Sagittal Fracture Of Mandibular Condyle Research Articles

Treatment of Sagittal Fracture of the Mandibular Condyle Using Resorbable-Screw Osteosynthesis

Screw osteosynthesis is advocated for the treatment of sagittal fracture of mandibular condyle (SFMC). This study aimed to explore the applicability of resorbable-screw osteosynthesis in the treatment of SFMC. A retrospective cohort study was performed in patients with SFMC treated with resorbable-screw osteosynthesis (group A) from June 2011 through June 2021. The patients who had undergone titanium-screw osteosynthesis served as the control group (group B). The primary outcome variable was fracture healing, defined as follows: 1) normal mouth opening and restoration of pretrauma occlusion; 2) without complications or discomfort of temporomandibular joint symptoms; and 3) fracture union without abnormal reactions or bone resorption in computed tomography images. The secondary outcome variable was condylar morphological changes including radiographic imaging appearance of the condyle, mandibular ramus height (MRH), anteroposterior diameter (APD), and mediolateral diameter (MLD) of the condyle, which were assessed by comparing the computed tomography images 1week after surgery with those of 3months after surgery. The collected data of the outcome variables of the 2 groups were analyzed correspondingly using Student's paired t test and Student's t test. There were 24 patients in group A and 71 patients in group B. All the patients displayed an evident improvement in mouth opening and restored pretrauma occlusion. Few patients had complications (group A, 8.33%; group B, 9.86%) and discomfort of temporomandibular joint symptoms (group A, 16.67%; group B, 15.49%). Fracture union without abnormal reactions or bone resorption was observed during the follow-up. The radiographic evaluation revealed no significant difference in the MRH, the maximum APD, and MLD of the condyles between 1week and 3months after surgery in both groups. There were no significant intergroup differences in the changes in the MRH, APD, and MLD of the condyles. Resorbable-screw osteosynthesis is a viable option for the treatment of SFMC.

Comparision of Conventional radiograph with Computed tomography for Diagnosis of sagittal fracture of mandibular condyle: A case report

Condylar fractures of mandible are not very easy to diagnose radiographicaly. If fracture is vertical, it would be much more difficult to diagnose. Since treatment depends on type of fracture, CT scan is advised rather than conventional radiographs to diagnose condylar fractures.The cases reporting to the hospital during the period of July 2019 to April 2020 were enrolled, of which 2 cases have been reported here. It was observed that there are chances of missing the diagnosis of the condylar fracture if only the conventional radiographs are used. CT along with conventional radiographs should be considered for better treatment and management of the patients with maxillofacial injuries.

Sagittal fracture of mandibular condyle: a review of 151 cases

Objective: A retrospective research was made to summarize the clinical characteristics, treatment methods, results of the adult cases with sagittal fracture of mandibular condyle (SFMC). Methods: One hundred and fifty-one cases of hospitalized patients were enrolled. The age, sex, etiology, level of fracture, degree of displacement, associated facial fractures, treatment methods and results were retrospectively analyzed. Results: The patient's age ranged from 16 to 81 years old, with a median age of 38.5 years. The male to female ratio was 2.97∶1. The most involved age group was 20-29 years old [35.1% (53/151)]. Falls [53.6% (81/151)] were the most common cause. According to the classification of He (2009) and Duan (2011), the most common type of SFMC was type A [60.5% (130/215)] and the displacement type [80.9% (174/215)]. Eighty-six point zero percent (185/215) of SFMC were treated by surgery. The surgical rates of type A, B and M fractures were 91.5% (119/130), 79.6% (43/54) and 88.5% (23/26), with significant differences between the groups (P<0.05). The surgical rates of the displacement and dislocation type were 89.7% and 100%, with significant differences. The differences between the fixations of type A, type B and type M fractures were statistically significant. The follow-up results showed that, 78.7% (59/75) of patients treated with surgery had normal occlusion, no joint symptoms and no limited mandibular movement. Patients treated with conservative therapy had good occlusion and an average maximum mouth opening of 36.25 mm with malunion occurred in 5/6 of the condyles. Conclusions: Under appropriate surgical indications, surgical treatment of SFMCs could achieve significantly better outcomes than conservative treatment.

