Advertisement

Minimally-invasive open reduction of intracapsular condylar fractures with preoperative simulation using computer-aided design

  • Ming-liang Yang
    Affiliations
    Department of Oral-Maxillofacial Surgery, The Affiliated Hospital of Stomatology, China Medical University, 117 Nanjing-Bei Street, Heping District, Shenyang, 110002, China
    Search for articles by this author
  • Bin Zhang
    Affiliations
    Department of Oral-Maxillofacial Surgery, The Affiliated Hospital of Stomatology, China Medical University, 117 Nanjing-Bei Street, Heping District, Shenyang, 110002, China
    Search for articles by this author
  • Qing Zhou
    Correspondence
    Corresponding author. Tel.: +86 24 22892461; fax: +86 24 22892645.
    Affiliations
    Department of Oral-Maxillofacial Surgery, The Affiliated Hospital of Stomatology, China Medical University, 117 Nanjing-Bei Street, Heping District, Shenyang, 110002, China
    Search for articles by this author
  • Xiao-bo Gao
    Affiliations
    Department of Oral-Maxillofacial Surgery, The Affiliated Hospital of Stomatology, China Medical University, 117 Nanjing-Bei Street, Heping District, Shenyang, 110002, China
    Search for articles by this author
  • Qiang Liu
    Affiliations
    Department of Oral-Maxillofacial Surgery, The Affiliated Hospital of Stomatology, China Medical University, 117 Nanjing-Bei Street, Heping District, Shenyang, 110002, China
    Search for articles by this author
  • Li Lu
    Affiliations
    Department of Oral-Maxillofacial Surgery, The Affiliated Hospital of Stomatology, China Medical University, 117 Nanjing-Bei Street, Heping District, Shenyang, 110002, China
    Search for articles by this author

      Abstract

      Reduction of intracapsular condylar fractures is difficult, so we have based our technique on preoperative simulation using computer-aided design (CAD), which has proved useful in other surgical specialties. We have treated 11 patients with intracapsular condylar fractures. Before the operation the procedure was shown on the computer using a three-dimensional simulation system. The relation between the stump and the fragment of the condyle, and assessment of the position and the size of the screw, were made preoperatively to obtain a perfect fit. The displaced fragment was reduced by elevators, and fixed with a bicortical screw through a minimised preauricular incision under general anaesthesia. The fragments and the location of the screws were similar on the preoperative simulation and on the postoperative computed tomographic (CT) scan. The reduction and fixation of the fracture showed a perfect fit on the same view in the preoperative CAD simulation in the Mimics 10.01 software and postoperatively. Postoperative clinical examinations showed good occlusion and satisfactory mouth opening. Two patients had temporary paralysis of the occipitofrontalis muscle that recovered within 3 months. All patients regained normal mandibular movements and had short and invisible scars at 6 months’ follow up. The technique of CAD simulation could help to improve the accuracy during open treatment for intracapsular condylar fractures.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to British Journal of Oral and Maxillofacial Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Rowe N.L.
        • Killey H.C.
        Fractures of the facial skeleton.
        2nd ed. Churchill Livingstone, Edinburgh1968 (p. 80–92)
        • Silvennoinen U.
        • Iizuka T.
        • Lindquist C.
        • Oikarinen K.
        Different patterns of condylar fractures: an analysis of 382 patients in a 3-year period.
        J Oral Maxillofac Surg. 1992; 50: 1032-1037
        • Loukota R.A.
        Fixation of dicapitular fractures of the mandibular condyle with a headless bone screw.
        Br J Oral Maxillofac Surg. 2007; 45: 399-401
        • Pilling E.
        • Schneider M.
        • Mai R.
        • Loukota R.A.
        • Eckelt U.
        Minimally invasive fracture treatment with cannulated lag screws in intracapsular fractures of the condyle.
        J Oral Maxillofac Surg. 2006; 64: 868-872
        • Iizuka T.
        • Lindqvist C.
        • Hallikainen D.
        • Mikkonen P.
        • Paukku P.
        Severe bone resorption and osteoarthrosis after miniplate fixation of high condylar fractures. A clinical and radiologic study of thirteen patients.
        Oral Surg Oral Med Oral Pathol. 1991; 72: 400-407
        • Kermer Ch.
        • Undt G.
        • Rasse M.
        Surgical reduction and fixation of intracapsular condylar fractures. A follow up study.
        Int J Oral Maxillofac Surg. 1998; 27: 191-194
        • Huang S.
        • Fan H.
        • Zhang C.
        • Zhou X.
        • Chen P.
        Clinical application of lateral lag screw in fixing intracapsular saggital condylar fracture.
        Zhonghua Kou Qiang Yi Xue Za Zhi. 2004; 39 ([in Chinese]): 481-483
        • Aboul-Hosn Centenero S.
        • Hernández-Alfaro F.
        3D planning in orthognathic surgery: CAD/CAM surgical splints and prediction of the soft and hard tissues results—our experience in 16 cases.
        J Craniomaxillofac Surg. 2012; 40: 162-168
        • Motohashi N.
        • Kuroda T.
        A 3D computer-aided design system applied to diagnosis and treatment planning in orthodontics and orthognathic surgery.
        Eur J Orthod. 1999; 21: 263-274
      1. Wang G, Li J, Khadka A, Hsu Y, Li W, Hu J. CAD/CAM and rapid prototyped titanium for reconstruction of ramus defect and condylar fracture caused by mandibular reduction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011; Jun 17 [Epub ahead of print].

