PILOT STUDY ON THE EFFECTS OF MANDIBULAR PARASYMPHYSIS FRACTURES ON CONDYLAR VOLUME: A CBCT ANALYSIS

Year 2024, Volume: 48 Issue: 3, 140 - 147, 20.12.2024

Aydın Onur Gerçek

Abstract

Background and Aim: This study aimed to evaluate the effects of mandibular parasymphysis fractures on temporomandibular joint (TMJ) condylar volume using cone-beam computed tomography (CBCT).
Materials and Methods: A retrospective analysis was conducted on 10 patients with isolated mandibular parasymphysis fractures. Pre- and postoperative CBCT images were used for volumetric measurements of TMJ condyles, performed with Mimics software. Postoperative scans were taken at least six months after surgery.
Results: The patients had a mean age of 27.7±6.29 years, with 40% female and 60% male, and a mean follow-up period of 34.10±27.01 months. Significant increases in condylar volume were observed bilaterally. The left condylar volume increased from 94.76 mm³ to 107.6 mm³ (p=0.028), and the right from 93.28 mm³ to 112.95 mm³ (p=0.028). Gender differences in condylar volume changes were not significant (p>0.999 and p=0.610 for left and right, respectively). Female patients showed a volume
increase of 11.99% on the left and 11% on the right, while males had increases of 10.91% and 14.64%, respectively.
Conclusion: Mandibular parasymphysis fractures appear to induce TMJ condylar remodeling, resulting in increased condylar volume. These changes, detected through CBCT, likely stem from intra-articular bleeding, dystrophic calcification, and bone mass adaptation driven by Wolff’s law. The findings suggest a biomechanical remodeling process without gender disparity. Further research is warranted to explore the long-term implications for TMJ function and morphology.

Keywords

Cone-beam computed tomography (CBCT) , Mandibular parasymphysis fractures , Temporomandibular joint (TMJ) remodeling

