Unilateral Mandibular Condylar Fractures Research Articles

Assessment of relationships between condylar fracture pattern and mandibular third molar position by panoramic radiography and computed tomography: A retrospective comparative study.

Although previous studies have revealed the influence of the mandibular third molar (M3) on mandibular condylar fracture risk and that the presence of M3 could result in different incidences of condylar and angle fractures, there have been no analyses of the influence of M3 on fracture patterns. Moreover, evaluations of M3 position using panoramic radiography have shown insufficient accuracy. This study investigated the relationship between condylar fracture patterns and M3 position using panoramic radiography and computed tomography. This retrospective study included 280 patients with unilateral mandibular condylar fractures and ipsilateral M3 admitted to West China Hospital of Stomatology between January 2016 and June 2022. Patient medical records, panoramic radiographs, and computed tomography images were collected. The vertical and horizontal positions of M3 were classified using the Pell and Gregory system. M3 angulation was defined as the angle between the long axis of M3 and the mandibular occlusal plane. Condylar fracture patterns were classified as intracapsular (Types A-C) or extracapsular (neck and base). Data were analyzed using McNemar-Bowker test, Pearson chi-squared test, and Fisher's exact test. Classification of M3 position differed significantly between panoramic radiography and computed tomography images (p < .05). There was a significant association between the mandibular condylar fracture pattern and M3 horizontal position on computed tomography (p < .05). Class I M3 position on computed tomography was associated with a higher incidence of intracapsular than extracapsular fractures, along with a higher incidence of Type B than base fractures; the opposite relationships were observed for Class II. No such association was identified on panoramic radiography. Mandibular condylar fracture patterns were presumably influenced by M3 horizontal position on computed tomography. The imaging modality affected the classification of M3 position and subsequent analyses. Computed tomography is recommended for future studies to improve accuracy and reliability.

Efficacy of Retromandibular Approach in The Management of Mandibular Subcondyle Fractures

Mandibular condylar fracturing are a common outcome of mandibular trauma. Condylar and subcondylar injuries benefit best from the retromandibular technique, which also offers the greatest exposure to the joint and ascending ramus. Objective: To determine the efficacy of the retromandibular approach in treating condylar fractures with open reduction and internal fixation (ORIF). Methods: A total of 25 subjects with age range 14 to 55 years having unilateral mandibular condylar fractures with disturbed occlusion utilizingretromandibular approach were included in the study. Relevant information was gathered and evaluated. Results: The average age of the sufferer was 31.18 ± 8.17 years and mean duration of fracture was 5.32 ± 0.73 days. There were 21(84%) male patients and 04 (16%) female sufferers. RTA was the most common mode of injury seen among patients (60%). The shattered segments' anatomic reduction and fixation were successful. The efficacy was 72% on basis of ease of operation and 96% on fracture stability. Conclusion: This technique is effective in term of ease of operation and fracture stability. Scar acceptability can be considered drawback of this procedure

Comparative evaluation of bite force in patients treated for unilateral mandibular condylar fractures by open and closed methods.

Condylar fractures account for a large proportion (20% to 52%) of mandibular injuries. The goal of treating these fractures is to restore the occlusion, thereby re-establishing the masticatory function as close as possible to the patient's pre-trauma state. The aim of this study was to compare the bite forces following unilateral condylar fractures treated by open reduction and internal fixation (ORIF) with those managed by the closed method. Patients with unilateral mandibular condylar fractures were divided into two groups (n=20) using a simple randomization method. Patients in group I were treated by open reduction and internal fixation (ORIF) using titanium miniplates and screws. Patients in group II were treated by the closed method with inter-maxillary fixation. Patients in both groups were evaluated pre-operatively and then post-operatively at one week, one month and three months for maximum bite force achieved at the central incisor, premolar and molar regions. Pre-operative bite forces on the unaffected site were significantly higher than the affected site in both groups, whereas no significant difference was observed in bite forces between the unaffected and affected sites in both groups post-operatively. The bite forces achieved at both the unaffected and affected sites in the ORIF group were significantly higher than in the closed group. Maximum bite forces differed significantly when the treatment was done with the open method, and the patients treated with the open method needed less time to achieve the maximum bite forces, thereby making an earlier return to function.

Prediction of Conservative Treatment Failure for Isolated Unilateral Mandibular Condylar Fractures Using Quantitative Measures: Suggestion of Indications for Intervention.

