Journal of the Korean Association of Oral and Maxillofacial Surgeons

The Korean Association of Oral and Maxillofacial Surgeons (대한구강악안면외과학회)
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A RETROSPECTIVE CLINICAL STUDY OF CONDYLAR FRACTURES OF THE MANDIBLE IN A 4-YEAR PERIOD

하악 과두 골절에 대한 4년간의 후향적 임상연구

  • Ryu, Jae-Young (Department of Oral & Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 2nd Stage of Brain Korea 21) ;
  • Kim, Hyun-Syeob (Department of Oral & Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 2nd Stage of Brain Korea 21) ;
  • Park, Chung-Youl (Department of Oral & Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 2nd Stage of Brain Korea 21) ;
  • Kook, Min-Suk (Department of Oral & Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 2nd Stage of Brain Korea 21) ;
  • Park, Hong-Ju (Department of Oral & Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 2nd Stage of Brain Korea 21) ;
  • Oh, Hee-Kyun (Department of Oral & Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 2nd Stage of Brain Korea 21)
  • 류재영 (전남대학교 치의학전문대학원 구강악안면외과학교실, 전남대학교 치의학연구소, 2단계 BK21) ;
  • 김현섭 (전남대학교 치의학전문대학원 구강악안면외과학교실, 전남대학교 치의학연구소, 2단계 BK21) ;
  • 박충열 (전남대학교 치의학전문대학원 구강악안면외과학교실, 전남대학교 치의학연구소, 2단계 BK21) ;
  • 국민석 (전남대학교 치의학전문대학원 구강악안면외과학교실, 전남대학교 치의학연구소, 2단계 BK21) ;
  • 박홍주 (전남대학교 치의학전문대학원 구강악안면외과학교실, 전남대학교 치의학연구소, 2단계 BK21) ;
  • 오희균 (전남대학교 치의학전문대학원 구강악안면외과학교실, 전남대학교 치의학연구소, 2단계 BK21)
  • Published : 2008.06.30
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Abstract

The present study was performed to evaluate the function of the mandible according to the pattern of fracture and treatment methods of condylar fractures of the mandible and help operators in making a treatment plan. Sixty patients (average follow-up period was $7.8{\pm}9.4$ months) who were treated for condylar fracture from June, 2002 to May, 2006 at the Department of Oral and Maxillofacial surgery, Chonnam National University Hospital were reviewed. The common causes of the condylar fracture were traffic accident and fall-down (35.0%). In concomitant injuries, laceration was 46.7% and the fracture of the mandibular symphysis was highest incidence (60.0%). The common site of the fracture was the condylar head (47.8%), followed by subcondyle (36.2%) and condylar neck (15.9%). Under 15 years old patients, the closed reduction was performed in 87.5% out of the patients. All of the condylar fragments were fixed to the mandible with titanium miniplates in cases of open reduction. The mean period of intermaxillary fixation (IMF) was $14.2{\pm}6.5$ days in closed reduction and $10.0{\pm}4.2$ days in open reduction. The old patient with bilateral condylar head fractures, who were treated by closed reduction with IMF for 3 weeks, showed the limitation of mandibular movements. But, there was no significant different results between open reduction and closed reduction with the respect of the Helkimo's mandibular mobility index and clinical dysfunction index (DI). Complications, such as fibrous ankylosis and resorption of the mandibular condyle, were not observed in all patients. These results suggest that the good results can be obtained by closed reduction with proper IMF periods and functional exercise in most condylar fractures of the mandible except severely displaced extracapsular fractures.

