Evaluation of the Efficacy of Three Times Titanium Plate Gradual Fixation Method in the Treatment of Extracapsular Condylar Fractures.

OBJECTIVE: An improved method of treating inwardly dislocated mandibular extracapsular condylar fracture-three times titanium plate gradual fixation method was introduced, and the clinical efficacy of this method was evaluated. METHODS: Twenty patients with extracapsular condylar fractures who underwent surgical treatment using the three times titanium plate gradual restoration and fixation method in the Department of Oral Craniomaxillofacial Surgery of the Ninth People's Hospital of Shanghai from November 2020 to June 2023 were selected as the study subjects. RESULTS: After condylar restoration 22 sides reached healing and 1 side was basically healed; in 3 months after the operation, the degree of opening the mouth and the type of the opening of the mouth reached normal, and 1 case had mildly poor occlusion, which required to be further adjusted through orthodontics, and there was no temporomandibular function disorder or facial nerve function damage. CONCLUSION: Three times of gradual fixation with a titanium plate can make the condylar process achieve precise and stable repositioning, and make the surgical process orderly, and it is a kind of reliable fixation method for extracapsular condylar fractures.

Management of Mandibular Condylar Sagittal Fracture Accompanied by Lateral Condylar Crest Defect.

BACKGROUND: The sagittal fracture of the mandibular condyle can be fixed with absorbable long screws. Absorbable long screws are generally inserted from the lateral crest of the condyle and are as close as possible to the medial pole of the condyle to obtain sufficient retention force. However, in clinical practice, patients with locally comminuted condylar fractures and partial defects in the lateral crest are often encountered. We validated the use of absorbable plates and long screws to fix mandibular condylar fractures with lateral crest defects, and postoperative follow-up showed good results. METHODS: The preoperative design indicated that if conventional long screws were used, more soft tissue need to be pulled downward to achieve the appropriate drilling angle. If an absorbable plate was used, the degree of downward pulling of soft tissue was smaller, which can better protect the parotid gland tissue and facial nerve. The surgery was performed according to the preoperative design, using an absorbable plate scheme. RESULTS AND DISCUSSION: Postoperative CT confirmed a stable anatomical reduction of condyle. Four-month follow-up showed that the patient's facial shape, occlusion, and mouth opening were all good. Follow-up CT showed good fracture healing. It is feasible to use absorbable plates and long absorbable screws to fix mandibular condylar sagittal fracture accompanied by lateral condylar crest defect.

Characteristics of pediatric mandibular condylar fractures in Southwest China: A single-center and 12-year retrospective study.

BACKGROUND/AIM: Mandibular condylar fractures in pediatric patients may exhibit distinct epidemiological characteristics attributed to their unique growth and development phase, as well as various anatomical, physiological, biomechanical, and behavioral factors that differentiate them from adults. This study aimed to investigate the demographics, injurious factors, classifications, clinical manifestations, and treatments of pediatric mandibular condylar fractures, as well as the concomitant injuries in maxillofacial and other body parts. MATERIALS AND METHODS: This retrospective study analyzed the clinical data of 189 pediatric patients with mandibular condylar fractures between 2011 and 2022. Variables investigated included age, gender, timing of onset, causes, classification of condylar fracture, concomitant injuries, clinical manifestations, and treatment modalities. RESULTS: A total of 189 patients, a higher proportion of boys compared to girls was observed, with the highest incidence rate in children aged 1-3 years. They occurred primarily in July, June, and September as well as on Saturdays and Sundays. The most prevalent cause of mandibular condylar fractures was falls from heights in 73 patients (38.62%). Pediatric patients exhibited a higher susceptibility to condylar head fractures. A significant majority (81.48%) of these fractures were accompanied by soft tissue injuries in the maxillofacial region, with the chin being particularly vulnerable to injury. In addition, 61.90% of pediatric patients experienced fractures in other areas of the maxillofacial region, with the mandibular symphysis being the most commonly affected site. Dental trauma predominantly occurred in the anterior region (44.97%). Notably, a substantial proportion (28.04%) of cases also presented with multiple systemic injuries. CONCLUSIONS: The characteristics of pediatric mandibular condylar fractures exhibit distinct features in terms of age, gender, timing of onset, etiology, location and type, the presence of concomitant maxillofacial soft/hard tissue injuries and multiple systemic injuries, as well as clinical manifestations and treatment modalities. Therefore, clinicians should pay special attention to the diagnosis and treatment of pediatric condylar fractures.

