Treatment of mandibular condyle fracture - a comparison of two protocols.

Objectives: To compare the outcome of two protocols (open reduction and closed reduction) in the treatment of mandibular condyle fracture. Study Design: Comparative study. Setting: Department of Oral & Maxillofacial Surgery, Institute of Dentistry, Liaquat University of Medical and Health Sciences Jamshoro. Period: January 2016 to September 2016. Material & Methods: After selection of patient into either group, for closed reduction technique, maxillomandibular fixation was applied for 4-6 weeks. For open reduction, a preauricular incision was given and fracture was reduced and fixed with miniplates after achieving the normal occlusion. Post operatively, patients of both the group were recalled after one, two and three months for the assessment of the functional effects such as occlusion and range of motion in both groups. Results: Mean age of the patients was29.80+4.42 years in group 1 (open reduction group), while mean age of the group 2 (closed reduction group) was 23.95+6.63 years. Male were in the majority in both groups 17 in group 1 and 16 in group 2. Out of 20 patients in group 1, 11 patients had condylar neck fracture and 9 had subcondyle fracture. While in group 2, 13 patients had subcondyle fracture and 7 had condylar neck fracture. In both groups again no significant difference was found according to location of the fracture (p-value 0.20). Group 1 (open reduction) had better functional results in terms of occlusion and range of motion after 3 months as compared to the group 2 (closed reduction). P-value 0.19. Conclusion: In dealing with mandibular condyle fractures it was concluded that open reduction and internal fixation is a better technique as compared to the closed reduction with maxillomandibular fixation.

A Case Report of Comminuted Mandibular Fracture with Condylar Neck Fracture

The fracture of the comminuted type has a prevalence of 30 to 50 % when related to the affecting mandibular bone. They are characterized by the presence of multiple bone involving several lines of fracture, resulting in small fragments within the same area. Treatment modalities for the management of comminuted mandibular fractures include closed reduction, external pin fixation, internal wire fixation, and open reduction and internal fixation using miniplates, titanium mesh tray and screws. The following case report highlights open reduction and internal fixation of a comminuted mandibular fracture in a 24-year-old male patient. The patient treated with open reduction and with a reconstruction plate followed by a short period of maxillomandibular fixation.

Comparison of Titanium and Bioresorbable Plates in “A” Shape Plate Properties—Finite Element Analysis

(1) Background: The main disadvantage of rigid fracture fixation is remain material after healing period. Implementation of resorbable plates prevents issues resulting from left plates. The aim of this study is to compare the usage of bioresorbable and titanium “A” shape condyle plate in condylar fractures. (2) Methods: Thickness of 1.0 mm, height of 31 mm, and width of 19 mm polylactic acid (PLLA) and titanium “A” shape plate with 2.0 mm-wide connecting bar and 9 holes were tested with finite element analysis in high right condylar neck fracture. (3) Results: On bone surface the highest stress is on the anterior bridge around first hole (approx. 100 MPa). The highest stress on screws is located in the first screw around plate in the anterior bridge and is greater in titanium (150 MPa) than PLLA (114 MPa). (4) Conclusion: Pressure on bone in PLLA osteosynthesis is two times higher than in titanium fixation. On small areas where pressure on bone is too high it causes local bone degradation around the fracture and may delay the healing process or make it impossible. Fixation by PLLA is such flexible that bone edges slide and twist what may lead to degradation of callus.