ABSTRACT
PURPOSE: This study was to evaluate the postoperative stability of the mandibular condyle according to the number of screws in the proximal segment using cone beam computed tomography (CBCT). PATIENTS AND METHODS: Thirty patients diagnosed with skeletal class III malocclusion and underwent sagittal split ramus osteotomy (SSRO) were enrolled in this study. In Group A, 4 screws and a 4-hole miniplate were used for the internal fixation of an osteotomy and 3 screws, only 1 screw in the proximal segment, and a 4-hole miniplate were used in Group B. We digitally measured anteroposterior, supero-inferior, and mediolateral positions and angles of the long axis of the mediolateral poles in CBCT scans pre-operatively, within 1 week postoperatively and 3, 6 months after surgery. RESULTS: The condylar head angle in the axial plane showed consistent and significant changes. The condylar head angle in the coronal plane decreased in both groups, which shows that condylar heads bent inward. In the axial plane, Group A showed statistically significant differences while Group B did not in early stage (T0-T1-T2). The change in distance between condylar heads shows that these have moved outward in both groups. CONCLUSION: The results show that a fixation method using 3 screws with a 4-hole miniplate did seemed preferable and may give some flexibility for condylar heads to be positioned in physiologic position during postoperative phase.
Subject(s)
Bone Screws , Cone-Beam Computed Tomography/methods , Malocclusion, Angle Class III/surgery , Mandibular Condyle/diagnostic imaging , Orthognathic Surgical Procedures/methods , Adolescent , Adult , Anatomy, Cross-Sectional/methods , Bone Plates , Cephalometry/methods , Female , Follow-Up Studies , Humans , Image Processing, Computer-Assisted/methods , Imaging, Three-Dimensional/methods , Male , Orthognathic Surgical Procedures/instrumentation , Osteotomy, Sagittal Split Ramus/instrumentation , Osteotomy, Sagittal Split Ramus/methods , Rotation , Temporal Bone/diagnostic imaging , Treatment Outcome , Young AdultABSTRACT
Condyle fractures represent 20% to 30% of all mandibular fractures and are thus among the most common facial fractures. The fracture pattern can vary greatly and may occur anywhere along the line from the sigmoid notch to the mandibular angle. The main problems are access, difficulty in repositioning the extremely slender fragments, and fixation of the condyle.Eighty-seven patients were diagnosed with condylar neck or condylar base fractures from January 2007 to December 2009 in the Department of Oral & Maxillofacial Surgery of Kyung Hee University Dental Hospital. In this study, we included 35 patients who underwent open surgery and a total of 28 patients who were treated using a retromandibular transparotid approach.Surgical treatment aims were anatomic repositioning and rigid fixation of the fragments, occlusal stability, rapidly return to function, maintenance of vertical ramus dimension, no airway compromise, and reduced long-term temporomandibular joint dysfunction. Considering the high rate of occurrence of condylar fracture and the importance of the condylar as a growth center of the mandible, extraoral approaches for the open reduction of condylar fractures are considered effective and can be used widely.Short access route, easy reduction, short operating time, and stable postoperative occlusion are the advantages of the retromandibular transparotid approach. Also, there was no permanent damage from facial nerve injury, salivary leakage, or preauricular hypoesthesia. Therefore, the retromandibular transparotid approach is considered a safe and effective method for patients with a condylar neck or condylar base fracture classified according to the Strasbourg Osteosynthesis Research Group's classification, who require surgical treatment with an extraoral approach.