[Fractures of the mandibular condyle]. / Fracturen van het collum mandibulae.

A fracture of the mandibular condyle is a common fracture of the mandible. After the diagnosis has been made, there are various treatment options: wait and see, conservative or surgical. Which of these treatment options is best depends on several different factors and is often the subject of debate. A common complication of a fracture of the mandibular condyle is malocclusion. Malocclusion can cause problems - even in the long term - for which the patient often requires secondary treatment.

Does the Treatment Approach for Mandibular Condyle Fractures Impact Self-Perceived Quality of Life?

PURPOSE: There is no consensus in mandibular condylar fracture/s treatment. In medicine, quality of life (QOL) includes the individual's satisfaction toward their own health condition, disease, or treatment. The purpose of this study was to investigate self-perception QOL outcomes for patients who sustained mandibular condylar fracture/s. METHODS: This cross-sectional study surveyed patients at Grady Memorial Hospital in Atlanta, Georgia from November 2016 to June 2020. The study included patients who were at least 16 years old at the time of injury, diagnosed with mandibular condylar fracture/s, treated by close reduction or open reduction and internal fixation (ORIF), presented for 6-months post-operative follow-up, and had a valid phone number. The primary predictor variable was treatment approach. The primary outcome variable was mood. Covariates were demographics, injury details, and self-perception QOL questionnaire. Univariate, bivariate, and ordinal regression analysis were performed (P < .05 significance). RESULTS: A total of 108 patients met inclusion criteria. Response rate was 84.2%. Our data showed that patients who underwent ORIF treatment were statistically more likely to experience no or milder pain when chewing (tau = 0.390, P = .002), to not require pain medications (tau = 0.389, P = .002), to report larger maximum mouth opening (tau = 0.402, P = .0003), and to report better QOL (tau = 0.440, P = 7.407e-05). Ordinal regression analysis showed that patients who had undergone ORIF treatment were positively associated with better mood (estimate: -0.062; OR: 0.54; P = .29) and statistically significant associated with excellent QOL (estimate: -2; OR: 0.13; P = 3.99e-05). Patients who sustained class III Lindahl mandibular condyle fracture were statistically significantly associated with depressed mood (estimate: 1.46; OR: 4.33; P = .002). CONCLUSION: ORIF treatment was positively associated with better QOL when compared to closed reduction for mandibular condyle fracture.

Transoral Endoscopic-Assisted Reduction and Internal Fixation of Mandibular Condylar Fractures in Children.

PURPOSE: Extraoral approaches for open reduction and fixation of condylar fractures in children are associated with serious risks of complications, including facial nerve injury, facial scarring, parotid fistula, and auriculotemporal nerve injury. The purpose of this study was to retrospectively evaluate the outcomes of transoral endoscopic-assisted open reduction and internal fixation of condylar fractures and hardware removal in pediatric patients. MATERIAL AND METHODS: This study was designed as a retrospective case series. The study included pediatric patients admitted with condylar fractures that were indicated for treatment with open reduction and internal fixation. The patients were clinically and radiographically evaluated with regard to occlusion, mouth opening, lateral and protrusive movement of the mandible, pain, chewing and speech difficulties, and bone healing at the fracture site. Computed tomography images were used to assess the reduction of the fractured segment, the stability of fixation and progress of healing of the condylar fracture at follow-up visits. The same surgical treatment approach was applied to all patients. The data from the study were analyzed for a single group without any comparison to other groups. RESULTS: The technique was used for the treatment of 14 condylar fractures in 12 patients between the ages of 3 to 11 years. A total of 28 transoral endoscopic-assisted approaches to the condylar region either for reduction and internal fixation or hardware removal were applied. The mean operating time was 53.1 (±11.3) minutes for the fracture repair and 20 (±2.6) minutes for hardware removal, respectively. The mean follow-up time of the patients was 17.8 (±2.7) months (median: 18) months. All patients regained stable occlusion, satisfactory mandibular motion, stable fixation, and complete bone healing at the fracture site at the end of their follow-up period. There was no transient of permanent facial nerve or trigeminal nerve injury in any of the patients. CONCLUSIONS: Endoscopically assisted transoral approach is a reliable technique for reduction and internal fixation of condylar fracture and hardware removal in pediatric patients. The serious risks of extraoral approaches including facial nerve injury, facial scar, and parotid fistula can be eliminated by using this technique.

