REMOVAL OF INTERNAL FIXATORS IN PATIENTS WITH CONDYLAR HEAD FRACTURES AS AN ELEMENT OF COMPREHENSIVE FUNCTIONAL REHABILITATION
DOI:
https://doi.org/10.11603/2311-9624.2024.4.15195Keywords:
mandible, condylar head fracture, TMJ, revision of soft tissues, arthroscopy.Abstract
The literature presents different, sometimes diametrically opposed approaches to the removal of fixation elements. Many experts recommend routine removal of fixators in the longterm postoperative period, while other authors recommend performing such operations only with some clinical sympoms. The most active discussion about removing fixation elements among all fractures of the mandible revolves around condylar head fractures (CHFs). The aim of the study was to evaluate the effect of fixators removal and endoscopic revision of the TMJ in patients with CHFs on the integral results of functional rehabilitation and the risk of complications associated with additional surgical intervention. The inclusion criteria were 74 patients with 95 CHFs (mean age 35.8 ± 14.4 ) with CHF type B and C according to Neff 2004 with displacement of fragments, who underwent open reduction and osteosynthesis. The patients were divided into two groups: in the first group in 4 months after osteosynthesis, the fixators were removed with revision of the surrounding soft tissue, in the second group, second sugery was not performed. It was found, that in patients with CHFs who had functional disorders after surgery, removal of fixators and revision of the surrounding tissues allows achieving better functional results in long-term postoperative period and reducing the symptoms of crunching, clicking and pain. Assessment of TMJ function in 6 months using the clinical dysfunction index according to M. Helkimo showed diiference between groups: patients with no functional impairment in the main group were 52.3% and 20.8% in the control group (p<0.05), with a minor degree of dysfunction (Di I) 42.8% and 62.5%, respectively (p>0.05). On the other hand, patients who had minor functional limitations in the early period after surgery fully recovered without additional surgical procedures. Obtained results confirm the feasibility of removing fixators in patient with CHF after consolidation of fragments as a routine procedure in the complex rehabilitation, especially in cases of functional deficit of the joint in 4 months after osteosynthesis. The second surgery should be aimed not only remove foreign bodies, but also revising the TMJ with the elimination of pathological changes in it and creating conditions for full recovery of both bone and soft tissue elements.
References
Rauso Р. Plates removal in orthognathic surgery and facial fractures: when and why Р. Rauso, G. Tartaro, S. Stea, U. Tozzi, P. Biondi The Journal of Craniofacial Surgery. – 2011. – Vol. 22, № 1. – P. 252–254. DOI: 10.1097/SCS.0b013e3181f7b7f4.
Champy M. Mandibular osteosynthesis by miniature screwed plates via a buccal approach M. Champy, J. P. Loddé, R.Schmitt, J. H. Jaeger, D. Muster Journal of Maxillofacial Surgery. – 1978. – Vol. 6, № 1. – P. 14–21. DOI: 10.1016/s0301-0503(78)80062-9.
Michelet F. X. Osteosynthesis with miniaturized screwed plates in maxillo-facial surgery F. X. Michelet, J. Deymes, B. Dessus Journal of Maxillofacial Surgery. – 1973. – Vol. 1, № 2. – P. 79–84. DOI: 10.1016/s0301-0503(73)80017-7.
Woodman J. L. Metal ion release from titanium-based prosthetic segmental replacements of long bones in baboons: a long-term study. J. L. Woodman, J. J. Jacobs, J. O. Galante, R. M. Urban Journal of Orthopaedic Research. – 1984. – Vol. 1, № 4. – P. 421–430. DOI: 10.1002/jor.1100010411.
Manor Y. Risk factors contributing to symptomatic plate removal in orthognathic surgery patients Y. Manor, G. Chaushu, S. Taicher Journal of Oral and Maxillofacial Surgery. – 1999. – Vol. 57, № 6. – P. 679–682. DOI: 10.1016/s0278-2391(99)90430-5.
Jain R. Effect of stainless steel and titanium low-contact dynamic compression plate application on the vascularity and mechanical properties of cortical bone after fracture / R. Jain, N. Podworny, T. Hearn, G. I. Anderson, E. Schemitsch // Journal of Orthopaedic Trauma. 1997. Vol. 11, № 7. – P. 490–495. DOI: 10.1097/00005131-199710000-00006.
