Modified surgical method for diacapitular condylar fractures in 38 consecutive patients

doi:10.19438/j.cjoms.2018.03.010

Abstract

Abstract: PURPOSE: To introduce a modified surgical method for diacapitular condylar fractures. METHODS: Thirty-eight patients (50 TMJs) diagnosed as diacapitular condylar fracture through clinical examinations(CT and MRI) were treated with a modified surgical technique from January 2015 to December 2016. The technique was mainly proposed for diacapitular fractures. A minimized preauricular incision and transparotid access was used. Then reduction and fixation of diacapitular condylar fractures were performed. After confirming that the fracture was fixed rigidly, the articular disc was repositioned and anchored by a special anchorage nail. All patients were estimated by CT and MRI pre- or post-surgery, and followed up for 1 year at least. For patients who had other fractures of the mandible, open and internal fixation were conducted simultaneously. Radiologic, anatomic and objective functional parameters (axiography and MRI) were used to assess the vertical height, disk mobility, protrusive and translatory movement as well as potential physical complaints. All results were statistically analyzed with SPSS 17.0 software package. RESULTS: Spiral CT revealed that 96.0% (48/50 TMJs) of DCFs were correctly reduced and fixed. All patients showed significant difference in the vertical height between preoperation and postoperation (P<0.05) and there was no significant difference between the uninjured side and the postoperative affected side (P>0.05) in19 unilateral DCFs. Postoperative MRI showed that the displaced discs were reduced to its normal position in 46 of 50 TMJs(92.0%). Long-term follow-up of 38 patients included mouth opening(35.67 mm), maximum lateral occlusion (4.45 mm), maximum protrusive occlusion (5.63 mm), mouth open with deviation in 2 cases (5.3%), TMJ click in 2 cases(4.0%), facial nerve injury in 4 cases (3 cases were recovered spontaneously 3 months after surgery, another relieved by taking mecobalamin orally) and all occlusion was stable. CONCLUSIONS: This modified technique was proposed for DCF, clinical results were very good and should be popularized in clinic, but further evaluation was necessary.

Key words: Diacapitular condylar fracture, Open reduction and internal fixation, Temporomandibular joint disc anchorage;

CLC Number:

R318.08

REN Rong, CAI Bo-lei, ZHI Yin, SI Jia-wen, ZHANG Jian-fei, SHI Jun.. Modified surgical method for diacapitular condylar fractures in 38 consecutive patients[J]. China Journal of Oral and Maxillofacial Surgery, 2018, 16(3): 242-247.

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