of mandibular condylar neck fractures. Closed reduction is the most conservative treatment; however, achievement of anatomic reduction is difficult, and there are some risks of mandibular functional impairment. Open anatomic reduction and internal fixation have some advantages; therefore, many oral and maxillofacial surgeons have attempted to achieve anatomic reduction through the open approach and extracorporeal reduction and fixation. However, when using this method, there is some risk of resorption of the fractured mandibular condylar head. Therefore, we designed a modified extracorporeal reduction technique, without detaching the lateral pterygoid muscle in order to maintain the blood supply to the fractured mandibular condylar head. We believe that this minor modification may minimize the risk of resorption of the fractured mandibular condylar head. In this article, we introduce this technique in detail, and report on two cases.

Treatment of myogenic temporomandibular disorder: a prospective randomized clinical trial, comparing a mechanical stretching device (TheraBite®) with standard physical therapy exercise

Aims:To compare in a randomized controlled clinical trial (RCT) the application of the TheraBite® (TB) Jaw Motion Rehabilitation System with a standard physical therapy (PT) exercise regimen for the treatment of myogenic temporomandibular disorder (TMD).Methodology:Myogenic TMD patients were randomized for the use of the TB device or for standard PT. Mandibular function was assessed with the mandibular function impairment questionnaire (MFIQ). Pain was evaluated using a visual analog scale, and maximum inter-incisor (mouth) opening (MIO) was measured using the disposable TB range of motion scale.Results:Of the 96 patients randomized (46 TB, 50 standard PT exercises), 38 actually started with the TB device and 41 with the standard PT exercises. After six-week follow-up, patients using the TB device reported a significantly greater functional improvement (MFIQ score) than the patients receiving regular PT exercises (P = 0·0050). At 6 weeks, no significant differences in pain, and active or passive MIO were found between the two groups. At 3 months, patients in both treatment groups did equally well, and showed a significant improvement in all parameters assessed.Conclusions:This RCT on myogenic TMD treatment, comparing standard PT with passive jaw mobilization using the TheraBite Jaw Motion Rehabilitation System®, shows that both treatment modalities are equally effective in relieving myogenic TMD symptoms, but that the use of the TB device has the benefit of achieving a significantly greater functional improvement within the first week of treatment.

Is there an association between anxiety/depression and temporomandibular disorders in college students?

ObjectiveConsidering the high incidence of Temporomandibular Disorders (TMD) in the population aged 15-30 years and the fact that students are exposed to stressful psychosocial factors, the purposes of this study were: to verify clinical symptoms and jaw functionality in college students with TMD according to the anxiety/depression (A/D) level and to evaluate the correlation between A/D and functionality, maximum mouth opening (MMO) and pain and muscle activity. Material and MethodsNineteen students with TMD diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders underwent two assessments during an academic semester. The evaluations were based on questionnaires (MFIQ - Mandibular Function Impairment Questionnaire; HADS - Hospital Anxiety and Depression Scale), clinical measurements (MMO without pain, MMO and assisted MMO; palpation of joint and masticatory muscles), and electromyography. The HADS scores obtained in the two assessments were used to classify all data as either "high" or "low" A/D. Data normality, differences and correlations were tested with the Shapiro-Wilk test, Student's t-test (or the Wilcoxon test), and Spearman test, respectively. The alpha level was set at 0.05. ResultsNone of the clinical variables were significantly different when comparing low and high A/D data. In low A/D there was a significant correlation between HADS score and: MFIQ (P=0.005, r=0.61), and MMO without pain (P=0.01, r=-0.55). ConclusionsVariation in A/D level did not change clinical symptoms or jaw functionality in college students with TMD. Apparently, there is a correlation between TMJ functionality and A/D level, which should be further investigated, taking into account the source of the TMD and including subjects with greater functional limitation.