Interest in the treatment of mandibular condyle fracture in cases of maxillofacial trauma has been a huge concern for decades because of a diversity of opinions on the topic and the relatively few studies conducted on individuals treated by physiotherapy or rehabilitation with or without intermaxillary fixation (IMF). We measured fracture gaps between bone ends over an 8-year period from 2012 to 2019. The study cohort was composed of only conservatively treated patients. This retrospective study was conducted to identify factors that influence treatment failure by comparing a functional treatment (physiotherapy) group with an IMF group in terms of fracture gaps and other variables. In addition, an algorithm was devised to enable clinicians to determine promptly whether IMF is needed for mandibular condylar fractures. Significant correlations were observed between several parameters and malocclusion. Multiple regression analysis resulted in the following coefficients: 0.072 for fracture gap (P = 0.006) and 0.006 for age (P < 0.05) in functional treatment group. However, in the IMF group, correlations with malocclusion were 0.063 for fracture gap (P = 0.000) and 0.003 for age (P = 0.083). We proposed a diagnostic algorithm for isolated unilateral mandibular condyle fractures that provides guidance regarding surgical correction. If indications for surgical correction, as regards anatomical location, fracture level, fracture gap between bone ends, and patient cooperability, are not satisfied, clinicians should select IMF or functional treatment (rehabilitation). If the fracture gap is less than 6 mm and the patient is cooperative, functional rehabilitation would be more suitable than IMF.

Radiologic Analysis of Surgically Treated Fractures of the Condylar Process by an Endoscopic-Assisted Transoral Approach

This study analyzed the radiologic outcomes of patients with unilateral mandibular condylar fractures treated with open reduction-internal fixation (ORIF) through a transoral approach. In this retrospective study, the radiologic images of 40 patients who underwent open reduction-internal fixation through a transoral approach were presented to 2 independent examiners. All patients underwent the surgical procedure between January 2015 and December 2016 at the Department of Cranio-Maxillofacial Surgery at UniversitätsSpital Zürich and were included in a previous functional outcome study.The surgical results were analyzed and graded as poor, acceptable, or good. The examiners declared whether they would have made any intraoperative revisions if the radiologic information had been available. Finally, the examiners estimated the required duration of elastic intermaxillary fixation (IMF) from the radiologic images, which was compared with the actual duration. Fracture reduction was classified as good in 33 cases (82.5%), acceptable in 5 cases, and poor in 2 cases by one examiner and as good in 32 cases (80%), acceptable in 6 cases, and poor in 2 cases by the other examiner. The inter-rater reliability was determined to be good (Cohen κ=0.92). Correct osteosynthesis placement was found in 19 cases by one examiner and in 21 cases by the other examiner, with good inter-rater reliability (κ=0.8). Moderate inter-rater reliability (κ=0.4) was found for the required duration of elastic IMF. Furthermore, the estimated elastic IMF duration matched the actual duration in fewer than half of the cases. It is feasible to achieve reliably good radiologic results when operating on condylar process fractures by a transoral approach with endoscopic assistance and angled instruments. Intraoperative 3-dimensional imaging enables instant quality control and prompts surgical revision if needed.

Postoperative Quality-of-Life Analysis of Open Versus Closed Reduction of Mandibular Condyle Fractures: Our Experience

The treatment of unilateral mandibular condylar fractures remains a topic that continues to elicit controversy. Closed reduction with maxillomandibular fixation (CRMMF) and open reduction with internal fixation (ORIF) are two widely accepted treatment options. Several studies attempted to illustrate the advantage of ORIF by demonstrating better anatomical reduction and functional outcomes (Throckmorton & Ellis, 2000; Ishihama et al., 2007; Singh et al., 2011). However, a number of studies showed no significant differences in functional outcomes between the two procedures, and some favored CRMMF due to the lack of potential complications of ORIF, such as facial nerve paralysis and scarring (Landes et al., 2008; Leon et al., 2011; Gupta et al., 2012). While many studies have attempted to solve this dilemma by comparing treatment outcomes, few have focused their analysis on patients’ quality-of-life (QoL) and data on this aspect are inconclusive (Kommers, 2012). The purpose of this study is to compare ORIF and CRMMF in terms of patients’ QoL through a survey-based patient-centered analysis in an attempt to influence surgical decision making in the treatment of unilateral condylar fractures.

Epidemiology of Surgically Managed Mandibular Condylar Fractures at a Tertiary Referral Hospital in Urban Southwest China.

Background:Mandibular condylar fracture is one of the commonest maxillofacial fractures treated by maxillofacial surgeons. Demography of the patients, causation, and characteristics of the fracture depends on various socio-economic factors. Hence, maxillofacial surgeons should be familiar with epidemiology of mandibular condylar fracture.Objective:This study retrospectively describes the demography, etiology, fracture characteristics, and hospital utilization of surgically treated mandibular condylar fractures in a tertiary referral hospital in urban China in past five years.Methods:Data of all patients who underwent surgical management between 2011 and 2015 were collected. This included aetiology, characteristics of fracture, time, age, sex, associated injuries, and hospital utilization of 166 patients with 208 mandibular condylar fractures. These patients had undergone open reduction and internal fixation with either miniplates or lag screws. Among the fracture of head of mandibular condyle, 21.28% of the patients had the fracture segments removed. These data were statistically analyzed to describe the epidemiology of mandibular condylar fracture.Results:Most of the patients had unilateral mandibular condylar fractures (74.7%). Male patients (76.51%) outnumbered female patients (23.49%) in this cohort. The average age of the patients was 37 years. The fractures were mostly caused by fall from height (60.84%) and were located at the condylar neck (53.61%). Most of the patients had other associated maxillofacial injuries (71.08%) which were mostly located at symphysis and parasymphysis (44.59%). It took 12.58 +/- 0.35 days of hospitalization for the treatment.Conclusion:Fall from height was the most prevalent cause of mandibular condylar injury in mountainous urban China. The people at highest risk were middle-aged men. Mandibular condylar fracture was mostly located at the condylar neck and was usually associated with fracture at the symphysis and parasymphysis.

