Does Soft Tissue Injury Affect Intracapsular Condylar Fracture Healing?

Yang, Xudong; Yao, Zhendong; He, Dongmei; Cai, Yuanlong; Dong, Mei; Chen, Yang

doi:10.1016/j.joms.2015.05.030

Cited by 25 publications

(7 citation statements)

References 14 publications

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“…After the occurrence of intracapsular condylar fractures, the continued traction of the lateral pterygoid muscle results in the anteromedial displacement of the fragment in condylar head fractures 9 . A previous study 10 revealed that immediately after injury, nearly all intracapsular condylar fractures showed anteromedial displacement of the disc and fractured condylar fragment. Even at 3 months after injury, all patients continued to exhibit displacement of the disc and the condylar segments.…”

Section: Discussionmentioning

confidence: 95%

Fracture fragment of the condyle determines the ramus height of the mandible in children with intracapsular condylar fractures treated conservatively

Yang

Cui

Zhou

et al. 2022

Sci Rep

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This study aimed to explore and impart understanding of bone remodelling in children with intracapsular fractures treated conservatively. Records of children (less than 12 years), who sustained intracapsular fractures and treated conservatively, were retrieved consecutively for the period of March 2011 to February 2016. Data about age, gender, date of injury, dates of admission and discharge, mechanism of trauma, location and pattern of fracture, other mandibular fractures, treatment methods and time of review were recorded and analysed. Image dates of pre- and post-treatments, including date of review, were also recorded. A total of 22 patients complete their follow-up and show bone remodelling process. During their follow-up, all the displaced condylar fragments fused with the ramus stump at the displaced position. Regardless of the type of conservative procedure, both treatments cannot promote the spontaneous fracture reduction in patients with intracapsular condylar fractures. During follow-up, the absorption of the lateral process of the condyle after the closed treatment becomes close to the ‘horizontal absorption’, until the height (or articular surface) of the lateral condylar process dropped and aligned to the articular surface of the medial process. In children with intracapsular condylar fractures, the fracture fragment of the condyle determines the ramus height of the mandible. Closed treatment cannot restore the fracture fragment. If the height of the fracture fragments dropped remarkably, then open reduction and rigid internal fixation become more suitable.

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Section: Discussionmentioning

confidence: 95%

Fracture fragment of the condyle determines the ramus height of the mandible in children with intracapsular condylar fractures treated conservatively

Yang

Cui

Zhou

et al. 2022

Sci Rep

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“…Estos hallazgos se resolvían espontáneamente en la mayoría de los casos y confirmaban lo que se había sugerido en estudios previos en relación con el papel protector de la integridad discal para evitar anquilosis mandibulares; así, la interposición de tejido discal entre el remanente condilar y la fosa era fundamental para prevenir cambios osteoartríticos y anquilosis. Basándose en estos hallazgos, los autores recomiendan intervenir quirúrgicamente estas articulaciones cuando existan daños en los tejidos blandos, con el fin de reposicionar el disco y los fragmentos óseos y evitar secuelas degenerativas a largo plazo 3 .…”

Section: Resultsunclassified

“…En estos casos el daño sobre los tejidos no óseos (ligamentos, partes blandas, discomenisco o músculos) suele quedar relegado y puede generar secuelas a largo plazo. Otra causa para un inadecuado diagnóstico de los daños en partes blandas es la dificultad de realizar una RM de urgencias por el tiempo que requiere el estudio o por la escasez de estos aparatos en algunos hospitales 2,3 . Por ello, hoy en día con el avance de los tratamientos quirúrgicos y la posibilidad de terapéuticas multidisciplinares asociadas, se debería de llevar a cabo un manejo integral de estos casos.…”

Section: Introductionunclassified

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Artroscopia de la articulación temporomandibular en fracturas condilares