Validity and reliability of the Portuguese version of Mandibular Function Impairment Questionnaire

The aim of this study is to evaluate the validity and reliability of the Mandibular Function Impairment Questionnaire (MFIQ) (Portuguese version). Face and content validity of the Portuguese version were performed. To assess reproducibility of the data gathered with MFIQ, it was applied to 62 individuals who completed the questionnaire on two occasions. Validity and reliability of the data gathered with MFIQ were evaluated in a sample of 249 patients. Construct-related validity was assessed through factorial validity (by means of a confirmatory factor analysis), and convergent and discriminant validities were assessed, respectively, by the average variance extracted (AVE), composite reliability (CC) and bivariate correlations between factors. The internal consistency was estimated by the standardised Cronbach's alpha coefficient (α) and reproducibility by the intra-class correlation coefficient (ICC). All the items of MFIQ showed content validity. Reproducibility was excellent in both the 'functional capacity' dimension (D1) (ICC(D1) =0·895, 95% CI=0·832 to 0·935) and the 'feeding' dimension (D2) (ICC(D2) =0·825, 95% CI= 0·726 to 0·891). Items 1, 2, 6 and 7 of D1 had factor weights below the desired cut-off (0·5), and overall fit of the original bifactorial structure of the MFIQ was poor [(confirmatory fit index) CFI= 0·850, (goodness of fit index) GFI= 0·781, (root mean square error of approximation) RMSEA= 0·118]. Thus, these items were excluded, and the new, reduced version of the MFIQ showed good fit (CFI=0·933, GFI=0·879, RMSEA=0·099). The convergent validity was adequate (AVE≥0·5, CC≥0·7) for both factors. However, their discriminant validity was low (AVE(D1) = 0·51 and AVE(D2) = 0·66 <ρ(2) (D1D2) =0·70). The internal consistency was excellent (α(D1) =0·874; α(D2) =0·918). The Portuguese version of the reduced MFIQ produced data with good validity and reliability.

One‐year evaluation of the effect of physical therapy for masticatory muscle pain: A randomized controlled trial

Physical therapy is widely used to decrease pain and restore function in patients suffering from masticatory muscle pain. Controlled studies on its efficacy are scarce. This study evaluated the 1-year effect of a 6-week physical therapy programme in a single blind, randomized, controlled trial. Fifty-three subjects were randomly assigned to either a physical therapy group [n = 26; 19 women, mean age (SD) 36.6 years (15.5 years)] or a control group [n = 27; 20 women, mean age (SD) 42.9 years (15.1 years)]. In the physical therapy group, the patients received education, muscle stretching, exercises and homework for nine treatments in 6 weeks. In the control group, the patients received education on the evaluation days only. At baseline and after 3, 6, 12, 26 and 52 weeks, pain and masticatory function were evaluated using visual analogue scales, the McGill Pain Questionnaire, pressure pain thresholds of the masseter and temporalis muscles, the mandibular function impairment questionnaire, and active and passive maximal mouth opening. All pain rating variables decreased and all function variables increased significantly over time in both groups. No significant differences in improvement between the groups (time-treatment interaction) were found. These data suggest that the long-term decrease in pain and the improvement of function are not related to active physical therapy.

Temporomandibular disorders in patients with mandibular fractures: a preliminary comparative case–control study between South Australia and Oman

The status of temporomandibular disorders (TMD) in subjects with previously treated mandibular fracture was evaluated in two centres: South Australia (SA) and Oman (O). TMD status was evaluated using Mandibular Function Impairment Questionnaire (MFIQ), Helkimo index for clinical dysfunction (HI), RDC/TMD and Wilkes’ classification. Data were retrieved for adult patients treated for mandibular fracture over 3 years from January 2004 to December 2006. Thirty-six subjects participated from SA and 23 from O. Their results were compared with matched controls. The incidence of TMD symptoms in SA injured and control groups was higher compared with the O groups. There was statistically significant difference on all evaluation indices for SA injured subjects compared with controls (MFIQ/P 0.04, HI/P 0.0015, RDC/TMD/P 0.05, Wilkes classification/P 0.03). These TMD symptoms were clinically insignificant for most subjects and all were internal derangement of the temporomandibular joint (TMJ). There was no significant difference in all evaluation indices for O injured subjects compared with controls. For SA injured subjects who reported clinically significant TMD symptoms, assault and bilateral mandibular fractures were predominant features. The study shows that most mandibular injuries fully recover and the associated TMJ trauma usually has low clinical significance in the long term.

Etiologic Factors and Clinical Symptoms in Patients With Disc-Related Disorders of the Temporomandibular Joint

Etiologic Factors and Clinical Symptoms in Patients With Disc-Related Disorders of the Temporomandibular Joint

Impaired Mandibular Function in Spinal Muscular Atrophy Type II

The aim of the study is to assess mandibular function in young patients with spinal muscular atrophy type II. A total of 12 children and young adults with spinal muscular atrophy type II and 12 healthy matched controls participated. The mandibular function impairment was moderate to severe in 50% of patients. A limited mouth opening (≤30 mm) was observed in 75% of the patients. In patients with a severe reduction of the mandibular range of motion the temporomandibular joint mainly rotated during mouth opening instead of the usual combination of rotation and sliding. The severity of the limited active mouth opening correlated with the severity of the disease (motor function measure scores). This study shows that mandibular dysfunction is common among young patients with spinal muscular atrophy type II. Early recognition of mandibular dysfunction may help to prevent complications such as aspiration as a result of chewing problems.

