成長期 患者의 下顎頭 骨折時 顎關節의 再形成에 關한 考察

TMJ REMODELING AFTER CONDYLAR FRACTURE IN A GROWING CHILD : Report of a Case & Review Literature

This is a case report that deals with TMJ remodeling after both condylar fractures in a puberty child. Patient, 14 years old boy, was referred to our department from local hospital for the evaluation of the traumatic injuries on the face which was developed by traffic accident 10 days ago. On the basis of clinical and radiographic examinations, he was diagnosed as both mandibular condyles and symphysis fractures, right maxillary alveolar fracture, and multiple teeth injury. The mandibular and maxillary fractures were treated with closed reduction and intermaxillary fixation with arch bar and multiple loop wiring. IMF was applied for two weeks and early movement of jaw was carried out to prevent TMJ ankylosis. Endodontic and prosthodontic treatments were performed for the restoration of the missing teeth. Patient was examined periodically for the evaluation of TMJ function and remodeling. On the 10th day after trauma (on the admission day), the intracapsular both condylar fractures were observed in the panormaic view. The both fragments were displaced anteriorly which were located below the articular emnences. The contour of fragments was superimposed with condylar stump in the panormaic view. In the P-A mandible view, both fragments was slightly displaced to the medial side. On the 3rd week after trauma (after removal of IMF), the contour of condylar fragments were slightly disappeared and the radiopacity of both TMJ was observed, but the sigmoid notches and coronoid processes were seen as normal contour. On the 3rd month after trauma, the fragments of condylar heads resorbed completely and the articular surfaces of condyle became round in shape. Both coronoid processes were elongated and the articular space was observed distinctly. On the 9th month after trauma, condylar processes similar to normal were repositioned anterior to glenoid fossae. The deepening of sigmoid notch and elevation of coronoid process to zygomatic arch were noted. Articular fossa became to be shallow and articular eminence was flattened. On the 18th month after trauma, the complete resorption of condylar fragments and remodeling of condyle were observed. Deepended sigmoid notch and elongated coronoid process were apparently recognized. Condylar heads were repositioned anterior to articular fossae in the panoramic view. In the P-A mandible view, left condyle was seen as normal, but the neck portion of right condyle was markedly curved to lateral side. In spite of the changes of TMJ function and structures, viz elongation of coronoid process, deepending of sigmoid notch, flattening of articular fossa and eminence, and anterior repositioning of condylar process, patient complained nothing and could function absolutely.