Virtual surgical planning is a useful tool in the surgical management of mandibular condylar fractures / 中华创伤杂志(英文版)

PURPOSE@#The aim of this study is to evaluate the application value of virtual surgical planning in the management of mandibular condylar fractures and to provide a reliable reference.@*METHODS@#This was a prospective randomized controlled study and recruited 50 patients requiring surgical treatment for their mandibular condylar fractures. The inclusion criteria were patients (1) diagnosed with a condylar fracture by two clinically experienced doctors and required surgical treatment; (2) have given consent for the surgical treatment; and (3) had no contraindications to the surgery. Patients were excluded from this study if: (1) they were diagnosed with a non-dislocated or only slightly dislocated condylar fracture; (2) the comminuted condylar fracture was too severe to be treated with internal reduction and fixation; or (3) patients could not complete follow-up for 3 months. There were 33 male and 17 female patients with 33 unilateral condylar fractures and 17 bilateral condylar fractures included. The 50 patients were randomly (random number) divided into control group (25 patients with 35 sides of condylar fractures) and experimental group (25 patients with 32 sides of condylar fractures). Virtual surgical planning was used in the experimental group, but only clinical experience was used in the control group. The patients were followed up for 1, 3, 6 and 12 months after operation. Variables including the rate of perfect reduction by radiological analysis, the average distance of deviation between preoperative and postoperative CT measurements using Geomagic software and postoperative clinical examinations (e.g., mouth opening, occlusion) were investigated for outcome measurement. SPSS 19 was adopted for data analysis.@*RESULTS@#The average operation time was 180.60 min in the experimental group and 223.2 min in the control group. One week postoperatively, CT images showed that the anatomic reduction rate was 90.63% (29/32) in the experimental group and 68.57% (24/35) in the control group, revealing significant difference (X2 = 4.919, p = 0.027). Geomagic comparative analysis revealed that the average distance of deviation was also much smaller in the experimental group than that in the control group (0.639 mm vs. 0.995 mm; t = 3.824, p < 0.001).@*CONCLUSION@#These findings suggest that virtual surgical planning can assist surgeons in surgical procedures, reduce operative time, and improve the anatomic reduction rate & accuracy, and thus of value in the diagnosis and treatment of condylar fractures.

Indication selection and efficacy analysis of condylar fracture / 口腔疾病防治

Objective@#The present study examined the effects of surgical and conservative treatment on the curative effect of patients with condylar fracture to determine the best treatment scheme and indication. @* Methods @#A total of 339 clinical cases of condylar fracture were selected, and pain severity, degree of mouth opening, angle of condylar fracture (calculated as the difference in the angle of the condylar between the fractured side and uninjured side) and the height of the mandibular ramus (calculated as the difference in the height of the mandibular ramus between the fractured side and uninjured side) of patients at admission were measured and analyzed. The effects of surgical treatment (rigid internal fixation) and conservative treatment (functional therapy) were evaluated and compared 6 months after treatment. @*Results @#Among the patients with a condylar fracture displacement angle ≥ 11.50°, Significantly more (χ2= 26.38, P < 0.05) patients exhibited good recovery 6 months after surgical treatment [69.4% (118/170)] than those after conservative treatment [35.4% (29/82)]. Among the patients with a condylar fracture displacement angle < 11.50°, there was not a significant difference (χ2= 0.55, P > 0.05) between the numbers of patients who exhibited good recovery 6 months after surgical treatment [52.4% (22/42)] and conservative treatment [44.4% (20/45)]. Among the patients with mandibular ramus height ≥ 4.19 mm, significantly more (χ2= 20.35, P < 0.05) patients exhibited good recovery 6 months after surgical treatment [64.7% (112/173)] compared with those after conservative treatment [35.6% (32/90)]. Among the patients with mandibular ramus height < 4.19 mm, there was not a significant difference (χ2= 0.21, P > 0.05) between the numbers of patients who exhibited good recovery 6 months after surgical treatment [46.7% (14/30)] and conservative treatment [41.3% (19/46)]. @*Conclusion@# Patients with a displacement angle of condyle fracture greater than 11.50° and a mandibular ramus height less than 4.19 mm exhibit the greatest pain and a better effect from surgical treatment than those from conservative treatment.

