【Abstract】 Objective To assess the feasibility and clinical outcomes of artificial condylar process in reconstruction of the temporomandibular joint. Methods Between January 2005 and January 2010, the reconstructions of the temporomandibular joints with artificial condylar process were performed in 10 cases (11 sides, including 7 left sides and 4 right sides). There were 7 males and 3 females with an average age of 50 years (range, 40-68 years). Mandibular condyle defects were caused by mandible tumor in 7 patients with a mean disease duration of 15 months (range, 9-24 months) and by bilateral condylar fractures in 3 patients with the disease duration of 2, 3, and 2 days respectively. According to Neff classification, there were type M and A in 1 case, type M and B in 1 case, and type M in one side and subcondylar fracture in the other side in 1 case. Results Incisions in all patients healed by first intention, and no complication occurred. All cases were followed up 1 to 4 years, showed facial symmetry and good occluding relation, and the mouth opening was 22-38 mm (mean, 30 mm). No temporomandibular joint clicking or pain and no recurrence of tumor were observed. Most of the artificial condylar process were in good position except 1 deviated from the correct angle slightly. All the patients could have diet normally. Conclusion The results of temporomandibular joint reconstruction after tumor resection with artificial condylar process are good, but the clinical outcome for intracapsular condylar fracture is expected to be further verified.
Objective To compare the effectiveness of open reduction and conservative treatment for pediatric mandibular condylar fractures and to provide the evidence for the selection of cl inical therapy. Methods The cl inical data were retrospectively analyzed from 25 patients with the mandibular condylar fractures between January 1988 and December 2006. Of them, 8 patients (11 fractures) were treated with surgical treatment (surgical group) and 17 patients (22 fractures) withnon-surgical treatment (non-surgical group). In surgical group, there were 6 males (9 fractures) and 2 females (2 fractures) with an age range of 8-13 years; fracture was caused by tumbl ing in 7 cases and by traffic accident in 1 with an interval of 1-6 days between injury and hospital ization; and 5 cases were identified as unilateral condylar fractures (3 compl icated by mental fractures) and 3 cases as bilateral condylar fractures compl icated by mental fractures. In non-surgical group, there were 12 males (15 fractures) and 5 females (7 fractures) with an age range of 3-12 years; fracture was caused by fall ing from height in 4 cases, by tumbl ing in 10, and by traffic accident in 3 with an interval of 1-25 days between injury and hospital ization; and 12 cases were identified as unilateral condylar fractures (3 compl icated by mental fractures) and 5 cases as bilateral condylar fractures (1 compl icated by mental fracture). Results Incision healed by first intention in surgical group, and 25 cases were followed up 1-6 years with an average of 3.5 years. At 12 months after treatment, no temporomandibular joint pain, eating disorder, or l imited mandibular movement occurred in 2 groups. No significant difference was observed in opening mouth extent, protrusive and lateral movements between 2 groups at 6 and 12 months (P gt; 0.05). During centric occlusion, mental point located at the midl ine with symmetric face figure. Two patients in surgical group and 3 in non-surgical group had sl ight snap when opening their mouths. Mandible deviation was observed in 3 patients of 2 groups, respectively when gaping. The X-ray films showed heal ing of fracture and condylar remodel ing at 3-6 months. Mandibular ramus were symmetric in cephalometry. Conclusion Good effectiveness can be obtained by surgical or non-surgical treatment in pediatric mandibular condylar fractures. Considering the pediatric mandibular condyle having powerful heal ing and reconstructing potency and avoiding secondary injury on the temporomandibular joint from surgery, non-surgical treatment should be first selected for the pediatric mandibular condylar fractrues in patients under 7 years.