Tratamiento Ortopédico de las Fracturas de Cóndilo Mandibular A Propósito de Tres Casos / Orthopedic Treatment for Mandibular Condyle Fracture: A Three Case Series

RESUMEN: Las fracturas de cóndilo mandibular son frecuentes en el trauma maxilofacial. Pueden tratarse ortopédicamente o en forma quirúrgica, dependiendo principalmente de las características morfológicas y funcionales del caso, y también de la experiencia del cirujano y los recursos disponibles. En los últimos años se ha establecido una corriente proclive al tratamiento quirúrgico, basada en la rápida recuperación del enfermo y la disminución de las secuelas funcionales y estéticas. Sin embargo, el tratamiento ortopédico bien indicado y ejecutado, puede ser una buena alternativa de tratamiento y que debe ser considerada dentro de las propuestas terapéuticas. El Objetivo de este estudio, es presentar una serie de tres casos de pacientes afectados por fracturas de cóndilo mandibular, tratados en forma ortopédica, en el Hospital El Carmen Dr. Luis Valentín Ferrada, Santiago - Chile. Además, se presentará una revisión de las dos tendencias de tratamiento con énfasis en las indicaciones y protocolo adecuado de tratamiento ortopédico.

ABSTRACT: The Mandible condyle fracture, are common in maxillofacial trauma. They can be treated orthopedically or surgically, depending on the characteristics of the case, the available means and the experience of the surgeon. In recent years, a trend has been established that is prone to surgical treatment, based on the patient's rapid recovery and the reduction of aesthetic and functional sequelae. However, orthopedic treatment can be an excellent treatment alternative. This is why today the treatment of mandibular condyle fractures has become a controversy in the specialty. The objective of this report is to present a series of three cases of patients with mandibular condylar fractures, treated orthopedically, at the Carmen Clinical Hospital, Santiago - Chile. In addition with a brief review of the two treatment trends will be presented with emphasis on the indications and appropriate protocol of orthopedic treatment.

Fratura de côndilo mandibular em criança: tratamento ortopédico-funcional / Fracture of Condyle Mandibular in Children: Functional Orthopedic Tretment

As fraturas de côndilo mandibular são as mais freqüentes do osso mandibular, tendo uma prevalência de 34 a 45%, e eventualmente ocorrem em jovens e adultos. O tratamento dessas fraturas é controverso, indo desde o tratamento funcional ortopédico a redução com fixação dos cotos fraturados de forma aberta. Neste trabalho descrevemos uma técnica conservadora e altamente resolutiva, descrevendo como modelo um paciente de 5 anos de idade, vítima de queda da mesma altura, com fratura alta e cominutiva do côndilo mandibular direito, proporcionando ao mesmo desoclusão dental, assimetria facial, artralgia e dificuldade de abertura de boca. Foi realizado artrocentese e na sequência instalação de aparelho ortopédico do tipo Bimler A, visando intervenção mínima nas articulações epifisárias. O Tratamento teve uma duração clínica de 6 meses e acompanhamento por 2 anos, com resultados extremamente satisfatórios... (AU)

The mandibular condyle fractures are the most frequent of the mandibular bone, having a prevalence 34 - 45%, and generally occur in young adults. The treatment of these fractures is controversial, ranging from functional orthopedic treatment until reduction with fixation of the fractured stumps openly. In this paper we described a case of the patient with 5 years old, victim of the fall, with comminuted condilar fracture, in temporomandibular join left, while providing dental malocclusion, facial asymmetry, arthralgia and difficulty mouth opening. Was accomplished conservative treatment, throught of the arthrocentesis and installation of orthopedic device, type Bimler A, aiming minimal intervention at the epiphyseal joints still forming. The treatment had a clinical duration of 6 months and 2 years clinical follow-up, with extremely satisfactory results... (AU)

The Treatment for Mandibular Condyle Fracture of Children by a Threaded Kirshcner Wire and External Rubber Traction

