Efficacy of a Single Trapezoidal-Shaped 3-D Condylar Plate in the Osteosynthesis of Mandibular Condylar Fractures

ABSTRACT

Aim:

In the osteosynthesis of mandibular condylar fractures, the goal had been to assess the stability of a single trapezoidal-shaped 3-D condylar plate.

Materials and Methods:

We evaluated 15 individuals who had mandibular condylar fractures. Under general anesthesia, the chosen patients underwent open reduction and fixation using three-dimensional titanium miniplates called trapezoidal condylar plates (TCPs). The Mini Retro Mandibular Approach and the Trans Masseteric Antero Parotid Approach were used to treat each of these fractures.

Results and Conclusion:

The three-dimensional Trapezoidal Condylar Plate titanium miniplates were found to be an efficient osteosynthesis device for stabilising condylar fracture and hence, yielded acceptable results in terms of achieving anatomical and functional stability.

INTRODUCTION

The most frequent causes of oral and maxillofacial injuries include falls, sports-related injuries, traffic accidents, and interpersonal aggression. Mandibular fractures account for over 70% of all maxillofacial fractures, which are second only to nasal bone fractures in frequency.[1] A common finding is damage to the temporomandibular joint complex, and 26–40% of all mandible fractures are condylar and subcondylar fractures.[2] Condylar fractures that go undiagnosed or are treated improperly may cause substantial functional impairment, including as malocclusion, restricted lateral mandibular motions, and decreased mouth opening due to jaw deviation.[3] For the care of condylar fractures, there are two potential treatment modalities: closed reduction and open reduction. The optimal course of treatment for intracapsular fractures and fractures in children is conservatism,[4] but there is no consensus on how to treat extracapsular fractures in adults. While some surgeons choose closed reduction or cautious treatment, others prefer open reduction internal fixation (ORIF). ORIF for condylar fractures has historically been treated with a variety of techniques, including bioresorbable miniplates, 3-D miniplates, Champy’s miniplates, Lag screws, transosseous wiring, and dynamic compression plates (DCPs) and eccentric dynamic compression plates (EDCPs).[5] Along with the typical benefits of 3-D plates, such as the ability to use more screws, maintain stability in three dimensions, and resist torque forces while keeping a low profile and malleability, the trapezoidal-shaped plates meet most of the requirements for rigid fixation of subcondylar fractures.[6] In the osteosynthesis of mandibular condylar fractures, the purpose of this research was to evaluate the stability of a single trapezoidal-shaped 3-D condylar plate.

PATIENTS AND METHODS

The current research was carried out on patients who came to SGT University, Budhera’s Oral and Maxillofacial Surgery outpatient department. Fifteen patients receiving treatment for mandibular condylar fractures made up the research sample. All patients with extracapsular condylar fractures who were at least 18 years old met the inclusion criteria. Mandibular extracapsular condylar fracture in addition to any other noncommunited mandibular fracture and patients unwilling to have the fracture repaired.

Intracapsular condylar fractures, individuals with poor health, and ASA grade III-V classification. The research did not include condyle fractures that were communited.

Written consent was obtained. Under general anesthesia, the chosen patients underwent open reduction and fixation using three-dimensional titanium miniplates called trapezoidal condylar plates (TCPs). The Mini Retro Mandibular Approach (MRMA) and the Trans Masseteric Antero Parotid Approach (TMAP) were used throughout the operations on each of these fractures. Every patient received routine follow-up at prearranged times. Orthopantomograms (OPGs) were obtained immediately after surgery, 1 month later, and 6 months later as part of the follow-up. The stability of fracture fragments, plate fracture, screw displacement, range of mandibular motions, and stability of postoperative occlusion were the research factors.