The Comparison of Functional Outcomes in Patients With Unilateral or Bilateral Intracapsular Mandibular Condylar Fractures After Closed or Open Treatment: A 10-Year Retrospective Study.

BACKGROUND: The treatment strategies for mandibular condylar head fractures, also known as intracapsular condylar fractures (ICFs), have not been concluded. We humbly present our treatment outcomes and share our experience in our department. AIMS AND OBJECTIVES: The aim of this study was to compare the functional outcomes between closed reduction (CR) and open reduction and internal fixation (ORIF) for management of unilateral or bilateral ICFs. MATERIALS AND METHODS: This 10-year retrospective cohort study included 71 patients with 102 ICFs who were treated in our department from May 2007 to August 2017. Nine patients mixed with extracapsular fractures were excluded; thus, 62 patients with 93 ICFs were included. All patients received treatment by the senior surgeon in Chang Gung Memorial Hospital, Linkou Branch, Taiwan. The patient's basic data, fracture morphologies, associated injuries, managements, complications, and maximal mouth opening (MMO) measurement at 1, 3, 6, and 12 months postoperative were reviewed for analysis. RESULTS: Among the 93 fractures, 31 (50%) were bilateral and 31 were unilateral (50%). Based on He's classification, 45 (48%) had type A fracture, 13 (14%) had type B, 5 (5%) had type C, 20 (22%) had type M, and 10 (11%) had no displacement. Maximal mouth opening of 37 mm in unilateral cases after 6 months was significantly higher than the 33-mm MMO in bilateral cases. In addition, the MMO in the ORIF group was significantly higher than that of the CR group in 3 months postoperative. Univariate (odds ratio, 4.92; P = 0.01) and multivariate (odds ratio, 4.76; P = 0.027) analyses revealed CR as an independent risk factor for trismus development compared with ORIF. Malocclusion was observed in 5 patients in both CR and ORIF groups. In addition, 1 patient developed temporomandibular joint osteoarthritis in the CR group. No surgical-related temporary or permanent facial nerve palsy was observed. CONCLUSIONS: Open reduction and internal fixation for condylar head fracture provided better recovery in MMO than CR, and the MMO recovery was less in bilateral condylar head fracture than unilateral condylar head fracture. Open reduction and internal fixation in ICFs have a lower risk for trismus development and should be the treatment of choice in selected cases.

Evaluation and Prediction of Healing Morphology After Closed Reduction for Unilateral Mandibular Condyle Fractures.

