Occlusal and temporomandibular joint disorders in patients with unilateral condylar fracture. A prospective one-year study.

Adult dentate patients with unilateral condylar fractures were followed up for one year after injury. Patients were interviewed about subjective complaints, and mandibular excursions and function of occlusion and temporomandibular joints (TMJs) were recorded. Radiological characteristics were assessed from panoramic and Towne's views and compared between patients with occlusal disorders and patients without. During follow up, mandibular deviation on opening towards the fractured side was more pronounced in cases with marked reduction of ramus height and condylar dislocation. This restriction of translation movement of the fractured joint was also seen radiologically in one-third of cases while in two-thirds of the fractured condyles, malpositioning was observed when compared with the healthy side. In patients (39%) having subjective symptoms such as TMJ pain, altered occlusion or ability to bite only unilaterally, and objectively verified occlusal interferences, a marked reduction of the ramus height on the fractured side was observed. In such cases nonoperative treatment of condylar fractures may be compromised.

Surgical treatment of condylar process fractures using axial anchor screw fixation: a preliminary follow-up study.

PURPOSE: The aim of this study was to evaluate use of the axial anchor screw system in the treatment of condylar process fractures. PATIENTS AND METHODS: Seven adult patients with displaced condylar process fractures were treated using axial anchor screw fixation. Indications for surgery were severe dislocation of the condyle and occlusal changes. Clinical and radiologic examinations were performed 6 weeks, 6 months, and approximately 2 years postoperatively (range, 18 to 30 months). Clinical factors recorded were occlusion, range of mandibular movement, and findings on palpation of the temporomandibular joints. Ramus height and angulation between the mandibular ramus and the dislocated condyle were measured and compared with the contralateral side preoperatively and at the last follow-up. RESULTS: The postoperative course was uneventful in most patients. All were free of pain, and the occlusion and facial symmetry were normal. Radiographs generally showed excellent fracture reduction. Translation of the condyles on mouth opening was symmetrical. No signs of resorption or osteoarthrosis were evident in most cases. However, some patients had complications. These involved unsatisfactory reduction in one patient causing osteolysis at the fracture line. In another patient bone over the screw fractured and the condyle and the screw tilted in a medial direction. CONCLUSION: Treatment of condylar process fractures using the axial anchor screw system is ideal in certain cases. The complications and difficulties seen may be avoidable by appropriate patient selection and techniques.

Analysis of possible factors leading to problems after nonsurgical treatment of condylar fractures.

PURPOSE: An attempt was made to identify types of condylar fractures that, despite active nonsurgical treatment, lead to unsatisfactory clinical results. PATIENTS AND METHODS: Ninety-two dentate adult patients with unilateral condylar fractures were studied clinically and radiologically. On the basis of the information collected, problematic cases were identified. These consisted of patients with persistent occlusal change and/or marked deviation of the mandible on mouth opening after removal of maxillomandibular fixation or during follow-up. Radiologic analyses were performed using panoramic and Towne's views, and the results of problematic and nonproblematic cases were compared. RESULTS: Using clinical parameters, two problem groups were found. In patients with persistent malocclusion, ramus height was significantly reduced, irrespective of degree or direction of angulation between the fragments. Deviation of the jaw on mouth opening, but no occlusal disturbances, occurred in those with dislocated condyles. CONCLUSION: Problematic condylar fractures can often be identified preoperatively by means of simple radiographic measurements and these cases should probably be treated surgically.

Dental injuries in association with mandibular condyle fractures.

A total of 356 patients with mandibular condyle fractures were studied regarding associated dental injuries. One third of the patients had injured teeth, on average, 3.7 teeth had been injured per accident. Dental traumas were distributed equally between the anterior (incisors and canines) and posterior teeth (premolars and molars) in both jaws. In unilateral condylar fracture cases maxillary dental injuries involved more often premolars and/or molars of the fracture side than those of the nonfracture side. The mean number of dental traumas in the mandible was higher in cases of simultaneous mandibular body fracture than without, whereas the presence of mandibular body fracture did not affect number of associated dental injuries in the maxilla. The dental injuries were mostly to hard tissue (78%), which were commonest in men, 20 to 29 years of age, and in victims of violence or fall accidents. Severe dental injuries in association with mandibular condyle fractures were more common in accidents due to traffic and miscellaneous causes than in those due to violence. Severe dental injuries were more often encountered when simultaneous mandibular body fracture was present than when it was not and more so in bilateral than unilateral condylar fracture cases. The most important factor correlating with the severity of dental injuries was the presence of bilateral condylar fracture.

