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PubMed1993

A potential role for costo-chondral grafting in adults with mandibular condylar destruction secondary to rheumatoid arthritis--a case report.

Little attention has been directed towards reconstruction of the mandibular condyles in adult patients with rheumatoid arthritis, other than with allogenic implants which are now known to cause serious complications. There is a relatively high incidence of condylar erosion and breakdown in rheumatoid arthritis, often leading to anterior open bite and retrognathia. Costochondral grafting does not appear to have been considered as a logical option for reconstruction, despite its high success rate in many other situations. A case is described of rapid bilateral condylar destruction occurring in a young woman with rheumatoid arthritis, leading to anterior open bite. Reconstruction was undertaken using bilateral costochondral grafts, giving an excellent clinical result which has been maintained over the follow-up period of two-and-a-half years. Radiologically complete healing of severe glenoid fossa erosion has taken place.

Adult↗
PubMed2002

Osteosarcoma of the temporomandibular joint: report of 2 cases.

The aim of this article is to report 2 cases of osteosarcoma of the mandibular condyle, a rare pathological condition, and to emphasize and discuss the usefulness of different imaging modalities in the diagnosis and evaluation of osteosarcoma of the temporomandibular joint. In our assessment of the different imaging modalities, we found that 2-dimensional computed tomograms provide excellent detection of tumor calcification, cortical involvement, and in most instances, soft tissue and intramedullary extension, whereas 3-dimensional computed tomography vascular protocol can help to define the extension of the lesion, improving the visualization of the lesion's relationship to the adjacent anatomical structures. Magnetic resonance imaging is more effective in demonstrating the intramedullary and extraosseous tumor components on T2 weighted images. Because metastasis from body tumors to the maxillofacial region occurs occasionally, it is useful to examine the oral cavity when symptoms first appear and devote special attention to the subtle changes that may indicate early metastatic involvement.

Adolescent↗
PubMed2003

Plate osteosynthesis of condylar fractures: a retrospective study of 45 patients.

OBJECTIVE: This retrospective study presents the type of osteosynthesis used for the fixation of condylar fractures and the postoperative results and complications observed. METHOD AND MATERIALS: Forty-five patients with fractures of the mandibular condyle underwent open reduction and osteosynthesis with plates and screws. The surgical approach was, in most cases, via a submandibular incision. Stabilization was achieved in the majority of the cases with a 2.0-mm single or double miniplate, but 2.0-mm mini dynamic compression plates were also used. RESULTS: The complications were mainly inadequate reduction, screw loosening, and limitation of mouth opening. No plate fractures or infections were observed. CONCLUSION: The use of a single plate (miniplate or dynamic compression plate) often produces inadequate stability and reduction postoperatively. The placement of two 2.0-mm zygomatic dynamic compression plates demands great tissue dissection and detachment and can lead to limitation of mouth opening. The use of two 2.0-mm miniplates seems to produce better stability and fewer complications.

Adolescent↗
PubMed2005

[Condylar metastasis. Review of the literature and report of a case].

BACKGROUND: Metastases in the mandibular condyle are rare. A survey of the literature showed that only 23 of 69 selected cases qualified under the criteria of Meyer and Shklar. REPORT OF A CASE: A 48-year-old white male suffering from a previously operated lung carcinoma was referred due to pain and discomfort in the left TMJ. A solitary condylar metastasis of the mandible was revealed. Because of diffuse tumorous infiltration into periarticular tissue, irradiation treatment was performed. During the long-term follow-up growth of additional skeletal metastases occurred. DISCUSSION: The course of condylar metastases in general is similar to other metastases involving the jaw. Breast cancer as the primary tumor is most frequent, followed by lung cancer. There are no specific clinical or radiological parameters leading to diagnosis. The clinician should take a potential metastasis into account when dealing with TMJ complaints, radiological oddities, and medical history of malignant tumors. For proper treatment planning, diagnosis should be based on histology. Since the diagnosis of metastasis is usually made at an advanced stage of disease, therapy will be mainly intended as palliative.

