Mini suture anchor: An effective device for reduction and fixation of displaced temporomandibular joint disc with intracapsular condylar fracture / 中华创伤杂志(英文版)

PURPOSE@#The main aim is to provide clinical reference for the application of mini suture anchor in the reduction and fixation of displaced temporomandibular joint (TMJ) disc with intracapsular condylar fracture.@*METHODS@#From October 2018 to October 2019, 21 patients (31 sides) with intracapsular condylar fractures and articular disc displacement from West China Hospital of Stomatology, Sichuan University were included. The selection criteria were: (1) mandibular condylar fractures accompanied by displacement of the TMJ disc, confirmed by clinical examination, CT scan and other auxiliary examinations; (2) indication for surgical treatment; (3) no surgical contraindications; (4) no previous history of surgery in the operative area; (5) no facial nerve injury before the surgery; (6) informed consent to participate in the research program and (7) complete data. Patients without surgical treatment were excluded. The employed patients were followed up at 1, 3, 6 and 12 months after operation. Outcomes were assessed by success rate of operation, TMJ function and radiological examination results at 3 months after operation. Data were expressed as number and percent and analyzed using SPSS 19.0.@*RESULTS@#All the surgical procedures were completed successfully and all the articular discs were firmly attached to the condyles. The articular disc sufficiently covered the condylar head after the fixation. The fixation remained stable when the mandible was moved in each direction by the surgeons. No complications occurred. The functions of the TMJ were well-recovered postoperatively in most cases. CT scan revealed that the screws were completely embedded in the bone without loosening or displacement.@*CONCLUSION@#Mini suture anchor can provide satisfactory stabilization for the reduced articular disc and also promote the recovery of TMJ functions.

Tratamiento quirúrgico de fracturas de cóndilo mandibular: reducción asistida por endoscopio como complemento al tratamiento convencional / Surgical treatment of mandibular condyle fractures: endoscope-assisted reduction as a complement to conventional treatment

Resumen Introducción: Las fracturas de cóndilo presentan una alta incidencia dentro de las fracturas de mandíbula. Son principalmente tratadas por reducción abierta y fijación interna mediante elementos de osteosíntesis (ORIF) o por reducción cerrada (CR) con fijación máxilo-mandibular (MMF). El tratamiento asistido por endoscopio de estas fracturas, ofrece una alternativa y complemento quirúrgico a las limitaciones que se pueden presentar en la ORIF clásica. Objetivo: Describir la técnica de reducción quirúrgica asistida por endoscopio mediante acceso transoral y acceso retromandibular, como complemento a la técnica quirúrgica convencional para el tratamiento de fracturas de cóndilo mandibular, evaluando criterios clínicos en una serie de casos operados por esta técnica. Materiales y Método: Estudio descriptivo de presentación de serie de casos de pacientes con fractura de cóndilo, tratados con reducción quirúrgica asistida por endoscopio mediante accesos transoral y retromandibular, entre los años 2017 y 2018. Resultados: De los siete pacientes operados, un 85,7% presentó una función mandibular normal, un 100% presentó una función motora neurológica facial normal y un 71,4% no presentó dolor posoperatorio en el control de los 6 meses. Todos los pacientes recuperaron la oclusión que tenían de forma previa a la fractura mandibular. No se reportaron casos que tuvieran la necesidad de reintervención quirúrgica. Conclusiones: La reducción quirúrgica asistida por endoscopio para las fracturas de cóndilo mandibular es una técnica que ofrece un complemento a la técnica quirúrgica convencional, permitiendo mayor visibilidad de las estructuras, menor morbilidad quirúrgica y complicaciones mínimas en relación a las técnicas convencionales descritas.