PURPOSE: The treatment of children mandibular condyle fracture that is severely displaced is controversial. The conservative treatment of it may lead to complications- mandibular deficiency, asymmetry, malocclusion and temporomandibular joint dysfunction. Moreover, open reduction carries risks for growth retardation, facial nerve injury, scarring and joint stiffness. The aim of this article is to present an alternative technique of the treatment by using a threaded Kirschner wire and external rubber traction. METHODS: From November 2005 to May 2008, three patients underwent the management by using a threaded Kirschner wire and external rubber traction. A threaded Kirschner wire was inserted in the condylar segment by using a C-arm. We applied the external rubber traction, and we reducted the segment progressively until complete reduction. The mandibular-maxillary fixations were removed after 3 weeks, and patients were sent to training for mouth opening. RESULTS: The technique didn't result in complications- joint dysfunction, facial nerve injury, sore, infection and nonunion during follow-up period. Radiologic follow-up examinations revealed correct reduction in all patients. In all cases, we found restoration of preinjury occlusion and temporomandibular joint function. CONCLUSION: Closed reduction of children mandibular condyle fracture by using a threaded Kirschner wire and external rubber traction did achieve anatomic reduction and restore mandibular height. This alternative technique is simple, effective, inexpensive, easy to apply and minimally invasive.

Clinical review of various surgical approaches in the treatment of mandibular condyle fracture

Open versus closed reduction of mandibular condyle fractures: A systematic review of comparative studies

Objective: The objective of this review was to provide reliable comparative results regarding the effectiveness of any interventions either open or closed that can be used in the management of fractured mandibular condyle PATIENTS AND METHODS: Research of studies from MEDLINE and Cochrane since 1990 was done. Controlled vocabulary terms were used. MeSH Terms were "Mandibular condyle" AND "Fractures, bone". Only comparative study were considered in this review using the "limit" function. According to the criteria, two review authors independently assessed the abstracts of studies resulting from the searches. The studies were divided according to some criteria, and following were measured: Ramus height, condyle sagittal displacement, condyle Towns's image displacement, Maximum open length, Protrusion & Lateral excursion, TMJ pain, Malocclusion, and TMJ disorder. RESULTS: Many studies were analyzed to review the post-operative result of the two methods of treatment. Ramus height decreased more in when treated by closed reduction as opposed to open reduction. Sagittal condyle displacement was shown to be greater in closed reduction. Condyle Town's image condyle displacement had greater values in closed reduction. Maximum open length showed lower values in closed reduction. In protrusive and lateral movement, closed reduction was less than ORIF. Closed reduction showed greater occurrence of malocclusion than ORIF. However, post-operative pain and discomfort was greater in ORIF. CONCLUSION: In almost all categories, ORIF showed better results than CRIF. However, the use of the open reduction method should be considered due to the potential surgical morbidity and increased hospitalization time and cost. To these days, Endoscopic surgical techniques for ORIF (EORIF) are now in their infancy with the specific aims of eliminating concern for damage to the facial nerve and of reducing or eliminating facial scars. Before performing any types of treatment, patients must be understood of both of the treatment methods, and the best treatment method should be taken on permission.

Retromandibular approach for open reduction & internal fixation of mandibular condylar neck fracture

Fractures of the mandibular condyle are account for between 26 percent and 57 percent of all mandibular fractures. Clinicians should decide how to treat the fractured condyle with many factors considered. Many surgical methods have been developed to reduction of fractured condyle and it's internal fixation. In open reduction of fractured condylar neck and subcondyle, retromandibular approach offers a safe and effective approach for direct fixation due to easy access and low surgical morbidity.

Retrospective study for prognosis after open and closed reduction of the mandibular condyle fractures

0.05). The level of the fracture influenced the ramus length and the degree of coronal change in the closed reduction group(P0.05). From the results obtained in this study, fractured mandibular condyles, were treated by closed reduction, had a tendency that continuous condylar displacement was occurred with aspect to horozontal and coronal plane in treatment period including intermaxillary fixation. And then there was a correlation between the level of the fracture and the position change in close reduction group statistically. These result suggested that care must be taken in basing treatment decisions on the degree of displacement of the condyle and in treating the mandibular condyle fractures for a long time.

Clinico-Statistical Analysis of Possible Factors Leading to Problems in The Surgical Treatment of Unilateral Mandiblar Condyle Fractures