Advertisement

Long-term results and complications after treatment of bilateral fractures of the mandibular condyle

  • Tymour Forouzanfar
    Affiliations
    Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
    Search for articles by this author
  • Frank Lobbezoo
    Affiliations
    Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands
    Search for articles by this author
  • Maarten Overgaauw
    Affiliations
    Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
    Search for articles by this author
  • Annemijn de Groot
    Affiliations
    Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
    Search for articles by this author
  • Sofie Kommers
    Affiliations
    Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
    Search for articles by this author
  • Maurits van Selms
    Affiliations
    Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands
    Search for articles by this author
  • Bart van den Bergh
    Correspondence
    Corresponding author at: Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. Tel.: +31 204441031.
    Affiliations
    Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
    Search for articles by this author
Published:February 01, 2013DOI:https://doi.org/10.1016/j.bjoms.2012.12.005

      Abstract

      The purpose of this study was to investigate the long-term results of conservative treatment of bilateral condylar fractures and to study the influence of possible functional impairment on intensity of pain and associated disability. We studied 71 patients (mean (SD) age 33 (14) years) with conservatively treated bilateral condylar fractures. Traffic crashes (n = 42, 59%) and falls (n = 20, 28%) were the main cause of the fractures. Forty-one patients (58%) were re-examined after about 90 months (mean 86, range 3–193). Five of the 41 (12%) had developed malocclusion, but did not experience any pain in the temporomandibular joint according to the Research Diagnostic Criteria for Temporomandibular Disorders. There was a significant negative relation between the presence of pain and the duration of follow up (p = 0.02). Increasing age was significantly related to reduction in the intensity of pain (p = 0.03). Of the remaining 30 patients who were not followed up, 2 had had bilateral sagittal split osteotomy and 1 a Le Fort I osteotomy. One patient had had orthodontic correction for a malocclusion. Including the five malocclusion patients, at least 9 of the total of 71 (13%) developed a malocclusion after conservative treatment. Functional impairment had no influence on the intensity of pain or pain-related disability in the patients with malocclusion after conservatively treated bilateral condylar fractures. This report may therefore be of value in the debate about whether open or closed treatment is better for bilateral mandibular 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

