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PubMed1998

Open reduction without fixation of dislocated condylar process fractures: long-term clinical and radiologic analysis.

PURPOSE: This study evaluates the long-term results of open reduction without fixation for displaced fractures of the condylar process. PATIENTS AND METHODS: Clinical and radiologic examinations were performed on 27 patients with 29 operated joints an average of 6.7 years postoperatively. The postoperative result was evaluated on the basis of occlusal and joint function, as well as radiographic assessment of condylar changes. RESULTS: Clinically, satisfactory results were achieved. Radiologically, despite correct intraoperative alignment of the fractured segments, a slight medial deviation of the condylar process was found on the posteroanterior radiograph. However, in only two cases was a 20-degree deviation observed. On final follow-up, 48% of the cases had a normal condylar configuration radiologically, and in the remaining cases, normal function was established even though there were condylar changes. Fully exposed and devascularized condylar processes generally showed more severe changes than those in which partial vascularization was maintained. CONCLUSION: The surgical management described enables a satisfactory outcome to be achieved with dislocated condylar process fractures.

Adolescent↗
PubMed1998

Adaptations of the masticatory system after bilateral fractures of the mandibular condylar process.

PURPOSE: The objective of this investigation was to evaluate the adaptations that occur in the masticatory system after treatment of bilateral fractures of the mandibular condylar process. PATIENTS AND METHODS: Twenty-two patients (15 men and seven women) with bilateral condylar process fractures treated by open reduction and rigid internal fixation (n = 6), closed therapy (n = 14), or a combination of these techniques (n = 2) were compared with 22 sex- and age-matched controls. Measures of mandibular range of motion, bite force, muscle activity, estimated joint forces, and skeletal morphology were determined at 6 weeks, 6 months, and 1, 2, and 3 years after treatment in all subjects. Various statistical tests were used for comparing differences between patients and controls. RESULTS: There was no significant difference in the patients' morphologic measures for the open and closed reduction procedures; therefore, all of these patients were tested as a single group. After treatment, patients had significantly increased mandibular plane and gonial angles and decreased facial axis angles. They also showed a significant reduction in posterior facial height and moment arm length for the masseter and pterygoid muscles. Anterior and posterior temporalis muscle direction also was significantly different between patients and controls. Patients had significantly limited mobility during the first year after fracture. Bite forces were lower for patients at all times and tooth positions, with a significant difference at 6 weeks after treatment. Patients had a tendency to use proportionally higher temporalis muscle activity during maximum biting; however, the differences were not statistically significant, probably because of the small sample size. The estimated joint force magnitudes were essentially identical between patients and controls; however, the direction of the patients' joint forces were more posteriorly directed for both incisor and molar bites. CONCLUSION: The results of this study suggest that early reduction in mandibular range of motion, bite force, and the distribution of masticatory muscle activity assist in preventing overloading of the bilaterally fractured mandibular condylar processes.

Adaptation, Physiological↗
PubMed1999

Fractures of the condylar process: surgical versus nonsurgical treatment.

PURPOSE: The purpose of this study was to compare outcomes from surgical and nonsurgical treatment of condylar process fractures. PATIENTS AND METHODS: Two hundred thirty-four patients with fractures of the mandibular condylar process were treated by open or closed methods. In the follow-up study, 150 patients with a mean follow-up time of 2.5 years were analyzed using radiologic and objective and subjective clinical examinations. RESULTS: No significant difference in mobility, joint problems, occlusion, muscle pain, or nerve disorders were observed when the surgically and nonsurgically treated patients were compared. The only significant difference was in subjective discomfort. Surgically treated patients showed significantly more weather sensitivity and pain on maximum mouth opening. CONCLUSION: Because of its disadvantages, open surgery is only indicated in patients with severely dislocated condylar process fractures.

Adolescent↗
PubMed1999

Further displacement of condylar process fractures after closed treatment.

PURPOSE: This study examined the changes in the position of the fractured condylar process immediately before and immediately after application of arch bars and at 6 weeks after surgery in a group of patients who underwent closed treatment. PATIENTS AND METHODS: Sixty-five patients over the age of 16 years underwent closed treatment of unilateral mandibular condylar process fractures. Coronal and sagittal displacement of the condylar process was examined using Towne's and panoramic radiographs before treatment, immediately after placement of arch bars, and at 6 weeks. The change in position of the condylar process from one time to the next was analyzed statistically. RESULTS: There was a statistically significant difference (mean, -5.5 degrees) in the coronal position of the condylar processes from immediately after injury to immediately after placement of arch bars. There was great variability, with some segments becoming more medially displaced and some more laterally displaced. In contrast, mean change in the sagittal position of the condylar process was not statistically significant, although some became more anteriorly and others became more posteriorly displaced. Similarly, from immediately after placement of arch bars to 6 weeks, there was great variability in position of the condylar process, but the overall change was not statistically significant. CONCLUSIONS: The results of this study showed that position of the condylar process is not static in patients treated for condylar process fractures by closed means. These results suggest that care must be taken in basing treatment decisions on the degree of displacement or dislocation of the condylar process in presurgical radiographs.

Adolescent↗
PubMed1977

Condylar fractures of the mandible. IV. Function of the masticatory system.

