Maxillofacial Plastic and Reconstructive Surgery

Korean Association of Maxillofacial Plastic and Reconstructive Surgeons (대한악안면성형재건외과학회)
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Anatomical and Functional Recovery of Intracapsular Fractures of the Mandibular Condyle: Analysis of 124 Cases after Closed Treatment

  • Lee, Jong-Sung (Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University) ;
  • Jeon, Eun-Gyu (Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University) ;
  • Seol, Guk-Jin (Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University) ;
  • Choi, So-Young (Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University) ;
  • Kim, Jin-Wook (Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University) ;
  • Kwon, Tae-Geon (Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University) ;
  • Paeng, Jun-Young (Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University)
  • Received : 2014.09.13
  • Accepted : 2014.11.06
  • Published : 2014.11.30
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Abstract

Purpose: The purpose of this study is to evaluate the influence of intracapsular fracture lines of the mandibular condyle on the anatomical and functional recovery after non-surgical closed treatment. Methods: Clinical and radiological follow-up of 124 patients with intracapsular fractures of the mandibular condyle was performed after closed treatment between 2005 and 2012. The intracapsular fractures were classified into three categories: type A (medial condylar pole fracture), type B (lateral condylar pole fracture with loss of vertical height) and type M (multiple fragments or comminuted fracture). Results: By radiological finding, fracture types B and M lost up to 24% vertical height of the mandibular condyle compared to the height on the opposite side. In Type M, moderate to severe dysfunction was observed in 33% of the cases. Bilateral fractures were significantly associated with the risk of temporomandibular joint (TMJ) dysfunction in fracture types A and B. Bilateral fracture and TMJ dysfunction were not statistically significantly associated in type M fractures. Conclusion: Most of the mandibular intracapsular condylar fractures recovered acceptably after conservative non-surgical treatment with functional rehabilitation, even with some anatomical shortening of the condylar height. The poor functional recovery encountered in type M fractures, especially in cases with additional fracture sites and bilateral fractures, points up the limitation of closed treatment in such cases.

