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Medicina Oral, Patologia Oral Y Cirugia... Nov 2018Bifid mandibular condyle (BMC) constitutes an extremely rare disorder characterized by a duplication of the head of the mandibular condyle. Its prevalence ranges from...
BACKGROUND
Bifid mandibular condyle (BMC) constitutes an extremely rare disorder characterized by a duplication of the head of the mandibular condyle. Its prevalence ranges from 0.31% to 1.82% in the published literature.
OBJECTIVES
The primary objective was to describe the main etiological, clinical and radiological characteristics of patients with BMCs and the existent treatment options. The secondary objective was to simultaneously include the characteristics of two new cases of BMC.
MATERIAL AND METHODS
An electronic search in Pubmed (MEDLINE), Scopus and The Cochrane Library was carried out by two independent reviewers until April 2018. Prospective or retrospective cohort studies, case series and case reports describing clinical and/or radiological characteristics of patients with BMC were included. Registered variables were demographic, etiological factors, diagnostic exam, clinical characteristics and treatment options. The results from the articles selected were organized in a Table along with the characteristics of two new cases of BMC provided by the authors.
RESULTS
From a total of 431 articles found in the initial search, 68 articles were finally included. This systematic review included 216 patients and 270 BMC with an average age of 30.6 (SD=14.7) years and a women:men ratio of 1.4:1. Mediolateral condylar orientation was the most prevalent position (80.1%). Among cases with known etiology, 40.8% of cases had a history of traumatism, while 55.9% did not present any relevant medical background. Half of the symptomatic cases had history of trauma. The most common symptoms were hypomobility (22.7%), arthralgia (18.1%), articular noise (17.2%) and ankylosis (17.6%). Active monitoring and manufacturing an occlusal splint were the most frequent treatment options.
CONCLUSIONS
BMC may have congenital or traumatic etiology. Hypomobility and arthralgia are the most frequent symptoms and treatment options are often conservative.
Topics: Congenital Abnormalities; Female; Humans; Male; Mandibular Condyle; Middle Aged
PubMed: 30341271
DOI: 10.4317/medoral.22681 -
The Journal of Prosthetic Dentistry Apr 2016Immediate mandibular lateral translation (IMLT) has been widely described in theory, but its clinical significance in prosthodontics and restorative dentistry is not... (Review)
Review
STATEMENT OF PROBLEM
Immediate mandibular lateral translation (IMLT) has been widely described in theory, but its clinical significance in prosthodontics and restorative dentistry is not clear.
PURPOSE
The purpose of this study was to systematically review the existing literature to identify the clinical significance of IMLT (immediate side shift).
MATERIAL AND METHODS
An electronic search for articles in the English language literature was performed independently by multiple investigators using a systematic search process with the PubMed search engine. After applying predetermined inclusion and exclusion criteria, the final list of studies was analyzed to identify the clinical significance of IMLT.
RESULTS
The initial electronic search yielded 858 titles. The systematic application of the inclusion and exclusion criteria eventually produced 23 studies addressing IMLT in 914 human participants. Eleven studies reported use of voluntary movements, 5 articles reported use of only induced movements, 2 studies reported use of both voluntary and induced movements, and 5 articles did not report the recording method. The amount of IMLT reported ranged from 0 to 3 mm with minimal clarity among authors on the exact description of IMLT. No studies reported on any clinical implication (harm or benefit to patients or clinicians) of incorporating IMLT in diagnosis and treatment planning.
CONCLUSIONS
This systematic review did not identify any scientific evidence on the clinical implications of IMLT. Furthermore, there is a lack of clear terminology related to IMLT and the timing of the side shift, occurrence of IMLT on the working versus nonworking condyle, and induced versus noninduced methods of recording and measuring. Current scientific evidence does not support the need to include IMLT as a factor when prosthodontic or restorative treatment is planned and executed.
Topics: Humans; Mandible; Patient Care Planning
PubMed: 26723093
DOI: 10.1016/j.prosdent.2015.09.021 -
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 -
Orthodontics & Craniofacial Research Nov 2015To estimate the effects of skeletal class II malocclusion treatment using fixed mandibular repositioning appliances on the position and morphology of the... (Review)
Review
To estimate the effects of skeletal class II malocclusion treatment using fixed mandibular repositioning appliances on the position and morphology of the temporomandibular joint (TMJ). Two independent reviewers performed comprehensive electronic searches of MEDLINE, EMBASE, EBM reviews and Scopus (until May 5, 2015). The references of the identified articles were also manually searched. All studies investigating morphological changes of the TMJ articular disc, condyle and glenoid fossa with 3D imaging following non-surgical fixed mandibular repositioning appliances in growing individuals with class II malocclusions were included in the analysis. Of the 269 articles initially reviewed, only 12 articles used magnetic resonance imaging and two articles used computed tomography (CT) or cone-beam CT images. Treatment effect on condyle and glenoid fossa was discussed in eight articles. Treatment effect on TMJ articular disc position and morphology was discussed in seven articles. All articles showed a high risk of bias due to deficient methodology: inadequate consideration of confounding variables, blinding of image assessment, selection or absence of control group and outcome measurement. Reported changes in osseous remodelling, condylar and disc position were contradictory. The selected articles failed to establish conclusive evidence of the exact nature of TMJ tissue response to fixed mandibular repositioning appliances.