Allurkar S. Surface analysis of titanium maxillofacial plates and screws retrieved from patients S. Allurkar, U. M. Joshi, K. Shah, N. Thakur, A. Mangalgi Journal of Dental Specialities. – 2016. – Vol. 4, № 2.
Matthew I. R. In vivo surface analysis of titanium and stainless steel miniplates and screws I. R. Matthew, J. W. Frame, R. M. Browne, B. G. Millar International Journal of Oral and Maxillofacial Surgery. – 1996. – Vol. 25, № 6. – P. 463–468. DOI: 10.1016/s0901-5027(96)80085-3.
Nakamura S. Complications of miniplate osteosynthesis for mandibular fractures S. Nakamura, Y. Takenoshita, M. Oka Journal of Oral and Maxillofacial Surgery. – 1994. – Vol. 52, № 3. – P. 233–239. DOI: 10.1016/0278-2391(94)90289-5.
Rosenberg A. Should titanium miniplates be removed after bone healing is complete? A. Rosenberg, K. W. Grätz, H. F. Sailer International Journal of Oral and Maxillofacial Surgery. – 1993. – Vol. 22, № 3. – P. 185–188. DOI: 10.1016/s0901-5027(05)80249-8.
Cawood J. I. Small plate osteosynthesis of mandibular fractures J. I. Cawood The British Journal of Oral & Maxillofacial Surgery. – 1985. – Vol. 23, № 2. – P. 77–91. DOI: 10.1016/0266-4356(85)90057-9.
Spiessl B. Rigid internal fixation of fractures of the lower jaw / Spiessl B. Reconstruction Surgery and Traumatology. – 1972. – Vol. 13. – P. 124–140.
Haug R. H. Retention of asymptomatic bone plates used for orthognathic surgery and facial fractures R. H. Haug Journal of Oral and Maxillofacial Surgery: Official Journal of the American Association of Oral and Maxillofacial Surgeons. – 1996. – Vol. 54, № 5. – P. 611–617. DOI: 10.1016/s0278-2391(96)90644-8.
Bhatt V. Removal of miniplates in maxillofacial surgery: a follow-up study / V. Bhatt, P. Chhabra, M. S. Dover Journal of Oral and Maxillofacial Surgery: Official Journal of the American Association of Oral and Maxillofacial Surgeons. – 2005. – Vol. 63, № 6. – P. 756–760. DOI: 10.1016/j.joms.2005.02.005.
Posnick J. C. Method of osteotomy fixation and need for removal following bimaxillary orthognathic, osseous genioplasty, and intranasal surgery: a retrospective cohort study J. C. Posnick, E. Choi, A. Chavda International Journal of Oral and Maxillofacial Surgery. – 2017. – Vol. 46, № 10. – P. 1276–1283. DOI: 10.1016/j.ijom.2017.05.014.
Borstlap W. A. Stabilisation of sagittal split advancement osteotomies with miniplates: a prospective, multicentre study with two-year follow-up. Part I. Clinical parameters W. A. Borstlap, P. J. Stoelinga, T. J. Hoppenreijs, M. A. van’t Hof /International Journal of Oral and Maxillofacial Surgery. – 2004. – Vol. 33, № 5. – P. 433–441. DOI: 10.1016/ j.ijom.2004.02.003.
Aramanadka C. Hardware Removal in Maxillofacial Trauma: A Retrospective Study C. Aramanadka, A. T. Kamath, G. Srikanth, D. Pai, N. Singla, S. Daundiyal, A. Desai The Scientific World Journal. – 2021. – Vol. 2021. 9947350. DOI: 10.1155/2021/9947350.
Strasbourg Osteosynthesis Group. Consensus statement: the 3rd SORG meeting, – 1991.
Neff A. Stabilität der Osteosynthese bei Gelenkwalzenfrakturen in Klinik und biomechanischer Simulation A. Neff, G. Mühlberger, M. Karoglan, A. Kolk, W. Mittelmeier, D. Scheruhn, H. H. Horch Mund-, Kiefer- und Gesichtschirurgie. – 2004. – Vol. 8. – P. 63–74.
