scholarly journals The Use of 3D Titanium Miniplates in Surgical Treatment of Patients with Condylar Fractures

2020 ◽  
Vol 9 (9) ◽  
pp. 2923 ◽  
Author(s):  
Maciej Sikora ◽  
Maciej Chęciński ◽  
Marcin Sielski ◽  
Dariusz Chlubek
Keyword(s):  
Three Dimensional ◽  
Mandibular Condyle ◽  
Rigid Fixation ◽  
Good Reliability ◽  
Open Treatment ◽  
The Stability ◽  
Condylar Fractures ◽  
Affect Bone Healing ◽  
Observation Period

The aim of this study was to evaluate the effectiveness of open treatment of mandibular condyle fractures using 3D miniplates. A group of 113 patients has been chosen for evaluation, including 100 men and 13 women. After hospitalization, each patient underwent a 6-month postoperative follow-up. The material chosen for the analysis consisted of data collected during the patient’s stay in the hospital as well as the postoperative outpatient care. A single 4-hole Delta Condyle Compression Plate (4-DCCP) was used in 90 out of 113 (79.6%) cases. In 16 out of 113 (14.2%) patients, the Trapezoid Condyle Plate (4-TCP or 9-TCP) was used. The remaining cases required more than one miniplate. No 3D miniplate fractures were found in the study subjects during the analyzed observation period. Loosening of one or more osteosynthesis screws was observed in 4 out of 113 (3.5%) patients. Screw loosening was a complication that did not affect bone healing in any of the patient cases. The conducted research confirms that titanium 3D mini-plates are easy to adjust and take up little space, therefore they can easily be used in cases of mandibular condyle base and lower condyle neck fractures. The stability of the three-dimensional miniplates for osteosynthesis gives very good reliability for the rigid fixation of the fractured mandibular condyle.

Rehabilitation of severely atrophic mandible: A 3-year Follow Up Protocol.

2021 ◽  
Author(s):  
Ricardo Andrés Landázuri Del Barrio ◽  
Edelcio de Souza Rendohl ◽  
Alia Oka Al Houch ◽  
Heloisa Fonseca Marão
Keyword(s):  
Three Dimensional ◽  
Rigid Fixation ◽  
Bovine Bone ◽  
Rehabilitation Process ◽  
Intraoral Approach ◽  
Bone Deficiency ◽  
Immediate Implants ◽  
Bovine Bone Mineral ◽  
Deproteinized Bovine Bone Mineral

Severe bone atrophies are considered a challenge in the rehabilitation process. In clinical situations involving excessive vertical bone deficiency in edentulous mandibles, there is risk of fracture and frequently the need for an approach that involves highly complex procedures. In this context, simultaneous three-dimensional bone reconstruction associated with rigid fixation is a viable alternative to optimize longevity and avoid failures in these cases. This clinical case report presents a technique for reconstruction of severely atrophic mandibles in an elderly female patient to allow the implant-supported prosthesis protocol. The placement of immediate implants was possible by using an intraoral approach for fixation of a titanium plate, followed by guided bone regeneration in association with rhBMP-2, deproteinized bovine bone mineral and titanium mesh in a one-stage surgical procedure. There are no reports in the literature with this approach for treating of severely atrophic mandibles. These association of techniques was shown to be predictable after three years of follow-up. Therefore, this protocol provides safe supported-implant prosthesis rehabilitation for patients with severely atrophic mandible.

scholarly journals Autosomal Dominant Gyrate Atrophy-Like Choroidal Dystrophy Revisited: 45 Years Follow-Up and Association with a Novel C1QTNF5 Missense Variant

2021 ◽  
Vol 22 (4) ◽  
pp. 2089
Author(s):  
Ulrich Kellner ◽  
Nicole Weisschuh ◽  
Silke Weinitz ◽  
Ghazaleh Farmand ◽  
Sebastian Deutsch ◽  
...  
Keyword(s):  
Autosomal Dominant ◽  
Late Onset ◽  
Three Dimensional ◽  
Missense Variant ◽  
Clinical Aspects ◽  
Gyrate Atrophy ◽  
Three Dimensional Modeling ◽  
Long Term Follow Up ◽  
The Stability

