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International Journal of Oral and... Apr 2017Of all mandibular fractures, 25-35% are condylar. Many studies have focused on whether to treat such fractures via open or closed modalities. A uniform protocol for... (Review)
Review
Of all mandibular fractures, 25-35% are condylar. Many studies have focused on whether to treat such fractures via open or closed modalities. A uniform protocol for closed treatment is lacking, but such a protocol could ensure good clinical practice. The aims of this systematic review were to provide an overview of the published studies exclusively pertaining to closed treatment and to summarize the existing modalities for closed treatment and their clinical outcomes. Sixteen studies were selected for detailed analysis. The treatments given were highly variable, ranging from doing nothing to applying maxillomandibular fixation with stainless steel wires. The results of the different studies and the treatment modalities used were difficult to interpret; however no clear differences in the outcome measures were seen between the treatment modalities applied. Complications encountered after closed treatment included malocclusion, limited mouth opening, reduced range of motion, and persistent pain. Due to the heterogeneity between groups, high loss-to-follow-up, poor descriptions of the treatments given, and variability in outcome measurement methods, no clear associations between adverse outcomes and the treatments applied could be determined. This review suggests that due to the high level of methodological variability in the relevant studies published to date, there are currently no uniform standards for the closed treatment of condylar fractures that can be expected to yield good clinical results. The establishment of such standards could potentially improve treatment outcomes.
Topics: Bone Wires; Conservative Treatment; Fracture Fixation; Humans; Jaw Fixation Techniques; Mandibular Condyle; Mandibular Fractures
PubMed: 27955799
DOI: 10.1016/j.ijom.2016.11.009 -
Oral Oncology Sep 2018Computer-assisted surgery (CAS) for mandibular reconstruction was developed to improve conventional treatment methods. In the past years, many different software... (Review)
Review
Computer-assisted surgery (CAS) for mandibular reconstruction was developed to improve conventional treatment methods. In the past years, many different software programs have entered the market, offering numerous approaches for preoperative planning and postoperative evaluation of the CAS process of mandibular reconstruction. In this systematic review, we reviewed planning and evaluation methods in studies that quantitatively assessed accuracy of mandibular reconstruction performed with CAS. We included 42 studies describing 413 mandibular reconstructions planned and evaluated using CAS. The commonest software was Proplan/Surgicase CMF (55%). In most cases, the postoperative virtual 3-dimensional model was compared to the preoperative 3-dimensional model, revised to the virtual plan (64%). The commonest landmark for accuracy measurements was the condyle (54%). Accuracy deviations ranged between 0 mm and 12.5 mm and between 0.9° and 17.5°. Because of a lack of uniformity in planning (e.g., image acquisition, mandibular resection size) and evaluation methodologies, the ability to compare postoperative outcomes was limited; meta-analysis was not performed. A practical and simple guideline for standardizing planning and evaluation methods needs to be considered to allow valid comparisons of postoperative results and facilitate meta-analysis in the future.
Topics: Bone Transplantation; Free Tissue Flaps; Humans; Imaging, Three-Dimensional; Mandibular Neoplasms; Mandibular Reconstruction; Software; Surgery, Computer-Assisted
PubMed: 30115476
DOI: 10.1016/j.oraloncology.2018.07.004 -
Journal of Oral and Maxillofacial... Jul 2017Third molars (M3s) have been hypothesized to be associated with the risk of mandibular angle fracture and mandibular condylar fracture. The authors systematically... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Third molars (M3s) have been hypothesized to be associated with the risk of mandibular angle fracture and mandibular condylar fracture. The authors systematically estimated the relative risk (RR) of M3 status for the development of mandibular angle fracture and mandibular condylar fracture through a meta-analysis of cohort studies.
MATERIALS AND METHODS
In this systematic review, the PubMed, EMBASE, and Cochrane Library databases were searched from inception to October 2016. The predictor of risk was the presence or absence of M3s. The primary outcome was the RR of mandibular angle or condylar fracture. A fixed- or a random-effects model was applied to evaluate the pooled risk estimates. Sensitivity analysis also was performed to identify the potential sources of heterogeneity. Publication bias was assessed by the Begg and Egger tests.
