Comparison of temporomandibular joint function and morphology after surgical and non-surgical treatment in adult condylar head fractures

Rong Ren; Jiewen Dai; Yin Zhi; Fuqiang Xie; Jun Shi

doi:10.1016/j.jcms.2020.01.019

Comparison of temporomandibular joint function and morphology after surgical and non-surgical treatment in adult condylar head fractures

J Craniomaxillofac Surg. 2020 Mar;48(3):323-330. doi: 10.1016/j.jcms.2020.01.019. Epub 2020 Feb 6.

Authors

Rong Ren¹, Jiewen Dai², Yin Zhi², Fuqiang Xie³, Jun Shi⁴

Affiliations

¹ Department of Oral and Craniomaxillofacial Science, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, People's Republic of China; Department of Oral and Maxillofacial Surgery, 2nd Hospital of Lanzhou University, Lanzhou, People's Republic of China.
² Department of Oral and Craniomaxillofacial Science, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, People's Republic of China.
³ Department of Oral and Maxillofacial Surgery, 2nd Hospital of Lanzhou University, Lanzhou, People's Republic of China. Electronic address: xiefq@lzu.edu.com.
⁴ Department of Oral and Craniomaxillofacial Science, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, People's Republic of China. Electronic address: dr_shijun@163.com.

PMID: 32113881
DOI: 10.1016/j.jcms.2020.01.019

Abstract

Purpose: The aim of this study was to evaluate whether surgical treatment can distinctly improve temporomandibular joint (TMJ) function and morphology in adult patients with condylar head fractures (CHFs) when compared with conservative treatment.

Patients and methods: A retrospective study was performed to evaluate surgical and conservative outcomes in all patients who had suffered CHFs. In this study, all patients were divided into a surgical group and a conservative group. In the surgical group patients were treated by open reduction and internal fixation (ORIF) combined disc anchorage, while in the conservative group patients were treated by a removable splint combined with intermaxillary elastics. Clinical and radiological outcomes were evaluated and functional outcomes were assessed using the Helkimo index score. Paired t-tests, Wilcoxon signed rank tests, independent t-tests and χ² tests were used to assess inter-group differences.

Results: 75 TMJs in 56 patients were included in this study and were divided into a surgical group (56 TMJs in 40 patients) and a conservative group (19 TMJs in 16 patients). The results showed that the Helkimo index score for TMJ in the surgical group was better than in the conservative group (p_Ai = 0.032, p_Di = 0.001, respectively). Ramus height in the surgical group (61.08 ± 4.04 mm) recovered more than in the conservative group (54.82 ± 3.06 mm) (p = 0.012). Discs became shorter, moved further forward, and became severely distorted in the conservative group (disc length = 7.32 ± 1.35 mm). In contrast, discs became longer, retained a normal disc-condyle relationship, and formed a normal shape in the surgical group (disc length = 11.05 ± 2.07 mm) (p = 0.003). According to the MRI images, joint effusion, retrodiscal tear, and lateral capsular tear were better cured in the surgical group (p = 0.001, p < 0.001, p = 0.012, respectively).

Conclusion: Based on these results, it seems that surgical treatment of condylar head fractures should be the preferred approach if there are no contraindications for general anesthesia.

Keywords: Condylar head fracture; Conservative treatment; Helkimo index; Surgical treatment.

MeSH terms

Adult
Humans
Joint Dislocations*
Magnetic Resonance Imaging
Mandibular Condyle
Mandibular Fractures*
Retrospective Studies
Temporomandibular Joint