Bone Marrow↗
PubMed1994

Condylar hyperplasia: correlation of histological and scintigraphic features.

Scintigaphy using 99mTc-MDP is widely advocated as a method of diagnosis and presurgical assessment of patients with condylar hyperplasia. A previous study has demonstrated that hyperplasia of the mandibular condyle is characterized histologically by the presence of an uninterrupted layer of undiffentiated germinative mesenchyme cells, a layer of hypertrophic cartilage and the presence of islands of chondrocytes in the subchondral trabecular bone. This study was undertaken to determine whether there was any association between the degree of 99mTc-MDP uptake and the histological features of condylar hyperplasia. The parameters examined were trabecular bone volume, depth of cartilage islands and the presence of forming and resorbing surfaces. The images were analyzed by three experienced observers, who ranked the images according to degree of asymmetry between sides and the degree of uptake on the affected side. There was a significant correlation between the proportions of resorbing and osteoid covered bone surfaces and scintigraphic appearances. The rank correlations were rs = 0.55 (P = 0.3) between the resorptive surfaces and degree of symmetry and rs = 0.53 (P = 0.04) between the osteoid surfaces and absolute uptake. The correlation was higher for both methods (rs = 0.64 in each case) when the osteoid surface and resorptive surface measurements were combined. The results indicate that visual examination of radioisotope bone scans by experienced observers is a valid form of assessment of bone activity in condylar hyperplasia.

Adolescent↗
PubMed2005

The periauricular transparotid approach for open reduction and internal fixation of condylar fractures.

INTRODUCTION: Treatment of fractures of the mandibular condyle fractures varies among centres as there still is no general consensus. The aim of this paper was to determine the safety and efficiency of surgical treatment using a transparotid approach for direct plating. PATIENTS AND METHODS: A prospective clinical study was conducted on 34 patients with 36 fractures of the condyle. All 36 fractures were displaced, and 14 (39%) of them were fracture dislocations. The fractures were treated surgically with a transparotid facelift or retromandibular approach using miniplates and screws for fixation. Patients were carefully followed up and were asked to answer a survey paper 2-39 months postoperatively. RESULTS: Occlusion practically identical to the pretraumatic condition was achieved in 31 out of 33 dentate patients (94%). Postoperative interincisal distance was 30-61 mm (mean 44 mm), 4 patients (12%) had postoperative deflection to the side of injury during mouth opening. Facial symmetry was achieved in all of the patients. Eight out of 36 cases (22%) had a transient weakness of certain ipsilateral facial muscle groups, lasting for 4-8 weeks. In one of these patients, a mild weakness of the upper lip and lower eyelid persisted after 13 months. There were 5 cases of miniplate fractures (14%), all of them in patients in whom 1.7 or thinner miniplates were used. There were 5 cases of salivary fistulae (14%), all of them in patients where the parotid capsule was not closed in a watertight fashion. According to the postoperative survey completed by 32 patients, 30 of them (94%) were very satisfied with the outcome of treatment. CONCLUSION: If conducted properly, the transparotid facelift approach offers a safe and effective approach for direct fixation of condylar fractures.

Adolescent↗
PubMed2003

A comparative study of 2 imaging techniques for the diagnosis of condylar fractures in children.

