Three-dimensional assessment of accuracy for open reduction and internal fixation of the subcondylar fracture and its implications on the TMJ function |
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| Affiliation: | 1. Department of Oral and Maxillofacial Surgery, Lanzhou University First Affiliated Hospital, Lanzhou University, Lanzhou, Gansu Province, China;2. Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, 56th Lingyuanxi Road, Guangzhou, Guangdong, 510055, China;3. State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China;4. Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ibb University, Ibb, Yemen;5. Department of Orthodontic, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China;1. Department of Prosthetic Dentistry, University Hospital Würzburg, Pleicherwall 2, 97070, Würzburg, Germany;2. Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070, Würzburg, Germany;3. Institute for Hygiene and Microbiology, University of Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany;4. Department of Psychology (Biological Psychology, Clinical Psychology and Psychotherapy), University of Würzburg, Marcusstraße 9–11, 97070, Würzburg, Germany;1. Institute of Psychology, Christian-Albrechts-University Kiel, Olshausenstr. 62, 24118, Kiel, Germany;2. Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Building B, D-24105, Kiel, Germany;3. Institute for Scandinavian Studies, Frisian Studies and General Linguistic Christian-Albrechts-University Kiel, Leibnizstr. 10, 24118, Kiel, Germany;1. Department of Otorhinolaryngology, Asahi General Hospital, Chiba, Japan;2. Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan;3. Department of Otorhinolaryngology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan;1. Nankai University, Tianjin, 300071, China;2. Tianjin Stomatological Hospital, School of Medicine, Nankai University, Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin 300041, China;1. Nitte Meenakshi Institute of Craniofacial Surgery, Nitte Deemed to be University, India;2. Dept. of Periodontics, Srinivas Inst. of Dental Sciences, RGUHS, India;3. Dept. of Cleft and Craniofacial Orthodontics, Nitte Meenakshi Institute of Craniofacial Surgery, Nitte Deemed to be University, India;4. Dept. of Oral and Maxillofacial Surgery, A.B.Shetty Memorial Inst. of Dental Sciences, Nitte Deemed to be University, India;5. Klinik Professor Sailer, Zurich, Switzerland |
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| Abstract: | This study used three-dimensional cone beam computed tomography (CBCT) to assist the accuracy of open reduction and internal fixation (ORIF) for the unilateral subcondylar fracture and the long-term temporomandibular joint (TMJ) function impairment.Bilateral TMJs were analyzed postoperatively on CBCT images, involving the following three-dimensional (3D) parameters: condylar position and inclination; circumferential joint space, ramus, and mandible length; and the volumetric joint space. The inclusion criteria for adult patients included having a displaced fracture >5°, a shortening in ramus length >2 mm, and mouth opening limitation. The non-fracture side was used as the comparison group. The Helkimo index was employed for the clinical assessment of the outcomes, while the paired student t-test and Pearson coefficient test were used to compare both sides.The study included 60 joints in 30 consecutive patients. The condylar inclination to the horizontal plane on the fracture and non-fracture sides was 9.29 ± 3.9°, 12.46 ± 4.2°, (p < 0.001) and was positively related to the subjective (Helkimo Hi) and objective (Helkimo Di) clinical outcomes. In contrast, the condylar position to the midsagittal plane in the fracture and non-fracture sides was 51.95 ± 3.5 mm, 50.17 ± 3.6 mm (P = 0.038), and was positively related to the objective outcomes. Additionally, the objective outcome was negatively related to the change of the posterior joint space.ConclusionThe three-dimensional assessments seem to demonstrate that the ORIF is an accurate approach for obtaining a three-dimensional reduction to the displaced subcondylar fracture. |
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| Keywords: | Subcondylar fracture Open reduction and internal fixation Reduction accuracy Three-dimensional CBCT analysis |
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