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To reveal morphological changes in musculoskeletal apparatus after conservative treatment of condylar head fracture (CHF) by clinical examinations, condylar and masticatory muscle reconstruction, to guide the clinical therapeutic strategy. Patients with unilateral CHF and treated conservatively during November 2015 to January 2020 were enrolled and followed up for 2 years. Clinical assessments (mouth open, mandible deviation and occlusal relationship), and CT reconstruction (condyle, ramus height, masseter and lateral pterygoid) immediately and 2 years after fracture were compared with the unfractured side as control group. Mixed-effect analysis and two-way ANOVA were manipulated and P ≤ 0.05 was defined as significant. 26 patients were involved. The average of maximum mouth opening increased from 12.6 ± 5.40 mm to 27.8 ± 8.60 mm. Significant musculoskeletal resorption with an average condyle volume decrease of 241.86 mm3 (P = 0.0029), ramus height decrease of 1.87 mm (P = 0.0004), masseter volume decrease of 3,447.3 mm3 (P < 0.0001), and lateral pterygoid volume decrease of 1203.05 mm3 (P = 0.0049) occurred. No significant changes occurred to the unfractured sides. Conservative treatment of CHF displayed significant musculoskeletal resorption. Clinical assessments showed less optimal improvements. Surgeons should be aware of these trends and take full consideration before applying nonsurgical treatment.

Condylar-base-associated multiple mandibular fractures are more prevalent than single ones. Direct trauma to mandibular symphysis, body or angle are prone to induce indirect condylar fracture. However, little is known about the effects of various rigid internal fixation modalities in condylar base for relevant multiple mandibular fractures, especially when we are confused in the selection of operative approach. Within the finite element analysis, straight-titanium-plate implanting positions in condylar base contained posterolateral zone (I), anterolateral zone (II), and intermediate zone (III). Von Mises stress (SS) in devices and bone and mandibular displacement (DT) were solved, while maximum values (SSmax and DTmax) were documented. For rigid internal fixation in condylar-base-and-symphysis fractures, I + II modality exhibited least SSmax in screws and cortical bone and least DTmax, I + III modality exhibited least SSmax in plates. For rigid internal fixation in condylar-base-and-contralateral-body fractures, I + III modality exhibited least SSmax in screws and cortical bone, I + II modality exhibited least SSmax in plates and least DTmax. For rigid internal fixation in condylar-base-and-contralateral-angle fractures, I + III modality exhibited least DTmax. The findings suggest that either I + II or I + III modality is a valid guaranty for rigid internal fixation of condylar base fractures concomitant with symphysis, contralateral body or angle fractures.

Objectives Mandibular fractures, especially at the parasymphysis and angle, significantly affect the temporomandibular joint (TMJ) due to remodeling. This study assesses changes in condyle volume, morphology, and position after open reduction and internal fixation (ORIF) using 3D analysis methods. Materials and methods A retrospective study evaluated 16 patients (11 males, 5 females; mean age: 33.63 years) with parasymphysis fractures, categorized into isolated (PS-type) and those with angle involvement (A-type). Preoperative and postoperative CBCT scans (minimum 6-month follow-up) were analyzed. Volumetric, linear, and angular changes in the condyle were assessed on the fractured and non-fractured sides. Results Significant postoperative condylar volume increase was observed on both fractured ( p  = 0.0081) and non-fractured sides ( p  = 0.0453). In PS-type fractures, condylar volume ( p  = 0.0156) and height ( p  = 0.0352) significantly increased on the fractured side, with a marked inter-side volumetric difference ( p  = 0.0232). A-type fractures showed a significant increase in sagittal condylar position on the non-fractured side ( p  = 0.0078). No other parameters showed significant change across or within groups. Correlation analyses revealed no significant association between condylar volume change and patient age or follow-up time. Conclusion TMJ remodeling after ORIF varies by fracture type. Isolated parasymphysis fractures caused significant increases in condylar volume and height. Angle fractures involvement showed greater sagittal positional. These results highlight the impact of fracture location and mechanical force distribution on adaptive remodeling.