RESULTS

Fifteen patients in total—11 (73.3%) male and four (26.7%) female—with mandibular condylar fractures and various related fractures of the mandibular angle, body, parasymphysis, and symphysis were included in the current investigation. Patients’ ages varied from 18 to 50 years old, with a mean age of 31. Six patients had unilateral subcondylar fractures alone, while two had bilateral subcondylar fractures linked with parasymphyseal and body fractures of the jaw. Seven patients had subcondylar fractures related to angle, body, and parasymphysis fractures of the mandible. Low displaced subcondylar fractures accounted for 80% of all fracture cases. Men outnumbered women by around three times, and the majority of the fractures were unilateral, displaced, and subcondylar and occurred on the right side. Under general anesthesia, a three-dimensional titanium TCP was used for open reduction and internal fixation as shown in Figure 1. Desired miniplates were utilized to fixate additional related fractures. After the mandibular condyle fracture was fixed, a clinical evaluation of the occlusion was conducted. Of the 15 patients, 2 (13%) had bilateral loss of molar occlusal contact, and 5 (33.3%) experienced unilateral loss of molar connection on the day after surgery, which was resolved with the use of guiding elastic for 3 days.

Figure 1.

3D titanium TCP was used for ORIF

By using a bimanual approach. At the 6-month postoperative evaluation, there was no evidence of articular discomfort or noise on the operated side. Over the course of the follow-up period, no plate fractures were seen. The 6-month X-ray follow-up revealed that all the fractures had consolidated. On the second follow-up day, which is 1 month after surgery, four (24%) out of the 15 patients had one screw coming free, always from the proximal fragment alone. The screws remained loose on radiographic tests on the third follow-up day, which is 6 months after surgery, although the fracture line seemed to be progressively becoming smaller. Of the 15 patients, three (or 13%) experienced paresthesia, which persisted throughout the postoperative follow-up periods and preoperatively.

Maximal interincisal mouth opening (MIO), protrusion, and lateral excursions were evaluated in relation to the spectrum of mandibular motions. Compared to the MIO attained immediately postoperatively, which was ~17 mm (range 7–26), the MIO after 6 months follow-up was 36.50 mm (range 30–46). At the 6-month follow-up, protrusive movements were 3.94 mm (range 2–5), whereas laterotrusive movements were 4.56 mm (range 2–8) toward the normal side and 5 mm (range 3–9.0) toward the afflicted side. At subsequent follow-ups, the excursive motions and mean values of MIO were higher. When comparing MIO and excursive movements between the immediate and 6-month postoperative periods, the results were statistically significant at the P value of <0.001 level. Similarly, when comparing MIO between the preoperative and immediate postoperative periods as well as the preoperative and postoperative 6-month follow-up, the results were statistically significant at the 1% level. Protrusive movement comparisons between the preoperative and postoperative 6-month periods were also significant at the 1% level.

DISCUSSION

According to Lindhal’s classification¹ of mandibular condylar fractures, two patients in this research had surgery using the TMAP method, and 13 patients underwent surgery using the MRMA. The stability of fracture pieces was manually assessed in each of the participants under study, and it was always determined to be good. This result is in line with the conclusions reached by Al-Moraissi E[7] and Singh G.[8] At three follow-up intervals, radiography was used to examine plate fracture by looking for any deviations from the plate’s typical trapezoidal shape. The trapezoidal form itself, which reduces the torque force operating on it during function, and the 3-D idea may be to blame for this.[9]

On radiographic tests, the fracture line looked to be steadily reducing, even though screw loosening was seen in 4 (25%) out of 15 patients. Since none of the patients’ stability was at risk and there were no symptoms of infection or inflammation, none of the screws were taken out at a later date.

CONCLUSION

Since the 2 mm 3-D miniplate technology satisfies the requirements of dynamic osteosynthesis, it was used in this research for open reduction and internal fixing of the condylar fracture, resulting in excellent fracture segment stability and improved functional stability. The use of little hardware, particularly in relation to two miniplates, lowers the risk of infection and exposure, protecting the facial nerve. One may argue that this study’s tiny sample size is one of its weaknesses. To confirm these findings, further research with a bigger sample size and longer follow-up is needed.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.