[FRACTURES OF THE MANDIBULAR CONDYLE IN PATIENTS WITH MULTIPLE INJURIES].
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Fractures, Bone↗
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[Dislocation of mandibular condyle into middle cranial fossa].
A case of dislocation of the mandibular condyle into the middle cranial fossa is presented. The patient was a 8-year-old girl. Immediate conservative reposition was performed successfully with an intermaxillary fixation for two weeks. Two years after the accident her dental occlusion had remained stable, although there was a slight limitation in opening. Based on the present case and previous case reports it is concluded that early diagnosis and treatment is important. Manual reduction and fixation should be the first choice of treatment. The risk of intracranial complications necessitates a close cooperation with a neurosurgeon. Follow-up studies have revealed that most of the patients develop laterognatism and/or limited movements of the mandible.
Child↗
A radiological method on the classification of human mandibular condyles.
A radiological quantitative method applied in the classification of 210 mandibular condyles from 105 male and female subjects, aged 18-62 with no temporomandibular disorders has been taken up in this study. Through coronal sections, types of condyles were first determined by computer tomography (CT) per anterio-posterior aspects and then divided into four main groups described as flat, convex, angled and round. Then, using the parameters, every condyle type was divided into three subgroups. Finally, the percentage of each group has been estimated as follows: flat, 14.3%; convex, 35.2%; angled, 35.7% and round, 14.8%. When the condylar type was compared with sex, it was observed that the angled type (39.6%) in males and the convex type (40.3%) in females were higher than the other types. In the analysis of the relationship between age and condylar types, there appeared to be a trend toward an increase in the incidence of flat and a decrease in the incidence of convex with an increase in the age of males. In addition, following the determination of bilateral symmetry and asymmetry the bilateral asymmetry was determined to be higher in both sexes (56.2%).
Adolescent↗
The soft tissue cover of the mandibular condyle. Differentiation in histological forms and age-related changes of aggrecan- and versican-like proteoglycans.
Age-related changes of the composition of the extracellular matrix of the soft tissue cover of the mandibular condyle (STC), especially of the large proteoglycans, have been investigated. Proteoglycans were extracted from the STC of neonatal, juvenile and adult domestic pigs, fractionated by density gradient centrifugation and analyzed by electrophoresis/Western blotting. Experiments revealed firstly that a large CS/KS proteoglycan (aggrecan) is an essential constituent of the STC at all ages. This proteoglycan is required for nutrition of avascular tissues, and age-related changes in its average size and substitution with KS (keratan sulfate) may be a response to altered functional loading and tissue architecture of the STC. Secondly it was shown that a large CS/DS (chondroitin sulfate/dermatan sulfate) proteoglycan characterized by a doublet of core proteins at 200 and 250 kDa, thereby resembling perlecan, is present in the tissue of adults, but not of neonates and juveniles. Thirdly a large CS/DS proteoglycan characterized by core proteins at 350, 450 and 550 kDa, thereby resembling versican, was present in juveniles. It was detectable only weakly in neonates and not in adults. Results of core protein analysis were confirmed by results of agarose gel electrophoresis/Western blotting of the undigested proteoglycans isolated directly from the tissue extracts. Versican is believed to destabilize cell-matrix interactions required for cell proliferation and differentiation. In this context, presence of versican-like proteoglycans in the STC of growing individuals and its disappearance in adults appears to be related to the growth potential of the mandibular condyle.
Aggrecans↗
Mandibular condyle fractures: a consensus.
A consensus was obtained following a two-day international conference to review the management of mandibular condyle fractures. Whilst areas of disagreement still exist, there are many areas of agreement. It is hoped this editorial will stimulate debate leading to internationally accepted guidelines.
Humans↗
MR of osteochondritis dissecans and avascular necrosis of the mandibular condyle.
We studied 40 patients exhibiting radiologic changes of either osteochondritis dissecans (OCD) or avascular necrosis (AVN) involving the mandibular condyle to evaluate the structural changes associated with these lesions when using high-field-strength MR imaging. Various clinical indications for imaging each patient with routine radiography, tomography, and surface-coil MR included headache, temporomandibular joint (TMJ) and/or ilsilateral facial pain, joint crepitus, clicking, locking, and either recently acquired or changing (unstable) occlusal disorder. Radiologic findings included alterations in condyle morphology and MR signal characteristics compatible with either OCD or AVN or, in some cases, both. Previous nonsurgical mandibular trauma was temporally related to the onset of symptoms in eight patients. Five patients exhibiting either unilateral or bilateral AVN involving the condyles and condylar necks had undergone previous orthognathic surgery, including sagittal split mandibular osteotomies followed by intermaxillary fixation. One patient exhibiting condylar AVN with articular surface collapse and osseous destruction had undergone previous TMJ meniscectomy followed by insertion of a permanent Proplast implant. Thirty-one of 34 patients with no prior surgery and MR changes of condylar OCD/AVN had associated internal derangement of the TMJ meniscus. There was surgical confirmation of findings in 10 joints. We assert that OCD and AVN are relatively common, clinically significant lesions of the mandibular condyle often associated with preexisting internal derangement of the temporomandibular joint.