        • Li J.
        • Hsu Y.
        • Luo E.
        • Khadka A.
        • Hu J.
        Computer-aided design and manufacturing and rapid prototyped nanoscale hydroxyapatite/polyamide (n-HA/PA) construction for condylar defect caused by mandibular angle ostectomy.
        Aesthetic Plast Surg. 2011; 35: 636-640
        • Meng F.W.
        • Liu Y.P.
        • Hu K.J.
        • Kong L.
        Use of a temporary screw for alignment and fixation of sagittal mandibular condylar fractures with lateral screws.
        Int J Oral Maxillofac Surg. 2010; 39: 548-553
        • Palmieri C.
        • Ellis III, E.
        • Throckmorton G.
        Mandibular motion after closed and open treatment of mandibular condylar process fractures.
        J Oral Maxillofac Surg. 1999; 57: 764-775
        • Ellis III, E.
        • Palmieri C.
        • Throckmorton G.
        Further displacement of condylar process fractures with closed treatment.
        J Oral Maxillofac Surg. 1999; 57: 1307-1317
        • Worsaae N.
        • Thorn J.J.
        Surgical versus nonsurgical treatment of unilateral dislocated low subcondylar fractures—a clinical study of 52 cases.
        J Oral Maxillofac Surg. 1994; 52: 353-361
        • Baker A.W.
        • McMahon J.
        • Moos K.F.
        Current consensus on the management of fractures of the mandibular condyle. A method by questionnaire.
        Int J Oral Maxillofac Surg. 1998; 27: 258-266
        • Ferretti C.
        • Bryant R.
        • Becker P.
        • Lawrence C.
        Temporomandibular joint morphology following post-traumatic ankylosis in 26 patients.
        Int J Oral Maxillofac Surg. 2005; 34: 376-381
        • Hlawitschka M.
        • Eckelt U.
        Assessment of patients treated for intracapsular fractures of the mandibular condyle by closed techniques.
        J Oral Maxillofac Surg. 2002; 60: 784-792
        • Hlawitschka M.
        • Loukota R.
        • Eckelt U.
        Functional and radiological results of open and closed treatment of intracapsular (diacapitular) condylar fractures of the mandible.
        Int J Oral Maxillofac Surg. 2005; 34: 597-604
        • Davis B.R.
        • Powell J.E.
        • Morrison A.D.
        Free-grafting of mandibular condyle fractures: clinical outcomes in 10 consecutive patients.
        Int J Oral Maxillofac Surg. 2005; 34: 871-876