The Biology of Open Versus Closed Treatment of Condylar Fractures

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Key points

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    Closed treatment is indicated for children less than 12 years of age and this is best understood in relation to the regenerative and remodeling capacity of the condyle.

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    Vascular supply affects the remodeling capacity of the condyle.

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    Immediate mobilization and physical therapy are important to the outcomes in closed and open treatment by affecting remodeling with local cytokines; intermaxillary fixation is not supported.

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    Complex neuromuscular, skeletal, and occlusal adaptations affect functional

Temporomandibular joint

The TMJ is supplied by many named vessels that branch and contribute to the articular capsule. These vessels are primarily branches of the superficial temporal artery and maxillary artery1, 2 (Fig. 1). This plexus of vessels is richest to the posterior zone of retrodiscal tissue.

Condylar head

Condylar head blood flow is primarily through the TMJ capsule, with some endosteal and muscular contributions.

Condylar process

It has not been conclusively established what the nutrient artery to the condylar process is. Contributions

Injuries

Repair of soft tissue injury to the TMJ capsule, disc, and retrodiscal tissues plays an important role in rehabilitation and function of the TMJ. Endoscopic and MRI studies show that hemarthrosis and vascular hyperemia are common in the injured capsule when the joint is traumatized by condylar fractures (Fig. 8). Hemarthrosis resolves with functional rehabilitation and has little long-term consequence.11, 12, 13, 14, 15, 16

Other injuries to the disc and capsule have more significant

Summary

Fixation is not necessary for healing. Unlike other parts of the mandible, fractures of the condyle rarely result in malunion even without treatment.6 There is a wide variety of treatment recommendations, including immediate mobilization with soft diet, MMF for 2 to 6 weeks, and immediate mobilization with soft diet. Biology seems to support early mobilization in both closed and open treatments. Early mobilization has equal occlusal results to those with periods of MMF37 and helps patients to

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References (64)

  • S. Takaku et al.

    Magnetic resonance images in patients with acute traumatic injury of the temporomandibular joint: a preliminary report

    J Craniomaxillofac Surg

    (1996)
  • Z. Li et al.

    The role of the disc in the healing of displaced subcondylar fracture in the growing period: an experimental study in rats

    Int J Oral Maxillofac Surg

    (2010)
  • B.H. Choi et al.

    MRI examination of the TMJ after surgical treatment of condylar fractures

    Int J Oral Maxillofac Surg

    (2001)
  • Y. Zhang

    Clinical investigation of early post-traumatic temporomandibular joint ankyloses and the role of repositioning discs in treatment

    Int J Oral Maxillofac Surg

    (2006)
  • B.H. Choi

    Magnetic resonance imaging of the temporomandibular joint after functional treatment of bilateral condylar fractures in adults

    Int J Oral Maxillofac Surg

    (1997)
  • L. Dahlstrom et al.

    15 years follow-up on condylar fractures

    Int J Oral Maxillofac Surg

    (1989)
  • H. Thoren et al.

    Condylar process fractures in children: a follow-up study of fractures with total dislocation of the condyle from the glenoid fossa

    J Oral Maxillofac Surg

    (2001)
  • H. Strobl et al.

    Conservative treatment of unilateral condylar fractures in children: a long-term clinical and radiologic follow-up of 55 patients

    Int J Oral Maxillofac Surg

    (1999)
  • J. Hovinga et al.

    Long-term results of nonsurgical management of condylar fractures in children

    Int J Oral Maxillofac Surg

    (1999)
  • J.A. McNamara et al.

    Quantitative analysis of temporomandibular joint adaptations to protrusive function

    Am J Orthod

    (1979)
  • J.A. McNamara et al.

    Histologic analysis of temporomandibular joint adaptation to protrusive function in young adult rhesus monkeys (Macaca mulatta)

    Am J Orthod

    (1982)
  • A. Teixeira et al.

    Healing of the displaced condylar process fracture: an experimental study

    J Craniomaxillofac Surg

    (1998)
  • T. Iizuka et al.

    Open reduction without fixation of dislocated condylar process fractures: long-term clinical and radiological analysis

    J Oral Maxillofac Surg

    (1998)
  • R.G. Gerry

    Condylar fractures

    Br J Oral Surg

    (1965)
  • Y. Hu et al.

    Condyle and mandibular bone change after unilateral condylar neck fracture in growing rats

    Int J Oral Maxillofac Surg

    (2012)
  • R.J. Heurlin et al.

    Skeletal changes following dislocations: effects on growth in Macaca rhesus monkey

    Oral Surg

    (1961)
  • E. Ellis et al.

    Treatment of mandibular condylar process fractures: biological considerations

    J Oral Maxillofac Surg

    (2005)
  • L. Lindahl

    Condylar fractures of the mandible III. Positional changes of the chin

    Int J Oral Surg

    (1977)
  • J.P. Rutges et al.

    Functional results after conservative treatment of fractures of the mandibular condyle

    Br J Oral Maxillofac Surg

    (2007)
  • G. Santler et al.

    Fractures of the condylar process: surgical versus nonsurgical treatment

    J Oral Maxillofac Surg

    (1999)
  • L.M. Smets et al.

    Non-surgical treatment of condylar fractures in adults: a retrospective analysis

    J Craniomaxillofac Surg

    (2003)
  • S. Eulert et al.

    Study on treatment of condylar process fractures of the mandible

    Ann Anat

    (2007)
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