Treatment Of Condylar Neck Fractures Research Articles

New Minimally Invasive Intraoral Procedure for Condylar Fractures: Clinical Presentation and Considerations on Current Techniques.

Mandibular fractures are the third most prevalent maxillofacial traumatic events. Surgical approaches to the condyle are a debated topic. This study describes a mini-invasive technique for condylar fracture reduction. The patient of this study suffered multiple traumatic injuries including a carotid artery dissecting aneurysm, which contraindicated the standard open reduction and internal fixation technique. The novel minimally invasive technique involves intraoral access and fracture fragment realignment using a periosteal elevator, a molar occlusal splint, and intermaxillary fixation after intraoperative radiologic imaging confirmation of condyle reposition.The approach avoids skin incisions and tissue dissection, with good aesthetic outcomes and facial nerve preservation. This technique proved to be safe and simple to be less demanding for the patient, with a shorter recovery time than experienced with other techniques.The results suggest this technique is a good option for the surgical treatment of condylar neck fractures showing favorable rim morphology with primary stability after reduction.

Biomechanical Evaluation of Mandibular Condyle Fracture Osteosynthesis Using the Rhombic Three-Dimensional Condylar Fracture Plate

The aim of the present study was to evaluate the biomechanical stability of osteosynthesis in mandibular condyle fractures using a newly designed rhombic 3-dimensional (3D) condylar fracture plate and compare it with that using standard two 4-hole miniplates and with that in nonfractured condyles. Using 200 porcine mandibles, 3 different monocortical plating techniques were evaluated. The condyles were fractured along a defined line tangentially through the sigmoid notch and perpendicular to the posterior border. After anatomic reduction, osteosynthesis was performed using either standard rhombic 3D condylar fracture plates and standard screws (group A) or locking rhombic 3D condylar fracture plates, which were fixed either with standard screws (group B) or locking screws (group C). For comparison, nonfractured condyles (group D) and condyles fixed with standard two 4-hole miniplates and 8 screws (group E) were included. Using a universal mechanical testing machine (TIRA Test 2720; TIRA GmbH Schalkau, Germany), each group was subjected to linear loading from laterally to medially, medially to laterally, anteriorly to posteriorly, and posteriorly to anteriorly. The maximum axial force and displacement at the maximum force were measured. The mean values were compared for statistical significance using analysis of variance with Bonferroni's correction (statistical significance set at P<.05). The main mode of failure in the plating techniques investigated was the pull out of screws from the proximal fragment. We found no statistically significant differences in the stability of osteosynthesis between the two 4-hole miniplates and the rhombic 3D condylar fracture plate when loading from posteriorly to anteriorly, laterally to medially, and medially to laterally. However, when loading from anteriorly to posteriorly, a statistically significant difference between the standard and locking system and the two 4-hole miniplate system was observed, with the latter proving more stable. The results of the present biomechanical study suggest that the rhombic 3D condylar fracture plates are suitable for the treatment of condylar neck fractures. Both types of the plate are able to resist physiologic strains comparable to the two 4-hole miniplates.

Minimal Incision Approach for Condyle Fracture Treatment.

Surgical treatment of condylar neck fractures requires an extraoral approach when, due to the degree of difficulty of the fracture, an intraoral approach or an endoscopically supported treatment is not possible. In contrast to the cosmetically more favorable oral approach, extraoral approaches offer a better overview of the operating field and thus an easier fracture repositioning and osteosynthetic treatment. In 2007, Marti et al. described a minimal pre- and retroauricular incision with no extension to the hair-bearing skin and which aimed to improve the parotidectomy approach. We present two cases in which minimal incision was used as a surgical approach for treatment of the condylar neck. Using the minimal incision, we were able to access the condylar neck. This type of approach as well as having the advantages of an open approach makes it possible to conceal the scar in the periauricular region and reduce the likelihood of salivary fistula.

