CLINICAL REVIEW OF VARIOUS SURGICAL APPROACHES IN THE TREATMENT OF MANDIBULAR CONDYLE FRACTURE

하악과두부 골절 치료시 다양한 외과적 접근법에 대한 임상적 고찰

  • Kim, Ji-Hyuck (Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung National University) ;
  • Kim, Soung-Min (Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung National University) ;
  • Kwon, Gwang-Jun (Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung National University) ;
  • Park, Young-Wook (Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung National University)
  • 김지혁 (강릉대학교 치과대학 구강악안면외과학교실) ;
  • 김성민 (강릉대학교 치과대학 구강악안면외과학교실) ;
  • 권광준 (강릉대학교 치과대학 구강악안면외과학교실) ;
  • 박영욱 (강릉대학교 치과대학 구강악안면외과학교실)
  • Published : 2008.01.31

Abstract

Various surgical approaches in the mandibular condyle fracture have been reported and many advantages of intraoral reduction were also introduced. But there are still controversies about surgical method of condylar fractures up to date. To establish the surgical approach protocol of condylar fracture, from May 2001 to December 2004, total 65 patients with 74 fractures of the mandibular condyle were reviewed during 2 years, retrospectively. All cases were classified according to the treatment considering factors, such as the level of fracture, degree and direction of displacement of fractured segment, patient’s age and gender, surgical approach methods, and their complications. Especially, advantages and surgical limitations of extraoral surgical approach, such as direct reduction and fixation via submandibular approach, Nam’s method, and endaural approach, were compared with those of intraoral surgical approach, such as direct intraoral reduction with transbuccal fixation or right angle driver system, and intraoral reinsertional approach after extraoral fixation of fractured fragment. The guidelines of surgical approach of condylar fracture based on our clilnical retrospective experiences and literature reviews can be suggested.