Long-term oral appliance therapy in obstructive sleep apnea syndrome: a controlled study on temporomandibular side effects

The objective of this study was to assess variations in the occurrence of temporomandibular disorders (TMDs) and the risk of developing pain and function impairment of the temporomandibular complex in obstructive sleep apnea syndrome (OSAS) patients treated with either an oral appliance (mandibular advancement device) or continuous positive airway pressure (CPAP) in a 2-year follow-up study. In addition, we assessed the relationship between the mean mandibular protrusion and the frequency of wearing the appliance during follow-up with the occurrence of pain and function impairment of the temporomandibular complex. Fifty-one patients were randomized to oral appliance therapy and 52 patients to CPAP therapy. TMDs (diagnosed according to the Axis I Research Diagnostic Criteria for TMD), pain intensity and disability and mandibular function impairment were recorded at baseline, after 2 months, 1 year and 2 years of therapy. Only in the initial period of treatment the occurrence of pain-related TMDs was considerably higher (24%) in the oral appliance group compared to CPAP (6%). Oral appliance therapy furthermore resulted in more temporomandibular pain compared to CPAP (odds ratio 2.33, 95% confidence interval (1.22-4.43)). However, there were no limitations in mandibular function in both groups during the (entire) follow-up period. Although generally not serious and of transient nature, oral appliance therapy results in more pain-related TMDs in the initial period of use compared with CPAP therapy. Oral appliance therapy is associated with increased pain in the temporomandibular complex in the initial period of use. Because of the transient nature, this pain is not a reason to contra-indicate an oral appliance in OSAS patients. Moreover, TMDs and the risk of developing pain and function impairment of the temporomandibular complex appear limited with long-term oral appliance use.

Restrictions in oral functions caused by oral manifestations of epidermolysis bullosa

Several forms of epidermolysis bullosa (EB) present oral manifestations. Blistering of the (peri)oral mucosa affects the opening of the mouth, the mobility of the tongue and lips, thereby restricting oral functions. We describe the prevalence and characteristics of oral manifestations of EB in relation to loss of oral functions in a cross-sectional study of different types of EB patients using standardized measurement techniques. Twenty-two patients were included. The mobility of the mandible, lips and tongue was measured, the mandibular function impairment questionnaire (MFIQ) was filled out and additional questions regarding hindrance of EB during oral hygiene and intelligibility of speech (being understood) were asked in structured interviews. The median age was 11.8 yrs. Mobility of the mandible, tongue and lip was restricted, oral hygiene procedures were hindered in most patients. A data comparison was made between the recessive dystrophic EB (RDEB) and junctional EB (JEB) groups. Mandibular function was impaired in both groups but more severely in the RDEB-population. Intelligibility in both groups was almost unaffected. Restrictions in mobility of the mouth, tongue and lips are frequently present in EB patients. These are most severe in the RDEB group and support the clinical relevance of optimizing symptomatic treatment.

Orthodontic Space Closure versus Prosthetic Replacement of Missing Upper Lateral Incisors in Patients with Bilateral Cleft Lip and Palate

To compare dental aesthetics and function of orthodontic space closure versus prosthetic replacement of upper lateral incisors in patients with bilateral cleft lip and palate. The predominant mode of prosthetic replacement was resin-bonded bridges. The retrospective study group consisted of 17 patients treated with orthodontic space closure (13 men, four women; median age, 27.1 years; interquartile range, 20.6 to 33.3 years) and 10 patients treated with prosthetic replacement (five men, five women; median age, 27.7 years; interquartile range, 20.9 to 39.7 years). Dental aesthetics were evaluated by the patients and by a professional panel. Mandibular function was evaluated by means of the mandibular function impairment questionnaire. The level of mandibular impairment was calculated using the Function Impairment Rating Scale. With respect to dental aesthetics, no significant differences between patients treated with orthodontic space closure and prosthetic replacement were found. With respect to function, the level of mandibular impairment was significantly higher in patients treated with prosthetic replacement compared with patients treated with orthodontic space closure, as indicated by high scores on specific masticatory functions. Orthodontic space closure and prosthetic replacement in bilateral cleft lip and palate patients produce similar results in terms of aesthetics. In terms of function, prosthetic replacement results in significantly more impairment of specific masticatory functions.