Transoral vs. extraoral approach in the treatment of condylar neck fractures

PurposeThe aim of this study was to assess a non-endoscopic transoral versus extraoral technique in the open reduction and internal fixation of displaced or dislocated fractures of the condylar neck. Material and methodsA total of 104 patients, treated from 2007 to 2012 with 114 class II or class IV fractures according to Spiessl and Schroll were included in this study. Facial nerve function, scarring, pain and functional clinical parameters, such as protrusion, mediotrusion and maximum interincisal distance, were judged clinically (at 21 ± 12.1 months); repositioning and reossification were measured upon preoperative, postoperative and follow-up (at 8.8 ± 7 months) radiographs. Patient satisfaction was evaluated using the OHIP-G 14 questionnaire. ResultsIn all, 36 patients (35%) with 43 fractures (38%) presented for clinical follow-up. Both treatment groups showed clinically and radiologically comparable results. Scarring was obvious in all extraorally treated patients, and hypertrophic scars occurred in four class IV cases (24%). One class IV patient (6%) had a persistent facial nerve palsy; temporary pareses were more frequent (n = 4; 24%). ConclusionThe transoral approach did not jeopardize facial nerve function, and extraoral scars were avoided. Repositioning and fixation results and the frequency of revision operations were comparable. The transoral approach can be recommended generally in class II and class IV cases.

Open Versus Closed Reduction of Condylar Neck Fractures: A Prospective Randomized Multicenter Study With Regard to Fracture Localization

Statement of the problem: Prognosis criteria are essential for making therapy decisions in the treatment of condylar neck fractures. According to the IAOMFS 1997 consensus conference, a proper therapy decision should primarily be based upon fracture localization and the degree of displacement or dislocation. For a long time the localization of condylar neck fracture was assumed to be of vital prognostic and therapeutic importance. An increasing degree of displacement or dislocation of the condyle out of the fossa will cause an increasing degree of damage to the joint capsule and the ligaments. Aim of this prospective, randomized multicenter study was to analyze the results of open and closed treatment. Functional and subjective parameters were evaluated with regard to fracture localization. Materials and Methods: 66 patients from seven international treatment centers with 79 condylar neck fractures were prospectively examined. The decision for open (n 30 patients) or closed (n 36 patients) treatment was randomised. Closed treatment was performed by elastic immobilization for 10 days. In cases of malocclusion a prolonged period of immobilization and, where necessary, physiotherapy followed. In cases of open treatment, the surgeon decided on the appropriate operative technique. Osteosynthesis was performed by miniplates, miniscrews or lag screws. Six months after trauma the patients were examined. Clinical (mouth opening, protrusion, laterotrusion), radiographic (localization) and subjective (pain-visual analogue scale [VAS], impairment – Mandibular Function Impairment Questionnaire [MFIQ]) examination parameters were recorded. Data Analysis: a) 66 patients, 79 condylar neck fractures b) 6 months c) Statistical planning and analysis was performed by the Institute of Biometry University Dresden using SPSS 12.0 (SPSS Inc, Chicago, Illinois, USA). Results: Bilateral fractures receiving closed treatment showed significantly worse results in all categories. The 13 patients had bilateral fractures and exhibited a mouth opening of 36 mm (7 patients, 14 fractures) for closed treatment and 48 mm (6 patients, 12 fractures) for open treatment, p 0.001. Unilateral fractures showed a mouth opening of 42 mm (23 fractures) for closed treatment and 46 mm (30 fractures) for open treatment, p 0.003. Subjective parameters exhibited the highest level of pain with 25 mm VAS for closed treatment of bilateral fractures. Bilateral fractures receiving open treatment showed a VAS of 1 mm, p 0.001. Closed treatment of unilateral fractures showed a VAS 11 mm in contrast to 3 mm for fractures, receiving open treatment. The results were further approved by the measured degree of impairment – MFIQ. With regard to localization, the subjective degree of impairment was less pronounced for high condylar fractures. Conclusion: Open treatment with the aim of anatomical reconstruction of the joint shows significantly better treatment results in all evaluated categories for all fracture localizations. Interestingly, low fractures at the basis of the condylar neck exposed higher degrees of impairment and thus largely benefit from open treatment. Further, especially bilateral fractures benefit from open treatment. In these cases, treatment results of closed treatment are significantly inferior to open treatment which generally advocates open treatment.

