Abstract:
Introduction: Mandibular condyle fractures (MCF) in specialists’ opinion are some of the most difficult, given the anatomical complexity and complications that may arise. Currently neither the conduct
in the election of the optimal conservative or surgical treatment nor many other questions in this section
are determined.
The aim of this work is to improve the rehabilitation of patients with mandibular fracture in the region of the articular process by establishing treatment indications and tactics depending on the severity
of fracture, terms of patient's presentation and motivation. Research objectives were used to determine
the treatment conduct and results of conservative-orthopedic (CO) and surgical treatment in patients
subjected to the study.
Material and methods: The study material consisted of a group of 472 patients, 78(16.5%) famales
and 394(83.4%) males, examined, operated and treated in the Department of Oro-maxillo-facial Surgery
of the National Scientific and Practical Center of Emergency Medicine in Chisinau, within years 2001
2010. Patients' age ranged between 16-67 years (34.33 ± 0.576). Of the total number of hospitalized patients, 302 patients (64.0%) underwent CO treatment, 170 patients (36.01%) were subjected to operation
for osteosynthesis. For this purpose medical records data were analyzed and synthesized.
Results: The highest incidence of MCF was revealed at the age of 22-27 years (25.8%). Depending
on the etiological factor we obtained: aggression-in 123 patients (26.05%), patients who fell at home73(15.46%), road accidents-27(5.7%). Of the 472 examined patients, 242 had bilateral fractures (51.2%),
192 unilateral fracture (40.6%), 28 triple fractures (5.93%), 3 double fractures (0.63%) and one case of
multiple fracture (0.2%). The number of MCF with dislocation was estimated in 232 patients (49.1%),
with condylar luxation-12(2.5%), without dislocation-22(48.3%). 396 patients (83.9%) presented in the
first three days, within 3-7 days-46 patients (9.74%) and in more than 7 days-30(6.35%) patients.
Motivation of 27 patients to an early rehabilitation in case of insignificant dislocation was considered
for the indication to osteosynthesis fixation, as well as refuse of 52 patients to undergo surgical treatment
in case of absolute indications for it.
Conclusions: 1 . CO treatment provides reposition of the fragments and their maintenance in
the right position, only in cases of MCF without dislocation or with an insignificant displacement.
2. Patients rehabilitation and restoration of occlusion relationship in case of MCF with marked
dislocation, multi-splinters, old forms, with dislocation, are possible only by surgical treatment.
3. Surgical treatment requires a sufficiently stable fragments’ fixation, which allows postoperative immediate removal of the immobilization with early restoration of the mandible function.
