Functional results after conservative treatment of fractures of the mandibular condyle

Since the introduction of osteosynthesis materials for rigid internal fixation after anatomical reduction there is an ongoing discussion about the treatment of condylar fractures of the mandible. Sixty patient files were analyzed and 28 patients were seen for re-examination and a x-orthopantomogram was taken. Functionality was graded with the Helkimo index at an average of 3.0 years follow-up. The clinical dysfunction index showed: severe symptoms in 11%, moderate symptoms in 39%, mild symptoms in 39% and 11% had no symptoms. Index for occlusal state showed: 21% severe occusal disturbances, 61% moderate occlusal disturbances and 18% no occlusal disturbances. According to the anamnestic dysfunction index 89% of the patients were symptom-free. The clinical outcome group showed a significant left/right ramus length difference compared with a 20-person control group. The re-examined group did not significantly differ from the control group. Conservative treatment for condylar fractures was successful in only 46% according to the 1999 consensus criteria described by Bos et al.     

Evaluation of surgical treatment in mandibular condyle fractures

AimIn the past, fractures of the mandibular condylar process were, as a rule, treated conservatively. At the Department of Maxillofacial and Oral Surgery of the University Medical Centre Ljubljana, Slovenia, our doctrine was changed in 2002 on the basis of preliminary results and reports in the literature, and these fractures were started to be treated surgically by open reduction and internal fixation with miniplates and screws, which led to good results and a shorter rehabilitation period. The goal of this study was to determine the safety and efficiency of surgical treatment, as well as to compare long-term results of surgical and conservative treatment, as objectively as possible.Patients and methodsTwo groups of patients, which had all sustained a unilateral, extra-articular mandibular condyle fracture, were compared. In the test group, there were 42 surgically treated patients, and in the control group, 20 conservatively treated patients. Clinical parameters and X-ray images were assessed in both groups and compared by the two tailed Student t test, and in case of attributive variables by the χ² test. Within the surgically treated group, postoperative and intraoperative complications were noted: temporary facial nerve palsy, development of a parotid salivary fistula, disturbance of auricle sensibility due to injury of the greater auricular nerve, miniplate fracture, as well as intraoperative bleeding, postoperative haematoma formation, infection, reoperation due to fragment malposition and other complications. Postoperative scars were also assessed.ResultsStatistically significant differences between the surgically and conservatively treated patients were found when comparing clinical parameters as well as X-ray images, the results being better in the surgically treated group. Complications of surgical treatment were also noted, the most important among them temporary paresis of facial nerve branches, which occurred in 10 patients (24%). Plate fractures occurred in five patients (12%), in four of them miniplates of sizes less than 2.0 mm were used. There were no cases of significant intraoperative bleeding, two cases (5%) required drainage of postoperative haematomas, and one patient (2%) experienced a mild postoperative infection, which was easily controlled with amoxicillin with clavulanic acid. The scar was hidden best if a facelift incision was used, and a hypertrophic scar developed in only one patient (2%).ConclusionResults of surgical treatment of condylar process fractures are superior to the results of conservative treatment, and the procedure is safe with the transparotid surgical approach and adequate surgical technique.     

Evaluation of the indications used for conservative and surgical treatment of mandibular fractures in the light of late results

A survey of the literature on the selection of conservative or surgical treatment of mandibular fractures is presented. In view of great advances in traumatology and other related medical specialities the need arose of verification of the presently accepted indications to the choice of the type and mode of treatment of fractures in the facial skeleton. The range of studies on this problem and the methods are described. The results of own research work along these lines are discussed, and the continuation of this work and conclusions will be reported in the following issue of the Czasopismo Stomatologiczne.     

