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PubMed1998

MRI examination of the TMJ and functional results after conservative and surgical treatment of mandibular condyle fractures.

Thirty patients with healed condylar fractures were included in this study. Ten patients were conservatively treated while in 20 patients the fractures were treated surgically. All patients were assessed using: magnetic resonance imaging of both temporomandibular joints (TMJs) to evaluate the disc position and morphology; radiographs to evaluate the alignment of the bony fragments after consolidation; and clinical examination including the stomatognathic functional status and mechanical axiography. The study shows that anatomical reduction of a low, displaced or dislocated condylar fracture by surgical approach may be of benefit for the functional recovery of the TMJ.

Adolescent↗
PubMed1997

[Treatment of fractures of the mandibular condyle. Experiences at the Department of Oral Medicine and Maxillofacial Surgery at Toulon-La-Seyne/Mer].

The fractures of the gnathic condyle are constantly increasing due to the violent impact on the chine. The functional treatment is essential for good results whereas the restitution of a functional joint, i.e. teeth that engage into one another, is satisfactory for the patient as it can also justify a possible surgical reduction in such cases when significant shifts of fragments resulting from the fractures are present.

Bone Plates↗
PubMed1977

Osteochondroma of the mandibular condyle. Case report and its management.

1. A case of osteochondroma of the temporomandibular joint simulating a unilateral condylar hyperplasia is presented. 2. The need to divide the zygomatic arch to facilitate removal of large tumors is noted. 3. The removal of the growth resulted in normal functioning of the jaws with the disappearance of the features of unilateral hyperplasia. 4. Occlusal grinding is often necessary to correct the compensatory occlusal adjustment that occurs with the rotation of the mandible in these lesions. 5. The possibility of the presence of a tumor must be kept in mind when patients present with symptoms of unilateral condylar hyperplasia.

Cartilage↗
PubMed2005

[Solitary abscessing osteomyelitis of the mandibular condyle. A rarity].

CASE REPORT: We report on a rare case of secondary chronic osteomyelitis of the left condyle. Haemophilus aphrophilus could be isolated from the abscess material. The condyle was resected and reconstructed with an endoprosthesis in the same operation. DISCUSSION: Possible causes of the rare location of secondary chronic osteomyelitis are assembled in a review of the literature and compared with the actual case. CONCLUSION: We suggest the inoculation of microorganisms through the needle of a local anesthetic injection, bacterial contamination during the tooth extraction, or bacteremia following the dental extraction to be possible causes for the infection.

Abscess↗
PubMed1996

[Transoral miniplate osteosynthesis of mandibular condyle fractures--optimizing the surgical method].

Under certain conditions dislocated low subcondylar fractures of the mandible can be reset by intraoral approach and treated using miniplate osteosynthesis. This approach protects the facial skin as well as Ramus marginalis. Over a period of 30 months, the authors performed this surgery on 34 patients with dislocated low subcondylar fractures of the mandible. This approach requires a 90 degree drill and screw device, a special resetting hook and retractors. The surgery is performed preferably under endoscopic viewing conditions. The results show that transoral miniplate osteosynthesis is technically feasible, representing a recommended therapy considering the particular indication and requiring the equipment specified above.

Bone Plates↗
PubMed1992

[Mandibular condyle fractures in childhood--the clinico-roentgenological follow-up].

In a clinical and roentgenographical follow-up study in 35 children, who had suffered a fracture of the condylar process of the lower jaw, the following observations were made on the average 61 months after conservative treatment: The clinical outcome ranged from "satisfactory function" to "restitutio ad integrum". Best results were achieved after unilateral displaced fractures, while only few children showed a "restitutio ad integrum" after bilateral fractures or/and after fracture dislocations. In children, who were less than 8 years old, the results were much better than in older ones. Roentgenographically the morphological regeneration after fracture dislocations was frequently incomplete--in the contrary to fractures with displacement.

Adolescent↗
PubMed1981

[Primary mandibular condyle tumors. Osteomas, chondroma, fibrosarcoma, giant cell tumor (author's transl)].

Six out of 11 cases of primary condylar tumors treated in the Department of stomatology and Maxillofacial Surgery were analyzed. They included 3 patients with osteomas, and one case each of fibrosarcoma, chondroma, and multinucleated giant cell tumor. Typical signs were lateral displacement of the mandible (2 cases), reduction in the buccal opening (3 cases), and pain (3 cases) and swelling (3 cases) in the pretragal region. Swelling is never observed with osteomas, which develop antero-internally. The presence of the tumors was confirmed by radiological examination in all cases. Usual treatment is condylectomy, by means of C. Hosxés approach, confirmation of diagnosis requiring pathological examinations.

Adolescent↗
PubMed1991

[Dynamic bite block in fractures of the mandibular condyle and following surgery of temporomandibular ankylosis in children].

Early mobilization is the rule in cases of fracture and temporomandibular joint surgery. When prematurely discontinued, it may sometimes prove insufficient to prevent temporomandibular ankylosis in the child. Blockade in the open-mouth position is in keeping with an important general orthopedic rule, i.e., immobilization of joint fractures in position of function (ankylosis is loss of function, and is reflected by the child's inability or limited capacity to open his/her mouth). Continued night wear of re-habilitation devices, once consolidation is acquired, affords active joint mobilization during meals that is sufficient owing to the strength of the elevator muscles (five times than of the depressors).