Although closed reduction is common for condylar fractures, bone fragments may heal improperly. This study aimed to investigate the healing morphology of unilateral condylar fractures. We retrospectively investigated 70 patients with unilateral condylar fractures. Clinico-statistical analyses were performed on the whole-condylar fracture, closed reduction, and observation/functional therapy groups. Among these patients, 52 patients aged older than 16 years underwent closed reduction. The extent of maximum mouth opening, the incidence of malocclusion, and the relationship between healing morphology and Arbeitsgemeinschaft für Osteosynthesefragen classification or trismus were analyzed in the closed reduction group. There were significant differences in age ( P= 0.008) and sex ( P =0.025) between the closed reduction and observation/functional therapy groups. However, there were no significant differences in trauma etiologies and concomitant fractures between the 2 groups. The average maximum mouth opening extent for unilateral fractures after closed reduction was 42.6±6.1 mm. Only 1 case (2.1%) of post-treatment malocclusion was observed. In all the MacLennan classification of deviation or more, regardless of the classification, upper fractures (head and upper neck) tended to heal through a spherical ( P <0.001) morphology, whereas lower fractures (lower neck and subcondylar) tended to heal through an L-shaped and lateral fusion ( P <0.001). There was no significant difference in the incidence of trismus between the healing morphology of unchanged type and others ( P =0.690). Our results elucidated the etiology, dysfunction, and healing morphology classification of unilateral mandibular condyle fractures treated with closed reduction.

Control of Mandibular Width With 3D Printed Occlusal Splint in Children With Multiple Mandibular Fractures.

BACKGROUND: The fracture of mandibular symphysis combined with bilateral condylar fractures often leads to changes in the width of the mandible, which significantly widens the face of the child. Therefore, it is necessary to reposition the mandible through accurate adduction. METHODS: To ensure that the mandible can be accurately repositioned, a 3D printed occlusal splint was used. Bilateral maxillomandibular fixation screws were implanted. The 3D printed occlusal splint was located on the maxillary dentition and fixed to the maxillomandibular fixation screws with wire loops. The reference basis for adduction is to make the mandibular dentition located in the occlusal splint. The absorbable plate was contoured according to the restored model and fixed at the fracture site. The 3D printed occlusal splint was retained in the maxillary dentition for two months. RESULTS AND DISCUSSION: Postoperative computed tomography showed that the mandible had been adducted according to the preoperative design. Two months of follow-up showed that the child's facial development, mouth opening type, occlusion, and range of motion were good. It is especially suitable for children with mandibular symphyseal fractures accompanied by bilateral condylar fractures.

Does Open Reduction and Internal Fixation Yield Better Outcomes Over Closed Reduction of Mandibular Condylar Fractures?

PURPOSE: Despite decades of study, a consensus on therapeutic approaches to condylar fractures remains elusive, and the vexing question of invasive or noninvasive therapy remains to be definitively answered. This randomized clinical study aimed to compare the outcomes of mandibular condylar fractures (MCFs) treated by closed reduction (CR) with those treated by open reduction and internal fixation (ORIF). METHODS: The investigators designed and implemented a randomized controlled trial composed of patients with unilateral or bilateral MCFs. Patients were randomly allocated into the ORIF and CR groups. The primary predictor variable was treatment, either CR or ORIF. The primary outcome variable was temporomandibular joint function (pain and range of motion) assessed at 1 and 6 weeks and at 3, 6, and 12 months. The secondary outcomes included occlusion and complications (deviation, facial nerve injury, and scarring). Perioperative covariates included fracture displacement, ramus height loss, and associated mandibular fractures. The effect of treatment group on each of the 12-month outcomes was assessed using the χ2 test or the independent samples t test. A 5% significance level was used. RESULTS: A total of 116 patients with MCFs were included in the study. Sixty-eight (59%) and 48 (41%) patients were treated by CR and ORIF, respectively. No statistically significant differences were observed between the 2 groups for mouth opening (P = .073, protrusion (P = .71), laterotrusive movements toward fractured side (0.080), and nonfractured side (P = .28). The median pain scores decreased from 4 (interquartile range [IQR] 3 to 4) at 6 weeks to 0 (IQR 0 to 0) at 52 weeks and 6 (IQR 5 to 6) at 6 weeks to 0 (IQR 0 to 0) at 52 weeks in the CR and ORIF groups, respectively. Statistically significant differences between the groups were observed for the outcome of malocclusion (P = .040) and deviation (P < .0001). Ramal height loss (P = .013) and angle of displacement (P = .0084) were significantly associated with the presence of complications in the CR group. CONCLUSIONS: The results of the present study have shown that both treatment options for MCFs yield acceptable results. However, CR yielded more complications, especially in patients with bilateral MCFs, ramus height loss greater than 5 mm, and angle of displacement greater than 15°.

