Exclusive Functional Treatment for Mandibular Condylar Fractures.

Autor:	Vernhet E; Resident, Department of Plastic, Maxillofacial, and Oral Surgery, Gui de Chauliac Hospital, Montpellier, France. Electronic address: e-vernhet@chu-montpellier.fr., De Boutray M; Attending Surgeon and Instructor, Department of Plastic, Maxillofacial, and Oral Surgery, Gui de Chauliac Hospital, Montpellier, France., Hoarau R; Visiting Surgeon, Department of Plastic, Maxillofacial, and Oral Surgery, Gui de Chauliac Hospital, Montpellier, France., Jammet P; Attending Surgeon and Instructor, Department of Plastic, Maxillofacial, and Oral Surgery, Gui de Chauliac Hospital, Montpellier, France., Galmiche S; Attending Surgeon and Instructor, Department of Plastic, Maxillofacial, and Oral Surgery, Gui de Chauliac Hospital, Montpellier, France., Breton I; Physiotherapist, Department of Plastic, Maxillofacial, and Oral Surgery, Gui de Chauliac Hospital, Montpellier, France.
Jazyk:	angličtina
Zdroj:	Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons [J Oral Maxillofac Surg] 2019 Dec; Vol. 77 (12), pp. 2523.e1-2523.e8. Date of Electronic Publication: 2019 Jul 05.
DOI:	10.1016/j.joms.2019.06.188
Abstrakt:	Purpose: Despite the frequency of condylar fractures, no consensus has been reached regarding treatment alternatives (ie, operative vs nonoperative). The purpose of the present study was to describe functional treatment without intermaxillary fixation of condylar fractures and summarize the treatment outcomes. Patients and Methods: We designed a retrospective case series and enrolled patients with condylar fractures with malocclusion. The primary outcome was treatment success, assessed at the end of 6 weeks. We recorded 5 parameters to assess treatment success, including a stable return to the initial occlusion, lateral excursion of more than 7 mm, centered protrusion of more than 4 mm, centered mouth opening of more than 35 mm, and painless mandibular mobilization. If all 5 parameters were met, treatment was deemed a success. Treatment failure was defined as meeting less than all 5 parameters. We used numbers and percentages for these nominal qualitative variables (healing criterion absent or present). Two prognostic variables (ie, fracture type and age range), stratified by treatment success, were compared using the Fisher exact test for patients presenting with all healing criteria. Results: We included 30 patients with a median age of 33 years. Of the 30 patients (34 fractures), 15 had low subcondylar fractures (44.1%), 12 had high subcondylar fractures (35.3%), and 7 had head condylar fractures (20.5%). At the last consultation, 21 patients (70%) had exhibited all the criteria defining treatment success. A significant difference was found in the success rate when stratified by age (P = .002) in favor of the younger patients. Also, high subcondylar and head fractures were associated with a better success rate. Conclusions: Exclusive functional treatment showed promising results and should be considered for cooperative patients, avoiding the risks of surgery and the discomfort with intermaxillary fixation. (Copyright © 2019 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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