RESULTS
Overall, 13 retrospective cohort studies were included. Of these, 13 reported the association between M3s and mandibular angle fracture, and 5 reported the association with mandibular condylar fracture. Patients with M3s had an increased risk of mandibular angle fractures (RR = 2.63; 95% confidence interval [CI], 2.15-3.21) but a decreased risk of mandibular condylar fractures (RR = 0.47; 95% CI, 0.25-0.86). Substantial heterogeneity in the risk estimates was found. No evidence of publication bias was found.
CONCLUSION
The present meta-analysis provides further evidence associating the presence of M3s with an increased risk of mandibular angle fractures and a simultaneously decreased risk of mandibular condylar fracture. Because of potentially more serious complications associated with condylar fracture, clinicians should carefully consider the decision to remove M3s to decrease the risk of mandibular angle fracture.
Topics: Cohort Studies; Humans; Mandibular Condyle; Mandibular Fractures; Molar, Third; Risk Assessment
PubMed: 28412268
DOI: 10.1016/j.joms.2017.03.021 -
Journal of Oral & Maxillofacial Research 2023This systematic review searched three of the most used databases to assess if current evidence suggested a difference between surgical and non-surgical management of... (Review)
Review
OBJECTIVES
This systematic review searched three of the most used databases to assess if current evidence suggested a difference between surgical and non-surgical management of mandibular condyle fractures in paediatric patients.
MATERIAL AND METHODS
An electronic literature search was conducted of three well known databases - Ovid, PubMed and Web of Science. Studies included were conducted paediatric patients, in humans, written in English and published from January 1 1996 until April 1 2022. Data collection was carried out by two independent reviewers. Data collated from studies without high risk of bias was pooled for surgical vs non-surgical management and total tallies of all outcomes presented. Presence or absence of complications was recorded in 4 x 4 tables for each outcome and compared using a Chi-Square test.
RESULTS
After duplicate records were removed, 182 records were screened. After exclusion of unsuitable reports, 20 were included in the review. Further analysis showed the included studies had high risk of bias. Given this, comparison of this pooled data showed no significant difference between management methods.
CONCLUSIONS
Presently it appears conservative management is functionally adequate without risks associated with surgical management, even though incidence of these risks was shown to be low in the studies included in this review.
PubMed: 37521323
DOI: 10.5037/jomr.2023.14202 -
Journal of Stomatology, Oral and... Nov 2022Several systematic reviews have been published on the effects of mandibular surgery on condylar remodeling without reaching a consensus. The purpose of this systematic...
Several systematic reviews have been published on the effects of mandibular surgery on condylar remodeling without reaching a consensus. The purpose of this systematic review of systematic reviews was to assess the impact of mandibular advancement or bimaxillary surgeries on condylar resorption. A literature search, using several electronic databases, was carried out by two reviewers independently. Article preselection was based on titles and abstracts, and final article selection based on full-text analysis of preselected studies. After final study selection, the quality of studies was assessed using the AMSTAR 2 tool. A decision algorithm was subsequently established to choose the best body of evidence. From an initial yield of 1'848 articles, 23 systematic reviews were identified for further analysis, with ten studies being included in the final selection. Despite the generally low quality of the reviews, certain associations could be made: young patients, female patients, and those with a high mandibular plane angle are more prone to condylar resorption following mandibular advancement osteotomies, especially if anterior rotation of the mandible is performed during surgery. Patients undergoing bimaxillary surgery also appear to have a higher risk of developing condylar resorption. In conclusion, these results confirm the multi-factorial nature of condylar resorption, stressing the need for well-controlled prospective studies with long-term follow-up to clearly identify potential risk factors associated with orthognathic surgery.
Topics: Female; Humans; Bone Resorption; Mandibular Advancement; Mandibular Condyle; Orthognathic Surgical Procedures; Prospective Studies; Systematic Reviews as Topic
PubMed: 35263683
DOI: 10.1016/j.jormas.2022.03.008 -
The Journal of Prosthetic Dentistry Aug 2015Although several lateral occlusion philosophies have been proposed in the literature, there is a lack of compelling evidence supporting any scheme. (Review)
Review
STATEMENT OF PROBLEM
Although several lateral occlusion philosophies have been proposed in the literature, there is a lack of compelling evidence supporting any scheme.
PURPOSE
The purpose of this systematic review was to investigate the clinical implications of different lateral occlusion schemes.
MATERIAL AND METHODS
A literature search was completed through PubMed (MEDLINE), Google Scholar, and Cochrane Library, up to January 2014. The literature search aimed to retrieve 2 study categories: group 1: comparative studies; group 2: clinical outcome studies. The inclusion criteria were peer-reviewed human clinical studies published in English. The search was further supplemented by manual searching through the reference lists of the selected studies.
