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.

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.

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.