PURPOSE: We sought to compare the sensitivity and specificity of panoramic radiographs with those of coronal computed tomography (CT) scans in the diagnosis of mandibular condylar fractures in the pediatric population. METHODS: Medical, dental, and radiographic records of patients who presented between 1995 and 2000 were evaluated for injuries involving the mandibular condyle. The sample included 22 males and 15 females with ages ranging from 2 to 15 years (mean, 8 years). Control subjects were added and matched by age and gender. The panoramic radiographs were blocked to allow separate evaluation of each condyle. Representative images from the CT scans were selected and individually photographed for projection. Both sets of images were evaluated by 4 groups of examiners: oral and maxillofacial (OMF) surgeons who regularly deal with pediatric trauma (n = 2), community OMF surgeons who had been out of training for at least 5 years (n = 6), OMF radiologists (n = 3), and OMF surgery residents (n = 6). Each image was shown for 20 seconds and the examiners were given 3 options to choose: 1) fracture, 2) no fracture, and 3) uncertain. RESULTS: The overall diagnostic accuracy of CT scanning was 90% (sensitivity, 92%; specificity, 87%), and that of panoramic radiographs was 73% (sensitivity, 70%; specificity, 77%). Of interest, the most experienced clinicians were also those most likely to respond that panoramic films were not diagnostic. Statistical analysis of the results was performed using chi(2) analysis. The differences for sensitivity measurements using the CT scan were not statistically significant (P >.1). However, the differences in sensitivity measurements using the panoramic radiographs and the specificity measurements using both the CT and panoramic radiographs were statistically significant (P <.05). CONCLUSIONS: CT scans provide consistently greater accuracy of diagnosis, sensitivity, and specificity than panoramic radiographs in the assessment of children suspected of having condylar fractures. In view of the high rate of false-negative and false-positive results associated with panoramic radiographs, coronal CT scans should be considered routine investigation in these patients.

Child↗
PubMed1998

Roentgencephalometric analysis of the skulls of the Luxemburgs, the second Bohemian Royal Dynasty.

X-ray films of the skull of the king and emperor Charles IV and his four wives and two sons were made under standard conditions with the mandibles fixed in a centric occlusion. The results of roentgenocephalometric analysis were compared with norms valid for the contemporary Czech population. Consistent with the somatic condition of Charles IV, the findings indicate an above-average large face with the usual anteriorotational developmental type. The facial skeleton is structurally harmonious, but the sagittal intermaxillary relations belong into skeletal class II with a relatively retruded lower jaw in relation to the upper one. This is associated with a greater maxillary overjet of the upper incisors. The disharmony was caused by a fracture of the mandibular condyles. Reconstruction of the condition before the injury revealed an originally normal anteroposterior relationship of the jaws (skeletal class I) and occlusion of the incisors. As to the shape of the cranium, Charles IV's wives differ in basic features. In two, for different reasons, we find skeletal class II (retrogenia), in one skeletal class III (progenia) and only in Elizabeth of Pomerania, with marked flattening of the cranial base and posteriorotation of the face are the anteroposterior relations of the two jaws normal (skeletal class I). Wenceslas IV differs from his parents Charles IV and Anne of Svidnic by a flat cranial base which pushes the lower jaw backwards, however, it does not cause its posteriorotation; we find, similarly as in the father and mother, an anteriorotational growth type of the face. In the other basic parameters of the cranium there are no marked differences between son and parents. In evaluating the similarity of the facial structure of John of Görlitz to that of his parents, disagreement is caused by the flat cranial base of the mother Elizabeth of Pomerania associated with posteriorotation of the face. In the son we find, conversely, an even more marked anteriorotation than in the father and also other parameters of the facial configuration indicating plausible agreement with the findings in Charles IV. The curving of the cranial base has an impact on the shape of the whole cranium, but the results indicate that the heritability of the rotational growth type of face and the degree of cranial base curvature probably is not very marked.

Cephalometry↗
PubMed2000

Functional reconstruction of the TM joint in cases of severely displaced fractures and fracture dislocation.