Introduction: Condyle fractures have a high incidence within jaw fractures. They are mainly treated by open reduction and internal fixation with osteosynthesis elements (ORIF), or by closed reduction (CR) with maxillomandibular fixation (MMF). Endoscopic-assisted treatment of these fractures offers an alternative and surgical complement to the limitations that can occur in classic ORIF. Aim: To describe the technique of endoscope-assisted surgical reduction using transoral access and retromandibular access, as a complement to the conventional surgical technique for the treatment of mandibular condyle fractures, evaluating clinical criteria in a series of cases operated by this technique. Materials and Method: Descriptive study of case series presentation of patients with condyle fracture, treated with endoscopic assisted surgical reduction by transoral and retromandibular access, between the years 2017 and 2018. Results: Of the seven patients operated on, 85.7% presented normal jaw function, 100% presented normal facial neurological motor function, and 71.4% presented no postoperative pain at the 6-month control. All patients recovered the occlusion they had prior to the mandibular fracture. There were no reported cases in need of surgical reintervention. Conclusions: Endoscope-assisted surgical reduction for mandibular condyle fractures is a technique that offers a complement to the conventional surgical technique, allowing greater visibility of the structures, less surgical morbidity and minimal complications in relation to the conventional techniques described.

Three-dimensional finite element analysis of traumatic mechanism of mandibular symphyseal fracture combined with bilateral intracapsular condylar fractures / 北京大学学报(医学版)

OBJECTIVE@#To analyze the biomechanical mechanism of mandibular symphyseal fracture combined with bilateral intracapsular condylar fractures using finite element analysis (FEA).@*METHODS@#Maxillofacial CT scans and temporomandibular joint (TMJ) MRI were performed on a young male with normal mandible, no wisdom teeth and no history of TMJ diseases. The three-dimensional finite element model of mandible was established by Mimics and ANSYS based on the CT and MRI data. The stress distributions of mandible with different angles of traumatic loads applied on the symphyseal region were analyzed. Besides, two models with or without disc, two working conditions in occlusal or non-occlusal status were established, respectively, and the differences of stress distribution between them were compared.@*RESULTS@#A three-dimensional finite element model of mandible including TMJ was established successfully with the geometry and mechanical properties to reproduce a normal mandibular structure. Following a blow to the mandibular symphysis with different angles, stress concentration areas were mainly located at condyle, anterior border of ramus and symphyseal region under all conditions. The maximum equivalent stress always appeared on condylar articular surface. As the angle between the external force and the horizontal plane gradually increased from 0° to 60°, the stress on the mandible gradually concentrated to symphysis and bilateral condyle. However, when the angle between the external force and the horizontal plane exceeded 60°, the stress tended to disperse to other parts of the mandible. Compared with the condition without simulating the disc, the stress distribution of articular surface and condylar neck decreased significantly when the disc was present. Compared with non-occlusal status, the stress on the mandible in occlusal status mainly distributed on the occlusal surface, and no stress concentration was found in other parts of the mandible.@*CONCLUSION@#When the direction of external force is 60° from the horizontal plane, the stress distribution mainly concentrates on symphyseal region and bilateral condylar surface, which explains the occurrence of symphyseal fracture and intracapsular condylar fracture. The stress distribution of condyle (including articular surface and condylar neck) decreases significantly in the presence of arti-cular disc and in stable occlusal status when mandibular symphysis is under traumatic force.

Retrospective analysis of the treatment of mandibular condylar sagittal fracture with Kirschner wire in 13 cases / 口腔疾病防治

Objective@#To evaluate the value of Kirschner wire internal fixation in the treatment of sagittal mandibular condylar fractures.@*.Methods @#From January 2019 to January 2020, 13 patients (19 sides) with mandibular condylar sagittal fracture treated by Kirschner wire internal fixation at the Stomatological Medical Center, Foshan Hospital of Traditional Chinese Medicine were retrospectively analyzed. After conventional surgical incision and exposure and reduction of the mandibular condyle, 2-4 Kirschner wires were used for fixation, and other maxillofacial fractures were treated simultaneously. The reduction accuracy and stability of the free mandibular condyle were evaluated by CBCT one week after the operation, and the occlusion relationship, opening degree and opening type were evaluated by clinical examination.@*Results@#All patients had good fracture alignment and no twisting, breaking or loosening of the Kirschner wire. The occlusion relationship, opening degree and opening shape recovered well after the operation.@*Conclusion@# Kirschner wire is effective in treating sagittal fractures of mandibular condyles.