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References

  1. Turvey TA. Midfacial fractures: a retrospective analysis of 593 cases. J Oral Surg 1977;35:887-91.
  2. Schuchardt K, Metz HJ. Injuries of the facial skeleton. Mod Trends Plast Surg 1966;2:62-107.
  3. Tasanen A, Lamberg MA. Transosseous wiring in the treatment of condylar fractures of the mandible. J Maxillofac Surg 1976;4:200-6. https://doi.org/10.1016/S0301-0503(76)80036-7
  4. Olson RA, Fonseca RJ, Zeitler DL, Osbon DB. Fractures of the mandible: a review of 580 cases. J Oral Maxillofac Surg 1982;40:23-8. https://doi.org/10.1016/S0278-2391(82)80011-6
  5. Fridrich KL, Pena-Velasco G, Olson RA. Changing trends with mandibular fractures: a review of 1,067 cases. J Oral Maxillofac Surg 1992;50:586-9. https://doi.org/10.1016/0278-2391(92)90438-6
  6. Buchbinder D. Treatment of fractures of the edentulous mandible, 1943 to 1993: a review of the literature. J Oral Maxillofac Surg 1993;51:1174-80. https://doi.org/10.1016/S0278-2391(10)80285-X
  7. Schon R, Roveda SI, Carter B. Mandibular fractures in Townsville, Australia: incidence, aetiology and treatment using the 2.0 AO/ASIF miniplate system. Br J Oral Maxillofac Surg 2001;39:145-8. https://doi.org/10.1054/bjom.2000.0607
  8. Valiati R, Ibrahim D, Abreu ME, et al. The treatment of condylar fractures: to open or not to open? A critical review of this controversy. Int J Med Sci 2008;5:313-8.
  9. Rowe NL, Killey HC, editors. Fractures of the facial skeleton. 2nd ed. Edinburgh: E & S Livingstone; 1970. p.2-144.
  10. Spiessl B. Rigid internal fixation of fractures of the lower jaw. Reconstr Surg Traumatol 1972;13:124-40.
  11. Yamaoka M, Furusawa K, Iguchi K, Tanaka M, Okuda D. The assessment of fracture of the mandibular condyle by use of computerized tomography. Incidence of sagittal split fracture. Br J Oral Maxillofac Surg 1994;32:77-9. https://doi.org/10.1016/0266-4356(94)90131-7
  12. Choi BH. Magnetic resonance imaging of the temporomandibular joint after functional treatment of bilateral condylar fractures in adults. Int J Oral Maxillofac Surg 1997;26:344-7. https://doi.org/10.1016/S0901-5027(97)80794-1
  13. 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
  14. 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
  15. Walker RV. Condylar fractures: nonsurgical management. J Oral Maxillofac Surg 1994;52:1185-8. https://doi.org/10.1016/0278-2391(94)90542-8
  16. Hall MB. Condylar fractures: surgical management. J Oral Maxillofac Surg 1994;52:1189-92. https://doi.org/10.1016/0278-2391(94)90543-6
  17. Norholt SE, Krishnan V, Sindet-Pedersen S, Jensen I. Pediatric condylar fractures: a long-term follow-up study of 55 patients. J Oral Maxillofac Surg 1993;51:1302-10. https://doi.org/10.1016/S0278-2391(10)80132-6
  18. Kruger GO, editor. Textbook of oral surgery. 4th ed. Saint Louis: Mosby; 1974. p.2-360.
  19. Hovinga J, Boering G, Stegenga B. Long-term results of nonsurgical management of condylar fractures in children. Int J Oral Maxillofac Surg 1999;28:429-40. https://doi.org/10.1016/S0901-5027(99)80056-3
  20. Cascone P, Sassano P, Spallaccia F, Rivaroli A, Di Paolo C. Condylar fractures during growth: follow-up of 16 patients. J Craniofac Surg 1999;10:87-92. https://doi.org/10.1097/00001665-199901000-00017
  21. Strobl H, Emshoff R, Rothler G. Conservative treatment of unilateral condylar fractures in children: a long-term clinical and radiologic follow-up of 55 patients. Int J Oral Maxillofac Surg 1999;28:95-8.
  22. Neff A, Kolk A, Deppe H, Horch HH. New aspects for indications of surgical management of intra-articular and high temporomandibular dislocation fractures. Mund Kiefer Gesichtschir 1999;3:24-9. https://doi.org/10.1007/s100060050088
  23. Hlawitschka M, Eckelt U. Assessment of patients treated for intracapsular fractures of the mandibular condyle by closed techniques. J Oral Maxillofac Surg 2002;60:784-91; discussion 792. https://doi.org/10.1053/joms.2002.33246
  24. 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;67:101-21.
  25. Adi M, Ogden GR, Chisholm DM. An analysis of mandibular fractures in Dundee, Scotland (1977 to 1985). Br J Oral Maxillofac Surg 1990;28:194-9. https://doi.org/10.1016/0266-4356(90)90088-3
  26. Zachariades N, Mezitis M, Mourouzis C, Papadakis D, Spanou A. Fractures of the mandibular condyle: a review of 466 cases. Literature review, reflections on treatment and proposals. J Craniomaxillofac Surg 2006;34:421-32. https://doi.org/10.1016/j.jcms.2006.07.854
  27. Silvennoinen U, Lindqvist C, Oikarinen K. Dental injuries in association with mandibular condyle fractures. Endod Dent Traumatol 1993;9:254-9. https://doi.org/10.1111/j.1600-9657.1993.tb00282.x
  28. De Riu G, Gamba U, Anghinoni M, Sesenna E. A comparison of open and closed treatment of condylar fractures: a change in philosophy. Int J Oral Maxillofac Surg 2001;30:384-9. https://doi.org/10.1054/ijom.2001.0103
  29. Dahlstrom L, Kahnberg KE, Lindahl L. 15 years follow-up on condylar fractures. Int J Oral Maxillofac Surg 1989;18:18-23. https://doi.org/10.1016/S0901-5027(89)80009-8
  30. Lindahl L. Condylar fractures of the mandible. IV. Function of the masticatory system. Int J Oral Surg 1977;6:195-203. https://doi.org/10.1016/S0300-9785(77)80009-4
  31. Ingervall B, Lindahl L. Masticatory muscle function in patients treated for condylar fractures of the mandible. Int J Oral Surg 1980;9:359-66. https://doi.org/10.1016/S0300-9785(80)80060-3
  32. Ellis E 3rd, Simon P, Throckmorton GS. Occlusal results after open or closed treatment of fractures of the mandibular condylar process. J Oral Maxillofac Surg 2000;58:260-8. https://doi.org/10.1016/S0278-2391(00)90047-8

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