Three-dimensional assessment of accuracy for open reduction and internal fixation of the subcondylar fracture and its implications on the TMJ function

Mohamed, Abdo Ahmed Saleh; Abotaleb, Bassam; Abdulqader, Abbas Ahmed; Du, Hongwu; Sakran, Karim Ahmed; He, Da

doi:10.1016/j.jcms.2021.06.009

Cited by 8 publications

(5 citation statements)

References 37 publications

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“…This result is opposite to what Choi et al found. However, it is in line with previous study [12]. Interestingly, the mediolateral inclination of the condyle to the horizontal plane was significantly correlated, in submandibular approach patients, with both Helkimo Ai and Helkimo Di.…”

Section: Discussionsupporting

confidence: 93%

“…Radiographically, few studies analyze the condyle position after ORIF. Our previous study has highlighted the condylar positional change with ORIF regardless of the surgical incision approach [12]. To the best of our knowledge, no paper discussed the condyle position, angulation, and joint space-anatomical reduction-between the RMA and the SMA for the subcondylar fracture.…”

Section: Introductionmentioning

confidence: 99%

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Is the retromandibular approach a suitable approach to anatomical reduction of unilateral subcondylar fracture? A non-randomized clinical trial

et al. 2022

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The aim of this study was to evaluate the efficacy of the retromandibular approach (RMA) to produce three-dimensional (3-D) reduction of the unilateral subcondylar fracture and Temporomandibular Joint (TMJ) functional implication.Methods: A prospective cohort study was designed. Twenty-nine patients with unilateral subcondylar fracture underwent consecutively Open Reduction, and Internal Fixation. The cohorts were divided into two groups; RMA group (n = 16, 55.17%) and submandibular approach SMA group (n = 13, 44.82%). The primary outcome was the anatomical 3-D reduction of the condyle. The secondary outcome was to compare the condyle position and inclination finding with TMJ outcomes. Helkimo Index score was used to evaluate the TMJ outcome at six months postoperatively.Result: There was a significant difference between the mediolateral condylar inclination, condylar medial and vertical positions when RMA compared with SMA groups (P < 0.05). The medial joint space was correlated with the medial condylar position in both groups (P < 0.05). The Helkimo Ai and Di was associated with mediolateral condylar inclination in SMG; however, Helkimo Ai was found to be correlated with the RMA group.Conclusion: The current study demonstrates that the RMA could re-establish the anatomical position of the unilateral subcondylar fracture in patients undergoing ORIF. The clinical outcome of the TMJ with RMA was better than SMA.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Is the retromandibular approach a suitable approach to anatomical reduction of unilateral subcondylar fracture? A non-randomized clinical trial

et al. 2022

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“…Moreover, the evaluation systems, such as the Helkimo index, can be used to determine TMJ functional impairment [39]. The Helkimo index was also used to examine movement, joint function after mandibular reconstruction, mandibular condyle fractures, pain, musculature, TMD, and malocclusion, which provides a rapid, objective assessment that could be useful at various stages of therapy [14]. Regarding the Helkimo index correlation with condyle position and joint spaces, there was no significant relationship between the Helkimo index result and variables at T3 (P > 0.05), which indicates that the condyle position has a good adaptive position.…”

Section: Discussionmentioning

confidence: 99%

“…The orientation of the coordination system was set based on the points of facial skeletal midline: Nasion, incisive foramen, and basion, confirmed by Garcia et al as correct sites and validated by the previous studies with different objectives [12][13][14]. The lateral landmarks were determined by the right orbital (Or) point and two porion (Pr) points; second, the following landmarks Table 1 The craniofacial skeletal landmarks used in the study…”