RESULTS
The initial search revealed a total of 680 studies; however, after applying the inclusion criteria, 26 studies were found suitable for the analysis (13 for group 1 and 13 for group 2). The most commonly evaluated lateral occlusion schemes were canine-guided occlusion (CGO) and group function occlusion (GFO). Group 1 studies evaluated the impact of lateral occlusion schemes on muscular electromyographic (EMG) activity, condylar displacement, mastication, and mandibular movement. Group 2 studies evaluated the impact of restored occlusion on longevity, patient comfort, and pathologic consequences. CGO was associated with narrower mastication and less EMG activity of the masticatory muscles during clenching. GFO was associated with wider mandibular movement and quicker mastication. During mastication, there was no difference in EMG activity between the 2 lateral occlusion schemes. Furthermore, the long-term studies indicated that there is no difference between the 2 schemes in patient comfort and restoration longevity.
CONCLUSION
Although there are immediate differences between the different lateral occlusion schemes, patients have the capability to successfully adapt to CGO or GFO.
Topics: Dental Occlusion; Electromyography; Humans; Mandible; Mandibular Condyle; Mastication; Masticatory Muscles
PubMed: 25957242
DOI: 10.1016/j.prosdent.2014.04.032 -
Journal of Clinical Medicine May 2021The retroauricular approach (RA) has been developed in order to expose the temporomandibular joint in a way that minimizes the risk of injury to the facial nerve and... (Review)
Review
INTRODUCTION
The retroauricular approach (RA) has been developed in order to expose the temporomandibular joint in a way that minimizes the risk of injury to the facial nerve and masks the postoperative scar. One of its characteristics is an excellent posterolateral view of the mandibular head, which allows for the preservation of the lateral temporomandibular joint ligaments in the course of open intracapsular surgery.
AIM
The aim of this study is to systematically review the currently used variants and modifications of RA.
MATERIALS AND METHODS
The construction of the following study is based on PICOS and PRISMA protocols. A systematic literature search was performed based on the PubMed and BASE search engines; furthermore the authors performed a more detailed search in the Google Scholar article database as well as a loop search within the references of papers included in the systematic review.
RESULTS
Searching medical articles databases, Google Scholar, and references yielded a total of 85 records. First the titles and abstracts were blindly screened which was followed by a full-text eligibility check resulting in eventually including and qualifying 7 articles for detailed analysis.
DISCUSSION
All known variants and modifications of RA are characterized by high safety for the facial nerve and an aesthetically hidden scar. There were no reports of auricle necrosis in the collected material.
CONCLUSIONS
In this systematic review, 2 variants and 2 modifications of RA that allow for open temporomandibular joint surgery have been identified; all of them together cover a large spectrum of indications for joint surgery, including reposition and osteosynthesis of mandibular head fractures, eminoplasty, or eminectomy and treatment of some forms of ankylosis.
PubMed: 34064639
DOI: 10.3390/jcm10102049 -
Journal of Oral and Maxillofacial... Mar 2016Traumatic injuries of the mandible resulting in intrusion of the condyle into the middle cranial fossa are rare and treatment is often based on anecdotal experience. The... (Review)
Review
PURPOSE
Traumatic injuries of the mandible resulting in intrusion of the condyle into the middle cranial fossa are rare and treatment is often based on anecdotal experience. The objective of this study was to develop an algorithm for the management of condylar intrusion injuries by identifying factors that influenced the treatment decision of closed versus open reduction of the condyle.
MATERIALS AND METHODS
This study was a systematic review of the literature on intracranial intrusion injuries of the mandibular condyle. A thorough search of the PubMed and Cochrane databases and individual maxillofacial and craniofacial journal databases was conducted using the Medical Subject Heading terms condylar impaction, condylar dislocation, condylar intrusion, and middle cranial fossa and condyle without date and language restriction. Quantitative data on the patient's age, gender, etiology of injury, and time from injury to diagnosis were analyzed using descriptive statistics. The authors studied how the predictor variables of age, etiology, time from injury to diagnosis, and associated neurologic injuries influenced the outcome variable of closed versus open reduction of the condyle.
