The relationship between intracapsular fracture patterns and arthroscopic findings

Publication date: Available online 27 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Ko Ito, Fumie Yamazaki, Kosuke Takahashi, Shinnosuke Nogami, Toshirou Kondoh, Alastair Goss
PurposeTo observe the superior joint compartment (SJC) using ultra-thin arthroscopy in intracapsular condylar fracture (ICF) of the temporomandibular joint (TMJ) and describe the changes: To evaluate the relations between the fracture pattern, arthroscopic findings, and clinical outcome.Patients and methodsTwenty patients with 27 ICF were the subject group. Thirteen patients had unilateral ICF, seven patients had bilateral ICF. The fracture patterns were classified into nine categories, and all the patients had arthroscopic examination of the traumatized joint at the time of definitive treatment. At 4 months after treatment of the injury, all the patients had a secondary arthroscopy of the ICF joint. In all the patients, the range of motion (ROM) was measured as interincisal distance (mm) at the first visit to 12 months after first treatment, and the data was statistically evaluated.ResultsThere was intra articular hyperemia, hyper-vascularity, and temporal bone damage, and four had disc perforations at the first examination. At second arthroscopy 4 months later, normal healing occurred in 11 joints all of which had minimally displaced fractures. Fifteen joints showed complete filling of the SJC, all of these had a displaced minor fragment from the fossa. Comparison on ROM of the effect of the presence or absence of SJC fibrosis showed significant differences from 1 to 12 months. The effect of early or delayed definitive treatment showed significant differences at 4 and 12 months.ConclusionThe intra-articular condition at 4 months post-ICF as demonstrated arthroscopically related to the minor fragment position. If the minor fragment is undisplaced it will heal back to a normal state; however, if the minor fragment is displaced from the fossa, then the SJC shows disc damage and fibrosis. This may potentially lead to fibrous ankylosis.



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