Treatment of mandibular fractures in the 1980s.

Treatment of 317 mandibular fracture patients between 1981 and 1990 at the Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Oulu and Oulu University Hospital were analysed on the basis of patient files and radiographs. The patients had suffered altogether 452 mandibular fractures, most in the condylar region. The treatment was operative in 24% of cases and conservative in 76%. Operative treatment was commoner in edentulous than in partially edentulous or dentate patients. The proportion of operatively treated mandibular fractures increased toward the end of the period. The type of osteosynthesis also changed over the decade as wire and plate osteosynthesis gave way to compression plating and then to titanium miniplate and screw fixation of fractures. The advantages and disadvantages of the treatment methods are discussed and some typical cases using various modern fixation techniques are presented.

Mandibular fractures in northern Finland in the 1980s--a 10-year study.

A total of 317 mandibular fracture patients treated and diagnosed at the Oulu University Hospital and at the Department of Oral and Maxillofacial Surgery, University of Oulu, Finland, between 1981 and 1990 were analyzed from patient files and radiographs. The mean number of mandibular fracture patients per year was 31.7 (range 21 and 45) and the mean age of the patients 31.3 years (range 4-78 years). The female:male ratio was 1:3.1. There seemed to be a tendency for decrease in the proportion of violence and traffic accidents as causes of mandibular fractures toward the end of the period concerned, reflecting partly the influence of mandatory use of safety belts and partly that the hospital in the northernmost part of Finland, where the consumption of alcohol is higher than in the province of Oulu, could treat all mandibular fractures itself during the last year studied thus decreasing the injuries caused by violence at the Oulu University Hospital. It was also noted that fewer fractures were caused at weekends than on weekdays during the latter years of the decade and that the proportion of male victims decreased except for the last year examined, 1990.

Frequency and type of dental traumas in mandibular body and condyle fractures.

Dental injuries in association with 207 mandibular fractures were evaluated from patient files and radiographs. It was shown that 32% of the dentulous patients with condylar fractures had dental injuries, approximately 3.7 traumatised teeth per patient, most of which were dental hard tissue injuries and situated typically in the maxillary molar region. Dental injuries were diagnosed in 30% in association with mandibular corpus fractures, approximately 3.6 traumatised teeth per patient, and injuries were more often dental luxations in the anterior part of the mandible. It was found that 143 teeth were involved in the line of mandibular corpus fracture of 105 patients (1.4 per patient). More than half of the fracture lines were diagnosed as passing the periodontal ligament.

Different patterns of condylar fractures: an analysis of 382 patients in a 3-year period.

Three hundred eighty-two patients with 443 condylar fractures, accounting for 52.4% of all mandibular fractures, were given diagnoses and treated in our department between 1987 and 1989. A high proportion of the fractures (44%) were caused by interpersonal violence, followed in incidence by falls (29%) and road traffic accidents (21%). The type of condylar fracture seems to be influenced directly by its cause. Severe fractures in which the condyle was dislocated out of the glenoid fossa resulted more often from falls (22%) and road traffic accidents (26%) than from violence (8%). Fractures caused by violence showed a uniform type characterized by a subcondylar location and nondisplacement or deviation at the fracture line. A relatively large number of patients (56, 15%) were considered to have an indication for open reduction of the fracture.

Frequency of alcohol-associated mandibular fractures in northern Finland in the 1980s.

In order to evaluate the frequency of alcohol-associated mandibular fractures, information on patients treated and diagnosed at a University Hospital and Dental Institute in northern Finland between 1981 and 1990 was analysed. Altogether, 117 male patients (out of 239) and 23 female patients (out of 78) were under the influence of alcohol at the time of accident. The annual risk for men receiving a mandibular fracture under the influence of alcohol (odds ratio) varied between 0.6 and 6.6, compared with female patients. More alcohol-associated mandibular fractures occurred in late summer and autumn and fewer in spring. Patients suffering mandibular fractures at weekends were more often under the influence of alcohol than those injured on weekdays. There seemed to be a tendency for the proportion of alcohol-associated mandibular fractures to decrease towards the end of the decade.