Fractura de Hoffa en el cóndilo femoral. Reporte de caso / Femur Hoffa fracture. A case report

Las fracturas de tercio distal de fémur unicondilares en el plano coronal son conocidas como fracturas de Hoffa, son poco frecuentes y muy raras. Se han reportado pocos casos este tipo de fracturas, por definición son fracturas inestables y por lo tanto requieren de resolución quirúrgica. El mecanismo de trauma en este tipo de fracturas es directo con la rodilla en flexión. Muchas veces pueden pasar desapercibidas en las proyección radiográficas anteroposterior (AP), y por eso es importante evaluar la proyección lateral. Cuando se sospechan o se evidencian es necesario tomar una tomografía axial computarizada (TAC) con el fin de definir claramente su su resolución quirúrgica, puesto que el abordaje y el método de fijación es controversial. Aunque hoy en día ha aumentado la disponibilidad y las características delos diferentes tipos de implantes, no hay un consenso en la literatura debido principalmente a la falta de experticia en estos poco frecuentes casos.

Unicondylar coronal plane fractures of the distal third of the femur are known as Hoffa fractures, are uncommon and rather rare. Only few cases of this type of fracture have been reported worldwide. By definition they are unstable fractures and therefore require surgical resolution. The mechanism of trauma in this type of fracture is an anterior to posterior direct trauma with a flexed knee. They can often go unnoticed on the anterior-posterior (AP) radiographic projection, so it is important to carefully evaluate the lateral projection. When they are suspected or perhaps evident, it is necessary to perform a computerized axial tomography (CT) in order to clearly define both, the characteristics of the fracture itself as the surgical resolution options, since the approach and the fixation method are controversial. Although nowadays the availability and characteristics of the different types of implants have increased, there is no consensus about the way to manage these fractures in medical literature, mainly due to the lack of expertise in these rare cases.

Effect of parathyroid hormone on cartilage healing in a rabbit model of mandibular condylar fracture / 中国组织工程研究

BACKGROUND: A high fracture of the mandibular condyle is often accompanied by cartilage damage. At the same time, the muscle attached to the condyle is avulsed and becomes a free bone mass. How to speed up the concurrent healing of cartilage during bone healing has always been a clinical difficulty and challenge. OBJECTIVE: To investigate the effect of parathyroid hormone on the healing of condylar cartilage in rabbits with high condylar fracture after free reduction. METHODS: An experimental model of free reduction and fixation of condylar fracture was established in 48 New Zealand big-eared rabbits, which were randomly divided into experimental group and control group (n=20 per group). The experimental group was injected with parathyroid hormone (20 μg/kg) subcutaneously every other day, and the control group was injected with 1 mL of normal saline. The animals were sacrificed at 1, 2, 3, and 4 weeks postoperatively. The mandible condyle was histologically observed. Immunohistochemistry staining and PCR were used to detect the expression of Sox9 and matrix metalloproteinase 13 in the condylar cartilage. The study protocol was approved by the Animal Experimental Ethics Committee of Guizhou Medical University (approval No. 1700456). RESULTS AND CONCLUSION: The results of safranine O-fast green staining and hematoxylin-eosin staining indicated that there were more chondrocytes and cartilage matrix deposition in the experimental group than the control group. In the immunohistochemistry, the average absorbance of Sox9 in the experimental group was significantly higher than that in the control group within 1-3 postoperative weeks (P < 0.05). The average absorbance of matrix metalloproteinase 13 in the experimental group was lower than that in the control group within 1-3 postoperative weeks (P < 0.05). The expression of Sox9 mRNA in the experimental group was significantly higher than that in the control group within 1-3 postoperative weeks, P < 0.05). The expression of matrix metalloproteinase 13 mRNA in the experimental group was significantly lower than that in the control group within 1-3 postoperative weeks (P < 0.05). These findings indicate that intermittent subcutaneous injection of parathyroid hormone can up-regulate the expression of Sox9, inhibit the expression of matrix metalloproteinase 13, promote the transformation of mesenchymal stem cells to cartilage, and accelerate the repair of cartilage damage.