        • Bormann K.H.
        • Wild S.
        • Gellrich N.C.
        • et al.
        Five-year retrospective study of mandibular fractures in Freiburg, Germany: incidence, etiology, treatment, and complications.
        J Oral Maxillofac Surg. 2009; 67: 1251-1255
        • de Matos F.P.
        • Arnez M.F.
        • Sverzut C.E.
        • et al.
        A retrospective study of mandibular fracture in a 40-month period.
        Int J Oral Maxillofac Surg. 2010; 39: 10-15
        • Loukota R.A.
        • Eckelt U.
        • De Bont L.
        • et al.
        Subclassification of fractures of the condylar process of the mandible.
        Br J Oral Maxillofac Surg. 2005; 43: 72-73
        • Marker P.
        • Nielsen A.
        • Bastian H.L.
        Fractures of the mandibular condyle. Part 2: results of treatment of 348 patients.
        Br J Oral Maxillofac Surg. 2000; 38: 422-426
        • Palmieri C.
        • Ellis III, E.
        • Throckmorton G.
        Mandibular motion after closed and open treatment of unilateral mandibular condylar process fractures.
        J Oral Maxillofac Surg. 1999; 7: 764-775
        • Park J.M.
        • Jang Y.W.
        • Kim S.G.
        • et al.
        Comparative study of the prognosis of an extracorporeal reduction and a closed treatment in mandibular condyle head and/or neck fractures.
        J Oral Maxillofac Surg. 2010; 67: 2986-2993
        • Sharif M.O.
        • Fedorowicz Z.
        • Drews P.
        • et al.
        Interventions for the treatment of fractures of the mandibular condyle.
        Cochrane Database Syst Rev. 2010; 4: CD006538
        • Bhagol A.
        • Singh V.
        • Kumar I.
        • et al.
        Prospective evaluation of a new classification system for the management of mandibular subcondylar fractures.
        J Oral Maxillofac Surg. 2011; 69: 1159-1165
        • Yang W.G.
        • Chen C.T.
        • Tsay P.K.
        • et al.
        Functional results of unilateral mandibular condylar process fractures after open and closed treatment.
        J Trauma. 2002; 52: 498-503
        • Niezen E.T.
        • Bos R.R.
        • de Bont L.G.
        • et al.
        Complaints related to mandibular function impairment after closed treatment of fractures of the mandibular condyle.
        Int J Oral Maxillofac Surg. 2010; 39: 660-665
        • Silvennoinen U.
        • Raustia A.M.
        • Lindqvist C.
        • et al.
        Occlusal and temporomandibular joint disorders in patients with unilateral condylar fracture. A prospective one-year study.
        Int J Oral Maxillofac Surg. 1998; 27: 280-285
        • Zachariades N.
        • Mezitis M.
        • Mourouzis C.
        • et al.
        Fractures of the mandibular condyle: a review of 466 cases. Literature review, reflections on treatment and proposals.
        J Craniomaxillofac Surg. 2006; 34: 421-432
        • Gupta M.
        • Iyer N.
        • Das D.
        • et al.
        Analysis of different treatment protocols for fractures of condylar process of mandible.
        J Oral Maxillofac Surg. 2011; 70: 83-91
        • Chen C.T.
        • Feng C.H.
        • Tsay P.K.
        • et al.
        Functional outcomes following surgical treatment of bilateral mandibular condylar fractures.
        Int J Oral Maxillofac Surg. 2011; 40: 38-44
        • Becking A.G.
        • Zijderveld S.A.
        • Tuinzing D.B.
        Management of posttraumatic malocclusion caused by condylar process fractures.
        J Oral Maxillofac Surg. 1998; 56: 1370-1374
        • Newman L.
        A clinical evaluation of the long-term outcome of patients treated for bilateral fracture of the mandibular condyles.
        Br J Oral Maxillofac Surg. 1998; 36: 176-179
        • Lobbezoo F.
        • van Selms M.K.
        • John M.T.
        • et al.
        Use of the Research Diagnostic Criteria for Temporomandibular Disorders for multinational research: translation efforts and reliability assessments in The Netherlands.
        J Orofac Pain. 2005; 19: 301-308
        • Smets L.M.
        • Van Damme P.A.
        • Stoelinga P.J.
        Non-surgical treatment of condylar fractures in adults: a retrospective analysis.
        J Craniomaxillofac Surg. 2003; 31: 162-167
        • Downie J.J.
        • Devlin M.F.
        • Carton A.T.
        • et al.
        Prospective study of morbidity associated with open reduction and internal fixation of the fractured condyle by the transparotid approach.
        Br J Oral Maxillofac Surg. 2009; 47: 370-373
        • Vesnaver A.
        • Ahcan U.
        • Rozman J.
        Evaluation of surgical treatment in mandibular condyle fractures.
        J Craniomaxillofac Surg. 2012; 40: 647-653
        • Meyer C.
        • Zink S.
        • Chatelain B.
        • et al.
        Clinical experience with osteosynthesis of subcondylar fractures of the mandible using TCP plates.
        J Craniomaxillofac Surg. 2008; 36: 260-268
        • Ellis III, E.
        • McFadden D.
        • Simon P.
        • et al.
        Surgical complications with open treatment of mandibular condylar process fractures.
        J Oral Maxillofac Surg. 2000; 58: 950-958
        • Kim S.G.
        • Park S.S.
        Incidence of complications and problems related to orthognathic surgery.
        J Oral Maxillofac Surg. 2007; 65: 2438-2444
        • Morris D.E.
        • Lo L.J.
        • Margulis A.
        Pitfalls in orthognathic surgery: avoidance and management of complications.
        Clin Plast Surg. 2007; 34: e17-e29