We present a long-term follow-up in autosomal dominant gyrate atrophy-like choroidal dystrophy (adGALCD) and propose a possible genotype/phenotype correlation. Ophthalmic examination of six patients from two families revealed confluent areas of choroidal atrophy resembling gyrate atrophy, starting in the second decade of life. Progression continued centrally, reaching the fovea at about 60 years of age. Subretinal deposits, retinal pigmentation or choroidal neovascularization as seen in late-onset retinal degeneration (LORD) were not observed. Whole genome sequencing revealed a novel missense variant in the C1QTNF5 gene (p.(Q180E)) which was found in heterozygous state in all affected subjects. Haplotype analysis showed that this variant found in both families is identical by descent. Three-dimensional modeling of the possible supramolecular assemblies of C1QTNF5 revealed that the p.(Q180E) variant led to the destabilization of protein tertiary and quaternary structures, affecting both the stability of the single protomer and the entire globular head, thus exerting detrimental effects on the formation of C1QTNF5 trimeric globular domains and their interaction. In conclusion, we propose that the p.(Q180E) variant causes a specific phenotype, adGALCD, that differs in multiple clinical aspects from LORD. Disruption of optimal cell-adhesion mechanisms is expected when analyzing the effects of the point mutation at the protein level.

scholarly journals Validation of a 3D CBCT-based protocol for the follow-up of mandibular condyle remodeling

2020 ◽  
Vol 49 (3) ◽  
pp. 20190364
Author(s):  
Pieter-Jan Verhelst ◽  
Eman Shaheen ◽  
Karla de Faria Vasconcelos ◽  
Fréderic Van der Cruyssen ◽  
Sohaib Shujaat ◽  
...  
Keyword(s):  
Cone Beam Ct ◽  
Intraclass Correlation ◽  
Three Dimensional ◽  
Mandibular Condyle ◽  
Correlation Coefficients ◽  
Micro Ct ◽  
Gonial Angle ◽  
Volume Of Interest ◽  
User Friendly

Objectives: Three-dimensional models of mandibular condyles provide a way for condylar remodeling follow-up. The overall aim was to develop and validate a user-friendly workflow for cone beam CT (CBCT)-based semi-automatic condylar registration and segmentation. Methods: A rigid voxel-based registration (VBR) technique for registration of two post-operative CBCT-scans was tested. Two modified mandibular rami, with or without gonial angle, were investigated as the volume of interest for registration. Inter- and intraoperator reproducibility of this technique was tested on 10 mandibular rami of orthognathic patients by means of intraclass correlation coefficients (ICC’s) and descriptive statistics of the transformation values from the VBR. The difference in reproducibility between the two modified rami was evaluated using a paired t-test (p < 0.05). For the segmentation, eight fresh frozen cadaver heads were scanned with CBCT and micro-CT. These data were used to test the inter- and intraoperator reproducibility (ICC’s) and accuracy (Bland–Altman plot) of a newly designed workflow based on semi-automated contour enhancement. Results: Excellent ICC’s (0.94–0.99) were obtained for the voxel-based registration technique using both modified rami. If the gonial angle was not included in the volume of interest, there was a trend of increased operator error suggested by significant higher interoperator differences in translation values (p = 0,0036). The segmentation workflow proved to be highly reproducible with excellent ICC’s (0.99), low absolute mean volume differences between operators (23.19 mm3), within operators (28.93 mm3) and low surface distances between models of different operators (<0.20 mm). Regarding the accuracy, CBCT-models slightly overestimate the condylar volume compared to micro-CT. Conclusions: This study provides a validated user-friendly and reproducible method of creating three-dimensional-surface models of mandibular condyles out of longitudinal CBCT-scans.