Tratamento fechado em fratura mandibular: parassinfisária e côndilar bilateral ­ relato de caso clínico / Closed treatment in mandibular fracture: bilateral parasymphyseal and condyle ­ clinical case report

Objetivo: relatar um caso de fratura na região parassinfisária e côndilar bilateral após acidente ciclístico, tratada pela técnica de bloqueio maxilomandibular. Relato de caso: paciente do gênero feminino, 21 anos, deu entrada no Hospital Municipal Waldemar das Dores, Barão de Cocais, MG, vítima de acidente ciclístico, apresentando fratura de esmalte e dentina nos dentes 11 e 21, mordida aberta anterior, com incapacidade de atingir a máxima intercuspidação, juntamente com uma limitação de excursão lateral para o lado direito. Após exames tomográficos, foi constatada fratura completa de colo de côndilo direito, fratura em galho verde em côndilo esquerdo e fratura de cortical lingual parassinfisária. Por se tratar de uma paciente jovem e por apenas uma de suas fraturas apresentar-se completa (colo do côndilo direito), foi proposto tratamento fechado, por meio do bloqueio maxilomandibular. Conclusão: o bloqueio maxilomandibular foi considerado um tratamento eficaz no caso em questão, no qual foi possível estabelecer a consolidação das fraturas sem ocorrência de complicações pós-tratamento.(AU)

Objective: to report a case of fracture in the bilateral parasymphyseal and condylar region after a cycling accident, treated with the maxillomandibular block technique. Case report: a 21-yearold female patient was admitted to the Waldemar das Dores Municipal Hospital, Barão de Cocais, MG, Brazil, victim of a cycling accident, showing enamel and dentin fracture in teeth 11 and 21, anterior open bite, inability to reach maximum intercuspation, and a lateral excursion limitation to the right side. Tomographic examinations showed complete fracture of the right condyle neck, greenstick fracture in the left condyle, and parasymphyseal lingual cortical fracture. Considering it is a young patient with only one complete fracture (neck of the right condyle), a closed treatment was proposed through maxillomandibular block. Conclusion: maxillomandibular block was considered an effective treatment for the case in question, allowing to establish fracture consolidation without post-treatment complications.(AU)

Morphology Of Condyloid Process Of Mandible And It’s Surgical Relevance

Background: The aim of the study was to determine the morphological shapes of condyloid process of mandibleand finding out the prevalence of different forms in dry human mandibles.Methods: Gross examination of 60 dry human mandible was carried out from the collection of department ofAnatomy, Government medical college, bhavnagar, gujarat for the shape of condyloid process from superior,anterior, medial and lateral views.Results: From the superior view, shape was oval in 57.5%, elongated in 22.5%, rounded in 10%, angled in 9.17%and irregular in 0.83% of the mandibular condyles where as from the anteriror view, shapes were convex in47.5%, flat in 41.67% and angled in 10.83% of the condyles. From the lateral view, shapes observed were flat,rounded and pointed with their percentage being 58.33%, 33.33% and 8.33% respectively where as from themedial view, flat, rounded and pointed shapes were found in 32.5%, 60% and 7.5% of the condyles respectively.Conclusion: The data obtained from the present study may found helpful in personal identification, condylesurgeries and prosthesis making.

Small incision through the tragus for the treatment of sagittal condylar fracture / 口腔疾病防治