Section: Cbct Analysismentioning

confidence: 99%

Three dimensional condylar positional and morphological changes following mandibular reconstruction based on CBCT analysis: a prospective study

et al. 2023

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Objective This study aimed to evaluate the condylar positional changes following mandibular reconstruction with preservation of the condylar head using Cone-Beam Computed Tomography (CBCT). Also, to assess joint space changes and the overall volumetric space compared to the preoperative status. Methodology This prospective study included 30 patients (60 joints) subjected to unilateral mandibular resection and reconstruction with preservation of the condylar head. The Helkimo index and preoperative (T1), two weeks postoperative (T2), and follow-up CBCTs (T3) after at least six months were gathered and processed to evaluate the condylar position and TMJ joint space using Anatomage Invivo 6. A student’s t-test and repeated-measures ANOVA statistics were used. A P value of less than 0.05 was considered statistically significant. Results Thirty patients (14 males, 16 females) with a mean age of 40.01 ± 12.7 years (a range of 18.1–62.9 years) were included. On the tumor side, there were significant variances in the vertical and mediolateral condylar positions between the three-time points (T1, T2, T3). Immediately after the operation, the condyles were significantly displaced in a downward direction at T2, which became larger after the last follow-up period (T3) (p = 0.007). The condylar positions at the anteroposterior direction were relatively stable without significant differences between the three times points (p = 0.915). On the non-tumor side, the condylar positions were relatively stable in the mediolateral and anteroposterior positions. In the tumor side, all of the TMJ spaces were significantly increased in size following the mandibular reconstructions (T2 and T3). However, on the non-tumor side, the anterior, posterior, and medial joint spaces were significantly changed postoperatively. Conclusion After mandibular reconstruction with condylar preservation, the condylar position and volumetric measurement immediately changed noticeably and continued to be a permanent change over time compared to relatively stable condyles on the non-tumor side. According to Helkimo index, patients become adapted to the postoperative changes without significant differences between the two sides.

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“…Several indices have been used for the pre- and post-treatment evaluation of mandibular condylar fractures, such as ramal height, fracture fragment angulation, and resorption pattern of condylar fracture fragments. There are studies reporting better results when surgical treatment was conducted with respect to TMJ morphology—such as less resorption of the condylar fracture fragment and proper reduction of the condyle in the fossa—than those achieved with conservative treatment 11 - 14 . Studies have documented significant recovery of ramal height over time, even in patients who underwent adequate CR 15 .…”

Section: Discussionmentioning

confidence: 99%

Open versus closed treatment for extracapsular fracture of the mandibular condyle

Lee

Jung

Ryu

et al. 2022

JKAOMS

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Mandibular condylar fractures are common, and their most frequent causes are traffic accidents, violence, slip-down, fall-down, and sports. Mandibular condylar fractures are accompanied by dental trauma or concomitant fractures on the contralateral side. Clinically, complications such as malocclu-sion, anterior open bite, residual pain, mouth opening limitation (MOL), pathological changes in the temporomandibular joint (TMJ), osteonecrosis, facial asymmetry, and ankylosis may occur due to condylar fractures, and appropriate treatment is required to avoid these complications 1,2 .Mandibular condylar fractures can be treated using open reduction (OR) or closed reduction (CR). During OR, threedimensional stability of the mandible can be obtained through proper reduction of the fracture fragment, action of the lateral pterygoid muscle, a relatively fast recovery for a normal diet, and a short treatment period; however, there is the potential for damage to the facial nerve, blood vessels, and joint capsules or infection with this approach. Conversely, CR carries the advantages of being non-invasive and less likely to damage anatomical structures but has its own disadvantages, such as malocclusion, MOL, facial asymmetry, chronic pain,

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Three-dimensional assessment of accuracy for open reduction and internal fixation of the subcondylar fracture and its implications on the TMJ function

Cited by 8 publications

References 37 publications

Is the retromandibular approach a suitable approach to anatomical reduction of unilateral subcondylar fracture? A non-randomized clinical trial

Is the retromandibular approach a suitable approach to anatomical reduction of unilateral subcondylar fracture? A non-randomized clinical trial

Three dimensional condylar positional and morphological changes following mandibular reconstruction based on CBCT analysis: a prospective study

Open versus closed treatment for extracapsular fracture of the mandibular condyle

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