What Are Possible Contributors to Associated Dental Injury in Mandibular Fractures?

PURPOSE: Among previous reports on dental injuries associated with mandibular fractures, there are few investigating the conditions under which dental injuries commonly occur. The aim of this study was to determine specific characteristics of mandibular fractures accompanied by dental injuries. METHODS: This retrospective cohort study included dentate patients with mandibular fractures treated at a tertiary trauma center between 2011 and 2019. The data were analyzed according to 2 outcome variables: patients with additional dental injuries and patients without. The predictor variables were patient age, sex, accident mechanism, number and location of mandibular fractures, and presence of submental lacerations. Odds ratios for the risk factors for dental injury were calculated in conjunction with descriptive statistics. Binary logistic regression analysis was also performed to identify the factors associated with dental injuries as dependent variables. RESULTS: Of 252 patients who had only mandibular fractures, 95 (37.7%) had associated dental injuries. In the group with dental injuries, 55.8% of mandibular fractures were caused by a fall (P = .003). Condyle fractures (77.9%) with dislocation (67.6%) and bilateral involvement (41.9%) were more common than in the group without dental injuries (P < .001). In patients with dental injuries, the incidence of 3 or more fractures (29.5%) was significantly higher than in the group without dental injuries. Dental injuries were more likely to occur in patients with concomitant submental lacerations (confidence interval (CI) 1.135-4.983, P = .02), and the risk of dental injury was significantly lower in the presence of angle fractures (CI 0.113-0.999, P = .045). CONCLUSIONS: A frontal impact involving the anterior part of the mandible is often associated with condyle and multiple mandibular fractures. This seems to be the typical mechanism for concomitant dental injuries. Submental laceration can be considered a prime sign of associated dental injuries.

Treatment of Sagittal Fracture of the Mandibular Condyle Using Resorbable-Screw Osteosynthesis.

PURPOSE: Screw osteosynthesis is advocated for the treatment of sagittal fracture of mandibular condyle (SFMC). This study aimed to explore the applicability of resorbable-screw osteosynthesis in the treatment of SFMC. METHODS: A retrospective cohort study was performed in patients with SFMC treated with resorbable-screw osteosynthesis (group A) from June 2011 through June 2021. The patients who had undergone titanium-screw osteosynthesis served as the control group (group B). The primary outcome variable was fracture healing, defined as follows: 1) normal mouth opening and restoration of pretrauma occlusion; 2) without complications or discomfort of temporomandibular joint symptoms; and 3) fracture union without abnormal reactions or bone resorption in computed tomography images. The secondary outcome variable was condylar morphological changes including radiographic imaging appearance of the condyle, mandibular ramus height (MRH), anteroposterior diameter (APD), and mediolateral diameter (MLD) of the condyle, which were assessed by comparing the computed tomography images 1 week after surgery with those of 3 months after surgery. The collected data of the outcome variables of the 2 groups were analyzed correspondingly using Student's paired t test and Student's t test. RESULTS: There were 24 patients in group A and 71 patients in group B. All the patients displayed an evident improvement in mouth opening and restored pretrauma occlusion. Few patients had complications (group A, 8.33%; group B, 9.86%) and discomfort of temporomandibular joint symptoms (group A, 16.67%; group B, 15.49%). Fracture union without abnormal reactions or bone resorption was observed during the follow-up. The radiographic evaluation revealed no significant difference in the MRH, the maximum APD, and MLD of the condyles between 1 week and 3 months after surgery in both groups. There were no significant intergroup differences in the changes in the MRH, APD, and MLD of the condyles. CONCLUSIONS: Resorbable-screw osteosynthesis is a viable option for the treatment of SFMC.

New Minimally Invasive Intraoral Procedure for Condylar Fractures: Clinical Presentation and Considerations on Current Techniques.