Objective@#The purpose of this study was to a new operative approach for sagittal condylar fractures via a preauricular small incision-based technique and to examine the effectiveness of this approach. @*Methods@#Fifteen patients (19 sides) with sagittal condylar fractures were included in the study. The incision length was approximately 4 cm through the tragus, exposing the superficial temporal vessels, which was then pulled forward. Next, the deep temporal superficial fascia was cut, and the surface of the zygomatic arch and the articular capsule of the temporomandibular joint were exposed. Joint capsule incision was performed, with mandibular condylar fracture fixation under direct vision. We followed up with the patients postoperatively for 6 months with clinical and radiographic examinations. @*Results @#All patients had 1 week postoperation before being discharged, during which 2 cases of mild facial paralysis (with lateral temporal level Ⅱ facial paralysis, with lateral temporal branch level Ⅲ facial paralysis and level Ⅱ zygomatic branch of facial nerve paralysis after treatment) were observed, after given nerve nutrition agents, 2 cases returned to normal within 3 months. No patient exhibited a postoperative delayed fistula infection or other serious complications. Intraoperative occlusion relationships recovered well, and postoperative CTs suggested that the fracture ends and condyles were in good condition. The occlusion relationship was normal for 3 months after surgery, with a degree of opening greater than 30 mm, no play in the joints and no oblique openings being observed, and reexamination 6 months after the surgery revealed no obvious scars.@*Conclusion@#This surgical method involves a small incision and clear anatomic structures and avoids damage to the facial nerve. This method provides better surgical vision for treatment of sagittal condylar fractures, is safe and convenient, and deserves clinical recommendation.

Comparison of the therapeutic efficacy between surgical treatment and conservative treatment for intracapsular condylar fracture / 实用口腔医学杂志

Objective: To compare the therapeutic efficacy between surgical treatment and conservative treatment for intracapsular condylar fracture(ICF). Methods: 37 adult patients with unilateral ICF were recruited from January 2011 to January 2016. 21 patients were treated by surgery and 16 by conservative method. Before and after treatment patients were examined by clinical examinations,CT and MRI. Results: At 6th month follow-up,no occlusal disturbance and trismus was found in all cases. The mouth opening of surgical treatment group was significantly larger than that of the conservative treatment group(P ＜ 0. 05). The incidence of lateral deviation while mouth opening,TMJ discomfort and anterior disc displacement in the conservative treatment group was significantly higher than those in surgical treatment group(P ＜ 0. 01). Conclusion: Surgiry treatment is more effective than conservative method in the treatment of ICF and can improve the TMJ function.

Application of APP in continuing care of discharged patients with condylar fracture after operation / 中国实用护理杂志

Objective To investigate the application effect of APP in continuing care of discharged patients with condylar fracture after operation. Methods By convenience sampling,from September 2016 to March 2017 in a ward of oral and maxillofacial surgery and received surgical treatment of condylar fracture patients 81 cases, randomly divided into observation group (41 cases) and control group (40 cases).On the basis of routine health education,the observation group carried out continuous care by APP, while the control group received routine health education. The opening type, opening degree, occlusion relation and temporomandibular joint pain in two groups were compared at 6 months after discharge. Results The results of 6 months, the patients in the observation group were open type, occlusion and TMJ pain were better than the control group, the opening degree of the observation group was (35.51 ± 4.34) mm, control group was (31.28 ± 4.57) mm, the difference between the two groups was statistically significant(t=-4.28,P<0.05).There was no statistical difference between the two groups of occlusion and temporomandibular joint pain (P>0.05). Conclusions APP can improve the open type, opening and occlusal relation and temporomandibular joint pain in patients with condylar fracture after operation.

Arthrography in treatment of humeral condyle fractures with displacement of less than 2 mm in children / 中华创伤骨科杂志