In a clinical and axiographic study the outcome of patients with severely displaced fractures and fracture dislocations of the mandibular condyle was evaluated. Two operation methods were compared one via an intraoral approach without joint revision and another via a preauricular approach with open reduction of the joint. In the group with joint revision, resorbable material was used for osteosynthesis. Twenty-eight patients (32 joints) treated without revision of the joint and 26 patients (29 joints) with open reduction of the joint were evaluated. The mean observation time following surgery was 3 years and 10 months (range 1-7.5 years). Clinical examination utilized the Helkimo-index, while the electronic axiographical results were evaluated by using a five point scheme of joint-mobility. Concerning clinical evaluation, 20 out of 28 patients (71%) without joint revision and 23 out of 26 (89%) patients with joint revision had none or only slight dysfunction of the stomatognathic system. When focusing on arthralgia and pain in motion (part D and E of Helkimo's-index) significantly better results were achieved by open joint revision (Helkimo D: p< or =0.007; Helkimo E: p = 0.0029). No patient exhibited severe dysfunction (group D3). In axiographic evaluation optimal results (group A1) were achieved in seven joints (24%) with revision and four joints (12%) without revision. Twelve out of 29 joints with revision (41%) and six out of 32 joints without revision (19%) were classified as group A2 with a slightly shortened condylar excursion. Revision of joints with disc reduction and reconstruction of ligaments in cases of severely displaced or dislocated fractures resulted in better mobility and less pain. This was seen clinically and in the axiographic results. Looking at the long-term outcome of patients better mobility of the joint without internal derangement due to surgical repair also protects the contralateral (nonoperated) joint. When managing severe TMJ-trauma we suggest that both, bony and soft tissue structures should be reconstructed if there are any signs of internal derangement. However, the limits between bony reconstruction with or without joint revision are still not defined. Our results appear to be promising concerning mobility and absence of pain of the joints after open reduction. Further research comparing the two operative treatment regimes in a randomized controlled clinical trial will be necessary.

Adolescent↗
PubMed2003

Evaluation of the effects of functional orthopaedic treatment on temporomandibular joints with single-photon emission computerized tomography.

The aims of this investigation were to evaluate the temporomandibular joints (TMJs) with single-photon emission computerized tomography (SPECT) in subjects treated with a mandibular advancement repositioning splint (MARS), and to compare the results with the total effect on dento-facial morphology. The study was undertaken on 17 Class II division 1 malocclusion subjects (nine males, eight females) with mandibular retrusion. Ten patients (five males, five females) formed the treatment group and seven (four males, three females) were used as the control. SPECT was performed only in the treatment group. Cephalometric evaluation showed significant increases in NAPog (P < 0.001) and SNB (P < 0.05) angles. Increased bone formation in theTMJs was analysed with the aid of pre- and post-treatment scintigraphic studies. The results indicate that new bone formation in the mandibular condyles seems to contribute to the increase in mandibular prognathism resulting from functional jaw orthopaedics.

Adolescent↗
PubMed1978

Facial growth after condylectomy and alloplastic condylar replacement.

Condylectomy or condylectomy with immediate alloplastic condylar replacement was performed in six young and six adult rhesus monkeys to investigate the role of the mandibular condyl in facial growth. The experimental findings support the hypothesis that the condyle does not have a primary influence on mandibular growth and that alterations in biomechanics are mainly responsible for the observed alterations in mandibular morphology after condylectomy.

Acrylates↗
PubMed2002

[Extraoral and intraoral endoscopically assisted management of collum fractures].

AIM OF THE STUDY: Using limited extraoral and transoral incisions for an endoscopically assisted open reduction of condylar mandible fractures, the risk of facial nerve damage and extensive visible scars can be reduced. PATIENTS AND METHODS: The endoscopically assisted treatment of 17 consecutive patients with fractures of the condyle was performed from April 1998 to December 1999. Of the 17 patients, 14 had additional mandibular fractures, and 11 of the condylar fractures were dislocated. Of the 17 patients, 9 were treated by submandibular and 8 by transoral approach. Adequate anatomic reduction was achieved by the submandibular and transoral approaches using an endoscopically assisted technique. APPROACHES: In four patients angulated drills and screwdrivers facilitated the transoral treatment of condylar fractures. Transbuccal stab incisions and the use of trocars were not needed in these four patients. The transoral approach proved to be a reliable surgical approach for fractures of the mandibular condyle even when dislocation with lateral override was present. The extraoral approach was used for severely dislocated fractures such as fractures with medial override or comminution.

Adult↗