Oral symptoms and functional outcome related to oral and oropharyngeal cancer

PurposeThis study aimed to assess: (1) oral symptoms of patients treated for oral or oropharyngeal cancer; (2) how patients rank the burden of oral symptoms; (3) the impact of the tumor, the treatment, and oral symptoms on functional outcome.MethodsEighty-nine patients treated for oral or oropharyngeal cancer were asked about their oral symptoms related to mouth opening, dental status, oral sensory function, tongue mobility, salivary function, and pain. They were asked to rank these oral symptoms according to the degree of burden experienced. The Mandibular Function Impairment Questionnaire (MFIQ) was used to assess functional outcome. In a multivariate linear regression analyses, variables related to MFIQ scores (p ≤ 0.10) were entered as predictors with MFIQ score as the outcome.ResultsLack of saliva (52%), restricted mouth opening (48%), and restricted tongue mobility (46%) were the most frequently reported oral symptoms. Lack of saliva was most frequently (32%) ranked as the most burdensome oral symptom.For radiated patients, an inability to wear a dental prosthesis, a T3 or T4 stage, and a higher age were predictive of MFIQ scores. For non-radiated patients, a restricted mouth opening, an inability to wear a dental prosthesis, restricted tongue mobility, and surgery of the mandible were predictive of MFIQ scores.ConclusionsLack of saliva was not only the most frequently reported oral symptom after treatment for oral or oropharyngeal cancer, but also the most burdensome. Functional outcome is strongly influenced by an inability to wear a dental prosthesis in both radiated and non-radiated patients.

Complaints related to mandibular function impairment after closed treatment of fractures of the mandibular condyle

This study analysed the relationship between complaints and mandibular function after closed treatment of fractures of the mandibular condyle in a prospective study. In a 1-year follow-up, complaints were assessed during physical examination and function was assessed using the mandibular function impairment questionnaire (MFIQ), scoring range 0-68. Data from 114 patients (41 women, 73 men), mean age 28.1 years (SD 13.3), were available. On average the MFIQ scores were low 3.4 (SD 7.3). Ten patients (9%) experienced pain and 45 (39%) patients had a MFIQ score > 0. Mean mouth opening was 51.9 mm (SD 8.4). Occlusion was perceived as moderate or poor by 24% of the patients. In the logistic regression analysis mandibular function impairment (MFIQ score > 0) was entered as a dependent variable. Risk factors for mandibular function impairment were: pain, perceived occlusion (moderate or poor), absolute difference between left and right horizontal movements and age. A protective factor was mouth opening. The results of this study show that complaints (i.e. pain, perceived occlusion, reduced mouth opening, difference between left and right lateral movements and increased age) are predictors of mandibular function impairment after closed treatment of fractures of the mandibular condyle.

Clinical Follow-Up Examination of Surgically Treated Fractures of the Condylar Process Using the Transparotid Approach

The surgical approaches for the open treatment of condylar process fractures have been controversial. In our study, we evaluated the morbidity of the transparotid approach during 2 years of follow-up. A total of 48 patients with condylar process Class II and IV fractures according to classification of Spiessl and Schroll, were included in the present study. Of the 48 patients, 16 were female and 32 male. The patient age range was 16 to 79 years (average 36.52). All patients were treated using the transparotid approach, with rigid internal fixation using miniplates. Follow-up examinations were performed for a minimum of 6.5 months and a maximum of 25 months (average 12.16) after surgical treatment. At the follow-up examination, the patients completed the Mandibular Function Impairment Questionnaire, and the examiner completed the Helkimo index. X-rays taken before, directly after, and 6 months after surgery were compared. None of our patients had problems with wound healing; 2 patients developed a fistula of the parotid gland; and 4 patients developed palsy of the facial nerve that was completely reversible after 6 weeks. The results of the Mandibular Function Impairment Questionnaire and the Helkimo index revealed only a few subjective and objective problems after 6 months. The transparotid approach to condylar process fractures is most appropriate for strongly displaced Class II fractures. Especially for very old patients with dementia, for whom maxillomandibular fixation is contraindicated, this approach is very appropriate. Another benefit to this type of patient is the short operating time, with an average of 45 minutes.