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Reduction of diacapitular fractures of the mandibular condyle using a special repositioning pin
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British Journal of Oral and Maxillofacial Surgery 47 (2009) 558–559
Technical note
Reduction of diacapitular fractures of the mandibular condyle using a special repositioning pin Matthias Schneider a,∗ , Richard Loukota b,1 , Uwe Eckelt a a
Department for Oral and Maxillofacial Surgery, University Hospital “Carl Gustav Carus” of the Technical University Dresden, Fetscherstr. 74, 01307 Dresden, Germany b Department of Oral and Maxillofacial Surgery, Leeds Dental Institute, Clarendon Way, Leeds, LS2 9LU, UK Accepted 13 October 2008 Available online 12 December 2008 Keywords: Condylar fracture; Reposition; Diacapitular fracture; Intraarticular fracture
The reduction of diacapitular fractures1 of the mandibular condyle can be technically difficult and time-consuming but seems to have a beneficial effect on patients.2,3 The proximal condylar fragment is often considerably displaced medially and caudally by the pull of the lateral pterygoid muscle. Disruption of soft tissue should be kept to a minimum to compromise the blood supply to the proximal fragment as little as possible.4 Previously such a fractures has been reduced using small bone hooks, so a new repositioning pin to assist in reduction and fixation of the proximal condylar fragment with only minimal dissection has therefore been developed. The pin is held in the metal handle of a mini-screwdriver. Instead of the usual screw head, a 10 mm thread, equivalent to that of a 2 mm miniscrew, is located at the end of the 7 cm shaft. The shaft can easily be released from the handle by a bayonet nut. After exposure of the condylar fragment, it is drilled with a drill10 mm long and 1.8 mm in diameter on the dorsal surface. The pin can then be inserted. Using pharmacological muscle relaxation, the resistance of the contracted lateral pterygoid muscle can be overcome without difficulty and the fragment can be slowly reduced. After the correct position has been achieved, the bone is fixed, in most cases
with one or two mini screws, which are inserted into the condyle from lateral to medial, although cannulated screws can also be used.5 The use of this pin considerably simplifies the repositioning of complicated diacapitular condyle fractures. In addition to the improvement in the position of the fracture, reduction in soft tissue injuries and the subsequent risk of secondary resorption of the condyle seems to be reduced. Displacement of the pin from the condyle during manipulation is rare. During the placement of the permanent osteosynthesis screws, the resistance conferred by the pin is sufficient to maintain the condylar fragment in the correct position.
∗
Corresponding author. Tel.: +49 351 4583382; fax: +49 351 4583382. E-mail address: [email protected] (M. Schneider). 1 Tel.: +44 113 343 6219; fax: +44 113 343 6264.
Fig. 1. Repositioning pin within a handle of a mini-screwdriver (Company: Martin Medezintechnik, Tuttlingen, Germany).
0266-4356/$ – see front matter © 2008 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjoms.2008.10.017
M. Schneider et al. / British Journal of Oral and Maxillofacial Surgery 47 (2009) 558–559
559
Fig. 3. Computed tomograms before and after operation; the postoperative view shows the pin track through the proximal fragment.
References Fig. 2. Fixation of the condylar head after reduction using the repositioning pin.
The pin therefore enables reduction and osteosynthesis, not only for diacapitular fractures but also for condylar fractures at other sites, particularly those of the high condylar neck. The pin allows stable repositioining of the proximal fragment when the pin is applied transbuccally during osteosynthesis of the fracture by periangular, submandibular, or retromandibular approaches. We have used the pin in 34 consecutive cases without any immediate postoperative problems. The long term follow up of these cases is the subject of further study (Figs. 1–3).
1. Loukota RA, Eckelt U, De Bont L, Rasse M. Subclassification of fractures of the condylar process of the mandible. Br J Oral Maxillofac Surg 2005;43:72–3. 2. Hlawitschka M, Loukota R, Eckelt U. Functional and radiological results of open and closed treatment of intracapsular (diacapitular) condylar fractures of the mandible. Int J Oral Maxillofac Surg 2005;34:597–604. 3. Neff A, Kolk A, Neff F, Horch HH. Operative vs. konservative Therapie diakapitulärer und hoher Kollumfrakturen. Vergleich mit MRT und Achsiographie. (Surgical vs. conservative therapy of diacapitular and high condylar fractures with dislocation. A comparison between MRI and axiography). Mund Kiefer Gesichtschir 2002;6:66–73. 4. Rasse M. Neue Entwicklungen der Therapie der Gelenkfortsatzbrüche der Mandibula. (New developments in the treatment of fractures of the temperomandibular joint). Mund Kiefer Gesichtschir 2000;4:69–87. 5. Pilling E, Schneider M, Mai R, Loukota RA, Eckelt U. Minimally invasive fracture treatment with cannulated lag screws in intracapsular fractures of the condyle. J Oral Maxillofac Surg 2006;64:868–72.