The masticatory system was followed-up with respect to symptoms of dysfunction such as restricted mandibular movements, tenderness, and clicking from muscles and joints at predetermined times after condylar fractures of the mandible in 24 children, 17 teenagers, and 26 adults. Two years after the trauma, the initially reduced (less than 40 mm) maximal opening became normal (larger than or equal to 40 mm) in all but one individual. Asymmetry of mandibular movements, such as deviation at maximal opening and differences between fractured and nonfractured side in maximal lacterotrusion and protrusion, usually disappeared within 2 years in children, while it persisted or became aggravated in adults. Persistent symtoms from the joints and muscles, such as clicking and tenderness, were rare in children and frequent in adults.

Adolescent↗
PubMed1977

Condylar fractures of the mandible. II. a radiographic study of remodeling processes in the temporomandibular joint.

Remodeling processes in 76 temporomandibular joints were studied on radiographs from 67 individuals sustaining condylar fractures. The indivuduals were ranged into four age groups: 3-11, 12-15, 16-19, and larger than or equal to 20 years of age at the time of fracture. The radiographic examinations were to be performed at the time of the trauma and 3, 6, 12, 24 and 36-48 months after the injury. In the age group 3-11 there was a complete return to normal skeletal relations in 20 of the 27 joints. Joints in teenagers (12-19) did not become normal to the same extent and in adults only minor remodeling was observed. In children the remodeling of the condylar process was extensive but indistinctly outlined. With increasing age there was a shift towards a more distinct apposition of bone on the posterior part of the condylar head visualized as a double contour. This contour first appeared in the late teens. In adults the remodeling processes seemed only to be part of the functional adjustment. Thus, the remodeling processes of the condylar process in a clinical sense may be looked upon as restitutional in children and adjusting or functional in adults. As regards the articular fossa, in children the remodeling processes were first observed as a double contour, of which the new one became more and more distinct, while the original roof gradually disappeared. The final results was a flattened fossa. In adults, a sclerosis of the roof of the fossa was found.

Adolescent↗
PubMed1977

Condylar fractures of the mandible. III. positional changes of the chin.

Positional changes of the chin (symphysion = sy) following unilateral condylar fractures of the mandible were studied in 21 children and 20 adults by means of repeated radiographic examinations. On each occasion and for each individual the actual position of the sy was related to an estimated normal position. In those children in whom the remodeling processes in the temporomandibular joint (TMJ) resulted in normal skeletal relation, the result of the subcondylar fractures seemed to be a deviation of the sy towards the nonfractured side. In cases of condylar head and neck fractures a deviation towards the fractured side frequently occurred. In four of the five children in whom normal skeletal relation in the TMJ was not obtained, the sy deviated towards the condylar fracture side. In the majority of the adulsts, a deviation towards the condylar fracture side occurred irrespective of the level of the condylar fracture.

Adult↗
PubMed1978

Treatment of fractures of the articular process by functional stable osteosynthesis using miniaturized dynamic compression plates.

The application of miniplates in fractures of the base of the articular process, developed by Schilli for orbital stabilization of malar bone impression fractures, is reported. The ends of the fragments after open reposition and reduction of the proximal fragment could be fixed durably by functional stable compression osteosynthesis in 35 patients with fractures and luxation or dislocation. In spite of the technical difficulties in performing this operative method the procedure should find a large application because of the optimum anatomic and functional results.

Bone Plates↗
PubMed1978

Role of the meniscus in the etiology of posttraumatic temporomandibular joint ankylosis.

From an analysis of the factors that could contribute to the development of post-traumatic TMJ ankylosis, it is evident that a number of different conditions are probably operant. Based on clinical and experimental findings, however, it is suggested that of primary importance is the location of the meniscus in relation to the fracture site. It is proposed that the meniscus normally serves as a barrier to prevent fusion of the distal fragment with the glenoid fossa, and that ankylosis generally occurs if this relationship is not maintained. Based on this concept, possible modifications in the management of fractures of the condyloid process are suggested.

Age Factors↗
PubMed1980

The vertical avulsion flap.

Unilateral vertical tangential maxillofacial trauma may result in a combination of a certain number of charcteristic lesions. Although composed of wounds and fractures in the upper, middle and lower third of the face, this form of injury can be considered to be a separate distinct entity. Two patients are described, illustrating this type of injury. Both also sustained trauma of the ipsilateral shoulder.

Accidents, Traffic↗
PubMed1985

The shape of the mandible.

The validity of traditional cephalometric techniques for orthognathic surgical diagnosis and planning remains controversial. This not only reflects the fact that the linear and angular parameters combine size and shape together, but the techniques also generally rely upon non-homologous datum points, with the resultant data being of dubious mathematical significance. In order to circumvent these problems, the technique of medial (symmetric) axis transformation was used to compare mandibular shapes derived from lateral cephalographs of patients with various anomalies. This technique centers on defining the central (medial) axes of mandibular form and is based on equal weighting of points defining the peripheral border independent of cephalographic orientation. Measurement of the derived medial axes and their relative orientation described marked changes in mandibular shape resulting from pathosis and surgical intervention. However, further research is required to ascertain whether this specific technique for the description of biologic shape facilitates orthognathic surgical diagnosis and planning.

Adolescent↗