Topics: Activator Appliances; Humans; Imaging, Three-Dimensional; Malocclusion, Angle Class II; Mandible; Mandibular Condyle; Orthodontic Appliance Design; Orthodontic Appliances, Functional; Temporal Bone; Temporomandibular Joint; Temporomandibular Joint Disc
PubMed: 26260422
DOI: 10.1111/ocr.12099 -
Revue de Stomatologie, de Chirurgie... Feb 2016Condylar resorption after orthognathic surgery (CROS) represents a progressive alteration of shape and volume of the mandibular condyle. It is a known factor of surgical... (Review)
Review
INTRODUCTION
Condylar resorption after orthognathic surgery (CROS) represents a progressive alteration of shape and volume of the mandibular condyle. It is a known factor of surgical relapse. The aim of this systematic review was to discuss the physiopathology, mechanisms, risk factors, diagnosis and treatment of this disease.
MATERIALS AND METHODS
A systematic review of the literature was performed on the Pubmed database from 1970 to 2014, using following terms: ("orthognathic surgery") AND ("condylar resorption" OR "progressive condylar resorption" OR "idiopathic condylar resorption" OR "condylar atrophy" OR "condylolysis"). Papers were included according inclusion and exclusion criterias.
RESULTS
The search leaded to 32 articles. Seventeen were included. CROS was a condylar remodeling secondary to an imbalance between mechanical stress applied to the temporomandibular joints (TMJ) and the host adaptive capacities. It mainly occurred in 14 to 50years old women with pre-existing TMJ dysfunction, estrogen deficiency, class II malocclusion with a high mandibular plane angle, a diminished posterior facial height and a posteriorly inclined condylar neck. Mandibular advancement superior to 10mm, counterclockwise rotation of the mandible and posteriorly condylar repositioning were associated with an increased risk of CROS.
DISCUSSION
Treatment consists in re-operation in case of degradation of the occlusal result after an inactivity period of at least 6 months. Condylectomy with allogenic or autologous reconstruction is an alternative. Prevention is crucial and requires at-risk patient information.
Topics: Adolescent; Adult; Atrophy; Female; Humans; Male; Mandibular Condyle; Middle Aged; Orthognathic Surgery; Reoperation; Temporomandibular Joint Disorders; Young Adult
PubMed: 26682945
DOI: 10.1016/j.revsto.2015.11.002 -
The Cochrane Database of Systematic... Apr 2010Fractures of the condylar process account for between 25% and 35% of all mandibular fractures. Treatment options for fractures of the condyles consist of either the... (Review)
Review
BACKGROUND
Fractures of the condylar process account for between 25% and 35% of all mandibular fractures. Treatment options for fractures of the condyles consist of either the closed method or by open reduction with fixation. Complications may be associated with either treatment option; for the closed approach these can include malocclusion, particularly open bites, reduced posterior facial height and facial asymmetry in addition to chronic pain and reduced mobility. A cutaneous scar and temporary paralysis of the facial nerve are not infrequent complications associated with the open approach. There is a lack of consensus currently surrounding the indications for either surgical or non-surgical treatment of fractures of the mandibular condyle.
OBJECTIVES
To evaluate the effectiveness of interventions that can be used in the treatment of fractures of the mandibular condyle.
SEARCH STRATEGY
The databases searched were: the Cochrane Oral Health Group's Trials Register (to 12th March 2010), CENTRAL (The Cochrane Library 2010, Issue 2), MEDLINE (from 1950 to 12th March 2010), and EMBASE (from 1980 to 12th March 2010). The reference lists of all trials identified were cross checked for additional trials. Authors were contacted by electronic mail to ask for details of additional published and unpublished trials. There were no language restrictions and several articles were translated.
SELECTION CRITERIA
Randomised controlled trials (RCTs) which included adults, over 18 years of age, with unilateral or bilateral fractures of the mandibular condyles. Any form of open or closed method of reduction and fixation was considered.
DATA COLLECTION AND ANALYSIS
Review authors screened trials for inclusion. Extracted data were to be synthesised using the fixed-effect model but if substantial clinical diversity was identified between the studies we planned to use the random-effects model with studies grouped by action and we would explore the heterogeneity between the included studies. Mean differences were to be calculated for continuous outcomes and risk ratios for dichotomous outcomes together with their 95% confidence intervals.
