Soft tissue reduction during open treatment of intracapsular condylar fracture of the temporomandibular joint: our institution's experience.
OBJECTIVE
To evaluate the effect of soft tissue reduction during open surgery of intracapsular condylar fracture (ICF) of the temporomandibular joint (TMJ).


METHODS
A total of 129 patients (164 TMJs) with ICF were treated from June 2004 to May 2009. Osteosynthesis was performed by different methods without stripping the lateral pterygoid muscle (LPM). The disc was reduced with or without transecting adhesions, release of the epimysium of the LPM, and anchorage to the condyle. Retrodiscal tissue tear was repaired. The patients were evaluated by computed tomography, magnetic resonance imaging, and clinical signs pre- and postoperatively.


RESULTS
Inferomedial displacement of the condylar segment and disc occurred in 97.6% of cases. Adhesion of the superior joint space was found in 37 of 160 TMJs (23.1%). Retrodiscal tissue tear combined with disc displacement was found in 119 of 160 TMJs (74.4%). The condylar stump was found to be superolaterally displaced in 30.6% (49/160) and laterally dislocated out of the fossa in 41.9% (69/160). A lateral capsular tear was observed in 87 of 160 TMJs (54.4%). The condylar fragments and the discs were reduced and fixed completely with preservation of the attachment of the LPM. Coronal CT revealed that 95.6% (130/160 cases) of ICFs were correctly reduced and fixed. Postoperative magnetic resonance imaging showed that the disc was reduced to its normal position in 40 of 42 TMJs. Long-term complications of 45 patients included fibrous ankylosis in 1 case (0.8%), mouth opening limitation (<2.5 cm) in 5 cases, (3.9%), condyle resorption in 3 cases (2.3%) that needed plate removal, facial nerve injury in 3 cases (2.3%), TMJ click in 2 cases (1.6%), mouth open with deviation in 7 cases (5.4%), and malocclusion in 1 case (0.8%).


CONCLUSIONS
Anatomic reduction of soft tissue was of benefit for biomechanical function of the TMJ and decreased the complications of open surgery.
Chen
Minjie
M
Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Oral and Maxillofacial Surgery, Shanghai, China.
Yang
Chi
C
He
Dongmei
D
Zhang
Shanyong
S
Jiang
Bin
B
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D017746:Joint Capsule / Q000293:injuries / Q000601:surgery; D004204:Joint Dislocations / Q000601:surgery; D008297:Male; D008310:Malocclusion / Q000209:etiology; D008335:Mandibular Condyle / Q000293:injuries*; D008337:Mandibular Fractures / Q000150:complications / Q000601:surgery*; D008875:Middle Aged; D011626:Pterygoid Muscles / Q000601:surgery; D017695:Soft Tissue Injuries / Q000601:surgery*; D013704:Temporomandibular Joint / Q000293:injuries* / Q000601:surgery; D055815:Young Adult