Relationship Between The Function And Morphology After Condylar Fraction

In last century, treatment for the condylar fracture was still the hot spot of the argument. Traditionaly, open reduction is not the best choice for the condylar fracture because of it's major complications. But in Zide's opinion, the conlusions of the expectant treatment in the past are inappropriate, because they lack long-term following up. After the closed reduction of the displaceable condylar fracture, the osteoarticulation will occur the pathological changes a few years or decades because of the structural confused. As more control studies between the open treatment and the closed treatment, the indication for each treatment become clearer. At the same time, as the the development of the outlook on treatment, people pay more attention to the long-term therapeutic effect and evaluation of the functional result. A lot of scholars have compared the different methods in range of mandibular movement,occluding relation,facial symmetry and bite force, but there isn't anyone analyzing weather the method is right through the relationship between the rebuild of TMJ and the symptoms after treatment for condylar fracture.The objective of this study is to observe rebuilding state of TMJ through the complications causing from treatment for condylar fracture, then scan the rebuilded TMJ with MSCT, finish MPR and TMJ morphological measurement in the workstation, statistical treatment of the measurement is undertaken, analyze the dependablity, thereby find the correlated anatomic factors that may cause the symptoms. Especially for the patients with arthrocleisis caused by condylar fracture, follow up their classification of fracture and treatment, expecting find the best treatment for this kind of fracture.A retrospective study was conducted in 526 cases with condylar fractures on the sex,age,cause,fracture characteristics,complicated injury,treatment and sequela.I found that condylar fractures occured mainly in the male,and in 20—30 years old age.The traffic accident(47.97%)was the leading cause; condylar neck was the most fracture site(60.59%); 49.62%of the cases had complicated mental region fracture; the child condylar fracture (69.85% )used the conservative treatment; 3.23% of the case occurred TMJ ankylosis.Between 1985 and 2000, there were 350 cases condylar fracture patients, reject the 229 patients complicated with other fracture(eg: maxillary bone, mandibular body and mental region) or old fracture, 17 patients lost contact or died, there still 104 patients, and finally I visited 83 cases(58cases treated by open reduction, as 25cases treated by closed reduction). Of the 83 patients, 31 experienced clicking of the TMJs while mouth opening,and19 felt pain in TMJs when chewing.A clinical and radiologic study was conducted in 60 cases with one-side condylar fracture. Patients with the same symptom were divided into one group, without the symptom were divided into another group, and 30 normal adult volunteers were divided into the third group, then scaned TMJ respectively with MSCT, finish MPR and TMJ morphological measurement in the workstation, statistical treatment of the measurement is undertaken, analyze the dependablity, thereby find the correlated anatomic factors that may cause the symptoms. I find that in the limitation of mouth opening group or the arthrocleisis group, the joint space(anterior, middle, postetior) and exterior and interior diameter of the fractural side are significantly different from the other tow groups(P<0.05); in the occlusion disorder group, the height of the mandible ramus of the fractural side is significantly different from the other tow groups(P<0.05); in the clicking group or the pain while chewing group , the morphous of the condyle(width of anterior /posterior oblique surface, angle of slop of anterior /posterior oblique surface ) and the space of the condyle in the cavity(posteior space/anterior space) are significantly different from the other tow groups(P<0.05).If the condylar fracture is treated inappropriate, it may cause some complications, eg: limitation of mouth opening, pain in TMJs, occlusion disorder, arthrocleisis and so on. The fractural condylar can't rebuild well without treatment. For any kind of condylar fracture, treatment should strive for anatomic replacement and avoid removing the fractural residual.