A New 3-Dimensional Plate for Transoral Endoscopic-Assisted Osteosynthesis of Condylar Neck Fractures

Transoral surgical treatment of condylar neck fractures minimizes the risk of damaging the facial nerve. But fracture reduction and plate osteosynthesis remain challenging, especially when using 2 plates, although endoscopic assistance has proven helpful. To further improve and simplify osteosynthesis at the condylar neck, a new delta-shaped osteosynthesis plate that mimics the function of 2 plates has been developed. The present clinical follow-up study was conducted to evaluate this new plate. A total of 16 patients with 19 condylar neck fractures (3 Spiessl I, 13 Spiessl II, 1 Spiessl III, 2 Spiessl IV) and 3 bilateral fractures were treated through an endoscopic-assisted transoral approach. After reduction, the plate was applied, with the screws inserted either transcutaneously or with angulated instruments. The operation time ranged between 55 and 120 minutes. More than 6 months after the operation, functional parameters returned to normal, with an average mouth opening of 41 mm, protrusion of 5 mm, and laterotrusion of 6 mm. Radiographic controls showed good fracture alignment in 15 of 19 cases immediately after the operation, and in 14 of 19 cases 6 months after the operation. No plate fracture or bending was observed. In 3 patients, loose screws were found on plate removal. The clinical data and the engineering and biomechanical background suggest that the new delta-shaped plate can be regarded as 2 miniplates. The new plate is suitable for treatment of condylar neck fractures, particularly when used in an endoscopic-assisted transoral approach.

A comparison of MRI, radiographic and clinical findings of the position of the TMJ articular disc following open treatment of condylar neck fractures

We examined the position and function of the articular disc after open treatment of condylar fractures by comparing magnetic resonance images (MRI) and radiographs with clinical data. MRI and radiographs were taken after treatment of 28 patients with 33 fractures of the mandibular condyles. In all cases, the disc was located in the fossa after open reduction and internal fixation (ORIF). The MRI, radiographic and clinical findings did not correlate, and damage to the temporomandibular joint (TMJ) could be seen more clearly on MRI than on clinical or radiographic examination. Damage to soft tissues seen on MRI after treatment was more pronounced in dislocated than in displaced fractures.

Clinical and radiological evaluation following surgical treatment of condylar neck fractures with lag screws

It was the purpose of this study to evaluate the outcome of lag screw osteosynthesis in severely displaced fractures or fracture dislocations of the mandibular condyle as well as intra- and postoperative complications of this technique. From 1980 to 1996 a total of 492 patients with condylar fractures were treated with lag screw osteosynthesis. Clinical and radiological follow-ups were carried out in 230 patients with severely displaced fractures or fracture dislocations of the mandibular condyle. The period between surgery and follow-up was between 6 months and 2 years. The majority of the clinical results were satisfactory presumably due to the anatomically exact reduction of the fragment (93.4%). Extreme anatomic variations of the mandible (5.8%) and incorrect application of the technique (8.8%) resulted in reduced functional stability of lag screw osteosynthesis. Insufficient fragment reduction and postoperative complications (such as wound infection) entailed restriction of mandibular mobility and arthrotic deformations were seen as persistent radiological irregularities of the mandible. It has been possible to avoid complications and to achieve favourable functional results in complicated fractures of the mandibular condyle by applying strict indications for lag screw osteosynthesis and by considering the individual anatomical peculiarities.

Long-term results after conservative treatment of condylar neck fractures

Long-term results after conservative treatment of condylar neck fractures

Functional and morphological results after conservative and operative treatment of condylar neck fractures

Functional and morphological results after conservative and operative treatment of condylar neck fractures

Bone cement as means of fixation in the treatment of condylar neck fractures in dogs

Bone cement as means of fixation in the treatment of condylar neck fractures in dogs