Delayed open reduction and single screw internal fixation as a treatment option in cases of failed non-surgical treatment of bilateral condylar head fractures with fragmentation

Zhang, Bin; Yang, Mingyong; Zhou, Qing; Liu, Qiang

doi:10.1016/j.jcms.2016.08.013

Cited by 6 publications

(4 citation statements)

References 26 publications

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“…22,23 Nonetheless, anatomic reposition of fracture fragments is difficult in patients with intracapsular condylar fractures, especially in patients with comminuted, small piece or old/delayed fractures. 10 Therefore, the fracture fragments have to be removed. However, long-term follow-up studies on bone remodeling after condylar fracture fragments were removed remain lacking.…”

Section: Discussionmentioning

confidence: 99%

“…3,[6][7][8][9] However, whether the close treatment or open reduction of intra-capsular fractures, the results are not wholly satisfactory since there were so many reports of abnormal function and deformity in imaging findings. 2 Especially in patients with comminuted, small piece or old/delayed fractures, 10 the fragment may be too small to perform the reduction and fixation of the fracture, besides that its displacement may interfere or even avoid adequate occlusion and mouth opening reestablishment, correspondingly, some of the fracture fragments had to be removed during the surgical proce-dure. [11][12][13][14] However, few long-term follow-up reports exist on the removal of condyle fracture fragments.…”

Section: Referencesmentioning

confidence: 99%

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Removal of Fracture Fragments in Intracapsular Condylar Fractures: An Alternative Treatment Option

Cui¹,

Yang²,

Zhou

et al. 2022

Journal of Craniofacial Surgery

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Objective: This study aimed to explore bone remodeling after condylar fracture fragments have been removed from patients with intracapsular condylar fractures. it also evaluated whether condyle fracture removal can be used alternatively when the authors treat patients with comminuted or small pieces of fracture or in extremely difficult operations. Methods: Records of patients who sustained intracapsular condylar fractures and treated by removal of fragments for the period of February 2013 to September 2019 were retrieved. Data about age, gender, date of injury, dates of admission and discharge, mechanism of trauma, location and pattern of fracture, other mandibular fracture, treatment methods and time of review were recorded and analyzed. Image dates of pre- and post-treatment (including the time of review) were also recorded. Results: The data of a total of 103 patients ranging from 5 to 84 years old were retrieved during this study. A total of 135 sides of condylar fragments were removed. Almost all of the patients with comminuted condyle head fracture or type A fracture presented apparent shortening of the ramus height, and none of them showed osteogenesis (or new bone formation) during their follow-up. Present study only observed osteogenesis in few patients who sustained type B/C intracapsular condylar fractures during their follow-up. The younger the patient was, the longer the follow-up time was, and the higher the possibility of new bone formation was. No correlation was found between the amount of osteogenesis and follow-up time, the amount of osteogenesis was generally small, and no patient could form a new condyle head similar to the normal (or original) condyle head. Condylar hypertrophy only occurred in children. Four patients developed temporomandibular joint ankylosis. Conclusions: Removal of fracture fragments is an alternative treatment option for patients who sustained comminuted or small pieces of fracture or in extremely difficult operations.

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Section: Discussionmentioning

confidence: 99%

Section: Referencesmentioning

confidence: 99%

Removal of Fracture Fragments in Intracapsular Condylar Fractures: An Alternative Treatment Option

Cui¹,

Yang²,

Zhou

et al. 2022

Journal of Craniofacial Surgery

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“…Open reduction internal fixation (ORIF) has emerged as the gold standard of treatment for achieving anatomic reduction for a range of mandibular fractures, including condylar head fractures, despite the therapeutic value of a closed reduction of mandible fractures with mandibulomaxillary fixation (MMF) [ 23 , 24 ]. ORIF allows a fracture to be reduced in an efficient and safe way and may be implemented even in cases where a non-surgical approach failed [ 25 , 26 ]. However, in contrast to MMF, mandible ORIF is thought to carry a higher risk of postoperative infection problems [ 27 , 28 , 29 , 30 ].…”