Objectives Previous finite element analyses (FEA) have shown promising results for using two titanium screws in treating mandibular condylar head fractures but limited mechanical stability of a two-screw osteosynthesis with magnesium screws. Given the potential benefits of magnesium screws in terms of biocompatibility and resorption, this study aimed to compare two- and three-screw osteosynthesis solutions for a right condylar head fracture (AO CMF type p) with magnesium screws with a FEA. Materials and methods A previously validated finite element model simulating a 350 N bite on the contralateral molars was used to analyze von Mises stress within the screws, fragment deformation, and fracture displacement. All screws were modeled with uniform geometric specifications mirroring the design of Medartis MODUS ® Mandible Hexadrive cortical screws. Results The three-screw configuration demonstrated lower values for all three parameters compared to the two-screw scenario. There was a 30% reduction in maximum von Mises stress for the top screw and a 46% reduction for the bottom screw. Conclusions Fracture treatment with three magnesium screws could be a valuable and sufficiently stable alternative to the established treatment with titanium screws. Further studies on screw geometry could help improve material stability under mechanical loading, enhancing the performance of magnesium screws in clinical applications. Clinical relevance The use of magnesium screws for osteosynthesis of mandibular condylar head fractures offers the benefit of reducing the need for second surgery for hardware removal. Clinical data is needed to determine whether the advantages of resorbable screw materials outweigh potential drawbacks in condylar head fracture treatment.

Background Mandibular condyle fractures (MCFs) are common injuries, often resulting from trauma and leading to functional complications. Treatment approaches remain debated, with extracorporeal fixation emerging as a potential alternative to conventional methods. This study explores the effectiveness and outcomes of this technique to guide clinical decision-making. Materials and methods A comprehensive search was conducted across PubMed, EMBASE, and BVS (VHL) for studies published until August 2024. The review included observational studies and clinical trials that assessed postoperative complications following extracorporeal fixation in MCFs. Results Thirty-one studies, comprising 436 participants, were included. Data were extracted on trauma etiology, fracture classification, surgical approaches, and complications such as condylar resorption, which was the most common (18.58%). The studies varied in surgical techniques, with submandibular (40.62%) and retromandibular (37.5%) accesses being the most common. Osteosynthesis materials such as miniplates, screws, and wires were frequently used. Follow-up durations ranged from immediate post-operative periods to 15 years. The quality assessment revealed fair to moderate study quality, with observational studies generally showing methodological limitations, such as sample size issues and heterogeneity in surgical technique and follow-up. Despite concerns about condylar resorption and temporomandibular joint dysfunction, most studies reported that these complications did not significantly affect function or occlusion. Conclusions Extracorporeal fixation of MCFs offers a promising alternative in cases with limited condylar access where conventional methods may fail. Despite a higher risk of condylar resorption, studies suggest minimal long-term functional impairment. This technique remains viable for complex fractures. However, robust clinical trials are needed to evaluate long-term outcomes, particularly regarding resorption and postoperative recovery, given their potential to affect mandibular function, occlusion, and temporomandibular joint health.

Mandibular condylar fractures can lead to facial asymmetry, malocclusion, and temporomandibular joint instability. To minimize the risk of these issues, endoscopic‐assisted reduction techniques were developed. Nevertheless, the confined working space inherent in endoscopic procedures poses challenges, especially in cases with unstable fracture sites, movable plates, and screws. To solve this dilemma, we developed a novel surgical technique using long plate for condylar fracture fixation. “Long Plate Technique” involves a long plate being stabilized via the submandibular incision site, with screws inserted through the trocar to affix the titanium plate onto the superior condylar segment from the tragus incision site. A total of 98 patients were included in this study. The overall average operation time was 365 min. Specifically, the average operation time for the group treated with closed reduction and intermaxillary fixation was 250 min, for Group B cases treated with short plate open reduction and intermaxillary fixation was 429 min, and for Group C treated with long plate open reduction and intermaxillary fixation was 413 min. The utilization of the Long Plate Technique provides a secure and efficient operation technique that can lessen the stress on surgeons during the operation.

