Semi-Rigid Fixation Using a Sliding Plate for Treating Fractures of the Mandibular Condylar Process

Occlusal displacement often occurs after surgery for condylar process fractures because it is difficult to reduce these fractures precisely. However, performing semi-rigid fixation using a sliding plate may overcome this limitation. A retrospective clinical comparison between semi-rigid and rigid fixations was performed. Among 34 patients who had unilateral condylar process fractures, 17 were treated with rigid fixation and the remaining with semi-rigid fixation using a sliding plate. For all patients, panoramic radiographs were collected 1 day and 6 months after surgery. In these radiographs, ramus height and condylar process inclination were measured, and the differences between the fractured and normal sides were assessed. Additionally, the radiographic density of the fracture area was measured. Differences in surgical outcomes and operative times between the two groups and changes in postoperative deviations within each group were analyzed. There was no statistically significant difference in ramus height and condylar process inclination between the two groups at postoperative day 1 and 6 months. Radio-density was observed to be higher in the rigid fixation group, and it increased with time in both groups. The semi-rigid fixation group had a significantly shorter operative time than the other group did. Semi-rigid and rigid fixations showed no differences in terms of effectiveness and outcomes of surgery. In terms of operative time, semi-rigid fixation was superior to rigid fixation.

The Use of Panoramic Radiography for Condyle Shape Detection on Menopausal Periods in Dentistry Radiology Installation – Dental and Oral Hospital of Universitas Sumatera Utara

Panoramic radiographs can be used to detect temporomandibular morphology and condylar changes. This study shape-determines the female condyle in perimenopausal and postmenopausal using panoramic radiography. It used an observational survey technique with a sample of 80 people, consisting of 40 perimenopausal aged between 20 and 29, and 40 postmenopausal females aged over 52. The results on the perimenopausal condyle process obtained a round shape of 43.7%, an angle of 32.5%, and a pointed shape of 23.7%. Furthermore, the shape of the condylar process in postmenopause is 37.5% pointed, 30% angled, 25% round, and 7.5% flat. Data were analyzed using the Chi-Square test with a significance value of p<0.05. The results showed that changes in the size and shape of the condyles occur with age. There is a significant difference in the condyle shape between perimenopausal and postmenopausal periods.

Proximity of the middle meningeal artery and maxillary artery to the mandibular head and mandibular neck as revealed by three-dimensional time-of-flight magnetic resonance angiography

Purpose The close topographic relationship between vascular and osseous structures in the condylar and subcondylar region and marked variability in the arterial course has been revealed by both imaging and cadaveric studies. This study aimed to verify the previously published information in a large sample and to determine a safe surgical region. Methods We analyzed the three-dimensional time-of-flight magnetic resonance angiography images of 300 individuals. Results The mean distance between the middle meningeal artery and the apex of the condyle or the most medial point of the condyle was 18.8 mm (range: 11.2–25.9 mm) or 14.5 mm (range: 8.8–22.9 mm) respectively. The course of the maxillary artery relative to the lateral pterygoid muscle was medial in 45.7% of cases and lateral in 54.3%. An asymmetric course was evident in 66 patients (22%). The mean distance between the maxillary artery and condylar process at the deepest point of the mandibular notch was 6.2 mm in sides exhibiting a medial course (range: 3.7–9.8 mm) and 6.6 mm in sides exhibiting a lateral course (range: 3.9–10.4 mm). The distances were significantly influenced by age, gender, and the course of the maxillary artery. Conclusion Our study emphasizes the marked inter- and intra-individual variability of the maxillary and middle meningeal arterial courses. We confirmed the proximity of the arteries to the condylar process. Extensive surgical experience and thorough preparation for each individual case are essential to prevent iatrogenic vascular injury.