References

• 1. Ellis III E, Throckmorton GS. Treatment of mandibular condylar process fractures: biological considerations. Oral Maxillofac Surg 2005; 63: 115- 134.
• 2. Liu Y, Bai N, Song G, Zhang X, Hu J, Zhu S et al. Open versus closed treatment of unilateral moderately displaced mandibular condylar fractures: a meta-analysis of randomized controlled trials. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116: 169-173.
• 3. Rozeboom A, Dubois L, Bos R, Spijker R, De Lange J. Closed treatment of unilateral mandibular condyle fractures in adults: a systematic review. Int J Oral Maxillofac Surg 2017; 46: 456-464.
• 4. Su C-L, Su A-C, Chang C-C, Lin AY-H, Yeh C-H. Temporomandibular joint degenerative changes following mandibular fracture: a computed tomography-based study on the role of condylar involvement. Oral Radiol 2024: 1-9.
• 5. Cha S, Park G, Lee B-S, Kwon Y-D, Choi B-J, Lee J-W et al. Retrospective clinical study of mandible fractures. Maxillofac Plast Reconstr Surg 2022; 44: 36.
• 6. Frost HM. Wolff’s Law and bone’s structural adaptations to mechanical usage: an overview for clinicians. Angle Orthod 1994; 64: 175-188.
• 7. Kim YK, Kameo Y, Tanaka S, Adachi T. Capturing microscopic features of bone remodeling into a macroscopic model based on biological rationales of bone adaptation. Biomech Model Mechanobiol 2017; 16: 1697-708.
• 8. Zhao Y, Liu P, Chen Q, Ouyang N, Lin Y, Zhang W et al. Development process of traumatic heterotopic ossification of the temporomandibular joint in mice. J Craniomaxillofac Surg 2019; 47: 1155-1161.
• 9. Li L, Shi H, Xie H, Wang L. MRI assessment and histopathologic evaluation of subchondral bone remodeling in temporomandibular joint osteoarthritis: a retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126: 355-362.
• 10. Olate S, Netto HD, Rodriguez-Chessa J, Alister JP, de Albergaria-Barbosa J, de Moraes M. Mandible condylar hyperplasia: a review of diagnosis and treatment protocol. Int J Clin Exp Med 2013; 6: 727-737.
• 11. Park C, Kim H, Ryu J, Jung S, Park H-J, Oh H-K et al. Condylar volume and positional changes following a bilateral sagittal split ramus osteotomy in skeletal class II and III malocclusions. Maxillofac Plast Reconstr Surg 2023; 45: 41.
• 12. Stelea CG, Agop-Forna D, Dragomir R, Ancuţa C, Törok R, Forna NC et al. Recovery of post-traumatic temporomandibular joint after mandibular fracture immobilization: a literature review. Applied Sciences 2021; 11: 10239.
• 13. Al-Wesabi SN, Abotaleb B, Al-Shujaa EA, Mohamed AA, Alkebsi K, Telha W et al. Three dimensional condylar positional and morphological changes following mandibular reconstruction based on CBCT analysis: a prospective study. Head Face Med 2023; 19: 3.
• 14. Li Z, Djae KA, Li ZB. Post-traumatic bifid condyle: the pathogenesis analysis. Dent Traumatol 2011; 27: 452-454.
• 15. He D, Ellis III E, Zhang Y. Etiology of temporomandibular joint ankylosis secondary to condylar fractures: the role of concomitant mandibular fractures. J Oral Maxillofac Surg 2008; 66: 77-84.
• 16. Hirjak D, Galis B, Beno M, Machon V, Mercuri LG, Neff A. Intraoperative arthroscopy of the TMJ during surgical management of condylar head fractures: A preliminary report. J Craniomaxillofac Surg 2018; 46: 1989- 1995.
• 17. Zhao Y, Ouyang N, Chen L, Zhao H, Shen G, Dai J. Stimulating factors and origins of precursor cells in traumatic heterotopic ossification around the temporomandibular joint in mice. Front Cell Dev Biol 2020; 8: 445.
• 18. Lotz MK. New developments in osteoarthritis: posttraumatic osteoarthritis: pathogenesis and pharmacological treatment options. Arthritis Res Ther 2010; 12: 1-9.
• 19. Nicholson III HJ, Sakhrani N, Rogot J, Lee AJ, Ojediran IG, Sharma R et al. Effect of Blood on Synovial Joint Tissues: Potential Role of Ferroptosis. Applied Sciences 2024; 14: 6292.
• 20. Luz JG, Jaeger RG, de Araújo VC, de Rezende JR. The effect of indirect trauma on the rat temporomandibular joint. Int J Oral Maxillofac Surg 1991; 20: 48-52.
• 21. Christopherson GT, de Vasconcellos JF, Dunn JC, Griffin DW, Jones PE, Nesti LJ. Three-dimensional modeling of the structural microenvironment in post-traumatic war wounds. Tissue Eng Regen Med 2021; 18: 963-973.
• 22. Nesti LJ, Jackson WM, Shanti RM, Koehler SM, Aragon AB, Bailey JR et al. Differentiation potential of multipotent progenitor cells derived from wartraumatized muscle tissue. J Bone Joint Surg Am 2008; 90: 2390-2398.
• 23. Sorkin M, Huber AK, Hwang C, Carson IV WF, Menon R, Li J et al. Regulation of heterotopic ossification by monocytes in a mouse model of aberrant wound healing. Nat Commun 2020; 11: 722.
• 24. Frost HM. A 2003 update of bone physiology and Wolff’s Law for clinicians. The Angle Orthod 2004; 74: 3-15.
• 25. Beltran J, Zaror C, Moya MP, Netto HD, Olate S. Diagnosis and Treatment in Unilateral Condylar Hyperplasia. J Clin Med 2023; 12(3).
• 26. Nitzan DW, Katsnelson A, Bermanis I, Brin I, Casap N. The clinical characteristics of condylar hyperplasia: experience with 61 patients. J Oral Maxillofac Surg 2008; 66: 312-318.
• 27. Canger EM, Celenk P. Aplasia of the mandibular condyle associated with some orthopaedic abnormalities. Dentomaxillofac Radiol 2012; 41: 259-263.
• 28. Han L, Long T, Tang W, Liu L, Jing W, Tian W-D et al. Correlation between condylar fracture pattern after parasymphyseal impact and condyle morphological features: a retrospective analysis of 107 Chinese patients. Chin Med J (Engl) 2017; 130: 420-427.
• 29. Gomes LR, Cevidanes LH, Gomes MR, Ruellas AC, Ryan DP, Paniagua B et al. Counterclockwise maxillomandibular advancement surgery and disc repositioning: can condylar remodeling in the long-term follow-up be predicted? Int J Oral Maxillofac Surg 2017; 46: 1569-1578.
• 30. López Ramírez JC, Mariel Cárdenas J, Gutiérrez Cantú FJ, Salas Orozco MF Sr, Medina-Solís CE, Hernández Molinar Y et al. Association Between Gender, Age, and Skeletal Class With Mandibular Condyle Morphology: A Retrospective Study. Cureus 2023; 15: 49043.
• 31. Chouinard A-F, Kaban LB, Peacock ZS. Acquired abnormalities of the temporomandibular joint. Oral Maxillofac Surg Clin North Am 2018; 30: 83- 96.
• 32. Colebatch AN, Edwards CJ, Østergaard M, van der Heijde D, Balint PV, D’Agostino M-A et al. EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis 2013; 72: 804-814.