Comparison of temporomandibular joint function and morphology after surgical and non-surgical treatment in adult condylar head fractures. Issue 3 (March 2020) - Ren, Rong
Abstract: Purpose: The aim of this study was to evaluate whether surgical treatment can distinctly improve temporomandibular joint (TMJ) function and morphology in adult patients with condylar head fractures (CHFs) when compared with conservative treatment. Patients and methods: A retrospective study was performed to evaluate surgical and conservative outcomes in all patients who had suffered CHFs. In this study, all patients were divided into a surgical group and a conservative group. In the surgical group patients were treated by open reduction and internal fixation (ORIF) combined disc anchorage, while in the conservative group patients were treated by a removable splint combined with intermaxillary elastics. Clinical and radiological outcomes were evaluated and functional outcomes were assessed using the Helkimo index score. Paired t-tests, Wilcoxon signed rank tests, independent t-tests and χ 2 tests were used to assess inter-group differences. Results: 75 TMJs in 56 patients were included in this study and were divided into a surgical group (56 TMJs in 40 patients) and a conservative group (19 TMJs in 16 patients). The results showed that the Helkimo index score for TMJ in the surgical group was better than in the conservative group ( p Ai = 0.032, p Di = 0.001, respectively). Ramus height in the surgical group (61.08 ± 4.04 mm) recovered more than in the conservative group (54.82 ± 3.06 mm) ( p = 0.012). Discs became shorter, moved further forward, and became severely distorted in the conservative group (disc length = 7.32 ± 1.35 mm). In contrast, discs became longer, retained a normal disc–condyle relationship, and formed a normal shape in the surgical group (disc length = 11.05 ± 2.07 mm) ( p = 0.003). According to the MRI images, joint effusion, retrodiscal tear, and lateral capsular tear were better cured in the surgical group ( p = 0.001, p < 0.001, p = 0.012, respectively). Conclusion: Based on these results, it seems that surgical treatment of condylar head fractures should be the preferred approach if there are no contraindications for general anesthesia.