Keywords

References

  1. Villarreal PM, Monje F, Junquera LM, Mateo J, Morillo AJ, Gonzalez C: Mandibular condyle fractures: determinants of treatment and outcome. J Oral Maxillofac Surg 2004;62:155-163 https://doi.org/10.1016/j.joms.2003.08.010
  2. Fonceca GD: Experimental study on fractures of the mandibular condylar process. Int J Oral Surg 1974;3:89-101 https://doi.org/10.1016/S0300-9785(74)80040-2
  3. Lindahl L: Condylar fractures of the mandible. I. Classification and relation to age, occlusion, and concomitant injuries of teeth and teeth-supporting structures, and fractures of the mandibular body. Int J Oral Surg 1977;6:12-21 https://doi.org/10.1016/S0300-9785(77)80067-7
  4. Umstadta HE, Ellersa M, Mu ¨llerb HH, Austermanna KH: Functional reconstruction of the TM joint in cases of severely displaced fractures and fracture dislocation. J Cranio Maxillofac Surg 2000;28:97-105 https://doi.org/10.1054/jcms.2000.0123
  5. Ferri J, Carneiro JM, Lemiere E, Vereecke F, Baralle MM: Severe congenital hypoplasia of the mandibular condyle-diagnosis and treatment: a report of 2 cases. J Oral Maxillofac Surg 2006;64:972-980 https://doi.org/10.1016/j.joms.2006.02.019
  6. Hovinga J, Boering G, Stegenga B: Long-term results of nonsurgical management of condylar fractures in children. Int J Oral Maxillofac Surg 1999;28:429-440 https://doi.org/10.1016/S0901-5027(99)80056-3
  7. Palmieri C, Ellis E, Throckmorkon G: Mandibular motion after closed and open treatment of unilateral mandibular condylar process fractures. J Oral Maxillofac Surg 1999;57:764-775 https://doi.org/10.1016/S0278-2391(99)90810-8
  8. Dingman RO, Natvig P. Surgery of facial fractures. Philadelphia, W.B. Saunders Co. 1964:143-145
  9. Helkimo M: Studies on function and dysfunction of the masticatory system. II. Index for anamnestic and clinical dysfunction and occlusal state. Sven Tandlak Tidskr 1974;67:101-121
  10. Silvennoinen U, Lizuka T, Lindqvist C, Oilarinen K: Different patterns of condylar fractures: an analysis of 382 patients in a 3-year period. J Oral Maxillofac Surg 1992;50:1032-1037 https://doi.org/10.1016/0278-2391(92)90484-H
  11. 이상철, 김여갑, 류동목, 이백수, 윤옥병, 진택현: 하악 과두 골절의 임상통계학적 연구. 대구외지 1998;24:326-329
  12. 이희철, 강신익, 고영규: 하악골 관절 과두돌기 골절의 임상적 연구. 대악성외지 1989;11:287-295
  13. 민승기, 박상규, 오승환, 권경환, 최문기, 채영원: 하악 과두 골절에 관한 장기추적조사연구. 대악성외지 2005;27:535-544
  14. Haug RH, Prather J, Indresano AT: An epidemilogic survey of facial fractures and concomitnat injuries. J Oral Maxillofac Surg 1990;48:925-932
  15. Guven O, Keskin A: Remodelling following condylar fractures in children. J Craniomaxillofac Surg 2001;29:232-237 https://doi.org/10.1054/jcms.2001.0228
  16. 유선열, 황웅, 양규호: 소아에서 하악 과두 골절의 보존적 치료 후 골개조. 대구외지 2004;30:49-55
  17. MacLennan WD: Consideration of 180 cases of typical fractures of the mandibular condylar process. Br J Plast Surg 1952;5:122-128 https://doi.org/10.1016/S0007-1226(49)80020-8
  18. Zide MF, Kent JN: Indications for open reduction of mandibular condyle fractures. J Oral Maxillofac Surg 1983;41:89-98 https://doi.org/10.1016/0278-2391(83)90214-8
  19. Silvennoinen U, Raustia AM, Lindqvist C, Oikarinen K: Occlusal and temporomandibular joint disorders in patients with unilateral condylar fracture. A prospective one-year study. Int J Oral Maxillofac Surg 1998;27:280-285 https://doi.org/10.1016/S0901-5027(05)80615-0
