Condylar restoration after early TMJ fractures and functional appliance therapy

Abstract

The aim of this study was to measure quantitatively and to analyze the process of condylar restoration during and after functional appliance therapy with an activator in children and juveniles who had sustained condylar fractures. Spiral computed measurement of condylar morphology was performed in order to quantify the association described in the literature between condylar remodelling and age as well as certain types of fracture. Nineteen patients with an average age of 13.4 years, who had sustained a functionally treated unilateral condylar fracture 4.9 years earlier on average, were included in the present study as the follow-up group. Twenty patients, who had sustained a unilateral fracture at an average age of 8.1 years and had been treated functionally for 6 to 8 months, formed the treatment group. The condylar dimension and the condylar neck length of the ipsilateral and of the contralateral temporomandibular joints were measured from the axial and parasagittal reconstructions and were compared on the basis of sex, age and fracture type. The mediolateral condylar dimension of the follow-up group showed a sex-specific difference of 0.2 cm on the contralateral side and 0.4 cm on the ipsilateral side. The fracture side condyle indicated a relative mediolateral decrease of 4.2% and an anteroposterior increase of 12.6%. Shortening of the condylar neck and excessive bony overgrowth were found to occur more often in fractures with displacement and in low fracture types. The "10-plus" subgroup at time of trauma showed a significantly greater variation and greater differences in mediolateral and anteroposterior condylar dimension than the younger patients.

Condylar Degeneration and Diseases—Local and Systemic Etiologies

“…The primary guideline in both children and adults is to restore function as soon as possible to avoid ankylosis or the formation of fibrous tissue scarring. Treatment in the child who has experienced condylar trauma often includes the use of a "hybrid" functional appliance, 15 or a unilateral hyperpropulsion device (such as a fixed Herbst appliance 16 ); these may be used to guide subsequent growth and maintain as much free- dom of movement as possible. Any form of surgical treatment should not be used in children with mandibular asymmetry until conservative treatment with some form of growth modification has been attempted and failed.…”

Traumatologie des Unterkiefergelenkfortsatzes

“…12. Lebensjahr -angewandt [1,6,10,16]. Allerdings kommen konservative Verfahren trotz kontrovers geführter Diskussion auch bei der Behandlung dislozierter oder luxierter Frakturen des Gelenkfortsatzes im Erwachsenenalter immer noch verbreitet zum Einsatz.…”

“…Es ist bekannt, dass bei Kindern mit konservativer Therapie der Gelenkfortsatzfrakturen gute funktionelle Resultate erzielt werden können, da im Gegensatz zum Erwachsenen eine gute 7 Remodellierungskapazität der betroffenen Gelenkköpfchen besteht [1,10,16]. Derartige Frakturen werden daher weiterhin überwiegend konservativ und funktionell behandelt.…”

“…Eine Wiederaufrichtung des abgeknickten, dislozierten Gelenkfortsatzes wird mittlerweile als fragwürdig angesehen. Vielmehr entsteht durch laufende Umbauprozesse im Frakturbereich, bei gleichzeitiger Resorption des kleinen Fragments, ein Neokondylus[6,10,18]. Unterbleibt die funktionelle Therapie bei hohen und diakapitulären Frakturen, droht infolge der starken osteogenetischen Potenz die Ausbildung einer Ankylose.…”

Comparative Study between IMF and Pure Conservation in Management of Condylar Head Fracture in Children

“…Mandibular condylar fractures are classified according to the anatomic location into intracapsular and extracapsular and degree of dislocation of the articular head [20][21][22][23][24][25]. Concerning the management of mandibular condyle fracture, there are different methods of condylar fractures treatment with a great deal of discussion and controversy due to differences in outcome results of various retrospective and prospective studies [26][27][28][29][30][31][32][33][34][35]. For each type of condylar fractures, the treatment procedures must be chosen taking into consideration the presence of teeth, level of the fracture height, patients adaptation, patients masticatory system, disturbance of occlusal function, deviation of the mandible, internal derangements surgical (functional) treatment [41][42][43][44][45][46].…”