Basic and patient-oriented research
Intracapsular Condylar Fracture of the Mandible: Our Classification and Open Treatment Experience

https://doi.org/10.1016/j.joms.2009.02.012Get rights and content

Purpose

We studied the classification of intracapsular condylar fracture (ICF) of the mandible based on coronal computed tomography (CT) scans and present our open treatment experience at the temporomandibular joint (TMJ) division of Shanghai's Ninth People's Hospital (Shanghai, China).

Materials and Methods

From 1999 to 2008, 229 patients with 312 ICFs were treated in our division. Among them, 195 patients (269 joints) had CT scans for classification. We modified the classification of Neff et al, adding a new fracture type according to our experience: type A, fracture line through lateral third of condylar head with reduction of ramus height; type B, fracture line through middle third of condylar head; type C, fracture line through medial third of condylar head; and type M, comminuted fracture of condylar head. There was no ramus height reduction in fracture types B and C. Our treatment protocol is open reduction for a fracture in which the superolaterally dislocated ramus stump is out of the glenoid fossa or any type of fracture with displaced or dislocated fragments that may cause TMJ dysfunction later.

Result

Among the 269 joints, 116 had type A fractures (43.1%), 81 had type B fractures (30.1%), 11 had type C fractures (4.1%), and 58 had type M fractures (21.6%); 3 joints (1.1%) had fractures that were not displaced. Of the joints, 173 had open reduction–internal fixation; postoperative CT scans showed that 95.6% of these had absolute anatomic or nearly anatomic reduction. In all of them normal mouth opening and occlusion were restored. No or little deviation was found during mouth opening. Complications were pain in the joint (n = 1), crepitations (n = 2), and facial nerve (temporal branch) paralysis (n = 1). Two patients had the plate removed because of these complications.

Conclusion

Our new classification based on CT scans can better guide clinical treatment. Open reduction for ICF can restore the anatomic position for both the condyle and TMJ soft tissues with few complications, which can yield better functional and radiologic results.

Section snippets

Materials and Methods

From 1999 to 2008, 354 cases (480 joints) were diagnosed with mandibular condyle fractures and treated in the TMJ division of Shanghai's Ninth People's Hospital. Among the joints, 312 (65%) had intracapsular fractures, 147 (30.6%) had condylar neck fractures, and 21 (4.4%) had subcondylar fractures.

The charts of 229 patients with 312 joints with intracapsular fractures were reviewed. Of the patients, 195 had CT scan records before treatment. We reviewed their general information, cause of

Results

The age of the 195 patients ranged from 1 to 83 years. There were 57 female and 138 male patients. The cause of injury was as follows: fall, 93 patients (47.7%) (with a fall from a height in 22); motor vehicle accident, 34 patients (17.4%); bicycle accident, 24 patients (12.3%); workplace injury, 13 (6.7%); motorcycle accident, 6 patients (3.1%); sports, 3 patients (1.5%), and assault, 1 patient (0.5%). The cause in the other 21 patients was unknown (10.8%).

In the 195 patients, 269 joints were

Discussion

Our data showed that intracapsular fracture is the most common type of condylar fracture, accounting for 65% of cases. This is in contrast to the literature showing that subcondylar fracture is the most common type, accounting for 71% of cases.16, 17 It is possible that in many cases, intracapsular fractures are undiagnosed at the time of injury.18 In our division we perform a coronal CT scan in every patient if condylar fracture is suspected, which is more accurate and sensitive than

References (22)

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This work was supported by the Science and Technology Commission of Shanghai (08DZ2271100).

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