Influence Of Posterior Teeth On The Anatomical Location Of Fracture Line In
Condylar Fractures – A Cross Sectional Study Using Digital Panaromic
Radiographs
M.S. Jothish1 , P. Srinivasan2 , K. Janarthanan3 , S. Manikandaswamy4 , Fayeez Abdullah5 , D. Thirumaran6
2,3 Cuddalore Government Dental College, Department of Oral and Maxillofacial Surgery.
5,6 Cuddalore Government Dental College, Department of Prosthodontics.
DOI:DOI:https://dx.doi.org/10.54936/haoms2413742
SUMMARY: Background: Condylar fracture have been probably the most mismanaged fractures throughout history. They were either not treated because of improper diagnosis or were managed minimally using external bandages to immobilise the mandible. If left untreated, condylar fractures lead to temporomandibular disorders like ankylosis, dysfunction, chronic dislocation and chronic pain. Even though many authors classify condylar fractures based on their location, no literature currently exists in determining the exact cause which ascertains the location of the fracture line. In this study we attempted to analyse if the presence or absence of posterior teeth is in any way related to the anatomic level of condylar fractures. Materials and Methods: 200 Orthopantomographic images of patients who presented to the department of oral and maxillofacial surgery with condylar fracture from the year 2017-2021 were collected from the medical records department. Out of these 200 OPGs 170 images where finally selected based on the inclusion criteria. Presence or absence of posterior teeth and the total number of missing posterior teeth were calculated and subjected to statistical analysis. Results: Diacapitular fractures were common in patients with no missing teeth and sub condylar fractures were found in patients with absence of posterior teeth hence validating our hypothesis that the number of missing posterior teeth are indeed associated with the level of condylar fractures and that, missing maxillary posteriors, mandibular posteriors, premolars and molars all statistical significantly independently correlated with the level of condylar fracture. Conclusion: In condylar fractures, the level of fracture line is influenced by the presence or absence of posterior teeth. The teeth are usually neglected as they are considered as an accessory aid and not an integral component of the facial skeleton. Proving that the teeth are involved in a complex mechanism which protects the Temporo- Mandibular joint from traumatic forces on the mandible will further solidify their position as an integral functional component and shift the focus towards preserving rather than removing them whenever possible.
KEY WORDS: Condylar fracture, Fracture line, Orthopantomogram, Posterior teeth, Diacapitular fracture, Subcondylar fracture
REFERENCES:
1. Choi KY, Yang JD, Chung HY, Cho BC. Current concepts in the mandibular condyle fracture management part I: overview of condylar fracture. Arch Plast Surg. 2012 Jul;39(4):291-300. doi: 10.5999/aps.2012.39.4.291. Epub 2012 Jul 13. PMID: 22872830; PMCID: PMC3408272.
2. Zachariades N, Mezitis M, Mourouzis C, Papadakis D, Spanou A. Fractures of the mandibular condyle: a review of 466 cases. Literature review, reflections on treatment and proposals. Journal of CranioMaxillofacial Surgery. 2006 Oct 1;34(7):421- 32
3. Weiss JP, Sawhney R. Update on mandibular condylar fracture management. Current opinion in otolaryngology & head and neck surgery. 2016 Aug 1;24(4):273-8
4. Farzan R, Farzan A, Farzan A, Karimpour M, Tolouie M. A 6-Year Epidemiological Study of Mandibular Fractures in Traumatic Patients in North of Iran: Review of 463 Patients. World J Plast Surg. 2021 Jan;10(1):71-77. doi: 10.29252/ wjps.10.1.71. PMID: 33833957; PMCID: PMC8016382.
5. Zachariades N, Koumoura F, Konsolaki-Agouridaki E. Facial trauma in women resulting from violence by men. Journal of oral and maxillofacial surgery. 1990 Dec 1;48(12):1250-3
6. Mukhopadhyay S. A retrospective study of mandibular fractures in children. J Korean Assoc Oral Maxillofac Surg. 2018 Dec;44(6):269-274. doi: 10.5125/jkaoms.2018.44.6.269. Epub 2018 Dec 28. PMID: 30637240; PMCID: PMC6327018.
7. Cara AC, Gaia BF, Perrella A, Oliveira JX, Lopes PM, Cavalcanti MG. Validity of single- and multislice CT for assessment of mandibular condyle lesions. Dentomaxillofac Radiol. 2007 Jan;36(1):24-7. doi: 10.1259/dmfr/54883281. PMID: 17329584.