Keywords

References

  1. Fridrich KL, Pena-Velasco G, Olson RA : Changing trends with mandibular fractures : a review of 1,067 cases. J Oral Maxillofac Surg 50 : 586, 1992 https://doi.org/10.1016/0278-2391(92)90438-6
  2. Silvennoinen U, Iizuka T, Lindqvist C et al : Different patterns of condylar fractures: an analysis of 382 patients in a 3-year period. J Oral Maxillofac Surg 50 : 1032, 1992 https://doi.org/10.1016/0278-2391(92)90484-H
  3. Marker P, Nielsen A, Bastian HL : Fractures of the mandibular condyle. Part 1 : patterns of distribution of types and causes of fractures in 348 patients. Br J Oral Maxillofac Surg 38 : 417, 2000 https://doi.org/10.1054/bjom.2000.0317
  4. Motamedi MH : An assessment of maxillofacial fractures : a 5-year study of 237 patients. J Oral Maxillofac Surg 61 : 61, 2003
  5. Ferreira PC, Amarante JM, Silva AC et al : Etiology and patterns of pediatric mandibular fractures in Portugal: a retrospective study of 10 years. J Craniofac Surg 15 : 384, 2004 https://doi.org/10.1097/00001665-200405000-00008
  6. Hyde N, Manisali M, Aghabeigi B et al : The role of open reduction and internal fixation in unilateral fractures of the mandibular condyle : a prospective study. Br J Oral Maxillofac Surg 40 : 19, 2002 https://doi.org/10.1054/bjom.2001.0734
  7. Yang WG, Chen CT, Tsay PK et al : Functional results of unilateral mandibular condylar process fractures after open and closed treatment. J Trauma 52 : 498, 2002 https://doi.org/10.1097/00005373-200203000-00014
  8. Assael LA : Open versus closed reduction of adult mandibular condyle fractures : an alternative interpretation of the evidence. J Oral Maxillofac Surg 61 : 1333, 2003 https://doi.org/10.1016/S0278-2391(03)00736-5
  9. Brandt MT, Haug RH : Open versus closed reduction of adult mandibular condyle fractures : a review of the literature regarding the evolution of current thoughts on management. J Oral Maxillofac Surg 61 : 1324, 2003 https://doi.org/10.1016/S0278-2391(03)00735-3
  10. Defabianis P : TMJ fractures in children and adolescents: treatment guidelines. J Clin Pediatr Dent 27 : 191, 2003
  11. Smets LM, Van Damme PA, Stoelinga PJ : Non-surgical treatment of condylar fractures in adults : a retrospective analysis. J Craniomaxillofac Surg 31 : 162, 2003 https://doi.org/10.1016/S1010-5182(03)00025-8
  12. Villarreal PM, Monje F, Junquera LM et al : Mandibular condyle fractures : determinants of treatment and outcome. J Oral Maxillofac Surg 62 : 155, 2004 https://doi.org/10.1016/j.joms.2003.08.010
  13. Baker AW, McMahon J, Moos KF : Current consensus on the management of fractures of the mandibular condyle. A method by questionnaire. Int J Oral Maxillofac Surg 27 : 258, 1998 https://doi.org/10.1016/S0901-5027(05)80507-7
  14. Iizuka T, Ladrach K, Geering AH et al : Open reduction without fixation of dislocated condylar process fractures: long-term clinical and radiologic analysis. J Oral Maxillofac Surg 56 : 553, 1998 https://doi.org/10.1016/S0278-2391(98)90450-5
  15. Undt G, Kermer C, Rasse M et al : Transoral miniplate osteosynthesis of condylar neck fractures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 88 : 534, 1999 https://doi.org/10.1016/S1079-2104(99)70082-X
  16. Rallis G, Mourouzis C, Ainatzoglou M et al : Plate osteosynthesis of condylar fractures: a retrospective study of 45 patients. Quintessence Int 34 : 45, 2003
  17. 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 6 : 12, 1977 https://doi.org/10.1016/S0300-9785(77)80067-7
  18. Zachariades N, Mezitis M, Mourouzis C et al : Fractures of the mandibular condyle : a review of 466 cases. Literature review, reflections on treatment and proposals. J Craniomaxillofac Surg 34 : 421, 2006 https://doi.org/10.1016/j.jcms.2006.07.854
  19. Eckelt U : Commentary regarding the publication 'Fractures of the mandibular condyle-a review of 466 cases. Literature review, reflections on treatment and proposals' by N. Zachariades et al. J Craniomaxillofac Surg 34 : 433, 2006 https://doi.org/10.1016/j.jcms.2006.07.855
  20. Prigent A, Cosgriff P, Gates GF et al : Consensus Conference on Open or Closed Management of Condylar Fractures. 12th ICOMS. Budapest, 1995. Int J Oral Maxillofac Surg 27 : 243, 1998 https://doi.org/10.1016/S0901-5027(05)80503-X
  21. Bos RR, Ward Booth RP, de Bont LG : Mandibular condyle fractures: a consensus. Br J Oral Maxillofac Surg 37 : 87, 1999 https://doi.org/10.1054/bjom.1998.0014
  22. Neff A, Kolk A, Neff F et al : [Surgical vs. conservative therapy of diacapitular and high condylar fractures with dislocation. A comparison between MRI and axiography]. Mund Kiefer Gesichtschir 6 : 66, 2002 https://doi.org/10.1007/s10006-001-0345-4