Ankylosis↗
PubMed1995

Use of rigid external fixation in fractures of the mandibular condyle.

In this article the use of a rigid external fixation system is proposed for the early treatment of condylar fractures. This method offers the advantage of not damaging the articular structures during reduction and allows early mobilization for a rapid recovery. In our Centre 28 patients have been treated with the rigid external fixation system, with good functional results. Of these 15 men and 13 women, 22 had a monocondylar fracture and 6 had a bicondylar fracture. In all the cases there was complete recovery of the occlusal stituation and of the mouth opening; no patient surgically treated with this method has ever presented problems of a local or general nature. The purpose of this report was to evaluate the use of external fixation for the treatment of extracapsular condylar fractures with luxation of the fragment out of the glenoid cavity.

Adolescent↗
PubMed2003

Retromandibular approach to the mandibular condyle: a clinical and cadaveric study.

This prospective study was carried out to assess the morbidity of the retromandibular approach in the management of condylar fractures. Twenty consecutive patients underwent open reduction and internal fixation of their condylar fractures using this technique. Branches of the facial nerve were encountered in six cases (30%). Temporary weakness of the facial nerve occurred in six patients (30%), but this resolved in all cases within 3 months and there were no cases of permanent nerve injury. Two patients had a temporary deficit of the great auricular nerve and one patient developed a sialocoele that resolved with aspiration. A cadaveric study using 30 facial halves (15 fresh cadavers) was also conducted. Branches of the facial nerve were encountered in 12 dissections (40%). The literature regarding facial nerve morbidity in relation to the management of condylar fractures is reviewed.

Adult↗
PubMed2001

Resorption of the lateral pole of the mandibular condyle in temporomandibular disc displacement.

OBJECTIVES: To assess the possible relationship between resorption of the superolateral pole of the mandible condyle (RSLC) and TMJ disk displacement. METHODS: Two hundred and seventeen TMJs in 138 patients were studied. Displacement of the disc, degree of displacement and disc configuration were assessed using MRI. RSLC was assessed from a transorbital radiograph. RESULTS: Seventy-two joints (37%) were considered to have RSLC. A significantly higher prevalence of RSLC was found in joints with disc displacement (goodness test of fit for chi-square, P<0.05). A significantly higher prevalence of RSLC was found in joints with advanced disc displacement and advanced disk deformation (Mann-Whitney U-test, P<0.01). CONCLUSIONS: RSLC appears more likely to occur in joints with advanced disc displacement.

Adolescent↗
PubMed1995

[The value of 3-dimensional computed tomography in the preoperative evaluation of mandibular condyle fractures].

The recent expansion of surgical treatment for displaced condylar neck fractures should rely on a precise and careful preoperative radiological assessment. Two goals must be achieved. First the diagnosis must be confirmed by usually sufficient conventional imaging. Secondly, all the features of the fracture have to be analysed to come to the surgical decision and to choose the best osteosynthesis technique. Compared to traditional imaging, three dimensional computed tomography offers the possibility of a direct viewing. The extend of the fracture, the aspect and degree of displacement of the condylar fragment in relation to the ramus or the fossa are easily assessed. The examination and the integration of multiple axial or coronal bidimensional CT scan sections are no more necessary. The clearer perception of both the spacial relationships and delineation of these condylar fractures results in a better choice for surgical planning.

Adult↗
PubMed1996

[Late results of 15 years and longer after mandibular condyle fractures].

A sample of 91 patients who had suffered from condylar fractures in the years 1970-1977 could be followed up. The mean follow up period was 19.8 years. As a prognostic relevant parameter the patient's age at the time of the accident as well as the type of the fracture where taken into account. Clinically young (8-11 years at the time of the accident) patient's with no or low grade dislocation showed the best results. Almost 36% of the patients with high grade dislocation or luxation presented measurable pathological changes during function. The condylar movement was assessed by using 3D-optoelectronic measurement. Despite severe radiographic alterations and hindered condylar translation in cases with high grade dislocation or luxation, mouth opening was not restricted in the majority of the patients. It seems that the lack of condylar translation is compensated by extensive rotation.

Adolescent↗
PubMed2006

Functional results after conservative treatment of fractures of the mandibular condyle.

Since the introduction of osteosynthesis materials for rigid internal fixation after anatomical reduction there is an ongoing discussion about the treatment of condylar fractures of the mandible. Sixty patient files were analyzed and 28 patients were seen for re-examination and a x-orthopantomogram was taken. Functionality was graded with the Helkimo index at an average of 3.0 years follow-up. The clinical dysfunction index showed: severe symptoms in 11%, moderate symptoms in 39%, mild symptoms in 39% and 11% had no symptoms. Index for occlusal state showed: 21% severe occusal disturbances, 61% moderate occlusal disturbances and 18% no occlusal disturbances. According to the anamnestic dysfunction index 89% of the patients were symptom-free. The clinical outcome group showed a significant left/right ramus length difference compared with a 20-person control group. The re-examined group did not significantly differ from the control group. Conservative treatment for condylar fractures was successful in only 46% according to the 1999 consensus criteria described by Bos et al.

