Temporomandibular joint morphology in children after treatment of condylar fractures with functional appliance therapy: a follow-up study us computed tomography.

Abstract

The consequences of treating fractures of the temporomandibular joint in children by means of functional appliance therapy remain controversial. In this retrospective study we evaluated the temporomandibular joint morphology of 19 children and adolescents who had sustained a total of 21 condylar fractures between three and nine years previously and who had been treated in this way. Restoration of function was assessed clinically by measurement of mandibular movements, and palpation and auscultation of the joint. Spiral CT was used for the radiological examination with 2D and 3D reconstructions. Eleven patients with 13 fractures of different types showed restoration of normal function with favourable remodelling. The remaining eight patients had only good function with a deformed condyle and significant asymmetry in condylar angle and length of the condylar neck. Four of these cases had also developed bony spurs, neo-arthrosis and a bifid condyle. On the basis of these results, spiral CT imaging appears to be a valuable diagnostic aid in cases of condyle fractures where severe morphological changes are not recognized in earlier conventional X-ray examinations. The authors recommend a quantitative and qualitative analysis of the temporomandibular joint in order to encourage patients' compliance and, in cases of poor cooperation, to extend the treatment time.

Topography and Morphology of the Mandibular Condyle during Fixed Functional Orthopedic Treatment – a Magnetic Resonance Imaging Study*

“…Das MRT ist aufgrund der hohen Empfindlichkeit insbesondere zur Darstellung von unmineralisiertem Gewebe geeignet und kann so auch Umbauvorgänge des Knorpels bereits frühzeitig darstellen [27]. Nicht nur mittels spezieller CT-Techniken [6,9,12,14,21], sondern auch aus MRT-Datenmaterial ist eine 3-D-Darstellung von Kiefergelenkstrukturen möglich [20].…”

“…Für den Nachweis und die Bewertung möglicher adaptiver Mechanismen sind methodische Erweiterungen erfor- not only feasible with specific computed tomography techniques [6,9,12,14,21], but also with MRI data [20].…”

Eine kritische Bewertung der funktionellen Behandlung von Kollumfrakturen bei Kindern

“…Seitdem die computertomographische Untersuchungsmethodik der Kiefergelenke [3,7,8,10,11,17] auch vermehrt in der Frakturdiagnostik Anwendung findet, sind Berichte tiber posttraurnatische Gelenkkopfver~nderungen Ninfig: Hirschfelder hatte bei 61% der Nachuntersuchten atypische Neu-bzw. Umformierungen festgestetlt [9] und nach eigenen CT-Langzeitnachuntersuchungsbefunden wiesen nur 33% der Kondylen eine gute bis sehr gute Remodellierung auf [15]. Die Rekonstmktionen tier Spiral-CT-Aufnahmen zeigten verplumpte, verkiirzte oder hyperplastische Kondylen sowie einen zweik/Spfigen Kondylus mit Artikulation zum Jochbogen [16].…”

A Case of Bifid Mandibular Condyle

“…In this case, because there was no limitation of mouth opening and the patient's symptoms could not be checked, we did not treat the bifid condyle. However, if the patient's consciousness had recovered and he had reported symptoms, treatment for the fractured condyles develop bifid deformity [3,[16][17][18][19][20][21]. In many cases of horizontally fractured condyles, some healing occurs from the bone fracture to the joint, because these fractures are treated with intermaxillary fixation to correct occlusal disharmony.…”