• Maxillofacial Plastic and Reconstructive Surgery
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• v.36 no.1
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• pp.30-36
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• 2014

There are many treatment options in management of mandibular condylar neck fractures. Closed reduction is the most conservative treatment; however, achievement of anatomic reduction is difficult, and there are some risks of mandibular functional impairment. Open anatomic reduction and internal fixation have some advantages; therefore, many oral and maxillofacial surgeons have attempted to achieve anatomic reduction through the open approach and extracorporeal reduction and fixation. However, when using this method, there is some risk of resorption of the fractured mandibular condylar head. Therefore, we designed a modified extracorporeal reduction technique, without detaching the lateral pterygoid muscle in order to maintain the blood supply to the fractured mandibular condylar head. We believe that this minor modification may minimize the risk of resorption of the fractured mandibular condylar head. In this article, we introduce this technique in detail, and report on two cases.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.30 no.4
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• pp.359-369
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• 2008

Purpose: Fractures of the mandibular condyle accounts for 15% to 30% of all the mandibular fractures and lots of complications are reported. Among these complications, condylar resorption is the most important one to be taken into account. The purpose of this study is evaluating condylar resorption pattern in relation to extracorporeal fixation technique. Patients & methods: Thirty four patients with 42 mandibular condylar fractures were retrospectively examined with an average follow-up of 18.5 months (6-66 months). Male/female ratio is 27 males (7 bilateral cases) and 7 females (1 bilateral case). Applicated surgical techniques were extracorporeal fixation via submandibular approach and extracorporeal fixation via intraoral approach. We compared radiographic views of post-operative periods with that of most long term follow up in 34 operated sites respectively. Result: There were 2 generalized condylar resorption sites and 3 partial resorption sites with clinical implications. Others (29 joints) showed good healing or satisfactory adaptive state of temporomandibular joints clinically. Radiologically, signs of partial condylar resorption and/or osteoarthrosis were diagnosed in 11 patients. But, 8 out of the 11 patients didn't show significant clinical symptoms, which means successful adaptive remodeling of the surgically located condylar head. Conclusion: From the above results, intentional ramal osteotomy, temporary detachment of the fractured condyle and extracorporeal fixation technique seems to be effective and useful in those cases of condylar fractures in which reduction of the dislocated condyle is very difficult or virtually impossible.

• The Journal of Korean Academy of Prosthodontics
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• v.17 no.1
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• pp.35-46
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• 1979

A number of experimental studies have been carried out in order to clarify the question as to how temporomandibular joint adapt to the changes of mandibular movement and occlusal equilibration. Recently, the studies on the interrelations between anatomical structure of temporomandibular joint and the state of occlusion have been actively performed in dentistry particularly in prosthodontic field. Author performed extraction of unilateral mandibular molars in 30 mature male rats, and observed histological changes of temporomandibular joint through the light microscope. Following results were obtained. 1. The loss of unilateral teeth gave rise to the changes in the location of condylar head, that is, interior displacement of condylar head in the extraction side and upper displacement in the non-extraction side. 2. Articular disk was compressed by the interior surface of condylar head, resulting in its extension below the condylar neck in the extraction side, and the histological arrangement of the compressed area showed irregular feature. 3. The extension of articular disk below the condylar neck was accompanied with the contraction of muscle fibers which were originated from the articular disk. 4. The cartilage layer of articular fossa to the exterior of the extraction side showed hypertropy. 5. Early in the experiment, the inernal extremity of condylar head of extract ion side showed bone resorption, and cartilage layer of condylar head showed hypertropy. At 12 weeks after experiment, the condylar surface showed flattened, and the cartilage layer of condylar head was replaced by the compact bone. 6. The articular disk showed the formation of pannus in the extraction side as well as in the non-extraction side. 7. The occlusal disturbance due to unilateral missing teeth has brought about the non-inflammatory retrogressive change and osteoarthrotic change late in the experiment.

• The korean journal of orthodontics
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• v.20 no.2
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• pp.363-379
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• 1990