Development and clinical evaluation of a reduction forcep for mandibular condylar sagittal fracture

Objective To develop a suitable forcep for reduction and internal fixation of sagittal fracture of mandibular condyle (SFMC) and evaluate its role in clinical practice.Methods Twenty patients with SFMC diagnosed by three-dimensional CT undergone open surgery were divided into experimental group and control group with 10 patients per group,according to the random number table.Patients in experimental group were reduced and fixed using the new reduction forcep,while in control group by the classical vascular clamp and nerve retractor.Operation time,three-dimensional CT before operation and 2 weeks after operation,and occlusion,maximum mouth opening (MMO),visual analogue scale (VAS),joint clicking as well as noise before operation and 1 and 6 months after operation were recorded.Results Operation time was obviously lower in experimental group than in control group [(0.90 ± O.11)hours vs (1.34 ±0.10)hours,t =-10.8,P ＜0.01].MMO in experimental group revealed significant improvements compared to control group at postoperative 1 month [(32.6 ± 1.6) mm vs (29.7 ±1.6)mm,t =-10.1,P＜0.01] and at postoperative 6 months [(34.3 ± 1.2)mm vs (33.3 ± 1.1)mm,t =3.4,P ＜0.01].VAS between experimental group and control group also differed significantly at postoperative 1 month [(3.6 ± 0.7) mm vs (5.1 ± 0.7) mm,t =-12.5,P ＜ 0.01] and at 6 months [(3.5±0.9) points vs (4.8±0.6) points,t=-3.3,P＜0.01].Conclusion The new reduction forcep can shorten operative time and improve mouth opening and pai for SFMC. Key words: Fracture bone; Mandibular condyle; Oral surgical procedures

Clinical and radiological outcomes after treatment of sagittal fracture of mandibular condyle (SFMC) by using occlusal splint in children

This study was designed to investigate the effects of occlusal splints in the treatment of sagittal fractures of the mandibular condyle in children. From January 1995 to December 2011, 37 sagittal fractures of the mandibular condyle in 30 patients aged 4–8 years old were included in this study. All the patients were treated with 1–2mm occlusal splints in the molar region. The mouths of the patients were kept slightly open by the occlusal splints for 3–6 months, and we reviewed the clinical and radiological remodelling of the affected condyles after treatment. Excellent (n=20) and good (n=10) clinical outcomes were achieved with full radiological remodelling seen in 19 and partial remodelling in 11. Treatment with occlusal splints is effective in delivering good results and function with minimal morbidity in children with sagittal fractures of the condyle, while permitting ongoing remodelling and growth in the short term.

Evaluation of the clinical results of non-surgical treatment for pediatric sagittal fracture of mandibular condyle

To investigate the clinical results of occlusal splint in the treatment of sagittal fracture of mandibular condyle (SFMC) in children. Thirty-nine patients (48 condyles)aged 3-8 years with sagittal fracture of mandibular condyle were included in this study. All the patients were treated by occlusal splint.Slight open occlusion was maintained by occlusal splint for 3-6 months. Clinical and radiological examination was performed six mouths and every year after treatment. Good mandibular function was observed in 39 patients. Maximal mouth opening over 35 mm was achieved at 6 months. But 11 of the 39 patients presented with deviation on mouth opening at 6 months. The radiology showed an complete remodeling in 32 condyles (28 patients) and partial remodeling in 16 condyles (11 patients). Poor remodelling was not observed in any patients. Good clinical results can be obtained by using occlusal splint in the treatment of pediatric sagittal fracture of mandibular condyle.

The role of the lateral pterygoid muscle in the sagittal fracture of mandibular condyle (SFMC) healing process

The aim of this study was to examine the role of the lateral peterygoid muscle in the reconstruction of the shape of the condyle during healing of a sagittal fracture of the mandibular condyle. Twenty adult sheep were divided into 2 groups: all had a unilateral operation on the right side when the anterior and posterior attachments of the discs were cut, and an oblique vertical osteotomy was made from the lateral pole of the condyle to the medial side of the condylar neck. Ten sheep had the lateral pterygoid muscle cut, and the other 10 sheep did not. Sheep were killed at 4 weeks (n=2 from each group), 12 weeks (n=4), and 24 weeks (n=4) postoperatively. Computed tomograms (CT) were taken before and after operations. We dissected the joints, and recorded with the naked eye the shape, degree of erosion, and amount of calcification of the temporomandibular joint (TMJ). In the group in which the lateral peterygoid muscle had not been cut the joints showed overgrowth of new bone and more advanced ankylosis. Our results show that the lateral pterygoid muscle plays an important part in reconstructing the shape of the condyle during the healing of a sagittal fracture of the mandibular condyle, and combined with the dislocated and damaged disc is an important factor in the aetiology of traumatic ankylosis of the TMJ.