  23. Ellis E, Simon P, Throckmorton GS : Occlusal results after open or closed treatment of fractures of the mandibular condylar process. J Oral Maxillofac Surg 58 : 260, 2000 https://doi.org/10.1016/S0278-2391(00)90047-8
  24. Palmieri C, Ellis E, 3rd, Throckmorton G : Mandibular motion after closed and open treatment of unilateral mandibular condylar process fractures. J Oral Maxillofac Surg 57 : 764, 1999 https://doi.org/10.1016/S0278-2391(99)90810-8
  25. 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 Oral Maxillofac Surg 34 : 597, 2005 https://doi.org/10.1016/j.ijom.2005.02.004
  26. Schon R, Fakler O, Gellrich NC et al : Five-year experience with the transoral endoscopically assisted treatment of displaced condylar mandible fractures. Plast Reconstr Surg 116 : 44, 2005
  27. Zide MF, Kent JN : Indications for open reduction of mandibular condyle fractures. J Oral Maxillofac Surg 41 : 89, 1983 https://doi.org/10.1016/0278-2391(83)90214-8
  28. Eckelt U : [Fractures of the mandibular condyle]. Mund Kiefer Gesichtschir. 4 Suppl 1 : S110, 2000 https://doi.org/10.1007/s100060050180
  29. Devlin MF, Hislop WS, Carton AT : Open reduction and internal fixation of fractured mandibular condyles by a retromandibular approach: surgical morbidity and informed consent. Br J Oral Maxillofac Surg 40 : 23, 2002 https://doi.org/10.1054/bjom.2001.0748
  30. Manisali M, Amin M, Aghabeigi B et al : Retromandibular approach to the mandibular condyle: a clinical and cadaveric study. Int J Oral Maxillofac Surg 32 : 253, 2003 https://doi.org/10.1054/ijom.2002.0270
  31. Nam IW : The condylar head and upper neck fractures treated by oblique osteotomies in the ascending ramus. J Dental College of Seoul National University 3 : 11, 1978
  32. Boyne PJ : Free grafting of traumatically displaced or resected mandibular condyles. J Oral Maxillofac Surg 47 : 228, 1989 https://doi.org/10.1016/0278-2391(89)90223-1
  33. Mikkonen P, Lindqvist C, Pihakari A et al : Osteotomyosteosynthesis in displaced condylar fractures. Int J Oral Maxillofac Surg 18 : 267, 1989 https://doi.org/10.1016/S0901-5027(89)80092-X
  34. Hillerup S : Internal fixation of severely displaced mandibular condylar neck fracture with the aid of ramus osteotomy. A revised technique. Int J Oral Maxillofac Surg 26 : 272, 1997
  35. Sasaki K, Tamura H, Watahiki R et al : A surgical technique using vertical ramus osteotomy without detaching lateral pterygoid muscle for high condylar fractures. J Oral Maxillofac Surg 60 : 709, 2002 https://doi.org/10.1053/joms.2002.33128
  36. Sargent LA, Green JF : Plate and screw fixation of selected condylar fractures of the mandible. Ann Plast Surg 28 : 235, 1992 https://doi.org/10.1097/00000637-199203000-00006
  37. Vesnaver A, Gorjanc M, Eberlinc A et al : The periauricular transparotid approach for open reduction and internal fixation of condylar fractures. J Craniomaxillofac Surg 33 : 169, 2005 https://doi.org/10.1016/j.jcms.2005.01.008
  38. 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 71 : 257, 1991 https://doi.org/10.1016/0030-4220(91)90295-N
  39. Chen CT, Lai JP, Tung TC et al : Endoscopically assisted mandibular subcondylar fracture repair. Plast Reconstr Surg 103 : 60, 1999 https://doi.org/10.1097/00006534-199901000-00011
  40. Sandler NA : Endoscopic-assisted reduction and fixation of a mandibular subcondylar fracture : report of a case. J Oral Maxillofac Surg 59 : 1479, 2001 https://doi.org/10.1053/joms.2001.27536
  41. Schon R, Gellrich NC, Schmelzeisen R : Frontiers in maxillofacial endoscopic surgery. Atlas Oral Maxillofac Surg Clin North Am 11 : 209, 2003 https://doi.org/10.1016/S1061-3315(03)00019-2
  42. Lo J, Cheung LK : Endoscopic-assisted rigid fixation of condylar fracture: a technical note. J Oral Maxillofac Surg 64 : 1443, 2006 https://doi.org/10.1016/j.joms.2006.05.029
  43. Loukota RA : Endoscopically assisted reduction and fixation of condylar neck/base fractures-The learning curve. Br J Oral Maxillofac Surg 44 : 480, 2006 https://doi.org/10.1016/j.bjoms.2005.11.019
  44. Choung PH, Nam IW : An intraoral approach to treatment of condylar hyperplasia or high condylar process fractures using the intraoral vertico-sagittal ramus osteotomy. J Oral Maxillofac Surg 56 : 563, 1998 https://doi.org/10.1016/S0278-2391(98)90452-9
  45. Dunaway DJ, Trott JA : Open reduction and internal fixation of condylar fractures via an extended bicoronal approach with a masseteric myotomy. Br J Plast Surg 49 : 79, 1996