British Journal of Oral and Maxillofacial Surgery 47 (2009) 558–559
Technical note
Reduction of diacapitular fractures of the mandibular condyle using a special repositioning pin Matthias Schneider a,∗ , Richard Loukota b,1 , Uwe Eckelt a a
Department for Oral and Maxillofacial Surgery, University Hospital “Carl Gustav Carus” of the Technical University Dresden, Fetscherstr. 74, 01307 Dresden, Germany b Department of Oral and Maxillofacial Surgery, Leeds Dental Institute, Clarendon Way, Leeds, LS2 9LU, UK Accepted 13 October 2008 Available online 12 December 2008 Keywords: Condylar fracture; Reposition; Diacapitular fracture; Intraarticular fracture
The reduction of diacapitular fractures1 of the mandibular condyle can be technically difficult and time-consuming but seems to have a beneficial effect on patients.2,3 The proximal condylar fragment is often considerably displaced medially and caudally by the pull of the lateral pterygoid muscle. Disruption of soft tissue should be kept to a minimum to compromise the blood supply to the proximal fragment as little as possible.4 Previously such a fractures has been reduced using small bone hooks, so a new repositioning pin to assist in reduction and fixation of the proximal condylar fragment with only minimal dissection has therefore been developed. The pin is held in the metal handle of a mini-screwdriver. Instead of the usual screw head, a 10 mm thread, equivalent to that of a 2 mm miniscrew, is located at the end of the 7 cm shaft. The shaft can easily be released from the handle by a bayonet nut. After exposure of the condylar fragment, it is drilled with a drill10 mm long and 1.8 mm in diameter on the dorsal surface. The pin can then be inserted. Using pharmacological muscle relaxation, the resistance of the contracted lateral pterygoid muscle can be overcome without difficulty and the fragment can be slowly reduced. After the correct position has been achieved, the bone is fixed, in most cases
with one or two mini screws, which are inserted into the condyle from lateral to medial, although cannulated screws can also be used.5 The use of this pin considerably simplifies the repositioning of complicated diacapitular condyle fractures. In addition to the improvement in the position of the fracture, reduction in soft tissue injuries and the subsequent risk of secondary resorption of the condyle seems to be reduced. Displacement of the pin from the condyle during manipulation is rare. During the placement of the permanent osteosynthesis screws, the resistance conferred by the pin is sufficient to maintain the condylar fragment in the correct position.
∗
Corresponding author. Tel.: +49 351 4583382; fax: +49 351 4583382. E-mail address: [email protected] (M. Schneider). 1 Tel.: +44 113 343 6219; fax: +44 113 343 6264.
Fig. 1. Repositioning pin within a handle of a mini-screwdriver (Company: Martin Medezintechnik, Tuttlingen, Germany).
0266-4356/$ – see front matter © 2008 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjoms.2008.10.017
M. Schneider et al. / British Journal of Oral and Maxillofacial Surgery 47 (2009) 558–559
559
Fig. 3. Computed tomograms before and after operation; the postoperative view shows the pin track through the proximal fragment.
References Fig. 2. Fixation of the condylar head after reduction using the repositioning pin.
The pin therefore enables reduction and osteosynthesis, not only for diacapitular fractures but also for condylar fractures at other sites, particularly those of the high condylar neck. The pin allows stable repositioining of the proximal fragment when the pin is applied transbuccally during osteosynthesis of the fracture by periangular, submandibular, or retromandibular approaches. We have used the pin in 34 consecutive cases without any immediate postoperative problems. The long term follow up of these cases is the subject of further study (Figs. 1–3).
1. Loukota RA, Eckelt U, De Bont L, Rasse M. Subclassification of fractures of the condylar process of the mandible. Br J Oral Maxillofac Surg 2005;43:72–3. 2. Hlawitschka M, Loukota R, Eckelt U. Functional and radiological results of open and closed treatment of intracapsular (diacapitular) condylar fractures of the mandible. Int J Oral Maxillofac Surg 2005;34:597–604. 3. Neff A, Kolk A, Neff F, Horch HH. Operative vs. konservative Therapie diakapitulärer und hoher Kollumfrakturen. Vergleich mit MRT und Achsiographie. (Surgical vs. conservative therapy of diacapitular and high condylar fractures with dislocation. A comparison between MRI and axiography). Mund Kiefer Gesichtschir 2002;6:66–73. 4. Rasse M. Neue Entwicklungen der Therapie der Gelenkfortsatzbrüche der Mandibula. (New developments in the treatment of fractures of the temperomandibular joint). Mund Kiefer Gesichtschir 2000;4:69–87. 5. Pilling E, Schneider M, Mai R, Loukota RA, Eckelt U. Minimally invasive fracture treatment with cannulated lag screws in intracapsular fractures of the condyle. J Oral Maxillofac Surg 2006;64:868–72.