Background Patients presenting with partially impacted lower third molars (M3) have a higher likelihood of experiencing angle fractures while simultaneously decreasing the risk of condylar fractures. However, the specific biomechanical mechanism responsible for this occurrence remains unclear. Moreover, there is an ongoing debate regarding whether the removal of M3s might actually increase the risk of condylar fractures. This study aimed to evaluate how the presence of M3s influences mandibular fractures resulting from blows to the symphysis and lateral mandibular body, and to determine the indication for extracting M3s in such cases. Methods Models of the mandible with a partially M3-impacted model (M3I), M3-extracted model (M3E), and M3-absent model (M3A) were generated using a computer. A traumatic blown force of 2000 N was applied to the symphysis and the right body of the mandible. Von Mises and principal stresses were analyzed, and failure indexes were determined. Two cases of mandibular linear fractures were chosen for model verification and interpretation. Results When force was applied to the symphysis, the condylar region exhibited the highest stress levels, while stress in the mandibular angle region was much less regardless of the M3 state. On applying the force to the right mandibular body, stress in the condylar region decreased while stress in the mandibular body increased, especially in the blown regions. Impacted tooth or cavity formation post-M3 extraction led to uneven stress distribution on the blown side of the mandible, increasing the risk of mandibular angle fractures. In cases where M3 was absent or the extraction socket had healed, stress from lateral traumatic blown force was evenly distributed along both the inner and outer oblique lines of the mandible, thereby reducing the risk of mandibular fractures. Conclusions The reduced risk of condylar fractures in patients with partially impacted lower M3s and mandibular angle fractures is mainly due to lateral blows on the mandible, which generate less stress in the condylar region than blows on the mandibular symphysis, rather than being caused by the M3 itself. Extraction of the lower M3 can decrease the risk of mandibular fractures, with a minor influence on condylar fractures.

The purpose of the present case is to highlight the surgical management of the refractured condylar segment of the mandible after open reduction and internal fixation. A man in his 20s reported to the department with an alleged history of road traffic injury (RTI). He was diagnosed with a fracture of the right parasymphysis and left subcondylar region of the mandible. He was managed surgically using 2 mini plates of 2.0 mm in relation to the condyle, one 5-hole miniplate in relation to the posterior border of the mandible, one 3-hole miniplate in relation to the anterior border of the condyle. A 2.4 mm 8-hole reconstruction plate was placed in relation to the right parasymphysis region of the mandible. He again reported to the department of oral and maxillofacial surgery after 25 days with an alleged history of RTI. After a complete examination, he was diagnosed with a fracture of the symphysis and left subcondylar region of the mandible. He was managed surgically using 11-hole reconstruction plate 2.4 mm with bicortical screws to fix symphysis fracture of the mandible. A 4-hole high-profile matrix mandible 2.0 mm plate was used to fix the left subcondylar fracture. Now the patient is having good mouth opening, preinjury occlusion and a good range of functional movements of the mandible.After functionally stable fixation of the condyle and rigid fixation of the anterior mandible, refracture is rarely reported. The anatomy of the condyle is complex, so after the removal of the miniplates, the bone available is less. The purpose of reporting the present case is to highlight the management of refracture of the condyle using matrix mandible plate. The use of a synthes matrix mandibular plate is promising in such cases and can be used effectively.

The objective of this study was to compile the currently available evidence regarding the functional and morphologic outcomes of functional orthodontic therapy for mandibular condyle fracture. We performed searches in PubMed and Google Scholar as well as manually (IOK issues 2008-2019) using the keywords \"trauma\", \"TMJ\", \"activator\", \"condylar fracture\", \"fracture\", \"mandibular condylar fracture\", \"occlusal splint\" and \"functional appliance\". Screening and analysis of study eligibility were performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search strategy identified 198 studies published between 1971 and 2018, with 93 studies remaining after removing duplicate hits. Of the 93 studies, 19 were included in this study, considering the inclusion criteria. There were 12 follow-up, 4 prospective, and 3 purely retrospective studies. Some of the studies showed good functional results of mandibular condyle fracture treatment, in addition to subjective patient satisfaction. The incisal edge difference could be increased to physiological ranges of >35 mm by means of activator therapy. Partial mandibular deviations to the fractured side remained post-therapy, especially after unilateral fractures. Fractures without significant dislocation and luxation showed radiographic changes in shape, described as hypoplastic and ellipsoid, in addition to good morphologic results. One study found that collum length shortened twofold after a luxated fracture compared with fractures without significant dislocation, despite activator therapy. Straightening of the fragment occurred only in the low-dislocated fragments. Overall, children showed a higher remodeling potential than adult patients. Several studies observed an improved clinical outcome for functional therapy after mandibular condyle fracture. The outcome is essentially determined by fracture type, fracture height, and age. Further studies, especially prospective studies, are necessary to improve the evidence of functional orthodontic therapy for mandibular condyle fractures.

Though the incidence of maxillofacial injuries in children is lower compared to their adult counterparts, nasal bone and mandibular fractures are among the most commonly encountered. Management and treatment of mandibular fractures, in particular condylar, in this population is challenging due to anatomical and functional considerations, and conservative management remains the treatment of choice. This case report highlights an innovative technique of conservative management using orthodontic brackets and a myofunctional appliance in a patient who sustained a condylar fracture after falling from his bicycle. Recovery was uneventful, and follow-up revealed restoration of range of motion and bony union.