scholarly journals Fixação interna estável de fratura condilar: relato de caso

2020 ◽  
Vol 9 (6) ◽  
pp. 541-545
Author(s):  
Janaina Soares Silva ◽  
Rejane Kelly Andrade Beiriz ◽  
Marcus Antônio Brêda Júnior ◽  
Ricardo Viana Bessa-Nogueira ◽  
Marcelo Marotta Araujo ◽  
...  
Keyword(s):  
Critical Review ◽  
Rio De Janeiro ◽  
Mandibular Condyle ◽  
Surgical Approaches ◽  
Condylar Fracture ◽  
Condylar Process ◽  
Fracture Management ◽  
Open Treatment ◽  
Condyle Fracture ◽  
Condylar Fractures

As fraturas mandibulares são o segundo tipo de fraturas mais comum que acomete a face, e elas podem ter um impacto negativo na estética e anatomia facial, bem como causar problema em atividades cotidianas como falar e mastigar. Este artigo tem por objetivo relatar o caso clínico de um paciente vítima de agressão física, que apresentou uma fratura unilateral de côndilo associada à fratura oblíqua de sínfise. Paciente do gênero masculino, 32 anos, leucoderma, através das radiografias PA de mandíbula e Towne foram constatadas fratura da região de sínfise mandibular e côndilo do lado esquerdo. A escolha para o tratamento desta fratura, foi o tratamento cirúrgico com fixação interna da fratura condilar com sistema 2.0mm. Após sete dias foi iniciada a fisioterapia com espátulas de madeira para o restabelecimento de adequada abertura bucal, apresentando ao final uma recuperação satisfatória, sem intercorrências. O uso de placas e parafusos para o tratamento cirúrgico de fraturas de côndilo mandibular e sínfise se mostrou eficaz, resultando no sucesso cirúrgico com um pós-operatório sem complicações e no reestabelecimento funcional e da oclusão. Descritores: Fraturas Mandibulares; Côndilo Mandibular; Fixação de Fratura. Referências Bastos EO, Goldenberg DC, Alonso N. Acesso retromandibular transparotídeo: uma via simples, eficaz e segura para tratamento das fraturas de côndilo mandibular. Rev Soc Bras Cir Craniomaxilofac. 2009;12(1):10-5. Araújo CFSN, Braga PLS, Ferreira JDB. Tratamento tardio de fratura condilar: Relato de caso. Rev cir traumatol buco-maxilo-fac. 2013;13(3):17-24. Gois Filho DM, Amarante AS, Moura RQ, Dultra JA, Carneiro Júnior B. Uso do acesso retromandibular para tratamento de fratura bilateral de côndilo mandibular: relato de caso. Rev cir traumatol buco-maxilo-fac. 2013;13(1):29-34. Rodrigues CMC, Santos DM, Oliveira MMM, Silva MCP, Furtado LM. Tratamento conservador de fratura condilar alta: relato de caso. Rev Odontol Bras Central. 2019;28(85):87-90. Mendonça JCG, Bento LA, Freitas GP. Tratamento das fraturas de côndilo mandibular: revisão da literatura. Rev Bras Cir Craniomaxilofac. 2010;13(2):102-6. Ellis E 3rd, Throckmorton G. Facial symmetry after closed and open treatment of fractures of the mandibular condylar process. J Oral Maxillofac Surg. 2000;58(7):719-28;729-30. Dantas BPSS, Fialho PV, Fernandes ACF, Silva DT, Queiroz CS. Fratura complexa de mandíbula: relato de caso. Rev Odontol Araçatuba. 2017;38(3):43-8. Trento G, Corso PFCL, Scariot R, Kluppel LE, Costa DJ, Rebellato NLB. Tratamento cirúrgico de fratura da cabeça de mandíbula com parafusos bicorticais: relato de caso. Arq bras odontol. 2014;10(2):12-9. Bagheri SC, Bell RB, Khan HA. Terapias atuais em cirurgia bucomaxilofacial. Rio de Janeiro: Elsevier; 2013. Manganello LC, Silva Alexandre AF. Fraturas do Côndilo Mandibular: classificação e tratamento. Rev Bras Otorrinolaringol. 2002;68(5):249-55. Vieira WM, Siqueira OV, Scherma AP, Miranda LR. Fratura bilateral de côndilo mandibular: tratamento tardio e complicações. Rev Bras Cir Craniomaxilofac. 2011;14(2):115-18. Rampaso CL, Mattioli TMF, Andrade Sobrinho J, Rapoport A. Avaliação da prevalência do tratamento das fraturas de côndilo mandibular. Rev Col Bras Cir. 2012;39(5):373-76. Pogrel MA, Kahnberg KE, Andersson MA. Cirugia Bucomaxilofacial. Rio de Janeiro: Santos; 2016. Alencar MGM, Rebelo HL, Silva EZ, Breda Junior MA, Medeiros Junior MD. Tratamento de fratura complexa de mandíbula por abordagem transcervical: Relato de caso. Rev cir traumatol buco-maxilo-fac. 2015; 15(4):43-8. Rampaso CL, Mattioli TMF, Sobrinho JA. Rapoport Estudo epidemiológico das fraturas do côndilo da mandíbula. Rev Bras Cir Cabeça Pescoço. 2009;38(1):19-21. Ramalho RA, Farias Junior ON, Cardoso AB. Tratamento cirúrgico de fratura bilateral de côndilo associada à fratura de corpo mandibular: relato de caso. Rev cir traumatol buco-maxilo-fac. 2013;13(2):69-73. Kumaran S, Thambiah LJ. Analysis of two different surgical approaches for fractures of the mandibular condyle. Indian J Dent Res. 2012;23(4):46-68. Valiati R, Ibrahim D, Abreu ME, Heitz C, de Oliveira RB, Pagnoncelli RM, Silva DN. The treatment of condylar fractures: to open or not to open? A critical review of this controversy. Int J Med Sci. 2008;5(6):313-18. Choi KY, Yang JD, Chung HY, Cho BC. Current concepts in the mandibular condyle fracture management part I: overview of condylar fracture. Arch Plast Surg. 2012;39(4):291-300. Ellis E, Throckmorton GS. Treatment of mandibular condylar process fractures: biological considerations. J Oral Maxillofac Surg. 2005;63(1):115-34.  Iwaki Filho L, Pavan AJ, Camarini ET, Tondin GM. Tratamento das fraturas de côndilo mandibular: cirúrgico ou conservador? Rev cir traumatol buco-maxilo-fac. 2005;5(4):17-22.