Surgical Treatment of Sagittal Fracture of Mandibular Condyle Using Long-Screw Osteosynthesis

The retrospective study evaluated long-screw (bicortical screw) osteosynthesis used in the surgical treatment of sagittal fracture of the mandibular condyle and compared it with titanium plates and removal of the condylar fragment. Ninety-five patients with sagittal fracture of the mandibular condyle received open surgical treatment from 1997 to 2008. Among these patients, the condylar fragments were fixed with long screws in 56 cases (group A), were fixed with titanium plates in 12 cases (group B), and were completely removed in 24 cases (group C). Follow-up was carried out clinically and radiologically. The clinical features included limitation of mandibular mobility, occlusion disturbance, lateral deviation on mouth opening, joint pain, clicking, facial asymmetry, and patient's subjective evaluation. The radiologic parameters consisted of degree of bony resorption, bony change, change of osteosynthesis material, and shortening of mandibular ramus height. Anatomic reduction and functional restoration were obtained and no severe complication was detected in group A. However, 3 of 14 patients had severe osteoarthrosis and 2 of 14 patients had ankylosis in group B. In group C 3 of 24 patients had mandibular retrusion, 4 of 24 patients had front teeth open bite, 4 of 24 patients had severe osteoarthrosis, and 1 of 24 patients had ankylosis. The long-screw fixation group had a more favorable prognosis than the titanium plate group and the group in which removal of the condylar fragment was performed. The long-screw fixation technique might be suitable for use in the surgical treatment of sagittal fractures of the mandibular condyle.

A comparative study of two imaging techniques for the diagnosis of sagittal fracture of mandible condyle

To investigate the relationship between fractured fragment and joint disc displacement after sagittal fracture of mandibular condyle (SFMC). based on CT examination, SFMC were classified into fissue, displacement and dislocation type. Based on oblique sagittal MRI examination, the displacement of joint disc was grouped into type A and type B. Abnormal superiorposterior attachment was classified into elongation and avulsion type. CT exmination were taken in 26 patients with 41 SFMC. There were 5 SFMC (12%) with fissue type, 18 SFMC (44%) with displacement type and 18 SFMC (44%) with dislocation type. Both CT and MRI examination were taken in 19 patients with 32 SFMC. There were 27 (84%) SFMC with disc displacement. Five SFMC with type fissue showed no signs of disc displacement. Among 15 SFMC with type displacement, there were 3 cases with type A disc displacement and 12 cases with type B disc displacement. All the dislocated SFMC (12 cases) were type B disc displacement. In term of superiorposterior attachment figures, 4 cases (4/5) of type fissue SFMC showed normal. 14 cases (14/15) of the displacement SFMC showed elongated and all cases with dislocated SFMC showed sign of avulsion. There were 20 cases (63%) showing superior joint effusion. There were 13 cases (13/15) with displaced SFMC and 6 cases with dislocated SFMC showing joint effusion. One case with fissue SFMC showed no sign of joint effusion. Joint effusion, disc displacement and abnormal superiorposterior attachment were related to the displacement of condyle which was involved with SFMC.

A retrospective investigation on disc displacement in sagittal fracture of mandibular condyle and its association with joint ankylosis development

The purpose of this study was to evaluate disc displacement in condylar sagittal fracture and potential influence on TMJ ankylosis formation. Total 33 sagittal fractures of mandibular condyles (SFMCs) in 19 patients were included, 19 involved joints of 12 cases obtaining the prognosis of non-ankylosis and 14 involved joints of 7 cases being ankylosed after a systematic conservative treatment. Retrospectively, the change of discs in position were investigated by magnetic resonance imaging corresponding to mild, moderate and severe displacement of SFMCs based on computed tomography image, and comparison was carried out between ankylosis and non-ankylosis groups. Results showed that in non-ankylosis group presented mild displacement (type I) in 5 SFMCs and moderate displacement (type II) in 14 SFMCs. All type I SFMCs and 5 of 14 type II SFMCs did not display disc displacement. Whereas, the rest of type II SFMCs had disc displacement. In ankylosis group, all SFMCs were severe displacement the articular disc was anteriomedially displaced together. This study concluded that moderate and severe displaced SFMCs usually entailed displacement of the articular discs. The severe SFMC highly sustained TMJ ankylosis.

A new hypothesis of mechanisms of traumatic ankylosis of temporomandibular joint

Temporomandibular joint (TMJ) ankylosis is a disease that severely affects the human health. Although it is well known that trauma is the most common cause of TMJ ankylosis, the mechanisms by which the traumatic TMJ ankylosis develops are unclear. The existing hypothesis is not convincing in explaining the genesis of traumatic TMJ ankylosis. We make a hypothesis that the distraction osteogenesis (DO) of the lateral pterygoid muscle combining with the dislocated and damaged disc is an important factor in genesis of traumatic TMJ ankylosis. If this hypothesis is verified, it will be helpful for the prevention of traumatic TMJ ankylosis and change the principle of management of sagittal fracture of mandibular condyle (SFMC).

A sagittal fracture of mandibular condyle: report of a case

A sagittal fracture of mandibular condyle: report of a case