Post Traumatic Changes in TMJ Structure after unilateral Mandibular Fracture – a Longitudinal MRI Study
Journal Title: International Journal of Contemporary Medical Research - Year 2017, Vol 4, Issue 2
Abstract
Introduction: The condylar process of the mandible locates away from the direct traumatic insults; however it is a structure with frequent facial traumatic injury. The aim of the study was to evaluate the structural changes of TMJ (soft and hard tissues) immediately after unilateral condylar fracture using MRI and to evaluate their influence on the prognosis after closed treatment. Materials and methods: Clinical, radiological and MRI evaluation of 20 patients with unilateral condylar fractures immediately after trauma and reevaluated after 3 months of closed treatment. The position, shape and signal intensity of the condyle, disc and retrodiscal tissue were analysed. Condylar head location, condyle shape, degree of resorption and bony changes are evaluated. Mandibular mobility, TMJ function, pain in masticatory muscle, TMJ pain and pain during movement, occlusal disturbances if any, lateral deviation more than 2mm when opening the mouth, restricted mouth opening, clicking were summarized. Results: Mandibular dysfunction in the immediate post trauma was 85%, improved to 5% 3 months after closed treatment. Differences were found in the degree of displacement of fractured fragment between plain x-rays and MRI. The disc was placed anterior to condyle in 8 patients, posterior to condyle in 3 patients immediate posttrauma, where as re-evaluation after 3 months the condyle position as correlated to the disc as normal in 16 patients and anterior to condyle in 4 patients., signal intensity changes in the retrodiscal tissues were found to be high in 75% of the cases immediately after condylar fractures and repaired to normal after 3 months. During the immediate post trauma period the signal intensity of condyle was high in 6 patients and retrodiscal tissue was high in 5 patients, superior joint space was high in 18 patients and inferior joint space was high in 14 patients, signal intensity of mastoid was high in 2 patients out of 20 patients and re-evaluation of all bony structure were near normal after 3 months. Conclusion: It can be concluded that, irrespective of the degree of trauma, the healing of the tissues were satisfactory after closed reduction and immobilisation of the joint structures as examined by MRI. Also, closed reduction treatment is a near ideal option of treatment strategy for all cases of unilateral mandibular condylar fracture.
Authors and Affiliations
V. Senthilvelmurugan, U. Punitha Gnana Selvi, S. Rekha, P Nilofar Fathima
Keywords
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