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. 2024 Jul;40(3):385-393.
doi: 10.1007/s11282-024-00742-w. Epub 2024 Feb 29.

Temporomandibular joint degenerative changes following mandibular fracture: a computed tomography-based study on the role of condylar involvement

Chun-Lin Su  1 , An-Chi Su  2   3 , Chih-Chen Chang  2   3 , Arthur Yen-Hung Lin  3   4 , Chih-Hua Yeh  5   6
Affiliations

Temporomandibular joint degenerative changes following mandibular fracture: a computed tomography-based study on the role of condylar involvement

Chun-Lin Su et al. Oral Radiol. 2024 Jul.

Abstract

Objectives: This study assessed the incidence of postfracture radiological temporomandibular joint (TMJ) degeneration in patients with different types of mandibular fractures, focusing on the impact of condylar fractures.

Methods: This retrospective review included patients diagnosed as having mandibular fractures from 2016 to 2020 who had undergone initial computed tomography (CT) and a follow-up CT scan at least 1-month postfracture. Patient demographics, fracture details, treatment methods, and radiological signs of TMJ degeneration on CT were analyzed to identify risk factors for postfracture TMJ degeneration, with a focus on condylar head fracture and non-head (condylar neck or base) fractures.

Results: The study included 85 patients (mean age: 38.95 ± 17.64 years). The per-patient analysis indicated that the incidence of new radiologic TMJ degeneration on CT was significantly the highest (p < 0.001) in patients with condylar head fractures (90.91%), followed by those with non-head condylar fractures (57.14%), and those without condylar involvement (24.49%). The per-joint analysis indicated nearly inevitable degeneration (93.94%) in 33 TMJs with ipsilateral condylar head fractures. For the remaining 137 TMJs, multivariate logistic regression revealed that other patterns (ipsilateral non-head, contralateral, or both) of condylar fractures (odds ratio (OR) = 3.811, p = 0.007) and the need for open reduction and internal fixation (OR = 5.804, p = 0.005) significantly increased the risk of TMJ degeneration.

Conclusions: Ipsilateral non-head condylar fractures and contralateral condylar fractures are associated with a high risk of postfracture TMJ degeneration. Indirect trauma plays a vital role in postfracture TMJ degeneration.

Keywords: Computed tomography; Extracapsular fractures; Intracapsular fractures; Mandibular fractures; Temporomandibular joint disorders.

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