• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.39 no.5
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• pp.238-241
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• 2013

Lateral and superior-lateral dislocations of the intact condyle are a rare complication, following traumatic insult to the mandible. We report an unusual case of a 54-year-old male patient who experienced both types of dislocations of the intact condyles with symphysis fracture following a road-traffic accident. Under general anesthesia, conventional manipulation was unsuccessful in relocating the condyles into the glenoid fossa. After applying a percutaneous traction force, using a bone traction hook placed at the sigmoid notch, the displaced intact mandibular condyles were repositioned, and the symphyseal fracture was finally reduced and fixed. The mouth opening was within normal limits, and favorable occlusion was confirmed one month postoperatively. To our knowledge, this is the first case of dislocation of both intact condyles--associated with symphysis fracture--being reduced with bone traction hook.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.6
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• pp.521-528
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• 2010

Purpose: Anatomical reduction of the fractured condylar process is an important prerequisite for re-establishing function. The authors reported about effectiveness of transoral approach for mandibular subcondyle fracture using trochar device in cases that the fracture line is below the reference line, the perpendicular line of the longitudinal axis of condylar process passing the lowest point of sigmoid notch. As a serial study, we report the open reduction via preauricular approach for mandibular condyle fracture, in cases that the fracture line is above the reference line. Patients and Methods: Sixteen condylar fractures of 15 adult patients were divided two groups and treated by open reduction via preauricular approach (8 cases) or by closed reduction (8 cases). The degree of maximal mouth opening, occlusion, anatomical reduction, condylar resorption and complications were assessed and evaluated for the two groups. Results: The open reduction of condyle via preauricular approach leads to good results without permanent complications. Anatomical reduction of open reduction group and maximal mouth opening range of the closed reduction group is significantly better than the other group. No significant differences were found in the condylar resorption and the occlusion. Conclusion: The preauricular approach was useful to reduce and fix the condylar fragment, in cases that the fracture line is above the reference line.

• Journal of Dental Rehabilitation and Applied Science
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• v.22 no.4
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• pp.283-288
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• 2006

There are several manners for surgical approaches to the mandibular condyle. With the retromandiular approach, the condyle and fracture are exposed directly and allow for good inspection and reduction. The retromandibular scar is very well camouflaged and practically invisible. The aim of this study was to evaluate clinical results of retromandibular approach for the reduction and fixation of fractured mandibular condyles. We described postoperative complications such as temporary facial nerve weakness involving the marginal mandibular branch, mouth opening limitation and malocclusion in 13 patients with mandubular condylar fractures; 11 subcondylar fractures and 2 condylar neck fractures. The follow-up period was longer than 6 months in all patients. The retromandibular approach was successful in all subcondylar fracture cases. 2 patients with condylar neck fracture had mouth opening limitation and temporary marginal nerve palsy longer than 3 months. But there were no cases of permanent nerve injury and malocclusion. Our findings indicate that retromandibular approach is an easy and safe technique for subcondylar fracture but not for condylar neck fracture.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.34 no.1
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• pp.53-57
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• 2012

Purpose: This study considered the effects and proper treatments of mandibular condyle fractures by comparing clinical differences and complications according to analysis and treatment plan. Methods: From September 2007 to August 2010, patients who were diagnosed with condylar fracture and monitored for more than 3 months were selected. Cases were divided in a reductive manner and evaluated by type and period of intermaxillary fixation (IMF), status of occlusion and trismus according to the Spiessle/Schroll method. A total 50 patients were examined. Results: The number of the unilateral condyle fractures was 45 and 30 patients had multiple fractures. Type of fracture was categorized by the Spiessle/Schroll method. There were 21 patients with type I, 11 patients with type II, 3 patients with type 3, 10 patients with type V and 5 patients with type VI; there were no patients with a type IV fracture. 11 patients were operated on with open reduction. Among them, 9 patients were type II and 2 patients were type I. For type I patients, an intra-oral approach was conducted with an endoscope and trocar. For 3 of the type II patients, an retromandibular approach was conducted and for the rest of the type II patients, the same approach as type I was used. The periods of IMF were 2.36 weeks (mean) in open reduction group and 2.9 weeks (mean) in closed reduction group and the total mean period is 2.78 weeks. All patients had stable occlusion after removing the IMF. Trismus occurred in 1 patient for open reduction and 5 patients for closed reduction. Facial nerve palsy was observed in one patient postoperatively that resolved after 6 months. Conclusion: In this study, similar prognosis was shown after an open and closed reduction was conducted. Therefore, treatments need to be planned depending on the degree of condyle fracture and the amount of displacement. Additionally, the period of IMF could be shortened with open reduction.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.37 no.6
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• pp.448-456
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• 2011