Objective To evaluate the clinical efficacy of arthrography in the treatment of lateral condylar fracture of humerus with displacement of ≤ 2 mm in children.Methods A retrospective study was performed in the 21 children with lateral condylar fracture of humerus who had received arthrography in their surgery at Department of Pediatric Orthopedics,Honghui Hospital,Xi'an Jiaotong University College of Medicine from April 2015 to December 2016.They were 14 boys and 7 girls,aged from 5 to 12 years (average,8.6 years).Their primary diagnosis was made within one week from injury and they all had a displacement of ≤ 2 mm.Of them,2 were treated by plaster fixation because intraoperative arthrography found no fracture of articular cartilage (group A),11 by simple closed pining because intraoperative arthrography found fracture of articular cartilage involving the joint space (group B),and 8 by open reduction and fixation with kirschner wire because intraoperative arthrography found displacement of the involved articular surface (group C).The therapeutic efficacy was evaluated at final follow-ups by the Dhillon scoring system.Results All the 21 children were followed up from 9 to 23 months (average,16 months).The fracture union time ranged from 8 to 10 weeks (average,9 weeks) for groups A and B and from 11 to 13 weeks (average,12 weeks) for group C.By the Dhillon scores at final follow-ups,the therapeutic efficacy was evaluated as excellent in one and as good in one in group A,as excellent in 8 cases,as good in 2 cases and as fair in one in group B,and as excellent in 6 cases,as good in one and as fair in one in group C.No early closure of epiphysis,osteonecrosis or fishtail deformity was found in either group A or group B;one case of partial limitation of elbow flexion or extension,one case of fishtail deformity and one case of femoral head necrosis were observed in group C.No infection or skin necrosis was found in any of the 3 groups.Conclusions Because intraoperative arthrography can definitely judge whether the articular surface is intact or unstable,it can make up for the insufficiency of X-rays in judging integrity of the articular surface.In combination with closed reduction,percutaneous puncture or open reduction and internal fixation,intraoperative arthrography can contribute to an increased rate of successful surgery,and reduced complications due to redisplacement.

An attempt to treat Hoffa fractures under arthroscopy: A case report / 中华创伤杂志(英文版)

We treated a 15-year-old female patient with fracture of the post-lateral femoral condyle and the bone shifted in front of the knee. Considering that the traditional surgical approach has the shortcomings of significant trauma and poor prognosis, we designed an arthroscopic procedure, which achieved satisfactory short-term efficacy, effectively reduced and fixed the fractures, avoided damage to vascular nerves, and maximally reduced the trauma caused by surgery itself.

Facial symmetry after conservative treatment of unilateral condylar fracture in children: a three-dimensional study / 中华口腔医学杂志

Objective@#To investigate the influence of condylar fractures on the growth of condylars after conservative treatments by three-dimensional measurement.@*Methods@#Twenty three children with unilateral condylar fracture followed-up for at least 1 year in Shanghai Ninth People's Hospital were included from June 2016 to March 2017. CT scans were performed for each patient. Three-dimensional virtual skulls were reconstructed and measuring points were defined with Simplant 11.04 software. The depth of glenoid fossa, height of articular eminence, width, height and depth of condylar, deviation of pogonion were measured. Statistical analyses were conducted to assess difference between the bifid group and the normal group.@*Results@#No difference was observed in the vertical position of crest of the articular eminence between two groups (P=0.110). The vertical position of roof of the glenoid fossa in bifid side was significantly superior than the one in normal side (P=0.010). Bifid side had a shorter (P=0.002) and wider(P=0.002) condylar than normal side did. No difference was observed in the depth of condylar between two groups (P=0.071). The average deviation of pogonion was (0.69±1.75) mm (P=0.072) from sagittal plan.@*Conclusions@#This short-termed study indicates that children's growth potential of condylar is under average after conservative treatments. Because the bone hyperosteogeny of glenoid fossa compensates the hypotrophy of condylar, no deviation of pogonion is detected.

Long Term Follow-up of Children with Facial Asymmetry: A Case Report / 대한소아치과학회지

Mandibular fractures occur with high incidence among various fractures in maxillofacial region in children. Jaw fractures in children should be approached differently than in adults because bone growth continues throughout childhood. As far as displacement of the fragment is not severe, or if it is condyle that is fractured, closed reduction and additional intermaxillary fixation can be considered. Functional exercise is also required to prevent ankylosis of temporomandibular joint.Several complications, particularly malocclusion and facial asymmetry due to growth disturbances, can occur after condylar fractures. If growth disturbances take place after mandibular fractures, catch-up growth may occur in some patients, thus, periodic observation is necessary. In case of persistent growth disturbances, functional devices may be used to prevent severe facial asymmetry.This case report describes the long-term follow-up of two patients with facial asymmetry after mandibular fracture.