Retromandibular approach in the management of condylar fractures by open reduction and internal fixation a prospective study.

Aim:To evaluate the efficacy and safety of the retromandibular approach in the management of condylar fractures by open reduction and internal fixation (ORIF).Materials and Methods:A total of 20 patients with unilateral mandibular condylar fractures underwent ORIF using retromandibular approach. Pertinent data were collected and subjected to evaluation.Results:The retromandibular approach was found to be expeditious in adequately exposing the fracture site and enabling ORIF. The anatomic reduction of the fractured segments and the fixation was satisfactory in all the cases. Average duration of surgery was 39 min (range: 17-56 min) for satisfactory exposure, reduction, and fixation of each condylar fracture.Conclusion:The retromandibular approach provides adequate exposure of the subcondylar region and should be considered as commendable alternative in the management of condylar fractures.

Unilateral mandibular condylar fractures: a 31-year follow-up of non-surgical treatment

At the University Hospital of Malmö, Sweden, standardized trauma charts were used for registration of all jaw fractures from 1972 to 1976. During the year 2005 the aim was to interview all patients treated non-surgically for unilateral mandibular condylar fractures during this period. In total, 49 patients with unilateral condylar fractures were treated non-surgically in 1972–1976. Of these, 23 patients were available for follow-up, 17 were dead, 7 were not found and 2 did not answer letters or phone calls. The follow-up was a telephone interview according to a standardized questionnaire concerning occurrence of pain and headache, function of the jaw and joint sounds. Information from original records, radiographic reports and the standardized trauma charts revealed fracture site, type of fracture and intermaxillary fixation if any. Eighty-seven percent of the patients reported no pain from the jaws, 83% had no problems chewing and 91% reported no impact of the fracture on daily activities. Neck and shoulder symptoms were reported by 39% and back pain by 30%. The 31-year results of non-surgical treatment of unilateral non-dislocated and minor dislocated condylar fractures seem favourable concerning function, occurrence of pain and impact on daily life.

Management of bilateral condylar fractures: Case review

Unilateral mandibular condylar fractures occur approximately three times more frequently than bilateral fractures [1]. Fracture of the mandibular parasymphysis region is usually associated with fracture of contralateral condyle. Unilateral fracture condyle may occur as an isolated case or along with fracture of mandible or other facial bones. Unilateral condylar fractures without displacement, are generally treated conservatively using arch bars and intermaxillary fixation (IMF). It is rare to see bilateral fracture condyle without any other associated fracture. Deranged occlusion, inability to masticate food, difficulty in opening mouth, haemotympanum and pain in preauricular region are some of the complaints of patients. In bilateral subcondylar fractures the dilemma remains whether to manage it conservatively, perform open reduction and bone plating of one side only or perform open reduction and bone plating of bilateral condyles. The age of the patient, the level of fracture, angle of displacement, dislocation of condylar head and presence of other associated fractures influences a surgeon's decision. The growth of the mandible continues throughout childhood and adolescence. So in children, IMF is restricted to fourteen days to facilitate early movement and to prevent ankylosis of temporomandibular joint (TMJ). Four cases of bilateral condylar fractures are being reviewed.

保存治療を行った片側性関節突起骨折における開口障害持続期間および開口時の下顎偏位についての検討

The aim of this study was to clarify factors affecting the clinical outcomes of conservative treatments for unilateral mandibular condylar fractures. In 41 patients (30 males and 11 females) treated at our hospital, age, sex, clinical findings, image findings, and methods of treatment were investigated. The duration of trismus and mandibular deviation during mouth opening were clinically evaluated. The correlations were studied by multivariate analysis.The results were as follows:There were significant correlations between condylar dislocation and the duration of trismus and between the degree of malposition of bone fragments and mandibular deviation during mouth opening.

片側性下顎骨関節突起骨折の予後の検討

A statistical analysis was performed to determine factors that influence the clinical outcome of unilateral condylar fractures of the mandible. In this study, the fracture location was limited to the condylar neck and base of the condylar process. Twenty-eight patients, 18 males and 10 females, were treated at our clinic between January 1997 and December 2001. The age range was 7 to 79 years, and the average age was 32.6 years. Seventeen cases involved fractures of the condylar neck and 11 cases involved fractures of the base of the condylar process. Fifteen cases were treated conservatively by intermaxillary fixation, and 13 were treated surgically by using a titanium mini-plate or lag screw osteosynthesis system. The clinical outcome was determined according to the classification described by Kamiya 6 months after injury. The outcome was good in 21 cases, whereas 7 cases had restricted mouth-opening or joint sounds during jaw movements. This study revealed that two factors can negatively influence the clinical outcome of unilateral mandibular condylar fractures: one is the type of fracture in all cases and the other is the age of the patient at injury in cases treated conservatively.