Oral motor and electromyographic characterization of adults with facial fractures: a comparison between different fracture severities

OBJECTIVES: To characterize the oral motor system of adults with facial injuries and to compare the oral motor performance/function between two different groups. METHODS: An observational, descriptive, cross-sectional study was conducted in 38 patients presenting with facial trauma who were assigned to the Division of Orofacial Myology of a Brazilian School Hospital. Patients were divided into two groups: Group 1 (G1) consisted of 19 patients who were submitted to open reduction of at least one facial fracture, and Group 2 (G2) consisted of 19 individuals who were submitted to closed fracture reduction with maxillomandibular fixation. For comparison purposes, a group of 19 healthy volunteers was recruited. All participants underwent a clinical assessment that included an oral motor evaluation, assessment of the mandibular range of motions, and electromyographic assessment of the masticatory muscles. RESULTS: Clinical assessment of the oral motor organs indicated that G1 and G2 presented deficits related to the posture, position, and mobility of the oral motor organs. Patients also presented limited mandibular ranges of movement. Deficits were greater for individuals in G1, especially for maximal incisor opening. Additionally, patients in G1 and G2 presented a similar electromyographic profile of the masticatory muscles (i.e., patients with facial fractures presented lower overall muscle activity and significant asymmetrical activity of the masseter muscle during maximum voluntary teeth clenching). CONCLUSION: Patients in G1 and G2 presented similar functional deficits after fracture treatment. The severity of facial fractures did not influence muscle function/performance 4 months after the correction of fractures.

Surgical treatment of adult mandibular condylar fractures:a clinical analysis of 32 cases / 天津医药

Objective To investigate the effect of surgical treatment of adult mandibular condylar fractures (including intracapsular fracture). Methods Thirty-two patients (33 sides) with condylar fractures underwent open reduction and rigid fixation. Six patients with intracapsular condylar fractures were treated with two 18-mm positional screws through a preauricular approach. Six patients (7 sides) with condylar neck fractures were rigidly fixed by 1 mini-plate via a retromandibular transparotid approach. Twenty patients with subcondylar fractures were operated and fixed by two titanium plates using an angular approach. Results The mean follow-up period was 13.5 months, and the mean maximum mouth opening was 37.5 mm by the last visit. All patients acquired good occlusal relationship and mandibular symmetry. Seven patients (21.9%) experienced transient palsy of the branches of the facial nerve, and recovered completely after three months. One patient developed a salivary fistula, and healed after two weeks of gauze compression. No permanent deficit of any facial nerve branch was observed. No patient showed condylar head resorption. Conclusion Appropriate surgical approaches and fixation methods for different types of condylar fractures are the key factors to achieve reliable clinical results.

Analysis of two different surgical approaches for fractures of the mandibular condyle.

Background: Fractures of the condyle account for one third of all the mandibular fractures. Different surgical approaches to the condyle described hitherto testify to the advantages and disadvantages of the different surgical techniques used for approaching the condyle in such cases of fractures. We have described and compared two of such surgical techniques in this study. Aim: The aim of this study is to compare the outcome of dealing with condylar fractures by two different surgical techniques: the mini retromandibular approach, and the preauricular approach. Materials and Methods: A prospective study of 31 patients who had suffered with mandibular condylar fractures was carried out. Of these, 26 patients had unilateral condylar fractures, and 5 patients had a bilateral fracture. Further, 19 of these patients were treated by the mini retromandibular approach and 12 by the preauricular approach. The treated patients were followed up and evaluated for a minimum period of 1 year and assessed for parameters such as the maximum mouth opening, lateral movement on the fractured side, mandibular movements such as protrusion, dental occlusion, scar formation, facial nerve weakness, salivary fistula formation and time taken for the completion of the surgical procedure. Statistical Analysis: t- test was used for statistical analysis of the data obtained in the study. Results: Dental occlusion was restored in all the cases, and good anatomical reduction was achieved. The mean operating time was higher 63.53 (mean) ± 18.12 minutes standard deviation (SD) in the preauricular approach compared to 45.22 (mean) ± 18.86 minutes SD in the mini retromandibular approach. Scar formation was satisfactory in almost all the cases.