ABSTRACT: Mandibular fractures are the third most prevalent maxillofacial traumatic events. Surgical approaches to the condyle are a debated topic. This study describes a mini-invasive technique for condylar fracture reduction. The patient of this study suffered multiple traumatic injuries including a carotid artery dissecting aneurysm, which contraindicated the standard open reduction and internal fixation technique. The novel minimally invasive technique involves intraoral access and fracture fragment realignment using a periosteal elevator, a molar occlusal splint, and intermaxillary fixation after intraoperative radiologic imaging confirmation of condyle reposition.The approach avoids skin incisions and tissue dissection, with good aesthetic outcomes and facial nerve preservation. This technique proved to be safe and simple to be less demanding for the patient, with a shorter recovery time than experienced with other techniques.The results suggest this technique is a good option for the surgical treatment of condylar neck fractures showing favorable rim morphology with primary stability after reduction.

Change of the Inclination Angle in a Pediatric Bilateral Condylar Fracture Treated With Intermaxillary Fixation and an Occlusal Stop.

ABSTRACT: This paper presents the outcomes of a pediatric bilateral condylar fracture treated with intermaxillary fixation (IMF) and an occlusal stop.A 6-year-old girl presented with the complaint of pain on her chin. She had fallen down, whereas riding a bicycle and her face hit the road. She had limited mouth-opening (10 mm). Panoramic radiography and computed tomography confirmed a bilateral con-dylar fracture. The inclination of the fractured condyle (IFC) was 39.2° and 42.4° on the left and right sides, respectively. On the third post-trauma day, arch bars were applied and IMF was performed with a prefabricated wafer (occlusal stop) and rubber bands. The rubber bands were changed to wires on post-IMF day (PMF) 4.Immediately after IMF, the IFCs increased (left: 50.1° and right: 68.1°). On PMF 1, the IFCs had improved (44.5° and 46.9°, respectively). On PMF 3, 12, 28, and 35, the left and right IFCs were 46.9° and 70.7°,38.9° and 72.0°,38.0° and 56.5°, and 36.4° and 44.6°, respectively. On PMF 42, the IFCs had changed to 34.5° and 36.1 °, and wires were changed to rubber bands. On PMF 49, the IFCs were 34.0° and 36.5°, and rubber bands were applied at night only. On PMF 56, the IFCs had improved to 35.0° and 34.8°, and the arch bars were removed. The changes of IFC were fitted to an exponential regression model (left: y = 44.134e 0.005x and right: y = 11.378e 0.043x ).This case shows that pediatric bilateral mandibular condyle fractures can be treated by vertical lengthening using an occlusal stop and IMF.

Removal of Fracture Fragments in Intracapsular Condylar Fractures: An Alternative Treatment Option.

OBJECTIVE: This study aimed to explore bone remodeling after condylar fracture fragments have been removed from patients with intracapsular condylar fractures. it also evaluated whether condyle fracture removal can be used alternatively when the authors treat patients with comminuted or small pieces of fracture or in extremely difficult operations. METHODS: Records of patients who sustained intracapsular condylar fractures and treated by removal of fragments for the period of February 2013 to September 2019 were retrieved. Data about age, gender, date of injury, dates of admission and discharge, mechanism of trauma, location and pattern of fracture, other mandibular fracture, treatment methods and time of review were recorded and analyzed. Image dates of pre- and post-treatment (including the time of review) were also recorded. RESULTS: The data of a total of 103 patients ranging from 5 to 84 years old were retrieved during this study. A total of 135 sides of condylar fragments were removed. Almost all of the patients with comminuted condyle head fracture or type A fracture presented apparent shortening of the ramus height, and none of them showed osteogenesis (or new bone formation) during their follow-up. Present study only observed osteogenesis in few patients who sustained type B/C intracapsular condylar fractures during their follow-up. The younger the patient was, the longer the follow-up time was, and the higher the possibility of new bone formation was. No correlation was found between the amount of osteogenesis and follow-up time, the amount of osteogenesis was generally small, and no patient could form a new condyle head similar to the normal (or original) condyle head. Condylar hypertrophy only occurred in children. Four patients developed temporomandibular joint ankylosis. CONCLUSIONS: Removal of fracture fragments is an alternative treatment option for patients who sustained comminuted or small pieces of fracture or in extremely difficult operations.

