Computer-assisted preoperative simulation for screw fixation of fractures of the condylar head

Current Opinions on Surgical Treatment of Fractures of the Condylar Head

“…In all articles, computed tomography (CT) has been fundamental for an appropriate diagnosis and assessment of condylar head fractures, thus allowing an accurate treatment planning. 5,10,12 In fact, CT scans show the precise location of the fracture, size and position of the fragment, and most importantly, the relationship between the ramus stump, fracture segment, and glenoid fossa, 2,10 thus being the gold standard method for the diagnosis and classification of diacapitular fractures. 10 Furthermore, magnetic resonance imaging (MRI) was used by some authors to complete the evaluation of soft tissue changes in the TMJ after condylar fracture, such as disc displacement, capsular tear, and hemarthrosis.…”

“…5,9,17 Software such as Mimics (Materialise, Leuven, Belgium) and SimPlantTM (Materialise NV, Leuven, Belgium) have been used to enable computer-assisted preoperative simulation reconstructing the condylar head in three dimensions from Digital Imaging and Communications in Medicine (DICOM) CT data. 5,9,17 The condylar segments could be virtually repositioned, adjusted, and made as identical as possible to the image of the residual condyle and the glenoid fossa. After the virtual reduction, the width of the reduced condyle could also be measured to decide preoperatively the length and position of screw for fixation of the fractured condylar head.…”

“…After the virtual reduction, the width of the reduced condyle could also be measured to decide preoperatively the length and position of screw for fixation of the fractured condylar head. 5,9,17 Indications…”

“…In the literature, because of these various classifications, it is difficult to obtain a clear picture of the epidemiology of diacapitular fractures types [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] (►Table 4). However, the most frequently used classification revealed to be the He et al's system.…”

“…Differently from conservative treatment, open surgery can give early recovery of occlusion and movement of the jaw. 5,6 Furthermore, extensive condylar deformation, height reduction of the mandibular ramus, disc displacement, dysfunctional complaints (such as limitation of mandibular mobility, crepitation, lateral deviation during mouth opening), temporomandibular joint (TMJ) ankylosis, and occlusal disturbances have also been described after closed or conservative treatment of diacapitular fractures. 7,8 Recently, more and more surgeons have begun to perform open treatment for diacapitular fractures because it allows to restore the anatomical position of the fragments and disc, it allows an immediate functional movement of the jaw, and avoid the ankylosis of the TMJ induced by the trauma.…”