Perhaps no area of facial trauma has inspired more controversy than the management of mandibular subcondylar fractures. Fractures of the condylar region. Clinically, this equates to open treatment of condylar neck fractures or subcondylar (caudal) fractures (A). The surgeon may elect to place one or two plates. Background and objective: Mandibular fractures are the most frequent and sub condylar region is a common site of fracture. Proper.
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Furthermore, our results showed that the loads measured in the one DCP plate fixation group were higher than the loads measured in the two-adaption plate fixation group.
A Preoperative design of modified retromandibular incision, black line. An excellent visibility is achieved through the endoscope.
Therefore, we measured the biomechanical loads of four different plate fixation techniques in the experimental model regarding mandibular subcondylar fractures. When the trunk of the facial nerve or the temporofacial and cervicofacial division is exposed, the branches are retracted either superiorly or inferiorly depending on the location of the condylar fracture [ 7 ]. However in bilateral fractures, segments are more prevalently prone to displacement, thus an ORIF approach is recommended.
Over time, however, with the development of improved materials for fixation and the refinement of surgical techniques, the concept of rigid internal fixation has been increasingly applied to the injured craniomaxillofacial skeleton. Other complications related to the condylar fracture are ranged from tympanic bone fracture, fracture of mandibular fossa of temporal bone with or without dislocation of the condylar segment into the middle cranial fossa, injury to the cranial nerves, vascular damage and bleeding, growth inhibition and arteriovenous fistula 14 For example, the “open” surgeons claim better anatomic reduction and postoperative radiographic appearance, while the “closed” surgeons favor a conservative approach with potentially fewer surgical complications and acceptable long-term functional results.
Endoscopy-assisted open treatment of condylar fractures of the mandible: There is no conflict of interest to be declared. For other uses, see Broken jaw disambiguation.
Therefore, more and more authors advocate the use of a two-plate fixation technique, which seems to have the beneficial effect of restoring the tension and compression trajectories in subcondylar fractures. When reduction of the condylar fragment is unsatisfactory and the condyle is more rigidly fixed in a nonphysiologic position, the risk of postoperative remodeling and degenerative change is too high because of the increased functional loading [ 16 – 18 ].
Considerations in Subcondylar Fracture Management
This is called favorable. Study of the plating methods in the experimental model of mandibular subcondyle fracture. C Postoperative X-ray, the two 2.
It is common for both to be assessed with facial fractures. The Cochrane Fractufe 1: In case of bilateral fractures, the patient may present an anterior open bite.
Surgical Management of a Mandible Subcondylar Fracture
This 3-D reconstruction illustrates a high neck fracture with displacement. The option is sometimes used when a patient is edentulous has no teeth and rigid internal fixation cannot be used. J Oral Maxillofac Surg. Because the coronoid process of the mandible lies deep to many structures, including the zygomatic complex ZMCit is rare to be broken in isolation. This technique may be considered a useful means for fixation in order to reduce the postoperative internal maxillary fixation period and achieve early mobility of the jaw.
D The postoperative scar is cosmetically acceptable.
The modern day surgical techniques such as the endoscope-assisted technology, reducing the morbidity rate, again raises the question of choosing either the open or closed treatment technique Table manribular The load for permanent deformation and the maximum load for failure in each group. All authors read and approved the final manuscript. Higher tech solutions are also available, to help reduce the segments with arch bars using bonding technology.
Bilateral fractures with shortening and dislocation result in anterior open bite with minimal deviation of the midline. Angle fractures are defined as those that involve a triangular region bounded by the anterior border of masseter muscle and an oblique line extending from the lower third molar wisdom tooth region to the posteroinferior attachment of the masseter muscle.
Outside the mouth, signs of swelling, bruising and deformity can all be seen.
Reappraisal of the surgical strategy in treatment of mandibular condylar fractures. Therefore, we can conclude that the use of a two-plate fixation method provides more a stable fixation load than single-plate fixation. Sign in to save your search Sign in to your personal account. Cochrane Database of Systematic Reviews 4: However there are some studies about complications of open surgeries which indicate that permanent deformity and dysfunction after surgery is very rare 27fracturr the mandibular and condylar mobility is better 2930 and opening incisor pathway is subcondglar more normal 31 and also due to not decreasing the ramus height, less asymmetry is visible Patient benefit from endoscopically assisted fixation of condylar neck fractures-a randomized controlled trial.