Técnica de Boyne: una alterantiva en el tratamiento abierto de fracturas de cóndilo mandibular: a propósito de un caso clínico / Boyne´s technique: an alternative in the open treatment of mandibular condyle fractures: report of a clinical case

Las fracturas mandibulares son las fracturas más comunes de los huesos faciales; las de cóndilo mandibular ocupan un lugar importante entreellas. Dentro de sus factores etiológicos destacan los accidentes detránsito, agresión por terceras personas, accidentes deportivos y laborales. Existe gran controversia en el manejo de dicha entidad en cuantoa la elección de un tratamiento conservador o quirúrgico; hay varios factores considerados como razones para llevar a cabo el tratamiento quirúrgico, como la pérdida de altura facial posterior, la posición delcóndilo fracturado o la posibilidad de que el paciente adquiera el material de osteosíntesis. En este artículo presentamos una alternativa en el manejo quirúrgico de fracturas condilares mediante técnica de Boyne, así como una breve descripción de la técnica quirúrgica que empleamos en el Servicio de Cirugía Oral y Maxilofacial del Centro Médico Licenciado Adolfo López Mateos, la cual nos ha proporcionado adecuados resultados estéticos y funcionales.

Mandibular fractures are the most common fractures of the facial bones, with mandibular condylar fractures occupying an important place among them. Some of their etiological factors are traffic accidents, aggressions by third persons, sports, and work accidents.There is great controversy in the management of this entity, regardingthe selection of a conservative or surgical treatment; several factorsare considered reasons to carry out the surgical treatment, such as the loss of posterior facial height, the position of the fractured condylar, aswell as the possibility of having the patient purchase the osteosynthesis material. In this article, we present an alternative in the surgical management of condylar fractures using Boyne’s technique, as wellas a brief description of the surgical technique we used in the Oraland Maxillofacial Surgery Service of the Medical Center «Licenciado Adolfo Lopez Mateos¼, which has provided us with Suitable aestheticand functional results.

Risk factors of cubitus varus in humeral condylar fracture after conservative treatment in child / 中国骨伤

<p><b>OBJECTIVE</b>To further investigate the risk factors of cubitus varus in humeral condylar fracture after conservative treatment in children through Logistic regression analysis, so as to guide the clinical treatment.</p><p><b>METHODS</b>Children with humeral condylar fracture who were treated by manipulative reduction and plaster fixation in our hospital from March 2008 to December 2014 were studied. The clinical data including age, gender, BMI, time from injury to reduction, direction of displacement, rotation displacement, fixed position, and epiphyseal injury were collected. First, preliminary screen the risk factors through univariate analysis of the above data, then determine the risk factors of cubitus varus through multivariate Logistic regression analysis of the significant factors from univariate analysis.</p><p><b>RESULTS</b>Univariate analysis showed that time from injury to reduction, direction of displacement, rotation displacement and epiphyseal injury were significantly correlated with the cubitus varus. Multivariate Logistic regression analysis showed that time from injury to reduction which was longer than 8 h [=0.017, OR=3.303(1.243-8.774)], ulnar displacement [=0.001,=11.951(2.895-49.335)], rotation displacement [=0.003, OR=4.190(1.643-10.685)]and epiphyseal injury [=0.000,=7.092(2.557-19.671)] were independent risk factors of cubitus varus.</p><p><b>CONCLUSIONS</b>Time from injury to reduction, ulnar displacement, rotation displacement and epiphyseal injury are independent risk factors of cubitus varus. So it need corresponding treatment according to different risk factors.</p>

Intracorporeal reduction of condylar fracture using both pedicled condylar and seperated ramal fragments after vertical ramal osteotomy

