Assessment of the clinical symptoms of mandibular condyle fractures at 103 Military Hospital

To describe the clinical characteristics of mandibular condyle fractures with the aim to help the diagnosis easier, sooner and more exactly. Subjects and methods: Crosssectional descriptive, progressive clinical analysis of 56 cases, who were treated for acute condylar fractures at Maxillofacial Surgery Department, 103 Military Hospital from November 2017 to April 2019.

Journal of military pharmaco-medicine no6-2019 ASSESSMENT OF THE CLINICAL SYMPTOMS OF MANDIBULAR CONDYLE FRACTURES AT 103 MILITARY HOSPITAL Nguyen Hung Thang1; Nguyen Anh Tu1 SUMMARY Objectives: To describe the clinical characteristics of mandibular condyle fractures with the aim to help the diagnosis easier, sooner and more exactly Subjects and methods: Crosssectional descriptive, progressive clinical analysis of 56 cases, who were treated for acute condylar fractures at Maxillofacial Surgery Department, 103 Military Hospital from November 2017 to April 2019 Results: Male/female ratio = 6/1 The most common ages were 18 - 39 (66.1%) The main cause of injury was traffic accident (85.7%) Classification: Condylar head fractures accounted for 51.8%, 10 cases of neck condylar fractures (17.8%) and 17 cases fractured at the subcondylar site (30.4%) Most cases combined with fractures of maxillofacial region Clinical symptoms: Pain in the anterior auricular (100%), edema in the anterior auricular region malocclusion (98.2%), decreased ability to open mouth (94.6%) Conclusions: The great majority of mandibular condylar fractures occurred in males and in the 18 - 39 age group Associated fractures were encounted most often, especially the symphysis site was involved most frequently Unilateral condylar fractures were the most commonly types The most important clinical symptoms that played an important role in diagnosis included: Malocclusion, pain in the anterior auricular region * Keywords: Mandibular condyle fractures; Clinical characteristics INTRODUCTION The mandibular condyle is not only a participant component of the temporomandibular joint (TMJ) - an important anatomical structure in the maxillofacial, but also is the growth center of the mandible The TMJ is only movable joints of the maxillofacial region which plays an important role in the functions of eating, speaking, swallowing, breathing In addition, TMJ also contributes to the contour of the face Mandibular condyle fracture often does not affect the life but affects the aesthetic and function of the maxillofacial region Especially, if it is not diagnosed early, correctly and timely, treatment of the mandibular codyle fractures will lead to serious sequelae that are difficult to treat later such as dysfunction, ankylosis, disorder of mandible movement, open bite malocclusion, facial deformity [1] 103 Military Hospital Corresponding author: Nguyen Anh Tu (drnguyenanhtu@gmail.com) Date received: 06/06/2019 Date accepted: 08/08/2019 186 Journal of military pharmaco-medicine no6-2019 Therefore, it is necessary for physicians specialized in oral maxillofacial surgery to improve the ability to diagnose mandibular codyle fractures We conducted the study with the purpose: Describing the clinical characteristics of the mandibular codyle fractures to diagnose easier, sooner, more exactly and treat timely this type of fracture It will bring the most aesthetic and functional results for patients SUBJECTS AND METHODS Subjects 56 cases of mandibular condyle fracture having inpatient treatment at the Department of Maxillofacial, Plastic Surgery, 103 Military Hospital from November 2017 to April 2019, were diagnosed with clinical examination, X-ray Methods Cross-sectional descriptive, progressive clinical analysis - Patients admitted to the hospital had a physical examination of symptoms of mandibular codyle fracture: Pain in the anterior auricular region, edema in the anterior auricular region, malocclusion, decreased ability to open mouth, chin wound - Conventional X-ray shooting: Face, Panorama, multislice CT-scanner craniofacial region with axial, coronal and 3D rendering - Classification of the condylar fractures according to the fracture position with X-ray and CT-scanner: Condylar head fractures, neck condylar fractures and subcondylar fractures [5] - The collected data were recorded in the research medical record * Data processing: Data were processed by SPSS statistic software 20 RESULTS AND DISCUSSION Epidemiology * Age: - 17 years old: patients (12.5%); 18 - 39 yeas old: 37 patients (66.1%); 40 - 60 years old: 10 patients (17.8%); > 60 years old: patients (3.6%) The average age was 31 ± 13.1 * Gender: 48 patients (85.7%) were male; patients (14.3%) female Male/female ratio: 6/1 Most of mandibular condyle fractures occurred in male (85.7%), mainly in the age of 18 - 39 (66.1%) Our results had no difference with the other studies such as Pham Hoang Tuan [1], Nam et al [5] Men in the age of 18 - 39 are in the working age, participate in many social and traffic activities, so they are vulnerable to injuries and accidents * Causes: Traffic accident: 48 patients (85.7%); work accident: patient (1.8%); living accident: patients (8.9%); violence: patients (3.6%) Most of patients suffered from traffic accidents (85.7%) Our results were also consistent with the results of Pham Hoang Tuan [1] and Huynh Tran Gia Hung [2] In Vietnam, unsafe driving often occurs in men and young people, so the rate of injuries among young men is higher than others Classification * Position classification: Condylar head fractures: 29 patients (51.8%); neck condylar fractures: 10 patients (17.9%); subcondylar fractures: 17 patients (30.4%) The position of mandibular condyle fracture encounted mainly in the head of condyle (63.3%) due to the chin and condyle region is directly related to