Palyvoda R. Condylar fractures treatment including temporo-mandibular joint condition

This thesis is devoted to study of biomechanical and anatomical features of condylar fractures using loading test, CAD/CAE methods, axiography and electromyography. There are 65,8% of condylar fractures with and without dislocation in retrospective study. Only 4,9% of clinical cases were identified as outdated fractures and mentioned in case history. We report about different treatment time management compared with Europe figures. The time from moment of fracture to surgical treatment (if it’s needed) was 7,13±5 days, the duration of intermaxillary fixation was one of the highest among European countries – 25,4±4,9 days. Each patient with condylar fracture stay in hospital at least 15,24 ± 4,7 days. According to results of anonymous questionnaire in patients with condylar fractures 42% of them did’t have any complaints, 44% suffered by TMJ discomfort, weakness of mimic and chewing muscles, difficulties in clenching. Moreover, 82% patients with long-period intermaxillary fixation had psycho-emotional disturbances, 72% of them had emotional overstressing (Н = 41,0; degrees 2; p ˂ 0,001). Based on biomechanical test on cadaver specimen we got relations between load vector and strain in TMJ structure, and no evidence-based relation between contact area and strain of condylar disc (p≥0,05). It means that restoration of anatomical structure, shape of condyle and height of mandible ramus is one of the most important factors. Computer 3-dimentional model of mandible and TMJ in case of internal condyle fixation showed the overloading of condylar disc in 1,8-4,7 times comparing with healthy jaw. Lateral pterygoid muscle didn’t change any biomechanical properties during stress-strain analysis model of condyle fracture: upper screw (p=0,215), lower screw (р=0,152), external surface of mandible ramus (р=0,551), inner surface of mandible ramus (р=0,782). Actually bioelectrical activity of masseter and temporal muscles had some changes in main and comparison group but depends on surgical approach, intermaxillary fixation etc. that are not included in our study. However patients of main group had evidence-based better results of axiography (p˂0,05), absent of severe complaints, and opening mouth volume (47,3 ± 1,18 мм) that comparison group. After objective examination in clinical group only 21,2% patients had some problems in TMJ or chewing muscles.