The aim of this study is to introduce a surgical technique that can maintain blood supply to prevent condylar resorption in the extracorporeal reduction of condylar fracture. Neither the medial pterygoid muscle on the ramal bone nor the lateral pterygoid muscle on the condylar fragment was detached after vertical ramal osteotomy. Thus, reduction was performed in the intracorporeal state. Therefore, blood supply was expected to be maintained to the fragments of both the condylar and ramal bones. On postoperative radiographs, the anatomical outline of the fractured condyle was well restored, and the occlusion was stable. In the unilateral case, there were no signs of mandibular condylar resorption until postoperative 3 weeks. In the 2 bilateral cases, condylar displacements with plate fractures and screw loosening were observed at postoperative 1 month or 5 months, but radiodensity at the displaced fracture site increased during the follow-up period. Finally, complete remodeling of the condylar fragments with restored anatomic appearance was observed on 8-month or 2-year follow-up radiographs. All cases exhibited good healing aspects with no signs or symptoms of mandibular condylar dysfunction during the postoperative remodeling period after intracorporeal reduction of condylar fracture.

Intracorporeal reduction of condylar fracture using both pedicled condylar and seperated ramal fragments after vertical ramal osteotomy

The aim of this study is to introduce a surgical technique that can maintain blood supply to prevent condylar resorption in the extracorporeal reduction of condylar fracture. Neither the medial pterygoid muscle on the ramal bone nor the lateral pterygoid muscle on the condylar fragment was detached after vertical ramal osteotomy. Thus, reduction was performed in the intracorporeal state. Therefore, blood supply was expected to be maintained to the fragments of both the condylar and ramal bones. On postoperative radiographs, the anatomical outline of the fractured condyle was well restored, and the occlusion was stable. In the unilateral case, there were no signs of mandibular condylar resorption until postoperative 3 weeks. In the 2 bilateral cases, condylar displacements with plate fractures and screw loosening were observed at postoperative 1 month or 5 months, but radiodensity at the displaced fracture site increased during the follow-up period. Finally, complete remodeling of the condylar fragments with restored anatomic appearance was observed on 8-month or 2-year follow-up radiographs. All cases exhibited good healing aspects with no signs or symptoms of mandibular condylar dysfunction during the postoperative remodeling period after intracorporeal reduction of condylar fracture.

Modified endaural approach for the treatment of condylar fractures: A review of 75 cases.

Background: There are several treatment approaches for mandibular condyle fractures. Type of fracture, clinical experience, and preference of the operating surgeon dictate the approach. Given this highly varied outcome, this manuscript intends to document the treatment experience of 75 patients with extracapsular condyle fractures using author’s modification of the traditional endaural approach in the region. Materials and Methods: A retrospective chart review was performed on patients with mandibular condylar fractures who visited the author’s center between 2004 and 2014. For the surgical reduction and fixation, an endaural (ear) approach via the author’s modification of Al‑Kayat Bramley’s incision in the superficial temporal region was used. Postoperative clinical parameters were evaluated which include the degree of mouth opening, chin deviation during mouth opening, occlusal relationship, temporomandibular joint function, radiographic stability, and other postoperative complications of condylar fractures such as infection, plate fracture, and permanent paralysis of facial nerve. Adolescence/adult patients with unilateral/bilateral condylar fracture who underwent open reduction with the follow‑up of at least 1 year were included in the study. Edentulous and patients <15 years who underwent closed treatment were excluded from the study. Results: The study group consisted of 75 cases of mandibular condyle fractures, of which 55 cases were of unilateral condyle fractures and 20 cases were of bilateral condylar fractures. Postoperative follow‑up of patients ranged from 1 to 10 years with the mean of 3.04 ± 1.93 years. The occlusal relationships were excellent in all with the mean degree of mouth opening of 40.11 mm (maximum 4.5 cm and minimum 2.9 cm), of which four patients reported restricted mouth opening. Orthopantomogram and computed tomography showed complete anatomical reduction of the condyle fracture in all patients. Nine out of 75 patients developed transient facial weakness, with no other postoperative complications of condylar fractures such as infections, plate fracture, and permanent paralysis of facial nerve were noted. The overall success rate was 92%. Conclusion: Surgery for mandibular condyle fractures with modified approach allows direct vision of the fracture and reduces surgical trauma to the site while avoiding permanent facial nerve injury. Hence, the author’s modified Al‑Kayat Bramley incision via endaural approach could be considered as the best approach for open reduction and internal fixation of condylar neck and subcondylar mandibular fractures.