Y-reconstruction plate for the treatment of humeral condylar fracture with different surgical approaches / 中国矫形外科杂志

0.05).Complications included 6 cases of delayed union,1 cases of severe elbow stiffness,3 cases of heterotopic ossification,2 cases of ulnar nerve palsy,in which one case recovered after 6 months,another case remained symptoms.[Conclusion]With appropriate training aids,the majority of patients have good effect.Same good clinical outcome have been achieved for treatment of intracondylar humeral fractures with either triceps splitting approach or the olecranon osteotomy approach.

Nonsurgical management of pediatric condylar fractures: cases reports

Retrospective clinical analysis of 56 cases of condylar fractures / 医学研究生学报

Objective: To evaluate different treatment methods for condylar fractures.Methods: Retrospective analyses were made of the clinical data of 56 cases of condylar fractures treated from January 1996 to December 2007.Results: Condylar fractures occurred mostly in males(82.14%),and 89.29% of the patients were aged 20-50 years.Traffic accidents accounted for 51.79% and falling 26.79% of the causes,48.21% of the cases accompanied with injuries of other parts of the body,and 89.29% restored to normal occlusion after surgical or non-surgical treatment.Conclusion: The effect of the treatment is related with the type and severity of the fractures,the choice of surgical indications and the standardization of treatment.A thorough evaluation of the fractures is necessitated.The best protocol for condylar fractures should be intermaxillary elastic traction,surgical anatomic reduction plus rigid internal fixation by Ti plate.

Comparative study on the osseous changes of the TMJ and mandibular asymmetry after conservative or operative treatment in condylar fracture patients / 대한구강악안면방사선학회지

PURPOSE: To compare the effects of the conservative treatment and operative treatment by observation of osseous changes of the TMJ and mandibular asymmetry in condylar fracture patients. MATERIALS AND METHODS: 33 condylar fracture patients (17 with conservative and 16 with operative treatment) were included in this study. After a minimum of 6 months after the surgical procedure, patients were given a follow up examination of the osseous changes using a transcranial view. Differences in the osseous changes of both groups were compared and the asymmetry indices were calculated on a postero-anterior skull view. RESULTS: The TMJ of the operative treatment group showed more significant osseous changes than the conservative treatment group. The affected TMJ showed more significant osseous changes than the unaffected TMJ in the both groups. The unaffected TMJ of the conservative group and the affected TMJ of the operative group showed significant osseous changes. The mandibular asymmetry indices in the conservative and operative group were 5.12 and 7.30 respectively at the time of treatment, and 2.39 and 3.41 respectively at the follow-up. But the mandibular asymmetry between the both groups showed no statistical differences. CONCLUSION: The TMJ of the operative group showed more significant osseous changes than the conservative group, but the mandibular asymmetry between the both groups showed no statistical difference.

Clinical Studies Of Lag -Screw Osteosynthesis In Condylar Fractures Of The Mandible

This study evaluated clinical and radiographic results after open reduction and lag-screw fixation of mandibular condyle fractures. PATIENTS AND Methods : 26 patients had been treated by lag-screw fixation for madibular condyle fracures via submandibular approach and follow up for over 6 months. The lag-screw used in this study was designed by Eckelt. Radiographically, resorption of the condyle head found in 4 cases (15%) and minimal displacement of the condyle head was found in 3 cases (12%). Post-operative infection were not found in all cases. Clinically, All patiens had a stable occlusion and normal mouth opening (over 40mm). TMD problems with crepitus or some discomfort encountered in 4 patients but tolerable to the patients. CONCLUSION: Lag screw fixation can be a good option especially high level condylar fractures, however this procedure must be used in cautiously because of slipping of the fragments and possible to resorption of the fragments.