RESULTS
Forty-eight of the 62 retrieved case reports, case series, and review articles were published in the English-language literature from 1963 to 2015. Data on 51 patients with these injuries showed that 38 (75%) were female and younger than 30 years. The most common etiology of injury was motor vehicular accidents, occurring in 25 of 51 patients (49%). The mean time from injury to diagnosis was 31.2 days (0 to 106.4 days). Forty of the 51 patients (78%) were diagnosed within the first 2 weeks of injury. A good proportion of patients underwent open reduction (63%) and 18 of the 51 of patients (35%) underwent closed reduction.
CONCLUSIONS
Predictor variables that influenced the treatment decision of open versus closed reduction were age of the patient, etiology of injury, and time from injury to diagnosis. Based on the present results, younger patients (0 to 15 yr old), patients who sustain condylar intrusion injuries from bicycle accidents, and those diagnosed within the first 2 weeks of injury are more likely to benefit from closed reduction. The treatment algorithm emphasizes the importance of assessment of associated neurologic injuries and an interdisciplinary approach for the management of these injuries.
Topics: Accidents, Traffic; Age Factors; Algorithms; Brain Injuries; Clinical Protocols; Cranial Fossa, Middle; Decision Making; Early Diagnosis; Humans; Joint Dislocations; Mandibular Condyle; Mandibular Fractures
PubMed: 26514632
DOI: 10.1016/j.joms.2015.09.033 -
International Journal of Oral and... Nov 2017A systematic review of the literature was performed regarding the influence of oestrogen on the occurrence of mandibular condylar resorption. Search terms for oestrogen... (Review)
Review
A systematic review of the literature was performed regarding the influence of oestrogen on the occurrence of mandibular condylar resorption. Search terms for oestrogen were used in combination with terms related to the effect on condylar remodelling. A search of the PubMed, Embase, and Cochrane Central Register of Controlled Trials databases yielded 419 articles published between October 1993 and March 2017. An additional 48 articles were retrieved through manual searching of the reference lists. After initial abstract selection, 94 eligible articles were screened in detail, resulting in a final number of 33 articles included in the review. From this review, no evidence was found that oestrogen (deficiency) contributes to mandibular condylar resorption. The conclusions are limited by the lack of studies with a high level of evidence. Further investigations on serum oestrogen concentrations in women with condylar resorption are needed. Moreover, future studies should focus on the effects of the different types of medication and diseases influencing oestrogen concentrations, the utility of oestrogen concentrations during preoperative screening, and the policies for managing orthognathic surgery patients with an oestrogen deficiency. Finally, whether the mechanisms and risk factors that lead to idiopathic condylar resorption are the same in condylar resorption following orthognathic surgery remain to be elucidated.
Topics: Bone Resorption; Estrogens; Female; Humans; Mandibular Condyle; Orthognathic Surgical Procedures; Postoperative Complications
PubMed: 28684303
DOI: 10.1016/j.ijom.2017.06.012 -
International Journal of Oral and... Feb 2015Idiopathic condylar resorption (ICR) is progressive resorption of the condyle of unknown aetiology. There is no consensus on the approaches for diagnostic imaging and... (Review)
Review
Idiopathic condylar resorption (ICR) is progressive resorption of the condyle of unknown aetiology. There is no consensus on the approaches for diagnostic imaging and management of this disease. The objective of this systematic review was to examine the best practices for imaging and to appraise the success of surgical and non-surgical therapy of ICR. Eleven search engines were queried via explicit literature searches for studies describing ICR, published until 2012. Two authors independently extracted data using predetermined characteristics. Studies that identified patients as having either ICR or progressive condylar resorption and that described the radiographic findings or treatment options were included. Seventeen studies contributing 178 cases met the eligibility criteria. The major radiographic findings, as assessed mostly by two-dimensional imaging, included decreased ramus height, decreased condylar height, altered volume of the condyle, decreased SNB angle and mandibular plane angle, and a retrognathic profile. Treatments included occlusal splints with orthodontic treatment, condylectomy with costochondral graft, and other surgical approaches. This systematic review was limited by the lack of meta-analysis. Nevertheless, we identified the need for future investigations: characterization of findings on three-dimensional imaging and its contribution to treatment planning, outcomes of non-surgical and pharmacological management of ICR, and randomized trials and comparative studies with longer follow-up periods.
Topics: Bone Resorption; Diagnostic Imaging; Humans; Mandibular Condyle
PubMed: 25270187
DOI: 10.1016/j.ijom.2014.09.005