López

2021

j.maxilo

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Los daños a los tejidos blandos intrarticulares de la articulación temporomandibular (ATM) durante una fractura condilar han sido tradicionalmente relegados y escasamente estudiados. La artroscopia es un procedimiento quirúrgico mínimamente invasivo que puede combinarse con el abordaje abierto de las fracturas condilares con el fin de diagnosticar los daños intrarticulares y tratarlos si se precisa. Tras realizar una revisión bibliográfica, tan solo se han publicado 4 artículos sobre los hallazgos artroscópicos en estos casos y revelan una patología mayor de la esperada, que si no se soluciona puede llevar a secuelas importantes a largo plazo. Se presenta un caso clínico de una fractura subcondilar derecha desplazada en el que se combina una artroscopia de la ATM con un abordaje abierto y reducción de la fractura en el mismo acto. Los hallazgos artroscópicos más comunes son la hemartrosis, los coágulos, el desplazamiento discal, la sinovitis hiperplásica, los daños sobre el fibrocartílago y las perforaciones discales. La presente revisión concluye que es necesario evaluar y diagnosticar los daños intrarticulares en fracturas condilares mandibulares y que la artroscopia es un método adecuado que permite además tratar la patología articular asociada.

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“…due to interference with the intracapsular and periarticular soft tissues (32,109) and lack of stability (30,110,111), and may lead to severe osteoarthrosis in the long run, potentially ending up in TMJR. (IV) The importance of management of the soft tissues of the TMJ when treating condylar fractures is being increasingly recognised and plays a role in optimizing the outcome of ORIF (112)(113)(114)(115). The retention of the intra-articular disc in a functioning joint may even be as important as the bony reconstruction in the long term functioning of the TMJ (20,50,81,87,(116)(117)(118).…”

Section: Discussionmentioning

confidence: 99%

Indications for alloplastic temporomandibular joint replacement in maxillofacial trauma—an analysis of condylar trauma patients with scoping review of the literature

Neff¹,

McLeod²,

Jung³

et al. 2023

Front Oral Maxillofac Med

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Background: We undertook a review of the literature to assess the role of temporomandibular joint (TMJ) replacement (TMJR) in maxillofacial trauma and examined our own experience of temporomandibular joint bony complications. Methods: A scoping review of (I) a systematic literature research performed for the German evidence and consensus based (S3) guideline on total joint replacement, (II) a recent systematic review and meta-analysis by Niezen et al. [2022] (comprising 13,093 patients and 20,860 prostheses), (III) a systematic literature review of PubMed, google scholar and Cochrane database between November 2021 and February 2022 including English and German studies. In addition, we evaluated our cohort of surgically treated condylar fractures (n=604; head fractures: n=405 since 1993; neck and base fractures: n=199 since 2007) regarding complications which may potentially necessitate a TMJR.Results: Our search identified 8 studies including 10 patients in addition to the 83 cases found by Niezen et al. Although many reports on TMJR describe trauma as an aetiological factor, overall, merely 4 cases received an alloplastic TMJR as a primary treatment. Three cases met the criteria for an early secondary treatment within 6 months, 9 cases after 6 months past trauma. None of the surgically treated condylar fractures (n=604) in our cohort required joint replacement. Within the condylar head dataset (n=405) there was a significant correlation (P<0.05) between the presence of major fragmentation (n=52) and bony complications (n=23, 5.7%) such as osteoarthrosis, pseudarthrosis and heterotopic ossification (HO)/ankylosis. HO (n=9) correlated with delayed surgical treatment (>10-14 days, P<0.01). There was a significant correlation between subjective borderline feasibility of osteosynthesis (n=12/270, 0.4%) and major fragmentation (P<0.001), severe comminution (P<0.001), multilevel fractures (P<0.001) and severe osteoporosis (P<0.001). Conclusions:In contrast to orthopedic practice alloplastic TMJR does not play a noticeable role in primary or early secondary condylar fracture management. There may be indications in selected cases of major fragmented fractures where safe and stable osteosynthesis is not feasible. Most condylar fractures if treated according to best practice should not result in significant bony complications, but those that do may ultimately require further intervention including TMJR.

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Does Soft Tissue Injury Affect Intracapsular Condylar Fracture Healing?

Cited by 25 publications

References 14 publications

Fracture fragment of the condyle determines the ramus height of the mandible in children with intracapsular condylar fractures treated conservatively

Fracture fragment of the condyle determines the ramus height of the mandible in children with intracapsular condylar fractures treated conservatively

Artroscopia de la articulación temporomandibular en fracturas condilares

Indications for alloplastic temporomandibular joint replacement in maxillofacial trauma—an analysis of condylar trauma patients with scoping review of the literature

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