| Objective: The clinical and imaging data of adult patients with the type B intracapsular condylar fracture of mandibular were analyzed to evaluate the effectiveness of surgical versus conservative treatment and the effect on bone remodeling,with the aim of providing a scientific basis for the treatment of this disease.Methods: 1.The clinical data of adult patients with the type B intracapsular condylar fracture who were treated at the Department of Oral and Maxillofacial Surgery of the 940 th Hospital of Joint Logistics Support Force from January 2018 to December 2021 were collected.The enrolled patients were divided into the surgical treatment group and the conservative treatment group according to whether they had received open reduction and internal fixation surgery for condylar fracture or not.Patients in both groups were followed up for more than 6 months.The temporomandibular joint function,occlusal relationship,and complications of the patients were recorded.Temporomandibular joint function was evaluated using the Helkimo index.Two independent samples t-test and Fisher test were used to compare the differences between the surgical treatment group and the conservative treatment group in terms of general information and follow-up information.2.21 volunteers without TMJ symptoms in the same time period were randomly included as the control group.According to CBCT images,the condyle reconstruction was observed,and the fracture healing was graded.15 related indicators were measured and analysed including inner and outer diameter of condyle,anterior and posterior diameter,condyle radius distance,condyle horizontal angle,condylar head-neck distance,upper height,superior space,anterior space,posterior space,and middle space,internal space,external space,articular tubercle slope,width and depth of fossa.ANOVA and Fisher test were used to compare the differences between the three groups of study subjects in each index.Results: 1.A total of 34 patients were enrolled in this study,including 22 males and 12 females,with a male-to-female ratio of 1.83:1.The age range was 18-64 years,with a median age of 30.5 years.The most common cause of injury was falls,followed by falls from heights and traffic accidents.There were 7 patients with the type B intracapsular condylar fracture alone,and 27 patients with other fractures.There were 21 cases（22 sides）in the surgical treatment group and 13 cases（17 sides）in the conservative treatment group.There was no significant difference in general data between two groups（P>0.05）.During the 6-month follow-up,there was no significant difference in the occlusal relationship and Helkimo index distribution between two groups（P>0.05）.There were no complications such as temporomandibular joint ankylosis and jaw deformity in both groups.2.The analysis of imaging data showed that there were significant differences between the surgical treatment group,conservative treatment group and control group in the inner and outer diameter of condyle,anterior and posterior diameter,condylar head-neck distance,upper height,condyle radius distance,condyle horizontal angle,superior space,posterior space,internal space and articular tubercle slope（P<0.05）.Among them,the differences between the inner and outer diameter of the condyle,anterior and posterior diameter,condyle radius distance,upper height,condyle radius distance,superior space,and posterior space were statistically significant between the conservative treatment group and the surgical treatment group,and between the conservative treatment group and the control group（P<0.05）.There was a statistically significant difference in the articular tubercle slope between the surgical treatment group and the control group（P<0.05）.There was a statistically significant difference in the intra-articular space between the surgical treatment group and the conservative treatment group（P<0.05）.There was a statistically significant difference in fracture healing grade between the surgical treatment group and the conservative treatment group（P<0.05）.Conclusion: For adult patients with the type B intracapsular condylar fracture of mandibular,both surgical and conservative treatment can achieve satisfactory results without serious complications.However,surgical treatment appears to be more efficacious in all subjective and objective functional aspects.Measurements of CBCT in all planes showed that the condylar process was flattened,externally rotated and displaced forward,and the joint fossa was shallow after conservative treatment,whereas the condylar was similar to a normal joint in terms of shape,position,and joint fossa after surgical treatment.From the analysis of clinical manifestation and imaging examination,the effect of surgical treatment of the type B intracapsular condylar fracture in adults is better than that of conservative treatment. |
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