each other in the mechanism of injury The chin area is the first point of trauma, then it is transmitted to the 187 Journal of military pharmaco-medicine no6-2019 condylar head fractures, which is the most jet-resistant area from the surrounding anatomical structures (the glenoid, the external auditory canal), so it is most vulnerable area, leading to condylar head fracture * Classification of codyle side: Unilateral fracture: 42 patients (75%); bilateral fracture: 14 patients (25%) Unilateral/ bilateral fracture rate was 4/1 Our research results were also consistent with Hoang Anh Tuan’s [3], Pham Hoang Tuan’s [1] and Van den Berg B [6] * Classification of associated maxillofacial fractures with fractures of mandibular condyle: Pure mandibular condyle: 18 patients (32.1%); symphysis mandibular: 32 patients (57.1%); mandibular body: 10 patients (17.9%); mandibular angle: patients (7.1%); ramus: patient (1.8%); midface (zygoma, maxilla ): patients (3.6%); no case with coronoid The majority of cases of condylar fracture were associated with fractures of maxillofacial region (67.9%) Our results were also consistent with the research results of Zrounba H [7] Clinical symptoms Table 1: Clinical symptoms Functional symptoms Patients Percentage Pain in the anterior auricular 70 100 Outer ear bleeding 10 14.3 Edema in the anterior auricular region 69 98.2 Difficulty in opening the mouth 53/56 94.6 Malocclusion 43/56 76.8 Chin wound 33/56 58.9 188 Pain in the anterior auricular region had the highest percentage (100%), then edema in the anterior auricular region (98.6%), difficulty in opening the mouth (94.6%) and malocclusion (76.8%) We experienced pain in the anterior auricular in all patients with mandibular condyle fracture (100%) This is an easily identifiable symptom even in the case of patients with decreased edema However, these dazzling pain points may occur in patients with joint or soft tissue injuries That is the first sign about the lesions of the condyle fracture that doctors should examine carefully and indicate X-rays to avoid misdiagnose the lesions - Edema in the anterior auricular region accounted for 98.2% Only patient did not have edema because he went to the department after having treatment at the cranial specialty - Chin wound accounted for 58.9% This is the symptom that doctors need to examine carefully to diagnose a condyle fracture - Although bleeding of the outer ear canal accounted for a low rate (17.9%), in our opinion, this is an important symptom suggesting TMJ and condyle joint injury Injury forces impact firstly on the chin region then transmit to the mandibular condylar site, pushing the mandibular condyle backward, therefore tearing the skin and bleeding the outer ear - Most patients with condyle fracture had difficulty in opening the mouth (94.6%) This ratio was equivalent to the research results of Pham Hoang Tuan [1] (94.7%) Journal of military pharmaco-medicine no6-2019 - Malocclusion is a very important symptom in the mandibular fracture There is not only validity in diagnosis, but false joints are also valuable in determining treatments Especially in 100% of cases, we met 76.8% of patients with malocclusion Our malocclusion rate was lower than Pham Hoang Tuan’s (83.6%) [1], but the difference was not statistically significant CONCLUSIONS In 56 cases of mandibular condyle fractures treated at 103 Military Hospital, we found mainly male patients, aged 18 39 (66.1%), due to traffic accidents (85.7%) In particular, the majority of the condylar fracture was one side fracture (75%) and the most common fracture position was condylar fracture (51.8%) The combined condylar fracture with maxillofacial region accounted for a high proportion (67.9%), the position of the mandibular condyle fracture in combination with the common condylar fracture was the symphysis region (51.8%) Symptoms that play an important role in diagnosing a condylar fracture are pain in the anterior auricular (100%), malocclusion (76.8%) Early diagnosis of mandibular condyle fracture will help to plan treatment properly, promptly and avoid leaving behind sequelae that are difficult to repair later REFERENCES Phạm Hồng Tuấn Tình trạng chấn thương lồi cầu Bệnh viện Răng Hàm Mặt Trung ương Hà Nội Tạp chí Y học Việt Nam 2017, 2, tr.110-114 Huỳnh Trần Gia Hưng, Trương Nhựt Khuê Nhận xét đặc điểm lâm sàng, X quang gãy lồi cầu xương hàm Bệnh viện Đa khoa Trung ương Cần Thơ Bệnh viện Mắt - Răng Hàm Mặt Cần Thơ Tạp chí Y Dược học Cần Thơ 2018, 11-12, tr.144-150 Hoang Anh Tuấn Đánh giá kết điều trị gãy lồi cầu xương hàm Trường Đại học Y Hà Nội Luận văn Thạc sỹ Y học 2002 Perry M, Simon H Mandibular fractures Atlas of Operative Maxillofacial Trauma Surgery 2014 Nam et al Application of the Risdon approach for mandibular condyle fracture BMC Surgery 2013, 2, pp.13-25 Van den Berg B et al Conservative treatment of a mandibular condyle fracture: Comparing intermaxillary fixation with screws or arch bar A randomized clinical trial Journal of Cranio-Maxillo-Facial Surgery 2015, 43, pp.671-676 Zrounba H et al Epidermiology and treatment outcome of surgically treated mandibular condyle fractures A five years retrospective study Journal of Cranio-MaxilloFacial Surgery 2014, 42, pp.879-884 189 ... * Classification of associated maxillofacial fractures with fractures of mandibular condyle: Pure mandibular condyle: 18 patients (32.1%); symphysis mandibular: 32 patients (57.1%); mandibular. .. condylar fractures: 10 patients (17.9%); subcondylar fractures: 17 patients (30.4%) The position of mandibular condyle fracture encounted mainly in the head of condyle (63.3%) due to the chin and condyle. .. related to each other in the mechanism of injury The chin area is the first point of trauma, then it is transmitted to the 187 Journal of military pharmaco-medicine no6-2019 condylar head fractures,