scholarly journals Retromandibular Approach as a Method for Open Reduction and Internal Fixation of Mandibular Condyle Fractures. Experience in the Regional Hospital 1º de Octubre, ISSSTE and Literature Review

2021 ◽  
Vol 7 (7) ◽  
Author(s):  
González MGR ◽  
Munguía AMN ◽  
González CASJ ◽  
Tellez EB ◽  
Montes IDG
Keyword(s):  
Internal Fixation ◽  
Closed Reduction ◽  
Open Reduction ◽  
Surgical Techniques ◽  
Mandibular Condyle ◽  
Middle Cranial Fossa ◽  
Sufficient Evidence ◽  
Mandibular Fractures ◽  
Open Treatment ◽  
Condylar Fractures

Mandibular condyle fractures constitute 17.5% to 52% of mandibular fractures. Open reduction with internal fixation and closed reduction are described for their treatment. Fonseca describes the absolute indications for open treatment when there is displacement of the mandibular condyle to the middle cranial fossa, foreign body invasion, extra capsular displacement of the condyle, and/or malocclusion not susceptible to closed reduction. It includes indications with vast evidence for open treatment of bicondyle fractures, condylar displacement greater than 45 degrees, reduction in the height of the mandibular ramus greater than or equal to 2mm, fractures associated with fractures of the middle third and when there is unstable occlusion. The above establishes sufficient evidence to perform open treatment in various situations of condylar fractures. Regarding the approach of the mandibular condyle region there are different surgical techniques, such as, the preauricular, retroauricular, submandibular, retromandibular, and rhytidectomy approaches.