8. Naeem A, Gemal H, Reed D. Imaging in traumatic mandibular fractures. Quantitative imaging in medicine and surgery. 2017 Aug;7(4):46
9. Mahgoub MA, El-Sabbagh AH, Abd El-Latif EA, Elhadidy MR. Condylar Fractures: Review of 40 Cases. Ann Maxillofac Surg. 2018 Jan-Jun;8(1):19-27. doi: 10.4103/ams.ams_133_17. PMID: 29963420; PMCID: PMC6018287
10. Al-Moraissi EA, Ellis III E. Surgical treatment of adult mandibular condylar fractures provides better outcomes than closed treatment: a systematic review and meta-analysis. Journal of Oral and Maxillofacial Surgery. 2015 Mar 1;73(3):482-93
11. Chrcanovic BR. Surgical versus non-surgical treatment of mandibular condylar fractures: a meta-analysis. International journal of oral and maxillofacial surgery. 2015 Feb 1;44(2):158-79
12. Lee CY, McCullon 3rd C, Blaustein DI, Mohammadi H. Sequelae of unrecognized, untreated mandibular condylar fractures in the pediatric patient. Annals of dentistry. 1993 Jan 1;52(1):5-8.
13. Rowe NL. Fractures of the jaw in children. J. oral Surg.. 1969;27:497-507
14. Loukota RA, Eckelt U, De Bont L, Rasse M. Subclassification of fractures of the condylar process of the mandible. British journal of oral and maxillofacial surgery. 2005 Feb 1;43(1):72-3
15. Wassmund M. Über luxationsfrakturen des kiefergelenks. Dtsch Kieferch 1934;1:27e54
16. Ellis E 3rd, Palmieri C, Throckmorton GS. Further displacement of condylar process fractures after closed treatment. J Oral Maxillofac Surg 1999;59(2):120e9
17. Neff A, Kolk A, Deppe H, et al. Neue aspekte zur indikation der operativen versorgung intraartikul ärer und hoher kiefergelenklux-ationsfrakturen [New aspects for indications of surgical management of intra-articular and high temporomandibular dislocation fractures]. Mund Kiefer Gesichtschir 1999;3(1):24e9 [in German]
18. Da Fonseca, G. D. “Experimental study on fractures of the mandibular condylar process (mandibular condylar process fractures).” International journal of oral surgery 3.3 (1974): 89-101.
19. Tuchtan L, Piercecchi-Marti MD, Bartoli C, Boisclair D, Adalian P, Léonetti G, Behr M, Thollon L. Forces transmission to the skull in case of mandibular impact. Forensic science international. 2015 Jul 1;252:22-8
20. Allsop DL, Warner CY, Wille MG, Schneider DC, Nahum AM. Facial impact response—a comparison of the Hybrid III dummy and human cadaver. SAE transactions. 1988 Jan 1:1224-40.
21. Cornelius CP, Audigé L, Kunz C, Rudderman R, BuitragoTéllez CH, Frodel J, Prein J. The Comprehensive AOCMF Classification System: Mandible Fractures-Level 3 Tutorial. Craniomaxillofac Trauma Reconstr. 2014 Dec;7(Suppl 1):S031-43. doi: 10.1055/s-0034-1389558. PMID: 25489389; PMCID: PMC4251719.
2,3 Cuddalore Government Dental College, Department of Oral and Maxillofacial Surgery.
5,6 Cuddalore Government Dental College, Department of Prosthodontics.
DOI:DOI:https://dx.doi.org/10.54936/haoms2413742
SUMMARY: Background: Condylar fracture have been probably the most mismanaged fractures throughout history. They were either not treated because of improper diagnosis or were managed minimally using external bandages to immobilise the mandible. If left untreated, condylar fractures lead to temporomandibular disorders like ankylosis, dysfunction, chronic dislocation and chronic pain. Even though many authors classify condylar fractures based on their location, no literature currently exists in determining the exact cause which ascertains the location of the fracture line. In this study we attempted to analyse if the presence or absence of posterior teeth is in any way related to the anatomic level of condylar fractures. Materials and Methods: 200 Orthopantomographic images of patients who presented to the department of oral and maxillofacial surgery with condylar fracture from the year 2017-2021 were collected from the medical records department. Out of these 200 OPGs 170 images where finally selected based on the inclusion criteria. Presence or absence of posterior teeth and the total number of missing posterior teeth were calculated and subjected to statistical analysis. Results: Diacapitular fractures were common in patients with no missing teeth and sub condylar fractures were found in patients with absence of posterior teeth hence validating our hypothesis that the number of missing posterior teeth are indeed associated with the level of condylar fractures and that, missing maxillary posteriors, mandibular posteriors, premolars and molars all statistical significantly independently correlated with the level of condylar fracture. Conclusion: In condylar fractures, the level of fracture line is influenced by the presence or absence of posterior teeth. The teeth are usually neglected as they are considered as an accessory aid and not an integral component of the facial skeleton. Proving that the teeth are involved in a complex mechanism which protects the Temporo- Mandibular joint from traumatic forces on the mandible will further solidify their position as an integral functional component and shift the focus towards preserving rather than removing them whenever possible.
KEY WORDS: Condylar fracture, Fracture line, Orthopantomogram, Posterior teeth, Diacapitular fracture, Subcondylar fracture
REFERENCES:
1. Choi KY, Yang JD, Chung HY, Cho BC. Current concepts in the mandibular condyle fracture management part I: overview of condylar fracture. Arch Plast Surg. 2012 Jul;39(4):291-300. doi: 10.5999/aps.2012.39.4.291. Epub 2012 Jul 13. PMID: 22872830; PMCID: PMC3408272.