Adolescent↗
[A trans-parotid approach to the osteosynthesis of fractures of the mandibular condyle. A study apropos of 30 cases].
The authors report a homogeneous series of 30 cases with fractures of the mandibular condyles treated by internal fixation with a mini-plaque via the transparotidial route. The patient were treated between 1987 and 1992, with a minimum follow-up of one year. The transparotidial route has the reputation of being dangerous because of the proximity of the facial nerve and the poor vascular supply to the condyle. It is described in detail. Indications are exclusively extra-articular fractures. Complications were observed although no definitive facial nerve paralysis was seen. The authors conclude that the best indications are subcondylian fractures with or without luxation. In cases with luxation, it is important to verify the menisco-ligament system simultaneously. The authors emphasize the complementary nature of this treatment with the functional method.
Adolescent↗
A comparison of single-photon emission computed tomography and planar imaging for quantitative skeletal scintigraphy of the mandibular condyle.
A prospective study was designed to compare two methods of quantifying technetium-99m methylene diphosphonate uptake in the mandibular condyle. The standard technique expresses condylar activity as a ratio of condylar uptake to a reference (often the fourth lumbar vertebra) with planar scans (lateral images of the mandible). The experimental technique quantifies condylar activity as a ratio of condyle to clivus uptake with single-photon emission computed tomography (SPECT). The results of this study indicated that the uptake ratio of condyle/clivus by SPECT scintigram was positively correlated (p = 0.039) with the planar scan technique. The SPECT technique, similar to an axial computed tomography scan, was easier to perform with better reproducibility than the standard planar technique. In addition, activity in the clivus showed less variation than activity in the fourth lumbar vertebrae. With the development of normal uptake standards in the clivus, the SPECT technique may replace the planar image technique in nongrowing patients.
Adolescent↗
Association between radiographic findings in the mandibular condyle and temporomandibular dysfunction in an elderly population.
Our aims were to study the prevalence of abnormal radiographic findings in mandibular condyles and the possible association between such findings and clinical signs and symptoms of temporomandibular dysfunction (TMD) and dental state. Two cohorts of 70-year-old people, 384 men and 484 women, living in Göteborg, Sweden, participated in the study. The first cohort was examined in 1972 and the other one in 1992. Besides a functional and clinical examination, a questionnaire on TMD and panoramic radiography were included. A deviation from the normal appearance of one or both condyles was found in 26% of the subjects (17% of the condyles). There was no significant difference in this respect between the two cohorts. There were in general only minor and no statistically significant differences between those with normal and deviating condylar findings with regard to various TMD signs and symptoms. The subjects in Eichner group A (with dental support in all zones) showed a slightly lower frequency of abnormal radiographic condylar findings (22%) than those in groups B (reduced dental support) and C (edentulous in one or both jaws; both B and C, 28%). It is concluded that abnormal radiographic condylar findings in these elderly people were not at all or only weakly correlated with signs and symptoms of TMD and dental status.
Aged↗
[Cell populations of the human mandibular condyles during growth and in the adult (author's transl)].
Tumours of cartilaginous origin dominate the group of tumours of the mandibular condyles. These cartilaginous tumours consist in fact of hyperplasia of the growth zone or osteochondroma in the young adult or reawakening of the latter in the older adult in whom an occlusion problem originally is not without aetiological interest. Osteomas of the condyles are stabilised and ossified forms of such hypercondylism. Other tumours may be seen and are related to the original cell. Malignant tumours are rare.
Adolescent↗
Magnetic resonance evidence of joint effusion of the temporomandibular joint after fractures of the mandibular condyle: a preliminary report.
To investigate the clinical significance of magnetic resonance (MR) evidence of joint effusion of the temporomandibular joint after mandibular condylar fractures, magnetic resonance imaging (MRI) was performed on 18 joints in 15 patients with either unilateral or bilateral mandibular condylar fractures using a 1.5 Tesla MRI scanner (Signa, General Electric, Milwaukee, WI). MR evidence of joint effusion was evaluated and compared with the types and the positions of the fractures. MR evidence of joint effusion was observed in 11 of 18 TMJs, which was 61% of the condylar fractures. It appeared more frequently after fractures with dislocation than those without dislocation (p < 0.05). In addition, MR evidence of effusion appeared more frequently in TMJs after high condylar fractures (head to upper neck) than low condylar fractures (lower neck to subcondylar) (p < 0.05). These findings indicate that MR evidence of joint effusion may serve as a marker for the detection of severe intra-articular damage to the TMJ after mandibular condyle fractures.
Adolescent↗
Relationship between alteration of horizontal size and bony morphological change in the mandibular condyle.