scholarly journals Three-dimensional assessment of unilateral subcondylar fracture using computed tomography after open reduction

2014 ◽  
Vol 47 (02) ◽  
pp. 203-209 ◽  
Author(s):  
Sathya Kumar Devireddy ◽  
R. V. Kishore Kumar ◽  
Rajasekhar Gali ◽  
Sridhar Reddy Kanubaddy ◽  
Mallikarjuna Rao Dasari ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Statistical Difference ◽  
Sagittal Plane ◽  
Three Dimensional ◽  
Mandibular Condyle ◽  
Clinical Results ◽  
Considerable Change ◽  
Ct Scans ◽  
Open Method ◽  
Condylar Fractures

ABSTRACT Objective: The aim was to assess the accuracy of three-dimensional anatomical reductions achieved by open method of treatment in cases of displaced unilateral mandibular subcondylar fractures using preoperative (pre op) and postoperative (post op) computed tomography (CT) scans. Materials and Methods: In this prospective study, 10 patients with unilateral sub condylar fractures confirmed by an orthopantomogram were included. A pre op and post op CT after 1 week of surgical procedure was taken in axial, coronal and sagittal plane along with three-dimensional reconstruction. Standard anatomical parameters, which undergo changes due to fractures of the mandibular condyle were measured in pre and post op CT scans in three planes and statistically analysed for the accuracy of the reduction comparing the following variables: (a) Pre op fractured and nonfractured side (b) post op fractured and nonfractured side (c) pre op fractured and post op fractured side. P <; 0.05 was considered as significant. Results: Three-dimensional anatomical reduction was possible in 9 out of 10 cases (90%). The statistical analysis of each parameter in three variables revealed (P <; 0.05) that there was a gross change in the dimensions of the parameters obtained in pre op fractured and nonfractured side. When these parameters were assessed in post op CT for the three variables there was no statistical difference between the post op fractured side and non fractured side. The same parameters were analysed for the three variables in pre op fractured and post op fractured side and found significant statistical difference suggesting a considerable change in the dimensions of the fractured side post operatively. Conclusion: The statistical and clinical results in our study emphasised that it is possible to fix the condyle in three-dimensional anatomical positions with open method of treatment and avoid post op degenerative joint changes. CT is the ideal imaging tool and should be used on a regular basis for cases of condylar fractures.

scholarly journals Pediatric Bilateral Condylar High Displaced Fracture: Ten Years Follow-Up

2020 ◽  
Vol 5 ◽  
pp. 247275122094471
Author(s):  
Jonathas Daniel Paggi Claus ◽  
Matheus Spinella Almeida ◽  
Felipe Daniel Burigo dos Santos ◽  
Otacilio Chagas Júnior
Keyword(s):  
Pediatric Patients ◽  
Maxillofacial Surgery ◽  
Pediatric Trauma ◽  
High Capacity ◽  
Rigid Fixation ◽  
Anatomic Reduction ◽  
Controversial Topic ◽  
Displaced Fracture ◽  
Condylar Fractures

The treatment of mandibular condylar fractures is a controversial topic in maxillofacial surgery. Open surgery with anatomic reduction and internal rigid fixation is well established in the literature and appears to be the most common approach. Nonsurgical therapies are indicated to intracapsular fractures, medial condylar displacement, and pediatric trauma. The high capacity of tissue remodeling and articular adaptation are important factors to support nonsurgical treatment in pediatric patients. The purpose of this article is to present a case of a pediatric mandibular bilateral condylar fracture treated with closed reduction with 10 years of follow-up and a discussion based on the literature.