Introduction: Condylar fractures are common in the maxillofacial region, comprising 29-40 percent of all mandibular fractures, accounting for about 20-62 percent). Previous studies reported that pediatric condylar fractures can cause disorders in facial growth and function, and the treatment methods have been controversial. Recently, conservative treatment has shown good results in skeletal growth and functional recovery but the conservative treatment of pediatric condylar fractures has shown unpredictable and undesirable results in some cases, such as facial asymmetry and temporomandibular joint disorder. This study examined the specific age groups and specific mandibular condylar fracture type in growing children treated conservatively in the past. Materials and Methods: Eighteen patients (10 men and 8 women) who received conservative treatment for unilateral condylar fractures in Dankook University Dental Hospital between 2000 to 2007 were followed up for a mean period of 7.2 years. Results: In the survey of 18 pediatric patients who received conservative treatment for condylar fractures, the incidence of temporomandibular dysfunction and growth disturbance was 45% and 35%, respectively. Conclusion: In all complications, the symptoms observed most frequently was mouth opening displacement of the mandible exceeding 2 mm. The other complications of functional and growth disturbance included facial asymmetry concentrated along specific condylar types. Complications including facial asymmetry and functional and growth disturbances showed an increasing tendency according to the specific fracture types. Functional and growth disturbances in the undisplaced condylar fracture type showed a lower incidence(P <0.05). Functional and growth disturbances differed according to the fracture type, which has poor relationship with articular fossa and condyle(P <0.05). Functional and growth disturbance in the cases of the high-level condylar fracture type showed a higher incidence(P <0.05). The functional and growth disturbances of the fracture types were similar in the fragment-contact and non-contact groups(P >0.05).

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.41 no.1
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• pp.3-10
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• 2015

Objectives: We retrospectively evaluated the impact of mandibular third molars on the occurrence of angle and condyle fractures. Materials and Methods: This was a retrospective investigation using patient records and radiographs. The sample set consisted of 440 patients with mandibular fractures. Eruption space, depth and angulation of the third molar were measured. Results: Of the 144 angle fracture patients, 130 patients had third molars and 14 patients did not. The ratio of angle fractures when a third molar was present (1.26 : 1) was greater than when no third molar was present (0.19 : 1; odds ratio, 6.58; P<0.001). Of the 141 condyle fractures patients, the third molar was present in 84 patients and absent in 57 patients. The ratio of condyle fractures when a third molar was present (0.56 : 1) was lower than when no third molar was present (1.90 : 1; odds ratio, 0.30; P<0.001). Conclusion: The increased ratio of angle fractures with third molars and the ratio of condyle fractures without a third molar were statistically significant. The occurrence of angle and condyle fractures was more affected by the continuity of the cortical bone at the angle than by the depth of a third molar. These results demonstrate that a third molar can be a determining factor in angle and condyle fractures.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.48 no.5
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• pp.267-276
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• 2022

Objectives: Recently a modified high-submandibular approach (HSMA) has been introduced for treatment of condylar fracture. This approach involves an incision line close to the mandibular angle and transmasseteric transection, leading to a low incidence of facial palsy and allowing good visualization of the condyle area, especially the condylar neck and subcondyle positions. This study reports several cases managed with this modified HSMA technique for treating condylar fractures. Materials and Methods: Six cases of condylar fractures treated with modified HSMA technique were reviewed. Results: Three unilateral subcondylar fracture, 1 bilateral subcondylar fracture, 1 unilateral condylar neck fracture, 1 unlateral simultaneous condylar neck and subcondylar fracture cases were reviewed. All the cases were successfully treated without any major complication. Conclusion: Reduction, fixation, and osteosynthesis of condylar fractures via the modified HSMA technique enabled effective and stable treatment outcomes. Therefore, the described approach can be used especially for subcondylar and condylar neck fractures with minimal complications.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.27 no.5
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• pp.472-477
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• 2005