Section: Introductionmentioning

confidence: 99%

Orthodontic Approaches in the Management of Mandibular Fractures: A Scoping Review

et al. 2023

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Non-surgical approaches have been proposed in the management of mandibular fractures, especially in children, but there is a lack of clear guidelines on the clinical indications of conservative approaches. The aim of this scoping review is to provide the available evidence of the role of the orthodontist in the management of mandibular fractures. The PRISMA-ScR guidelines were followed to select eligible articles from the PubMed, Scopus, and Web of Science databases according to precise inclusion criteria. The research questions were formulated as follows: “what is the scientific evidence concerning the rule of orthodontists in the management of mandibular fractures” and “the preferential use of the direct bonding technique with orthodontic brackets rather than rigid arch bars”? Seventeen articles were included. Five articles presented the use of removable acrylic splints or functional appliances, six articles concerned the employment of cemented acrylic or rigid splints, and six articles described the management of mandibular fractures in adults and children using orthodontic brackets or mini-screws. Most of these techniques have been employed in children and growing subjects, while fewer data were available regarding conservative treatments in adults. Preliminary evidence suggests that condylar and some minor parasymphyseal fractures in children may be managed with conservative approaches. In adults, minor condylar and stable body mandibular fractures with minimal displacement have been reduced similarly. However, there are no sufficient elements that could suggest the preferential use of orthodontic brackets over rigid arch bars in adults. Further randomized and non-randomized clinical trials with long follow-ups will be needed to better define the clinical indications of the orthodontic approaches in the management of mandibular fractures based on severity, location, and age.

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“…Although closed reduction of mandible fractures via mandibulomaxillary fixation (MMF) has therapeutic value, open reduction internal fixation (ORIF) has become the standard of care for achieving anatomic reduction for a wide variety of mandibular fractures, including condylar head fractures. 1 However, mandible ORIF is considered to have a higher risk of postoperative infectious complications, as compared with MMF, 2 – 5 given the introduction of hardware in a grossly contaminated oral cavity. Intuitively, earlier ORIF should reduce the open fracture contamination exposure, though delayed ORIF allows for soft-tissue edema to subside and wound closure under reduced tension, which may theoretically decrease the risk of subsequent wound dehiscence and hardware exposure.…”

Section: Introductionmentioning

confidence: 99%

Treatment Delay Impact on Open Reduction Internal Fixation of Mandibular Fractures: A Systematic Review

Stone¹,

Corneman²,

Sandre³

et al. 2018

Plastic and Reconstructive Surgery - Global Open

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Background:The impact of mandible fracture treatment delay has been contested in the literature for decades, with conventional wisdom favoring earlier surgical treatment to prevent postoperative complications, primarily infection. Through a systematic review of all available evidence, this study aims to determine whether delay to open reduction and internal fixation of traumatic mandibular fractures influences outcomes.Methods:MEDLINE, EMBASE, CINAHL, and Web of Science were systematically searched for English language literature pertaining to the above research question and screened in duplicate. Methodological quality scoring was performed using MINORS criteria. Qualitative and quantitative findings from relevant studies are presented.Results:Twenty eligible studies including 2,671 patients had open reduction internal fixation, with or without adjunct mandibulomaxillary fixation. All studies were observational cohort or case-control studies of low methodological quality with a mean MINORS score of 6.5 of 16 (40.6%) for noncomparative studies and 11.2 of 24 (46.7%) for comparative studies. Only 5 of 20 (25%) studies recommended earlier treatment. Due to insufficient reporting of data and study heterogeneity, the impact of treatment delay on complications could not be quantitatively analyzed.Conclusions:There is substantial heterogeneity and no consensus on the definition of “early” versus “delayed” surgical treatment for patients with traumatic mandibular fractures. The majority of included studies do not make a recommendation for earlier treatment. Future, well-designed prospective studies are essential to determine if there is an optimal surgical treatment delay of mandibular fractures that mitigates the risk of infectious and noninfectious complications.

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Delayed open reduction and single screw internal fixation as a treatment option in cases of failed non-surgical treatment of bilateral condylar head fractures with fragmentation

Cited by 6 publications

References 26 publications

Removal of Fracture Fragments in Intracapsular Condylar Fractures: An Alternative Treatment Option

Removal of Fracture Fragments in Intracapsular Condylar Fractures: An Alternative Treatment Option

Orthodontic Approaches in the Management of Mandibular Fractures: A Scoping Review

Treatment Delay Impact on Open Reduction Internal Fixation of Mandibular Fractures: A Systematic Review

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