MAIN RESULTS
No high quality evidence matching the inclusion criteria was identified.
AUTHORS' CONCLUSIONS
No high quality evidence is available in relation to this review question and no conclusions could be reached about the effectiveness or otherwise of the two interventions considered in this review. A need for further well designed randomised controlled trials exists. The trialists should account for all losses to follow-up and assess patient related outcomes. They should also report the direct and indirect costs associated with the interventions.
Topics: Adult; Humans; Mandibular Condyle; Mandibular Fractures
PubMed: 20393948
DOI: 10.1002/14651858.CD006538.pub2 -
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 -
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... Oct 2020The aim of the present systematic review was to determine whether closed treatment (CLT) with intermaxillary fixation (IMF) is superior or equivalent to open reduction... (Meta-Analysis)
Meta-Analysis
Will Closed Treatment Provide Better Mandibular Motion Than Open Reduction and Internal Fixation in Cases of Unilateral Displaced Subcondylar Fracture? A Systematic Review and Meta-Analysis.
PURPOSE
The aim of the present systematic review was to determine whether closed treatment (CLT) with intermaxillary fixation (IMF) is superior or equivalent to open reduction and internal fixation (ORIF) in the management of unilateral displaced subcondylar fractures regarding the range of mandibular motion.
MATERIALS AND METHODS
To address our question, we conducted a systematic review and meta-analysis of the reported data after a comprehensive manual and electronic database search of studies reported up to 2017 in the English language that had compared CLT and ORIF of mandibular condyle fractures in adults. The following outcomes were recorded: maximum interincisal opening (MIO), protrusive movement (PM), lateral excursion toward the fractured side (LEFS), and lateral excursion toward the nonfractured side (LENFS).
RESULTS
The search resulted in 8 studies, 4 of which were included in the meta-analysis. The MIO and PM showed no statistically significant differences, with an effect size of -0.823 (P = .112) and -0.633 (P = .079), respectively. However, the LEFS and LENFS were superior after CLT, with an effect size of -0.710 (P = .031) and -0.682 (P = .017), respectively.
CONCLUSIONS
The findings from the present review suggest that both ORIF and CLT can provide comparable MIO and PM in subjects with unilateral displaced subcondylar fractures. However, CLT was superior to ORIF for both LEFS and LENFS.
Topics: Adult; Fracture Fixation; Fracture Fixation, Internal; Humans; Mandible; Mandibular Condyle; Mandibular Fractures; Open Fracture Reduction; Range of Motion, Articular; Treatment Outcome
PubMed: 32554064
DOI: 10.1016/j.joms.2020.05.020 -
BMC Oral Health Mar 2022This study aimed to assess whether functional mandibular advancement (FMA) will cause temporomandibular joint disorders (TMD) or have side effects on temporomandibular... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
This study aimed to assess whether functional mandibular advancement (FMA) will cause temporomandibular joint disorders (TMD) or have side effects on temporomandibular joint (TMJ) in adolescent patients.
METHODS
All searched databases, including PubMed, Web of Science, EMBASE, Cochrane Central Register of Controlled Trails and Scopus were searched. Gray literature and unpublished literature was also searched. Randomized controlled trails (RCT) and non-randomized studies of the effects of interventions (NRSI) directly observe the condition of adolescent patients' TMJ after finishing treatment will be considered to include in our study. According to Cochrane Handbook, Cochrane Collaboration risk of bias tool was used to assess the quality of included RCTs, and Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool was used to assess the quality of included NRSIs.
RESULT
Finally 18 researches were evaluated as eligible to include in this study. 5 of the studies were RCTs, 8 were NRSIs and 5 were systematic reviews. The data of RCTs and NRSIs were statistically pooled in meta-analysis. The number of samples under investigated among primary studies was 579 individuals,there were 80 patients who developed temporomandibular symptoms during or after treatment. But all the subjective symptoms disappeared during follow-up time. The statistical outcomes proved that patients received FMA didn't show more tendency to develop temporomandibular symptoms [I = 27%, OR = 0.54, 95%CI (0.33,0.87), p = 0.01].
CONCLUSION
(1) TMJ symptoms may occur during the functional oral appliance wearing, but the symptoms will release or disappear after treatment or during the follow-up period. (2) Less convincing evidence indicates that slightly previous TMD and condyle-glenoid fossa relationship will be improved after treatment. (3) There is TMJ disc anterior displacement observed during treatment, but most of them will return to the normal position later. (4) Moderate evidence support that FMA will not have side effects on TMJ of adolescent patients.
Topics: Adolescent; Humans; Malocclusion, Angle Class II; Mandibular Advancement; Temporomandibular Joint; Temporomandibular Joint Disorders
PubMed: 35241050
DOI: 10.1186/s12903-022-02075-8