Comparative study of intra-articular irrigation and corticosteroid injection versus closed reduction with intermaxillary fixation for the management of mandibular condyle fractures.
OBJECTIVE
To evaluate the clinical outcome of a modified conservative treatment protocol involving intra-articular irrigation and corticosteroid injection into the superior joint compartment (SJC) of patients with fresh mandibular condyle fractures. Study design A total of 26 consecutive unilateral fresh condylar fractures in 26 patients were divided into the intra-articular irrigation (IR) group (14 patients, 14 joints) and the conventional conservative treatment (CC) group (12 patients, 12 joints). In the IR group, the SJCs of the fractured joints were irrigated with saline solution and injected dexamethazone sodium, followed by conventional rehabilitation. In the CC group, patients were treated by closed reduction with intermaxillary fixation (IMF) for 2 weeks, followed by conventional rehabilitation. Clinical outcome at 1 month, 3 months, 6 months, and 1 year after injury was determined by clinical examination of jaw motion, joint pain, and occlusal changes. The posttreatment results were compared with the pretreatment baseline data. Between-group differences in clinical parameters were analyzed.


RESULTS
There were significant between-group differences in the range of mandibular motion at 1 month and 3 months after injury (1 month, P=.0022; 3 months, P=.0022). In the IR group, joint pain was well relieved from the early stage of treatment. Occlusal changes were found in 1 patient in the IR group and 4 patients in the CC group at 1 year after injury.


CONCLUSIONS
The modified treatment protocol involving intra-articular irrigation and corticosteroid injection into the SJC is a more effective and quick-acting modality than conventional closed reduction with IMF for functional recovery and control of clinical symptoms of patients with unilateral fresh condylar fractures.
Kondoh
Toshirou
T
Department of Oral Surgery, Nihon University, School of Dentistry at Matsudo, Matsudo, Japan.
Hamada
Yoshiki
Y
Kamei
Kazutoshi
K
Kobayakawa
Motohiro
M
Horie
Akihisa
A
Iino
Mitsuyoshi
M
Kobayashi
Kaoru
K
Seto
Kanichi
K
D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018771:Arthralgia / Q000503:physiopathology; D003766:Dental Occlusion; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007270:Injections, Intra-Articular; D019248:Jaw Fixation Techniques; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008335:Mandibular Condyle / Q000293:injuries* / Q000503:physiopathology; D008337:Mandibular Fractures / Q000628:therapy*; D019152:Paracentesis; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D007507:Therapeutic Irrigation / Q000379:methods; D016896:Treatment Outcome
D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D003907:Dexamethasone; D008012:Lidocaine