  46. Wilson AW, Ethunandan M, Brennan PA : Transmasseteric antero-parotid approach for open reduction and internal fixation of condylar fractures. Br J Oral Maxillofac Surg 43 : 57, 2005 https://doi.org/10.1016/j.bjoms.2004.09.011
  47. Iizuka T, Lindqvist C, Hallikainen D et al : Severe bone resorption and osteoarthrosis after miniplate fixation of high condylar fractures. A clinical and radiologic study of thirteen patients. Oral Surg Oral Med Oral Pathol 72 : 400, 1991 https://doi.org/10.1016/0030-4220(91)90547-P
  48. Choi BH, Yi CK, Yoo JH : Clinical evaluation of 3 types of plate osteosynthesis for fixation of condylar neck fractures. J Oral Maxillofac Surg 59 : 734, 2001 https://doi.org/10.1053/joms.2001.24283
  49. Wagner A, Krach W, Schicho K et al : A 3-dimensional finite-element analysis investigating the biomechanical behavior of the mandible and plate osteosynthesis in cases of fractures of the condylar process. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 94 : 678, 2002 https://doi.org/10.1067/moe.2002.126451
  50. Haug RH, Assael LA : Outcomes of open versus closed treatment of mandibular subcondylar fractures. J Oral Maxillofac Surg 59 : 370, 2001 https://doi.org/10.1053/joms.2001.21868
  51. Kitagawa Y, Sano K, Nakamura M et al : Transoral osteosynthesis at the mandibular ramus and subcondyle using angular screwing instrument and biodegradable miniplate system. J Oral Maxillofac Surg 62 : 1041, 2004 https://doi.org/10.1016/j.joms.2004.01.022
  52. Suzuki T, Kawamura H, Kasahara T et al : Resorbable poly-L-lactide plates and screws for the treatment of mandibular condylar process fractures: a clinical and radiologic follow-up study. J Oral Maxillofac Surg 62 : 919, 2004 https://doi.org/10.1016/j.joms.2004.01.016
  53. Landes CA, Lipphardt R : Prospective evaluation of a pragmatic treatment rationale: open reduction and internal fixation of displaced and dislocated condyle and condylar head fractures and closed reduction of non-displaced, non-dislocated fractures Part II: high condylar and condylar head fractures. Int J Oral Maxillofac Surg 35 : 115, 2006 https://doi.org/10.1016/j.ijom.2005.04.009
  54. Oki K, Hyakusoku H, Aoki R et al : Fixation of intracapsular fractures of the condylar head with bioabsorbable screws. Scand J Plast Reconstr Surg Hand Surg 40 : 244, 2006 https://doi.org/10.1080/02844310510042358
  55. Takenoshita Y, Ishibashi H, Oka M : Comparison of functional recovery after nonsurgical and surgical treatment of condylar fractures. J Oral Maxillofac Surg 48 : 1191, 1990 https://doi.org/10.1016/0278-2391(90)90535-A
  56. De Riu G, Gamba U, Anghinoni M et al : A comparison of open and closed treatment of condylar fractures: a change in philosophy. Int J Oral Maxillofac Surg 30 : 384, 2001 https://doi.org/10.1054/ijom.2001.0103
  57. Norholt SE, Krishnan V, Sindet-Pedersen S et al : Pediatric condylar fractures: a long-term follow-up study of 55 patients. J Oral Maxillofac Surg 51 : 1302, 1993 https://doi.org/10.1016/S0278-2391(10)80132-6
  58. Hovinga J, Boering G, Stegenga B : Long-term results of nonsurgical management of condylar fractures in children. Int J Oral Maxillofac Surg 28 : 429, 1999 https://doi.org/10.1016/S0901-5027(99)80056-3
  59. Ellis E, 3rd, McFadden D, Simon P et al: Surgical complications with open treatment of mandibular condylar process fractures. J Oral Maxillofac Surg 58 : 950, 2000 https://doi.org/10.1053/joms.2000.8734
  60. Kallela I, Soderholm AL, Paukku P et al : Lag-screw osteosynthesis of mandibular condyle fractures: a clinical and radiological study. J Oral Maxillofac Surg 53 : 1397, 1995 https://doi.org/10.1016/0278-2391(95)90663-0
  61. Pereira MD, Marques A, Ishizuka M et al : Surgical treatment of the fractured and dislocated condylar process of the mandible. J Craniomaxillofac Surg 23 : 369, 1995 https://doi.org/10.1016/S1010-5182(05)80132-5
  62. Hammer B, Schier P, Prein J : Osteosynthesis of condylar neck fractures: a review of 30 patients. Br J Oral Maxillofac Surg 35 : 288, 1997 https://doi.org/10.1016/S0266-4356(97)90050-4
  63. Rodriguez ED, Adamo AK, Anastassov GE : Open reduction of subcondylar fractures via an anterior parotid approach. J Craniomaxillofac Trauma 3 : 28, 1997
  64. Worsaae N, Thorn JJ: Surgical versus nonsurgical treatment of unilateral dislocated low subcondylar fractures: a clinical study of 52 cases. J Oral Maxillofac Surg 52 : 353, 1994 https://doi.org/10.1016/0278-2391(94)90436-7
  65. Tasanen A, Lamberg MA : Transosseous wiring in the treatment of condylar fractures of the mandible. J Maxillofac Surg 4 : 200, 1976 https://doi.org/10.1016/S0301-0503(76)80036-7