The purpose of this study was to evaluate the effects of the mandibular retractive force on the mandibular condyle of growing dog. The experimental animals were six mongrel dogs of two-month old. Their deciduous dentition were completed. Two of them was used as control group, and experimental group was composed of remaining four. Head band and chin cup were made of cotton tape, and hooks are fabricated on the chin cup and had band for closed coil. Mandibular retractive force was 100g/side and chin cap appliance was used for 14 hours/day during night. Experimental group were sacrificed at 2, 4, 6, 8 weeks from beginning of the experiment. Right TMJ was prepared for histologic study and left TMJ was examined grossly for disc, fossa, and condyle. The conclusions are: 1. Two-month old control animal showed active cartilaginous growth on the mandibular condyle, therefore showed thick proliferative and hypertrophic zones. Remodeling process in the condyle head was observed in which there were bone resorption on the anterior surface and bone apposition on the posterior surface. 2. Four-month old control animal showed marked reduction of hypertrophic zone but the condylar bone remodeling was more pronounced. 3. In experimental group, there are marked reduction of hypertrophic zone at 4 weeks from beginning of experiment, and hypertrophic zone disappeared at posterior-superior portion of condyle in 6-week experimental animal. 8 week experimental animal showed slight recovery of hypertrophic zone. 4. In experimental group, bone deposition was increased at anterior surface of condyle, and bone resorption was increased at posterior surface of condyle. 5. In control group, the glenoid fossa and surrounding bone showed mainly bone apposition. But experimental group showed bone resorption at anterior surface of articular eminence and increased bone apposition at posterior surface of postglenoid spine. 6. No marked traumatic change was seen but 4 weeks and 8 weeks experimental animal showed flattening of posterior surperior condylar surface. Bone marrow of condyle showed minute focal bleeding in 2 weeks and 4 weeks experimental animal, and congestion and depression of hematopoietic bone marrow during all experimental period.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.27 no.5
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• pp.442-446
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• 2001

Purpose : This study evaluated clinical and radiographic results after open reduction and lag-screw fixation of mandibular condyle fractures. Patients and Methods : 26 patients had been treated by lag-screw fixation for madibular condyle fracures via submandibular approach and follow up for over 6 months. The lag-screw used in this study was designed by Eckelt. Results : Radiographically, resorption of the condyle head found in 4 cases (15%) and minimal displacement of the condyle head was found in 3 cases (12%). Post-operative infection were not found in all cases. Clinically, All patiens had a stable occlusion and normal mouth opening (over 40mm). TMD problems with crepitus or some discomfort encountered in 4 patients but tolerable to the patients. Conclusion : Lag screw fixation can be a good option especially high level condylar fractures, however this procedure must be used in cautiously because of slipping of the fragments and possible to resorption of the fragments.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.34 no.3
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• pp.388-397
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• 2008

The present study was performed to evaluate the function of the mandible according to the pattern of fracture and treatment methods of condylar fractures of the mandible and help operators in making a treatment plan. Sixty patients (average follow-up period was $7.8{\pm}9.4$ months) who were treated for condylar fracture from June, 2002 to May, 2006 at the Department of Oral and Maxillofacial surgery, Chonnam National University Hospital were reviewed. The common causes of the condylar fracture were traffic accident and fall-down (35.0%). In concomitant injuries, laceration was 46.7% and the fracture of the mandibular symphysis was highest incidence (60.0%). The common site of the fracture was the condylar head (47.8%), followed by subcondyle (36.2%) and condylar neck (15.9%). Under 15 years old patients, the closed reduction was performed in 87.5% out of the patients. All of the condylar fragments were fixed to the mandible with titanium miniplates in cases of open reduction. The mean period of intermaxillary fixation (IMF) was $14.2{\pm}6.5$ days in closed reduction and $10.0{\pm}4.2$ days in open reduction. The old patient with bilateral condylar head fractures, who were treated by closed reduction with IMF for 3 weeks, showed the limitation of mandibular movements. But, there was no significant different results between open reduction and closed reduction with the respect of the Helkimo's mandibular mobility index and clinical dysfunction index (DI). Complications, such as fibrous ankylosis and resorption of the mandibular condyle, were not observed in all patients. These results suggest that the good results can be obtained by closed reduction with proper IMF periods and functional exercise in most condylar fractures of the mandible except severely displaced extracapsular fractures.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.23 no.1
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• pp.31-39
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• 2001

The purpose of this study is to reveal the factors leading to the problem of unilateral condylar fractures and suggest a treatment guideline of treatment for good prognosis in surgical treatment. The factors can be age, sex, fracture site, degree of displacement, posterior occlusion loss, post-operative alteration of condylar head position, post-operative condylar head resorption, and maxillomandibular fixation period. One hundred and eleven patients with unilateral condylar fractures, who were treated by surgical method from 1990 Feb. to 2000 Feb., were studied. Minimum follow-up period was 6 months. The results were as follows ; 1. In the age group of $41{\sim}60$, females had significantly higher complication rate than males, therefore we must be careful about treatment of female in this age group 2. In level I fractures of the mandibular condyle, because there were abundant complications when the patients were treated with fragment removal, conservative treatment is recommended over the surgical approach. 3. There were no differences in the complication rate, in the level II, III fractures. but were severe complications in the cases of patients treated by Dr.Nam's method or fragment removal. Therefore, open reduction and internal fixation is recommended over Dr.Nam's method or fragment removal. 4. In level IV fractures, open reduction and internal fixation is recommended 5. Although there was a higher complication rate depending on the degree of deviation, there was no correlation between the degree of deviation and development of complications in each level of fracture 6. Because the complication rate was higher in cases of condylar resorption, vertical dimension loss, and alteration of condylar head position, we must make an effort to prevent such complications during treatment