Evaluation of the indications for conservative and surgical treatment of mandibular fractures in the light of late therapeutic results. Own material results of studies

The studied material comprised 300 inpatients with mandibular fractures in whom the data necessary for the intended assessment were collected according to an acc epted programme. The collected material made possible to evaluate the indications to surgical and conservative treatment in the light of immediate and late results considering the duration of the treatment and its effectiveness, and the time of disability to work or school work. On the basis of the obtained therapeutic results the necessity was demonstrated of introduction of slight corrections in the presently accepted indications to the choice of treatment type. The result of the study is a suggestion for extension of the indications to surgical treatment with consideration of the modern methods of osteosynthesis in certain groups of patients with mandibular fractures. It was noted that a considerable number of patients had too long, unjustified illness leaves from work which the authors regard as a sociological phenomenon requiring further studies.     

Long-term results and complications after treatment of bilateral fractures of the mandibular condyle

The purpose of this study was to investigate the long-term results of conservative treatment of bilateral condylar fractures and to study the influence of possible functional impairment on intensity of pain and associated disability. We studied 71 patients (mean (SD) age 33 (14) years) with conservatively treated bilateral condylar fractures. Traffic crashes (n = 42, 59%) and falls (n = 20, 28%) were the main cause of the fractures. Forty-one patients (58%) were re-examined after about 90 months (mean 86, range 3–193). Five of the 41 (12%) had developed malocclusion, but did not experience any pain in the temporomandibular joint according to the Research Diagnostic Criteria for Temporomandibular Disorders. There was a significant negative relation between the presence of pain and the duration of follow up (p = 0.02). Increasing age was significantly related to reduction in the intensity of pain (p = 0.03). Of the remaining 30 patients who were not followed up, 2 had had bilateral sagittal split osteotomy and 1 a Le Fort I osteotomy. One patient had had orthodontic correction for a malocclusion. Including the five malocclusion patients, at least 9 of the total of 71 (13%) developed a malocclusion after conservative treatment. Functional impairment had no influence on the intensity of pain or pain-related disability in the patients with malocclusion after conservatively treated bilateral condylar fractures. This report may therefore be of value in the debate about whether open or closed treatment is better for bilateral mandibular condylar fractures.     

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提要：髁突骨折是下颌骨骨折的常见类型之一。有关髁突骨折的治疗争议仍然很大,本文结合文献和笔者的临床经验,就下颌骨髁突骨折的分类和治疗作一探讨,以其对读者的临床实践提供帮助。     

The results of the surgical treatment of fractures of the mandibular condyle in children]

The results of surgical treatment of fractures of the mandibular condyle are analyzed in 36 children (39 surgeries) aged 3 to 17; 33 of the operations were carried out in fractures complicated with the dislocation of the condylar head. Reposition and osteosynthesis of the fragments were carried out in 17 cases, replantation of the condyle in 10, and arthroplasty of the temporomandibular joint in 12 patients. Good late anatomico-functional and esthetic results were achieved in 84.6% of cases; this is explained by a differentiated approach to the choice of surgical strategy, an effective system of rehabilitation measures, including early exercise, orthodontic treatment, and low-frequency electromyostimulation.     

Long-term results of the treatment of mandibular condyle fracture

Long-term result of conservative and surgical treatment of varying types of mandibular condyle fracture in 34 cases was investigated. The study shows that 90% cases of condyle fracture, including that complicated with dislocation and displacement, could be successfully treated with simple immobilization by intermaxillary elastic bands. The long-term result of close reduction is closely related to the interval between the trauma and the start of treatment, the earlier the beginning of the treatment, the better the result. The unfavourable immediate result in form of imperfect occlusion and excursion, etc. could be corrected by forced mandibular movement. 10 cases complicated with badly dislocation or communicated fracture were treated with condylectomy, satisfactory results were achieved in 80% of them.     