  20. Smets LM, Van Damme PA, Stoelinga PJ: Non-surgical treatment of condylar fractures in adults: a retrospective analysis. J Craniomaxillofac Surg 2003:31:162-167 https://doi.org/10.1016/S1010-5182(03)00025-8
  21. Throckmorton GS, Ellis E 3rd: Recovery of mandibular motion after closed and open treatment of unilateral mandibular condylar process fractures. Int J Oral Maxillofac Surg 2000:29:421-427 https://doi.org/10.1016/S0901-5027(00)80072-7
  22. Stiesch-Scholz M, Schmidt S, Eckardt A: Condylar motion after open and closed treatment of mandibular condylar fractures. J Oral Maxillofac Surg 2005;63:1304-1309 https://doi.org/10.1016/j.joms.2005.05.293
  23. Ellis E 3rd, Dean J: Rigid fixation of mandibular condyle fractures. Oral Surg Oral Med Oral Pathol 1993;76:6-15 https://doi.org/10.1016/0030-4220(93)90285-C
  24. Lachner J, Clanton JT, Waite PD: Open reduction and internal rigid fixation of subcondylar fractures via an intraoral approach. Oral Surg Oral Med Oral Pathol 1991;71:257-261 https://doi.org/10.1016/0030-4220(91)90295-N
  25. Kendell BD, Frost DE. Applied surgical anatomy of the head and neck In: Fonseca RJ, Walker RV, Betts NJ, Barber HD, Powers MP. Oral and maxillofacial trauma 3rd ed. St. Louis, Elsevier Saunders Co. 2005:281-328
  26. Ellis E, Reynolds ST, Park HS: A method to rigidly fix high condylar fractures. Oral Surg Oral Med Oral Pathol 1989;68:369- 374 https://doi.org/10.1016/0030-4220(89)90130-8
  27. Haug RH, Assael LA: Outcomes of open versus closed treatment of mandibular subcondylar fractures. J Oral Maxillofac Surg 2001;59:370-375 https://doi.org/10.1053/joms.2001.21868
  28. Konstantinovic FX, Dimitrijevic B: Surgical versus conservative treatment of unilateral condylar process fractures: clinical and radiographic evaluation of 80 patients. J Oral Maxillofac Surg 1992:50:352-353 https://doi.org/10.1016/0278-2391(92)90396-H
  29. Santler G, Karcher G, Rida C, Kole E: Fractures of the condylar process: surgical versus nonsurgical treatment. J Oral Maxillofac Surg 1999:57:392-397 https://doi.org/10.1016/S0278-2391(99)90276-8
  30. Throckmorton G, Ellis E 3rd, Hayasaki H: Masticatory motion after surgical or nonsurgical treatment for unilateral fractures of the mandibular condylar process. J Oral Maxillofac Surg 2004;62:127-138 https://doi.org/10.1016/j.joms.2003.01.003
  31. Marker P, Mielsen A, Bastian HL: Fractures of mandibular condyle. Part2: results for treatment of 348 patients. Br J Oral Maxillofac Surg 2000;38:422-426 https://doi.org/10.1054/bjom.2000.0457
  32. Andersson J, Hallmer F, Eriksson L: Unilateral mandibular condylar fractures: a 31-year follow-up of non-surgical treatment. Int J Oral Maxillofac Surg 2007;36:310-314 https://doi.org/10.1016/j.ijom.2006.11.001
  33. Neff A, Kolk A, Neff F, Horch HH: Surgical vs nonsurgical treatment in diacapitular and high condylar fractures with dislocation. A comparison based on magnetic resonance imaging and anxiography. Mund Kiefer GesichtsChir 2002;6:66-73 https://doi.org/10.1007/s10006-001-0345-4
  34. Hlawitschka M, Loukota R, Eckelt U: Functional and radiological results of open and closed treatment of intracapsular (diacapitular) condylar fractures of the mandible. Int J Oal Maxillofac Surg 2005;34:597-604 https://doi.org/10.1016/j.ijom.2005.02.004