Pavlychuk T. Application of CAD/CAM technology for surgical treatment of condylar head fractures: A preliminary study T. Pavlychuk, D. Chernogorskyi, Y. Chepurnyi, A.Neff, A. Kopchak Journal of Oral Biology and Craniofacial Research. – 2020. – Vol. 10, № 4. – P. 608–614. DOI: 10.1016/j.jobcr.2020.08.018.
Hirjak D. Intraoperative arthroscopy of the TMJ during surgical management of condylar head fractures: A preliminary report D. Hirjak, B. Galis, M. Beno, V. Machon, L. G. Mercuri, A. Neff Journal of Cranio-Maxillo-Facial Surgery: Official Publication of the European Association for Cranio-Maxillo-Facial Surgery. – 2018. – Vol. 46, № 12. – P. 1989–1995. DOI: 10.1016/j.jcms.2017.05.032.
Piombino P. Titanium Internal Fixator Removal in Maxillofacial Surgery: Is It Necessary? A Systematic Review and Meta-Analysis P. Piombino, L. Sani, G. Sandu, E. Carraturo, G. De Riu, L. A. Vaira, F. Maglitto, L. Califano The Journal of Craniofacial Surgery. 2023. Vol. 34, № 1. – P. 145–152. DOI: 10.1097/SCS.0000000000009006.
Skroch L. Condylar remodeling after osteosynthesis of fractures of the condylar head or close to the temporomandibular joint L. Skroch, I. Fischer, A. Meisgeier, F. Kozolka, J. Apitzsch, A.Neff Journal of Cranio-Maxillo- Facial Surgery: Official Publication of the European Association for Cranio-Maxillo-Facial Surgery. 2020. Vol. 48, № 4. – P. 413–420. DOI: 10.1016/j.jcms.2020.02.005.
Xie S. T. Functional and radiologic outcome of open reduction and internal fixation of condylar head and neck fractures using miniplate or microplate system / S. T. Xie, D. Singhal, C. T. Chen, Y. R. Chen Annals of Plastic Surgery. – 2013. – Vol. 71, Suppl. 1. – P. S61–S66. DOI: 10.1097/SAP.0000000000000040.
Smolka W. Resorption behaviour of the articular surface dome and functional outcome after open reduction and internal fixation of mandibular condylar head fractures using small-fragment positional screws W. Smolka, C. P. Cornelius, C. Lechler // Journal of Cranio-Maxillo-Facial Surgery: Official Publication of the European Association for Cranio-Maxillo-Facial Surgery. – 2018. – Vol. 46, № 11. – P. 1953–1959. DOI: 10.1016/j.jcms.2018.09.008.
Neff A. Open reduction and internal fixation in temporomandibular joint traumatology: current concepts and future perspectives A. Neff Stomatological Disease and Science. – 2019. – Vol. 3. N-A. DOI: 10.20517/2573-0002.2018.27.
Helkimo M. Studies on function and dysfunction of the masticatory system. IV. Age and sex distribution of symptoms of dysfunction of the masticatory system in Lapps in the north of Finland M. Helkimo Acta Odontologica Scandinavica. – 1974. – Vol. 32, № 4. – P. 255–267. DOI: 10.3109/00016357409026342.
Kermer C. H. Surgical reduction and fixation of intracapsular condylar fractures. A follow-up study C. H. Kermer, G. Undt, M. Rasse // International Journal of Oral and Maxillofacial Surgery. – 1998. – Vol. 27, № 3. – P. 191–194. DOI: 10.1016/s0901-5027(98)80008-8.
Kolk A. Long-term results of ORIF of condylar head fractures of the mandible: A prospective 5-year follow-up study of small-fragment positional-screw osteosynthesis (SFPSO) A. Kolk, A. Neff Journal of Cranio-Maxillo-Facial Surgery: Official Publication of the European Association for Cranio-Maxillo-Facial Surgery. – 2015. – Vol. 43, № 4. – P. 452–461. DOI: 10.1016/j.jcms.2015.02.004.
Kozakiewicz M. Small-diameter compression screws completely embedded in bone for rigid internal fixation of the condylar head of the mandible M. Kozakiewicz The British Journal of Oral & Maxillofacial Surgery. – 2018. – Vol. 56, № 1. – P. 74–76. DOI: 10.1016/ j.bjoms.2017.04.013.
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