Choice of Screws for Fixation of Mandibular Condyle Fractures Guided by Anthropometric Data

Open reduction and internal fixation (ORIF) is becoming increasingly common in treatment of the condylar process, including mandible head fractures. This approach significantly improves the results in terms of anatomical reduction of bone fragments, and shortens the treatment time, allowing for early functional recovery. The success of ORIF is largely determined by the stability of the osteosynthesis. The stabilization effect depends on the screw type and length of the plate used, in addition to the diameter and length of the screws used. The aim of this study was to determine the largest possible screw length that can be used in ORIF of the mandibular condyle considering the variable bone thickness. A total of 500 condyles were examined using computer tomography (CT)-based 3D models in Caucasians. For all models, three measurements were made in the frontal projection in places typical for the stabilization of osteosynthesis plates in the fractures of the condylar process: the base, the top, and the sigmoid notch. In addition, one measurement of the mandible head was made in the place of the greatest width. The results showed that 8 mm screws should be used in the region of the condylar base as the longest anatomically justified screw, whereas in the area of a sigmoid notch only 1.5–2 mm screws should be used. Measurements in the area of the neck top revealed statistically significant differences in the measurements between the sex of patients, with average differences below 1 mm (p < 0.05). In this area, the maximal length of the screw was found to be 10 mm. In mandibular head fractures, the use of long screws is extremely important due to the desired effect of fragment compression. Statistically significant differences were found in the measurement results between women and men. The maximal screw length for bicortical fixation was found to be 22 mm in men and 20 mm in women. In post-traumatic patients, the ability to obtain a clear measurement is often limited by a deformed anatomy. Taking into account the fact that the fracture stability is influenced by both the plate length and the length of the fixation screws, an assessment of the standard measurement values in a cohort group will improve the quality of the surgical fixations of the fractures.

Posterior Mandibular Displacement. A Systematic Review Based on Animal Studies

Treating extreme mandibular growth is challenging. The mandible is pushed backwards to address itsprotrusion. Nevertheless, conclusions after such displacement in animals have been contradictory. The aim of the present review is to present measurable alterations of the mandible and the condyle following retractionin healthy rats or rabbits. PubMed, Scopus and Web of Science were accessed for relevant studies up to October 2020. Eligibility was determined by the PICOS process, while the risk of bias was estimated with SYRCLE’s risk of bias tool. Retraction resulted in a more distal molar occlusion and the condyle rested more posteriorly. Mandibular anteroposterior bilateral growth restriction was achieved, the condylar process measured smaller and its angulation increased. The condylar neck thickened, its posterior surface flattened, the coronoid process was measured longer, and enlarged retromolar density was registered. Differences in the ramus height and the intercondylar distance were insignificant. Changes persisted for the period of study and subsequently the mandible resumed its inherited growth pattern. The timing of mandibular shaping and TMJ outcomes might depend on the properties of the applied force. Stability is of concern and well-structured, long-term studies are expected to resolve the issue and further clarify the results of posterior mandibular displacement.

Condylar hypoplasia: Clinical case

The formation of the face and the stomatognathic system is complex in nature and involves the development of multiple tissue processes that must unite and fuse in an extremely orderly manner. Disorders in the growth of these tissue processes or in their fusions can result in facial changes. The temporomandibular joint is one of the most complex in the human body, with the condylar process responsible for the expression of mandibular growth. Condylar hypoplasia is characterized by a defective formation of the condylar process that can be congenital or acquired. In the case presented, the patient has facial asymmetry since the first year of life, only on the left side. Thus, professionals working in the region of the temporomandibular joint must have knowledge of the existence and clinical implications for an early diagnosis in order to avoid the development of facial asymmetries, restoring the patient’s function, aesthetics and psychological status.

Structural features of the temporomandibular joint in patients with gnathic mesial occlusion

The aim of the study was to evaluate the structural features of the temporomandibular joint in patients with a gnatic form of mesial occlusion of the dentition. Materials and methods. In studying the structural features of the facial skull in patients with gnatic mesial occlusion, the height of the condylar process was separately evaluated in the course of the study in order to avoid the incorrect measurement of the branch height in cases of degenerative changes in the condylar process. Results. The structural features of the temporomandibular joint were determined in 50 adult patients (aged 1844 years old) using cone-beam computed tomography.Сonclusion. Patients with gnathic mesial occlusion of the asymmetric group showed identical articular spaces (anterior and posterior) in the sagittal direction on both the deviating and non-deviating sides, suggesting that the bilateral relationship between the head and fossa may be as symmetrical as in patients with symmetry. However, the axial condylar angle had a bilateral difference only among patients in the asymmetric group; namely, it was significantly greater on the side of the deviating condyle.