Condylar Fractures: Multistep Surgical Planning by Mini-Invasive Approach, Patient Series.

PURPOSE: Surgical treatment for condylar fractures is a challenging procedure most debated in scientific literature without a broad consensus on the selection of surgical techniques to be used and relative indications.The goal of this work is to propose a multistep surgical planning for condylar fractures based on an effective mini-invasive approach and safe procedure aimed to avoid as much as possible skin incision in the aesthetic areas of the face and neck, to decrease the risk of facial nerve injury. METHODS: Ten patients with dislocated condylar neck fractures and sub-condylar fractures were included in this study.All the patients were studied with radiological images, computed tomography scans with three-dimensional reconstructions preoperatively and immediate postoperatively.Patients were evaluated pre- and post-operatively for dental occlusion, bone fragment alignment after reduction and after fixation, facial nerve functionality, skin scarring, temporomandibular joint functionality, temporomandibular joint symptomatology, and patient satisfaction. RESULTS: Results were satisfactory for different parameters evaluated. No significant complications resulted in follow-up, particularly for facial nerve injury. By using this multistep procedure with each stage functional to the following one, the authors achieved satisfactory results following treatment of dislocated condylar fractures.

Comparative evaluation of bite force in patients treated for unilateral mandibular condylar fractures by open and closed methods.

BACKGROUND/AIM: Condylar fractures account for a large proportion (20% to 52%) of mandibular injuries. The goal of treating these fractures is to restore the occlusion, thereby re-establishing the masticatory function as close as possible to the patient's pre-trauma state. The aim of this study was to compare the bite forces following unilateral condylar fractures treated by open reduction and internal fixation (ORIF) with those managed by the closed method. METHOD: Patients with unilateral mandibular condylar fractures were divided into two groups (n = 20) using a simple randomization method. Patients in group I were treated by open reduction and internal fixation (ORIF) using titanium miniplates and screws. Patients in group II were treated by the closed method with inter-maxillary fixation. Patients in both groups were evaluated pre-operatively and then post-operatively at one week, one month and three months for maximum bite force achieved at the central incisor, premolar and molar regions. RESULTS: Pre-operative bite forces on the unaffected site were significantly higher than the affected site in both groups, whereas no significant difference was observed in bite forces between the unaffected and affected sites in both groups post-operatively. The bite forces achieved at both the unaffected and affected sites in the ORIF group were significantly higher than in the closed group. CONCLUSION: Maximum bite forces differed significantly when the treatment was done with the open method, and the patients treated with the open method needed less time to achieve the maximum bite forces, thereby making an earlier return to function.

Traumatic temporomandibular joint bony ankylosis in growing rats.