Adolescent↗
PubMed1994

[Mandibular condyle fractures: conservative treatment versus surgical treatment].

A review of medical literature on the various principles of medical care of condylar fractures confirms that the treatment is still controversial. For a long period of time, the conservative functional treatment of condylar fractures was a dominant philosophy. However, rigid internal fixation of condylar fractures is increasingly accepted as an alternative which presents an improved stability provided by the use of plate and screw fixation techniques. The purpose of this study is to compare the clinical and radiographic long-term results of patients with condylar fractures treated between 1984 and 1992 in our department. 51 patients were treated in a conservative functional way. Rigid internal fixation was performed in 25 patients using an intraoral approach, according to a technique described by Steinhäuser in 1964. The results of this retrospective analysis indicate that in fractures of the condylar head a conservative functional treatment is the therapy of choice. Fractures of the subcondylar region and also--in selected clinical circumstances--fractures of the condylar neck represent indications for a carefully executed rigid internal fixation. The intraoral approach has been proved to cause minimal morbidity and complications.

Adult↗
PubMed1996

[Surgical reposition and fixation of mandibular condyle fractures via intraoral approach].

In a case series 54 patients with 61 subcondylar fractures had been treated by surgical repositioning and miniplate-fixation by an intraoral approach. Functional results with special regard to the function of the temporomandibular joint TMJ were registered not earlier than 1 year postoperatively and compared to a case series of 48 patients with 63 conservatively treated subcondylar fractures. Axiographic or pantographic investigation proved higher incidence of TMJ-disorders as it was the case for the common clinical functional examination. TMJ-function was worse in the conservatively treated cases especially in dislocated fractures. Therefore dislocated fractures especially with luxation of the TMJ should be surgically treated. Surgical repositioning and fixation by an intraoral approach is difficult and allows only limited access and view of the fracture, but avoids complications by scaring or facial nerve damage and seems to be sufficient for adequate repositioning. Minor dislocations showed no influence on TMJ-function. Of course surgical repair of disrupted TMJ-ligaments is not possible by an intraoral approach-disrupted TMJ-ligaments in luxated joints seem to be of major importance for the later TMJ-function.

Adult↗
PubMed2003

Intracapsular fractures of mandibular condyle: diagnosis, treatment, and anatomical and pathological evaluations.

The aim of this study was to attempt to establish a correlation between condylar localized fracture, onset of anatomicopathological lesions of the articular structures, and determination of ankylosis so as to define appropriate diagnostic and therapeutic procedures. Clinical, arthroscopic, and histological studies were carried out in two patients with a severe temporomandibular joint disorder after a condylar localized fracture. Treatment included removal of the displaced fragments, condylar surface remodeling, suture of retrodiskal perforations, and diskal repositioning. The histological study of the condylar specimens revealed signs of osteoarthrosis of the articular surface and chondroid metaplasia of the bilaminar zone with early onset of ankylosis. Results of this study confirmed the presence of causal relations between condylar localized fracture and ankylosis with alterations in retrodiskal tissue. These relations are found in 1) tissue damage caused by bony fragments remaining in the articular cavity (underestimated and poorly treated fractures), 2) the lesion that occurs in association with mechanical trauma; and, particularly, c) the disk and retrodiskal impairments caused by catabolic and degenerative osteoarthrotic changes secondary to condylar marrow damage. Thus, timeliness and accuracy of the diagnosis of condylar localized fracture are most important, as are correct diagnosis and treatment before the onset of degenerative anatomicopathological lesions.

Adult↗
PubMed2005

Free-grafting of mandibular condyle fractures: clinical outcomes in 10 consecutive patients.

"Free-grafting" of the superior segment, either alone or in combination with a posterior ramus osteotomy, is occasionally required when managing displaced condylar neck fractures. This allows ideal reduction and fixation, but carries the risk of proximal segment resorption, possibly requiring secondary reconstruction. The purpose of this study was to evaluate the clinical and radiographic outcomes of this technique in all patients who underwent this procedure during a seven-year period at a tertiary care centre. Ten patients who had undergone 11 free graft procedures were included in the study. Three patients required secondary costochondral reconstruction due to advanced resorption of the free-grafted condylar segment, this occurring from 3 to 9 months following the initial trauma surgery. All but one of the remaining patients exhibited varying degrees of condylar resorption/flattening radiographically, occurring within the first year only. However, no occlusal changes occurred in this group either objectively or subjectively during this year or during the subsequent follow-up period. The mean inter-incisal opening was 47mm (range 40-56). With the exception of one patient that had a non-painful reciprocal click of the treated side, no patients demonstrated either objective or subjective signs of TMJ pathology. No patients reported dietary limitations, and all reported satisfaction with treatment to date. Based on objective and subjective evaluation, free grafting of the fractured condylar segment in this patient population had a 70% success rate. All failures occurred within 9 months and required secondary costochondral reconstruction.

Adolescent↗