Clinical Experience with Osteosynthesis of Subcondylar Fractures of the Mandible using Delta Plate

2016 ◽  
Vol 6 (1) ◽  
pp. 63-66
Author(s):  
Shailesh Nareshkumar Kokal ◽  
Suraj Arjun Ahuja ◽  
Nareshkumar T Kokal ◽  
Haemant A Baonerkar
Keyword(s):  
Clinical Experience ◽  
Mandibular Condyle ◽  
Rigid Fixation ◽  
Controversial Issues ◽  
Facial Skeleton ◽  
Present Case Report ◽  
The Past ◽  
Subcondylar Fracture ◽  
Open Treatment ◽  
Fixation Techniques

ABSTRACT Mandibular condyle fractures are one of the most frequent injuries of the facial skeleton. The option for open treatment of mandibular condyle fractures has become more favorable since osteosynthesis materials were developed in the past few decades. However, the rigid fixation techniques of treating condyle fractures remain one of the controversial issues in maxillofacial trauma. Several techniques and plate types such as adaption miniplates, minidynamic compression plates, resorbable plates, and double plates have been evaluated biomechanically in various experimental and clinical studies. The present case report is to evaluate the clinical use of indigenously developed titanium delta-shaped miniplate in open reduction and internal fixation of subcondylar fracture. How to cite this article Kokal SN, Ahuja SA, Kokal NT, Baonerkar HA. Clinical Experience with Osteosynthesis of Subcondylar Fractures of the Mandible using Delta Plate. J Contemp Dent 2016;6(1):63-66.

scholarly journals Study of open versus closed reduction of mandibular condyle fractures

2021 ◽  
Vol 8 (11) ◽  
pp. 3402
Author(s):  
Nagaraj Gareikpatii
Keyword(s):  
Internal Fixation ◽  
Closed Reduction ◽  
Maxillofacial Surgery ◽  
Mandibular Condyle ◽  
Adult Males ◽  
Combined Approach ◽  
Open Treatment ◽  
Open Versus ◽  
Condylar Fractures ◽  
Suitable Technique

Background: Condylar fractures of the mandible are a commonest occurrence in maxillofacial surgery. Many surgeons prefer closed therapy with maxillomandibular fixation, while open treatment with rigid internal fixation has become more common in recent years. This study provides a comparative evaluation of open and closed reduction of the mandibular condyle.Methods: The 50 patients with condylar fractures were treated with open and closed reduction as per the requirement.Results: A higher incidence of unilateral segmented condylar fractures were seen in young adult males. Open reduction and internal fixation (ORIF) with a combined approach was the preferred treatment of choice with fewer post-op complications.Conclusions: ORIF is a suitable technique in the treatment of condylar fractures as it promises few complications.

scholarly journals Condylar Fractures: An Argument for Conservative Treatment

2020 ◽  
Vol 13 (1) ◽  
pp. 23-31
Author(s):  
Jasper Vanpoecke ◽  
Kathia Dubron ◽  
Constantinus Politis
Keyword(s):  
Road Traffic ◽  
Maxillofacial Surgery ◽  
Treatment Protocol ◽  
Mandibular Condyle ◽  
University Hospitals ◽  
Female Ratio ◽  
Conservative Group ◽  
First Choice ◽  
Condylar Fractures

Introduction: The treatment of mandibular condyle fractures remains a controversial topic in maxillofacial surgery. No uniform treatment protocol is currently available. Purpose: We performed a retrospective monocentric cohort study of patients with condylar fractures and their treatment, including long-term follow-up by telephone, followed by a short review of the literature. Patients and Methods: The available data on condylar fractures presenting at Leuven University Hospitals between January 1, 2009, and December 31, 2015, were analyzed. Cause, age, sex, fracture level, degree of displacement, associated facial fractures, malocclusion, type of treatment, and complications were noted. Follow-up by telephone was performed after an average 261 weeks for the conservative group. Results: A total of 109 condylar fractures were observed with a male/female ratio of 1.14:1. Most fractures were subcondylar, unilateral, displaced, caused by road traffic accidents, and treated conservatively. Discussion: In children and intracapsular fractures, conservative management remains the first choice. Maxillomandibular fixation should be used sparingly in children and for as short a time as possible. Some patients indicated for surgery can still have acceptable results if treated conservatively.

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