The treatment of mandibular condyle fractures: A meta-analysis

BackgroundThe treatment for mandibular condyle fractures remains controversial. Conservative management (CM) and open reduction/internal fixation (ORIF) are both used, but the evidence to support superiority of one method over the other has not been assessed.MethodsWe performed a meta-analysis of studies comparing CM versus ORIF in patients with condyle fractures. The primary outcome was post-treatment function; we looked at the status of the post-treatment occlusion, mouth opening, protrusion, facial height, pain and the presence of postoperative ankylosis. Furthermore, in studies evaluating ORIF, adverse effects such as facial nerve weakness and scarring, were also recorded.ResultsTwenty (20) studies enrolling 1596 patients were eligible. These included four randomized controlled trials (RCTs) and 16 non-randomized case series. Only 1186 of these patients were analyzed by the studies; the reasons for exclusion were rarely clarified. All four RCTs were prospective but the majority (69%) of the remaining studies were retrospective. The inclusion criteria were described in all four RCTs; however, this was not the case in half of the remaining studies (44%). Only four (20%) studies were blinded. Across all included studies, we recorded great variation between treatment protocols, follow-up periods, and outcomes measured. This precluded any quantitative synthesis. In nine studies (45%) the superiority of ORIF over CM reached statistical significance. The incidence of facial nerve weakness following ORIF averaged 6% and it was temporary for the majority of the patients. The identified RCTs were small (160 patients) and suffered from a number of methodological shortcomings. All of them reached statistically significant conclusions favoring ORIF over CM.ConclusionThe current meta-analysis suggests that ORIF for condylar fractures may be as good or better than CM. The morbidity associated with the operation is low. However, the available evidence is of poor quality and not strong enough to change clinical practice.     

Use of conservative condylectomy for treatment of osteochondroma of the mandibular condyle.

PURPOSE: The aim of the present study was to present a conservative condylectomy technique (condylectomy performed below the condylar head but high in the condylar neck) and articular disc repositioning as the surgical treatment approach for management of osteochondroma of the head of the mandibular condyle. PATIENTS AND METHODS: Six patients (4 females and 2 males) with an average age of 22.3 years (range, 13 to 32 years) and with an osteochondroma of the mandibular condyle were treated with conservative condylectomy. The remaining condylar neck stump was recontoured, and the articular disc was repositioned and stabilized over the "new" condyle. Any indicated orthognathic surgical procedures were then performed to optimize occlusion, function, and aesthetics. Clinical and radiographic evaluation was performed before surgery (T1), immediately after surgery (T2), and at the longest follow-up (T3). RESULTS: Average follow-up for the patients was 51 months (range, 22 to 108 months). No recurrence of the tumor was encountered in any of the cases. Subjective and objective evaluations of postsurgical temporomandibular joint function and range of mandibular motion were normal. Associated maxillary and/or mandibular orthognathic procedures were found to be stable in the long term. CONCLUSION: Conservative condylectomy with recontouring of the residual condylar neck to function as a condyle and repositioning of the articular disc is a viable option for treatment of osteochondromas of the mandibular condyle. The use of this method of treatment permits effective removal of the tumor and eliminates the need for autogenous grafts or total joint prostheses for temporomandibular joint reconstruction.     

75例下颌骨粉碎性骨折的治疗效果评价

目的:提出一种针对下颌骨粉碎性骨折的分类方法,并尝试将其用于临床评价.方法:回顾75例下颌骨粉碎性骨折患者,按照下颌骨是否伴有节段性骨缺损、下颌骨形态、下颌骨的粉碎程度、可否恢复稳定的咬合关系对其进行分类.按照严重程度,进行保守治疗或使用小型钛板、钛网或重建板进行手术.其中,44例按照分类及治疗策略进行治疗(实验组),...     

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.     

Late results of treatment of mandibular fractures

In a group of 1246 patients treated in the Department of Maxillofacial Surgery-Institute of Stomatology, Medical Academy in Warsaw, in a period of 3 years (1984-1986) late results of treatment of mandibular fractures were assessed. In the assessment the range of mandible abduction, function of temporomandibular joints, occlusal abnormalities, the sensory function in the area innervated by the mental nerves and the condition of posttraumatic scars changing the morphology and aesthetic appearance of the face were considered. Limitation of mandibular abduction after treatment was found in 39 cases. Functional disturbances of temporomandibular joints developed in 58 cases, and various occlusal complications were found in 130 out of 1246 patients. In 56 patients various sensory loss was noted in the innervation area of the mental nerves. Posttraumatic scars in 89 patients affected in various degree facial morphology and aesthetic appearance.