OBJECTIVE: To analyse the relationship between horizontal size and morphological changes on the articular surface and the lateral part of the mandibular condyle. METHODS: The study group comprised 139 joints in 88 women aged over 18 years. Horizontal condylar size was measured in the anteroposterior (AP) and mediolateral (ML) dimensions using axial MR images. Bony morphological change on the articular surface (sagittal change) was assessed on the sagittal MR image, and resorption of the lateral part of the condyle (RLC) was assessed on a plane radiograph in the AP projection. RESULTS: There was no significant relationship between horizontal condylar size and sagittal change. However, condyles with RLC were smaller than those without RLC in the ML dimension. CONCLUSIONS: The results of this study suggest a possible relationship between decreased horizontal condylar size and RLC. It is also suggested that sagittal bone changes do not influence the horizontal size of the condyle.
Adolescent↗
Osteoplasty of the mandibular condyle with preservation of the articular soft tissue cover: comparison of fibrin sealant and sutures for fixation of the articular soft tissue cover in rabbits.
Fibrin sealant and sutures were compared for fixation of the articular soft tissue cover after it had been raised in association with osteoplasty of the mandibular condyle. Nine adult rabbits were operated on bilaterally with the use of fibrin sealant on one joint and sutures on the other joint. The rabbits were killed after 3 months. Macroscopic and histologic evaluations of the condyles did not reveal any appreciable differences between the two techniques. Fibrin sealant was, however, technically easier to apply than the sutures. It was concluded that fibrin sealant might be an alternative to sutures for fixation of the articular soft tissue cover after it has been raised in association with osteoplasty of the mandibular condyle.
Animals↗
The assessment of fracture of the mandibular condyle by use of computerized tomography. Incidence of sagittal split fracture.
A survey was carried out to clarify the incidence of sagittal splitting fracture of the mandibular condyle using computerized tomography. There were 33 patients, between 11 and 67 years of age, with displaced or dislocated mandibular condylar process fractures (41 cases), seen at our clinic between 1986 and 1992. The incidence of no displacement was 4.9%; deviation and displacement, 34.1%; dislocation, 46.3%; and complete avulsion, 4.9%. A sagittal splitting fracture of condyle occurred with an incidence of 9.8%. Conservative treatment was effective in the treatment of sagittal splitting fracture. Therefore, classification of fracture of mandibular condyle should include the sagittal split fracture, and investigations should include computerized tomography.
Adolescent↗
The anatomical relationship between the position of the auriculotemporal nerve and mandibular condyle.
Head, neck, face, and ear pains are commonly associated with disorders of the temporomandibular joint (TMJ). Several theories have been proposed regarding the functional relationship of the TMJ and the associated structures, and how they might contribute to certain painful conditions. This study was conducted to determine the anatomic relationship of the auriculotemporal nerve to the middle meningeal artery and the mandibular condyle. Forty human cadaver temporomandibular joints were dissected to locate the precise position of the auriculotemporal nerve to the mandibular condyle. The study findings revealed a significant variation in the relationship of the auriculotemporal nerve to the middle meningeal artery. The auriculotemporal nerve was found to be between 10-13 mm inferior to the superior surface of the condyle and 1-2 mm posterior to the neck of the condyle. The nerve was not found to be in a position that would likely create an entrapment with adjacent tissues. These findings may assist the clinician to locate the most appropriate injection site for an auriculotemporal nerve block.
Adult↗
Distribution of insulin-like growth factor-I mRNA in the mandibular condyle and rib cartilage of the rat during growth.
This study makes a molecular biological comparison of primary and secondary cartilage at an early phase of postnatal development. The distribution of insulin-like growth factor-I (IGF-I) mRNA expression in the mandibular condyle and rib cartilage of 1-28-day-old rats was examined after in situ hybridisation using an oligo probe cocktail for IGF-I mRNA. In the condyle, expression was localised to a narrow strip under the articular layer where the cells are undifferentiated. Essentially, no differences were found in IGF-I synthesis within three samples from the same age group or between different age groups. In rib cartilage, IGF-I mRNA was localised within the germinative, proliferative and early hypertrophic cell layers in 1-28-day-old rats. Again, there were no differences in expression among animals of the same age or as a function of age. This pattern of IGF-I mRNA expression indicates that IGF-I synthesis during growth of the mandibular condylar cartilage is different from that of costal cartilage. The findings shed light on the problem of overgrowth often associated with the use of costochondral grafts to replace defective mandibular condyles.
Aging↗
Osteochondroma of the mandibular condyle. Report of a case and review of the literature.
Osteochondroma (osteocartilaginous exostosis) is a rare tumour in the region of the mandibular condyle. Much confusion seems to exist in the literature in differentiating these tumours from condylar chondromas as well as from condylar hyperplasias. A case of condylar osteochondroma with a review of the literature is presented.
Adult↗
[Long-term evaluation of the functional treatment of mandibular condyle fractures].
Clinical and radiologic examinations were carried out after a mean 7 year follow up of functional conservative treatment of a mandibular condyle fracture in 16 patients. Anatomic and functional recovery was excellent in children and was often very good in adolescents. Signs of dysfunction were a frequent finding in adults, but these were not considered as important by the patients and their specific treatment was not required.
Adolescent↗