2. Zachariades N, Mezitis M, Mourouzis C, Papadakis D, Spanou A. Fractures of the mandibular condyle: a review of 466 cases. Literature review, reflections on treatment and proposals. Journal of CranioMaxillofacial Surgery. 2006 Oct 1;34(7):421- 32
3. Weiss JP, Sawhney R. Update on mandibular condylar fracture management. Current opinion in otolaryngology & head and neck surgery. 2016 Aug 1;24(4):273-8
4. Farzan R, Farzan A, Farzan A, Karimpour M, Tolouie M. A 6-Year Epidemiological Study of Mandibular Fractures in Traumatic Patients in North of Iran: Review of 463 Patients. World J Plast Surg. 2021 Jan;10(1):71-77. doi: 10.29252/ wjps.10.1.71. PMID: 33833957; PMCID: PMC8016382.
5. Zachariades N, Koumoura F, Konsolaki-Agouridaki E. Facial trauma in women resulting from violence by men. Journal of oral and maxillofacial surgery. 1990 Dec 1;48(12):1250-3
6. Mukhopadhyay S. A retrospective study of mandibular fractures in children. J Korean Assoc Oral Maxillofac Surg. 2018 Dec;44(6):269-274. doi: 10.5125/jkaoms.2018.44.6.269. Epub 2018 Dec 28. PMID: 30637240; PMCID: PMC6327018.
7. Cara AC, Gaia BF, Perrella A, Oliveira JX, Lopes PM, Cavalcanti MG. Validity of single- and multislice CT for assessment of mandibular condyle lesions. Dentomaxillofac Radiol. 2007 Jan;36(1):24-7. doi: 10.1259/dmfr/54883281. PMID: 17329584.
8. Naeem A, Gemal H, Reed D. Imaging in traumatic mandibular fractures. Quantitative imaging in medicine and surgery. 2017 Aug;7(4):46
9. Mahgoub MA, El-Sabbagh AH, Abd El-Latif EA, Elhadidy MR. Condylar Fractures: Review of 40 Cases. Ann Maxillofac Surg. 2018 Jan-Jun;8(1):19-27. doi: 10.4103/ams.ams_133_17. PMID: 29963420; PMCID: PMC6018287
10. Al-Moraissi EA, Ellis III E. Surgical treatment of adult mandibular condylar fractures provides better outcomes than closed treatment: a systematic review and meta-analysis. Journal of Oral and Maxillofacial Surgery. 2015 Mar 1;73(3):482-93
11. Chrcanovic BR. Surgical versus non-surgical treatment of mandibular condylar fractures: a meta-analysis. International journal of oral and maxillofacial surgery. 2015 Feb 1;44(2):158-79
12. Lee CY, McCullon 3rd C, Blaustein DI, Mohammadi H. Sequelae of unrecognized, untreated mandibular condylar fractures in the pediatric patient. Annals of dentistry. 1993 Jan 1;52(1):5-8.
13. Rowe NL. Fractures of the jaw in children. J. oral Surg.. 1969;27:497-507
14. Loukota RA, Eckelt U, De Bont L, Rasse M. Subclassification of fractures of the condylar process of the mandible. British journal of oral and maxillofacial surgery. 2005 Feb 1;43(1):72-3
15. Wassmund M. Über luxationsfrakturen des kiefergelenks. Dtsch Kieferch 1934;1:27e54
16. Ellis E 3rd, Palmieri C, Throckmorton GS. Further displacement of condylar process fractures after closed treatment. J Oral Maxillofac Surg 1999;59(2):120e9
17. Neff A, Kolk A, Deppe H, et al. Neue aspekte zur indikation der operativen versorgung intraartikul ärer und hoher kiefergelenklux-ationsfrakturen [New aspects for indications of surgical management of intra-articular and high temporomandibular dislocation fractures]. Mund Kiefer Gesichtschir 1999;3(1):24e9 [in German]
18. Da Fonseca, G. D. “Experimental study on fractures of the mandibular condylar process (mandibular condylar process fractures).” International journal of oral surgery 3.3 (1974): 89-101.
19. Tuchtan L, Piercecchi-Marti MD, Bartoli C, Boisclair D, Adalian P, Léonetti G, Behr M, Thollon L. Forces transmission to the skull in case of mandibular impact. Forensic science international. 2015 Jul 1;252:22-8
20. Allsop DL, Warner CY, Wille MG, Schneider DC, Nahum AM. Facial impact response—a comparison of the Hybrid III dummy and human cadaver. SAE transactions. 1988 Jan 1:1224-40.
21. Cornelius CP, Audigé L, Kunz C, Rudderman R, BuitragoTéllez CH, Frodel J, Prein J. The Comprehensive AOCMF Classification System: Mandible Fractures-Level 3 Tutorial. Craniomaxillofac Trauma Reconstr. 2014 Dec;7(Suppl 1):S031-43. doi: 10.1055/s-0034-1389558. PMID: 25489389; PMCID: PMC4251719.
|
How to cite this article:
|
| ||
View the full-text PDF: