Outcomes of functional treatment versus open reduction and internal fixation of condylar mandibular fracture with articular impact: A retrospective study of 83 adults - Archive ouverte HAL Access content directly
Journal Articles Journal of Stomatology, Oral and Maxillofacial Surgery Year : 2018

Outcomes of functional treatment versus open reduction and internal fixation of condylar mandibular fracture with articular impact: A retrospective study of 83 adults

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Abstract

INTRODUCTION: The treatment of fractures in the mandibular condylar process remains controversial. The aim of this study was to assess the outcomes of isolated functional treatment versus open reduction and internal fixation (ORIF) of mandibular condylar fracture with articular impact based on clinical and radiological criteria. MATERIALS AND METHODS: Eighty-three patients with a mandibular condylar fracture with articular impact were included in this retrospective study. They were divided according to Loukota, Spiessl and Schroll, Mercier and Rasse, Neff, and Hlawitschka classifications. Two groups were created: operated patients (operated) and non-operated patients (non-operated). Occlusal and functional features were evaluated using clinical measurements at 1, 3, 6, and 12 months after the treatment as well as radiological measurements performed preoperatively, 6 weeks later, and at the end of the follow-up. RESULTS: A male predominance was observed in the data (69.9%, P<0.0001). Isolated functional treatment was applied in 55 patients (66.26%). Twenty-eight patients (33.7%) were operated upon using a pre-auricular or modified Risdon's approach. Maximal mouth opening (MMO) was lesser in "operated" group compared to "non-operated" group until 6 months (25.75mm vs 31.96mm, 34.76mm vs 37.95mm, 38.06mm vs 41.87mm respectively 1, 3 and, 6 months, P<0.05). Results were satisfactory 1 year after treatment (41.29mm vs 45.22mm, P>0.05). There was no difference concerning temporo-mandibular joint dysfunctions between operated and non-operated patients. For unilateral fractures, the loss of height of the ramus was significantly higher in operated patients initially compared to "non-operated" group (P=0.0137). After surgical correction, there was no difference between the two sides of mandible. At the end of the follow-up, the there was no difference between operated and non-operated ramus (P=0.1304 and 0.6420). CONCLUSION: The present study showed that a properly followed isolated functional treatment provided similar clinical results to ORIF for mandibular condylar fractures with articular impact. Surgical treatment should be preferred when the loss of height of the ramus is severe to restore the ramus height since adult condylar remodeling is less efficient than in children.
HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés. mandibular fracture with articular impact: a retrospective study of 83 adults Merlet Fanny-Laure (1), Grimaud Fanny (1), Pace Richard (2), Mercier Jacques-Marie(1), Paré Arnaud(3), Corre Pierre(1). 1) Service de Chirurgie maxillo-faciale et stomatologie, CHU NANTES,
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inserm-01856305 , version 1 (09-03-2021)

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F-L Merlet, F. Grimaud, Richard Pace, J-M Mercier, M. Poisson, et al.. Outcomes of functional treatment versus open reduction and internal fixation of condylar mandibular fracture with articular impact: A retrospective study of 83 adults. Journal of Stomatology, Oral and Maxillofacial Surgery, 2018, 119 (1), pp.8 - 15. ⟨10.1016/j.jormas.2017.10.007⟩. ⟨inserm-01856305⟩
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