BACKGROUND: The pathogenesis of traumatic temporomandibular joint (TMJ) bony ankylosis remains unknown. This study aimed to explore the pathogenesis of traumatic TMJ bony ankylosis in a rat model. METHODS: Twenty-four 3-week-old male Sprague-Dawley rats were used in this study. Excision of the whole disc, the fibrocartilage damage of the condyle and glenoid fossa, and narrowed joint space were performed in the left TMJ of the operation group to induce TMJ bony ankylosis (experimental side). The right TMJ underwent a sham operation (sham side). The control group did not undergo any operations. At 1, 4, and 8 weeks postoperatively, rats of the operation group were sacrificed and TMJ complexes were evaluated by gross observation, Micro-CT, histological examinations, and immunofluorescence microscopy. Total RNA of TMJ complexes in the operation group were analyzed using RNA-seq. RESULTS: Gross observations revealed TMJ bony ankylosis on the experimental side. Micro-CT analysis demonstrated that compared to the sham side, the experimental side showed a larger volume of growth, and a considerable calcified bone callus formation in the narrowed joint space and on the rougher articular surfaces. Histological examinations indicated that endochondral ossification was observed on the experimental side, but not on the sham side. RNA-seq analysis and immunofluorescence revealed that Matrix metallopeptidase 13 (MMP13) and Runt-related transcription factor 2 (RUNX2) genes of endochondral ossification were significantly more downregulated on the experimental side than on the sham side. The primary pathways related to endochondral ossification were Parathyroid hormone synthesis, secretion and action, Relaxin signaling pathway, and IL-17 signaling pathway. CONCLUSIONS: The present study provided an innovative and reliable rat model of TMJ bony ankylosis by compound trauma and narrowed joint space. Furthermore, we demonstrated the downregulation of MMP13 and RUNX2 in the process of endochondral ossification in TMJ bony ankylosis.

Maxillofacial trauma in children: Association between age and mandibular fracture site.

PURPOSE: To describe the association between age and location of facial fractures in the pediatric population. MATERIALS AND METHODS: A retrospective analysis of the Healthcare Cost and Utilization Project (HCUP) from the 2016 Kids' Inpatient Database (KID) in children aged ≤18 years was conducted. International Statistical Classification of Diseases, 10th Revision (ICD-10) codes were used to extract facial fracture diagnoses. Logistic regression was used to evaluate and compare the contribution of various demographic factors among patients who had different types of facial fractures. RESULTS: A total of 5568 admitted patients were identified who sustained any type of facial bone fracture. Patients who had facial fractures were significantly more likely to be male (68.2% versus 31.8%; p<0.001) and were older with a mean age of 12.86 years (95% confidence interval [CI]: 12.72-12.99). Approximately one-third of patients with a facial fracture had a concomitant skull base or vault fracture. Maxillary fractures were seen in 30.9% of the cohort while mandibular fractures occurred in 36.9% of patients. The most common mandibular fracture site was the symphysis (N=574, 27.9% of all mandibular fractures). Condylar fractures were more common in younger children while angle fractures were more common in teenagers. Regression analysis found that age was the only significant contributor to the presence of a mandibular fracture (ß=0.027, p<0.001) and race was the only significant contributor to maxillary fractures (ß=-0.090, p<0.001). CONCLUSIONS: Facial fractures increase in frequency with increasing age in children. The mandible was the most commonly fractured facial bone, with an age-related pattern in fracture location.

The Influence of the Mandibular Chin Angle on the Occurrence of Mandibular Condylar Fracture: A Retrospective Study.

BACKGROUND: Condylar fractures are commonly associated with symphysis/parasymphysis fractures. Condylar fractures have been attributed to direct and indirect traumatic forces, the direction and magnitude of the forces, and the condylar anatomy. The chief aim of this study was to determine the association between the newly defined mandibular chin angle and the occurrence of condylar fractures. MATERIALS AND METHODS: A retrospective study was conducted to analyze two-dimensional computed tomography (2D CT) scans of patients with a history of chin trauma. The outcome was a symphysis/parasymphysis fracture with or without fracture of the mandibular condyle. The Mediff InstaRISPACS web-based platform was used to measure the chin angle. The cerebral aqueduct of Sylvius in the corresponding 2D CT midsagittal image was the standard reference plane to measure the chin angle. The SPSS Version 20 (IBM Corp, Armonk, NY) was used for data analysis. RESULTS: The sample size included 120 2D CT scans of patients with symphysis/parasymphysis fractures (60 associated with condylar fractures and 60 without condylar fractures). The mean chin angle in the group without condylar fracture was 133.35 ± 3.87°, which was approximately 15° lesser than in the condylar fracture group (mean, 148.56 ± 5.49°), and these findings were statistically significant (P < 0.05). CONCLUSION: Individuals with a high chin angle are potentially at a higher risk of sustaining associated condylar fractures.