This study investigated the mandibular fractures that were treated at the Seoul National University Boramae Hospital in order to analyze the characteristics of mandibular fractures and the relationship between the causes and injury patterns. A total of 141 patients with mandibular fractures who were treated between 1996 and 2004 were analyzed retrospectively. The male to female ratio in the patient group was 5.13:1, and the mean age was 33.7 years. The most common etiologic factor was assaults (45.4%), and which was followed by activities associated with daily-life (40.4%) includeding falls, stumbling, collisions, and traffic accidents (11.3%). Single fracture sites were present in 75 patients (53.2%), two or more fracture sites were observed in other patients, and a total of 211 fracture sites were observed. The mandibular angle fractures (46.7%) was the most common in case of single fractures, and symphysis and angle fractures (45.4%) was most common in multiple fractures. Through out overall fracture sites, the most common fracture site was the symphysis (41.2%), followed by the angle (32.2%) and condyle (18.5%). Among assault and falls-related injuries, the common involving sites were the symphysis, and followed by the body and condyle. In case of traffic accidents, the symphysis fracture was the most common, and which was followed by the condyle and angle fractures. This study documented the characteristics of the mandibular fractures. The results demonstrate that preventive measures according to these characteristics will need to be implemented in order to minimize the risk of maxillofacial injuries.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.14 no.4
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• pp.283-294
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• 1992

Functional recovery associated with mouth opening after mandibular condyle fracture was a contradictory result of many authors. The treatment goal of condyle fracture has been not only the good reduction and fixation but also the rapid functional recovery with mouth opening capacity. The purpose of this study is to evaluate the mouth opening capacity after surgical or non-surgical treatment of condyle fracture according to the site, level, maxillomandibular fixation(MMF) and operation method based on 39 patents with condyle fracture who were admitted to the department of oral and maxillofacial surgery, Wonkwang University Hospital from May.1, 1990 to Aug.31, 1992. The results were as follows. 1. The most common fracture site was level IV (17 cases : 42.2%) and level I (14 cases : 36.8%), level II (5 cases: 13.2%) and level III(3 cases : 7.9%) were in decreasing order of frequency. Compound fracture with symphysis was more frequent (69.2%) than simple fracture(30.8%). 2. The mouth opening capacity was increased in the level I compared with level IV. 3. The mouth opening capacity was increased in the group of segment removal. 4. The mouth opening capacity was increased in the MMF period was decreased. 5. Better mouth opening capacity was recorded in the physical therapy group of more than 3-4 weeks of treatment period.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.5
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• pp.488-492
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• 2010

This review evaluates the literature on the relationship between mandibular condylar process fracture and temporomadibular joint (TMJ). The topic of condylar fracture generated more discussion and controversy than any other field of maxillofacial trauma associated with TMJ. Disturbance of occlusal function, devia-tion of mandible, internal derangements of TMJ, and ankylosis of the joint with resultant inability to move the jaw are sequelae of condylar process fracture. Thus it is necessary to understand how the masticatory system adapts to the structural alterations that accompany fractures of the mandibular condyle. Treatment of condylar process fracture include two methods ; closed treatment and open treatment. If one chooses totreat closed, one must understand that adaptations in the musculature, skeleton, and dentition will be necessary. Open treatment of condylar process fractures probably requires fewer adaptations within the masticatory system to provide a favorable functional outcome. However, one must weigh the risk of open surgery against the possible improvement in outcome. The risks are not just surgical risk, but biological risk as well, such as disruption of the blood supply to the condyle. This review presents relevant aspects of change of TMJ associated with condylar process fracture.