Open Reduction and Rigid Internal Fixation of Mandibular Condylar Fractures by an Intraoral Approach: A Long-Term Follow-Up Study of 15 Patients

PURPOSE: To evaluate the long-term results obtained with open reduction and rigid internal fixation of mandibular condylar fractures by an intraoral approach. PATIENTS AND METHODS: Fifteen patients with 24 mandibular condylar fractures were retrospectively examined with an average follow-up of 23 months (range, 6-63 months). Clinical and radiographic examination was conducted according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), including an evaluation of maximum voluntary bite force measurements and facial nerve function. Statistical analysis was performed on maximum voluntary bite force measurements and maximum pressure pain threshold. RESULTS: Two patients fulfilled the criteria for a RDC/TMD diagnosis. Myofacial pain (group I) and bilateral arthralgia (group III), combined with a moderate nonspecific physical symptom score, was diagnosed in 1 patient and 1 patient received a diagnosis of disc displacement with reduction (group II). Satisfying radiographic fracture healing was seen in 12 joints. However, miniplate fracture occurred in 3 patients and severe bone resorption of the condylar head was seen in one patient. Minor adjustment of the postoperative occlusion was necessary in 6 patients. No significant difference between maximum voluntary isometric bite force measurements or maximum pressure pain threshold was found between the fracture side and the opposite side in unilateral cases or between the operated and nonoperated side in bilateral cases. None of the patients showed facial nerve injury or visible facial scars. CONCLUSION: Within the limitations of a retrospective study, the present study emphasized that optimal management of dislocated bilateral condylar injuries combined with other fractures of the facial skeleton constitute a challenging issue in maxillofacial trauma. Moreover, open reduction and rigid internal fixation of mandibular condylar fractures by an intraoral approach is a technically demanding surgical procedure associated with a high risk of postoperative complications in these injuries.     

Protocol for Antibiotic Administration in Mandibular Trauma: A Prospective Clinical Trial

Purpose

The purpose of this study is to determine the necessity and/or effectiveness of antibiotics in cases with maxillofacial trauma and emphasise the administration of antibiotics in maxillofacial fractures indicated for open reduction and rigid internal fixation (ORIF).

Materials and Methods

This study is a single blind, prospective, randomized clinical trial composed of subjects who presented with non-comminuted, linear fractures of the mandible and were treated by ORIF via an intraoral approach. One hundred and forty-four subjects (2011–2015) who belonged to the above entities were randomly categorized into 2 groups of 72 each, on lottery method. Patients in Group A were administered a 5 day course of antibiotic (1 day IV antibiotics followed by 4 days oral) while patients in Group B received a 1 day course of IV antibiotic (1 dose post op). Both the groups were followed up on the 1st day, 3rd day, 1st week, 1st month, 3rd month post operatively and were evaluated for pain, swelling, infection, fever, spontaneous wound dehiscence, purulent discharge and any other adverse effects.

Results

Post operative infection when measured clinically and radiographically was comparatively higher in Group B. Out of 72 patients in both the groups, 5 patients each in Group A and Group B reported with wound dehiscence, 9 patients in both groups developed pyrexia.

Conclusion

Though the post operative infection was slightly more in Group B compared to Group A, 1 day antibiotic regimen was found to be equally effective when compared to 5 day regimen and helps in reducing the after effects, superinfection and antibiotic resistance. It has better patient compliance and is cost effective.

     

髁突增生与下颌骨畸形研究进展

1概述及流行病学情况 髁突增生（condylar hyperplasia），有文献称之为髁突肥大（condylar hypertrophy），髁突良性肥大（benign condylar hypertrophy）。本病是由于一侧髁突骨质增生而引起下颌骨不对称性畸形，在下颌骨不对称畸形中，其发病比例相当高，而国内文献却罕有这方面的报道。本文即针对该病的研究情况作一个综述。     

下颌骨缺损修复37例临床分析

目的:选择理想的下颌骨缺损修复方法,重建下颌骨的连续性和完整性。恢复下颌骨的功能。纠正口腔颌面畸形,提高患者的生存质量。方法:比较37例下颌骨缺损患者的修复方法的优缺点。结果:自体游离骨移植修复下颌骨缺损者22例,占59.5%,其中2例因术后感染失败。6例吻合血管的自体骨移植全部成活。修复效果理想。结论:自体游离骨移植是目前最常用的修复方法,而血管化骨移植是目前最理想的修复方法。     

固定功能矫治器前伸大鼠下颌后髁突适应性生长改建特征的计算机辅助图像分析

目的：探讨持续性前伸大鼠下颌条件下髁突后部的适应性生长改建特征。方法：模拟临床固定功能矫治器,引导大鼠下颌前伸,制取相应的组织切片,采用ＬｅｉｃａＱ５５０ＩＷ计算机辅助图像分析系统进行精确定量分析。结果：对照组各层细胞面积随生长发育过程而变化,除生发层外,各层变化基本稳定。实验组和对照组进行比较,纤维层面积无显著性差异,其余各层都存在显著性差异,最能体现生长改建活跃程度的生发层及移行层有较剧烈的变动。结论：大鼠下颌持续性前伸引发了髁突软骨内各细胞层面积的变化,从而引起髁突从软骨到骨的改建,为临床上采用固定功能矫治器提供了实验依据。     

Re-Assessment of Coronoid as a Graft for Condylar Reconstruction in TMJ Ankylosis Patients: A Prospective Study and Literature Review

Introduction

Treatment for TMJ ankylosis aims at restoring joint function, improving the patient’s aesthetic appearance and quality of life and preventing re-ankylosis. To rebuild a structurally and functionally satisfactory neocondyle is a challenging problem. Aim of this study is to re-assess the coronoid as a graft for condyle reconstruction.

Materials and Methods

Twenty patients of TMJ ankylosis without involvement of the coronoid process in ankylotic mass, coming in age group elder than 14 years were selected for the study over a period 3 years from 2011 to 2014. Clinical examination, radiographs, and photographs were used postoperatively to evaluate the grafts and TMJ function. After osteoarthrectomy coronoid process was detached and fixed with a 4 hole L-shaped titanium miniplate to form neo condyle.

Result

No donor site morbidity was observed as reported with other autogenous grafts. Satisfactory mouth opening was observed during follow up period with mean mouth opening 37.33 ± 4.20 mm except one case which required graft removal due to postoperative infection. Radiographically moderate amount of resorption of grafted coronoid process was observed in nearly all the cases however satisfactory mandibular function and occlusion was observed.