• Imaging Science in Dentistry
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• v.46 no.1
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• pp.25-31
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• 2016

Purpose: This study was performed to evaluate condylar surface changes and remodeling after orthognathic surgery using three-dimensional computed tomography (3D CT) imaging, including comparisons between the right and left sides and between the sexes. Materials and Methods: Forty patients (20 males and 20 females) who underwent multi-detector CT examinations before and after surgery were selected. Three-dimensional images comprising thousands of points on the condylar surface were obtained before and after surgery. For the quantitative assessment of condylar surface changes, point-to-point (preoperative-to-postoperative) distances were calculated using 3D processing software. These point-to-point distances were converted to a color map. In order to evaluate the types of condylar remodeling, the condylar head was divided into six areas (anteromedial, anteromiddle, anterolateral, posteromedial, posteromiddle, and posterolateral areas) and each area was classified into three types of condylar remodeling (bone formation, no change, and bone resorption) based on the color map. Additionally, comparative analyses were performed between the right and left sides and according to sex. Results: The mean of the average point-to-point distances on condylar surface was $0.11{\pm}0.03mm$. Bone resorption occurred more frequently than other types of condylar remodeling, especially in the lateral areas. However, bone formation in the anteromedial area was particularly prominent. No significant difference was found between the right and left condyles, but condylar surface changes in males were significantly larger than in females. Conclusion: This study revealed that condylar remodeling exhibited a tendency towards bone resorption, especially in the lateral areas. Condylar surface changes occurred, but were small.

• Imaging Science in Dentistry
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• v.52 no.1
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• pp.103-108
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• 2022

Purpose: Disc displacement can cause resorption of the head of the condyle and affect its volume. This study analysed the volume of normal condyles and those with disc displacement with reduction (DDR) in cone-beam computed tomography (CBCT) scans from the Indonesian population. Materials and Methods: This study analysed 56 condyles (26 normal and 30 with DDR) from patients who visited the Oral and Maxillofacial Radiology Unit after being referred from the Prosthodontics Unit at Dental Hospital Universitas Padjadjaran from December 2020 to February 2021. Samples were divided into 2 groups (normal and DDR left and right-side condyles) based on the DC/TMD Axis 1 form through the clinical examination results. Both sample groups were exposed to CBCT radiation. The CBCT imaging results in the Digital Imaging and Communications in Medicine format were exported to the open-source ITK-SNAP format to determine condyle volume. Volumetric data from the cortical and trabecular areas of the right or left side condyles were arranged by sex. The independent t-test was used to determine the significance of differences with IBM SPSS version 21.0. Intra- and inter-observer reliability and validity were tested before determining the volume of the condyles. Results: Normal condyles and DDR condyles showed significant differences in volume (P<0.05). Significant differences were also seen in cortical (P=0.0007) and trabecular (P=0.0045) volumes. There was a significant difference in condylar volume based on sex. Conclusion: The normal condyle volume was significantly different from the DDR condyle volume in both sexes.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.31 no.5
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• pp.409-416
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• 2005

Purpose of study: The temporomandibular joint (TMJ) occupies a key functional role in mastication and contributes to normal deglutition, speech as well as cosmesis. When a large amount of mandible including the condyle head is resected, it is very difficult to reconstruct it as a functional unit. In this retrospective study, we present the functional, radiographic and cosmetic results of reconstructed temporomandibular joint using free fibular flap. Patients and Methods: Total 12 patients (M:F = 6:6) who underwent condylar reconstruction with the fibular flap were interviewed and examined by radiographs and Bio-PAK$^{(R)}$. Mean follow up periods was $47.7{\pm}20.0$ months and the average age was $38.7{\pm}15.3$ years. Remodeling of condyle and function of TMJ were evaluated and facial contour was judged subjectively. Results: All flaps were viable and no immediate postoperative complication had happened. One patient showed decreased mouth opening, so interpositional gap arthroplasty was performed. The resorption rates of reconstructed fibular were minimal and the condyle heads were changed into domeshaped neocondyle after 2 years. All patients had normal diet and no speech difficulty was reported. Nine patients were satisfied with their facial contour but three patients complained about the depression of cheek. Conclusion: The reconstruction of TMJ with free fibular flap was reliable methods and very effective means of restoring mandibular function. The functional and morphologic results were excellent and showed little complications.