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Use of Two Lag Screws for ORIF of Mandibular Condylar Sagittal Split fracture: An Anti-rotational Concept—A Prospective Clinical Trial

  • Manish J. RaghaniEmail author
  • Biju Pappachan
  • Nisha Raghani
Original Article
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Abstract

Background

Condylar process fracture is one of the most common mandibular fractures. Approximately 11–16% of all facial fractures and 30–40% of all mandibular fractures are fractures of the mandibular condyle. Treatment can broadly be divided into open or closed, but there are no clear criteria to determine the choice between them. Sagittal split fracture of the mandibular condyle is rare and can be easily missed on conventional radiographs, like OPG and multiple standard films, but because of the high incidence of subsequent ankylosis is an important entity. So a CT scan with axial and coronal cuts is advisable in high condylar or intracapsular fractures of mandibular condyle.

Purpose

The hypothesis in this study is that open reduction and internal fixation (ORIF) of sagittal split mandibular condylar fractures with two lag screws is more stable and there is no rotation of the medial fractured segment of condyle.

Methods

In this prospective clinical trial, ORIF of four patients with sagittal split fracture of mandibular condyle was done using two lag screws. In all the patients, pre-op and post-op clinical and radiological findings were evaluated, with a follow-up of two years.

Results

All the patients were evaluated postoperatively at periodical interval with various clinical parameters, viz. mouth opening, occlusion, pain, deviation of mandible while opening, other complaints (like clicking, tenderness), and radiologically with CT scans. All patients showed good occlusion and adequate mouth opening postoperatively. In this series, there was no pain, deviation of mandible while opening and other complaints like tenderness and clicking. In CT scan, the medial fragment was reduced anatomically in position and the lag screws were not protruding in the TM joint space.

Conclusion

Use of two lag screws for ORIF of sagittal split mandibular condylar fractures is recommended to prevent the rotation of fractured medial condylar segment and for more stable fixation.

Keywords

Sagittal split Condylar fractures Two lag screws 

Notes

Compliance with Ethical Standards

Conflict of interest

All the three authors declare no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Liao HT, Wang PF, Chen CT (2015) Experience with the transparotid approach via a mini-preauricular incision for surgical management of condylar neck fractures. J Craniomaxillofac Surg 43(8):1595–1601CrossRefGoogle Scholar
  2. 2.
    Yamaoka M, Furusawa K, Iguchi K, Tanaka M, Okuda D (1994) The assessment of fracture of the mandibular condyle by use of computerized tomography. Incidence of sagittal split fracture. Br J Oral Maxillofac Surg 32(2):77–79CrossRefGoogle Scholar
  3. 3.
    Antoniades K, Karakasis D, Elephtheriades J (1993) Bifid mandibular condyle resulting from a sagittal fracture of the condylar head. Br J Oral Maxillofac Surg 31(2):124–126CrossRefGoogle Scholar
  4. 4.
    He D, Yang C, Chen M, Jiang B, Wang B (2009) Intracapsular condylar fracture of the mandible: our classification and open treatment experience. J Oral MaxillofacSurg 67(8):1672–1679CrossRefGoogle Scholar
  5. 5.
    Agarwal CA, Mendenhall SD 3rd, Foreman KB, Owsley JQ (2010) The course of the frontal branch of the facial nerve in relation to fascial planes: an anatomic study. Plast Reconstr Surg 125(2):532–537CrossRefGoogle Scholar
  6. 6.
    Jing J, Han Y, Song Y, Wan Y (2011) Surgical treatment on displaced and dislocated sagittal fractures of the mandibular condyle. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 111:693–699CrossRefGoogle Scholar
  7. 7.
    Vesnaver A (2008) Open reduction and internal fixation of intra-articular fractures of the mandibular condyle: our first experiences. J Oral Maxillofac Surg 66:2123–2129CrossRefGoogle Scholar
  8. 8.
    Meng FW, Liu YP, Hu KJ, Kong L (2010) Use of a temporary screw for alignment and fixation of sagittal mandibular condylar fractures with lateral screws. Int J Oral Maxillofac Surg 39:548–553CrossRefGoogle Scholar
  9. 9.
    Luo S, Li B, Long X, Deng M, Cai H, Cheng Y (2011) Surgical treatment of sagittal fracture of mandibular condyle using long-screw osteosynthesis. J Oral Maxillofac Surg 69(7):1988–1994CrossRefGoogle Scholar
  10. 10.
    Long X, Goss AN (2007) Pathological changes after the surgical creation of a vertical intracapsular condylar fracture. Int J Oral Maxillofac Surg 36(9):834–837CrossRefGoogle Scholar

Copyright information

© The Association of Oral and Maxillofacial Surgeons of India 2019

Authors and Affiliations

  • Manish J. Raghani
    • 1
  • Biju Pappachan
    • 2
  • Nisha Raghani
    • 3
  1. 1.Department of Dentistry, Cranio-Maxillofacial Surgery ClinicAll India Institute of Medical Sciences (AIIMS)RaipurIndia
  2. 2.Department of Oral and Maxillofacial SurgeryGovernment Dental College and HospitalRaipurIndia
  3. 3.Rungta College of Dental Sciences and Research CentreBhilaiIndia

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