الفهرس 
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Abstract
The objective of this study was to evaluate the efficacy of arthrocentesis on restoring mandibular function in unilateral subcondylar fracture following maxillomandibular fixation.
This study was conducted on 20 patients suffering from unilateral subcondylar fracture with/without contra-lateral parasymphyseal or mandibular body fracture. They were randomly selected from the Emergency Room of the University Hospital of Alexandria and treated in the operating room of the Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University.
After sample selection to fulfill the inclusion and exclusion criteria; the patients were allocated randomly into two equal parallel groups following the removal of MMF after 2 weeks:
group I (study group): Ten patients were treated with active mobilization and arthrocentesis following MMF removal.
group II (control group): Ten patients were treated with only active mobilization following MMF removal.
group I&II were subdivided into A&B where group A involved five patients with isolated subcondylar fracture who were treated by closed reduction with MMF for 2 weeks while group B involved five patients with subcondylar fracture and contralateral parasymphyseal or mandibular body fracture in addition who were treated by ORIF using conventional miniplates and closed reduction for the associated subcondylar fracture with also MMF for two weeks.
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Patients evaluation
All cases were evaluated as follows:
Proper history taking including the present history of trauma as well as the patient’s past medical history.
Thorough clinical examination including both general and local examinations.
Radiographic examination using orthopantograms (OPG) and reverse Towne’s view.
Maximum interincisal mouth opening, lateral excursive and protrusive mandibular movements, pain intensity, edema together with the bite forces were measured preoperative to be considered as baseline.
Surgical procedures
In cases of subcondylar fracture associated with contralateral fracture
Ivy loops or arch bars were fixed followed by exposure of the fracture line using intraoral incision, fixation of the fracture using conventional mini plates and mini screws while the subcondylar fracture was treated through closed reduction by the application of upper and lower arch bars and MMF for 2 weeks.
In case of isolated unilateral subcondylar fracture
Application of only maxillary and mandibular arch bars was performed lining up the teeth in normal occlusion and MMF was done for 2 weeks.
In the study group immediately after the removal of MMF Arthrocentesis was done using Shepherd arthrocentesis instrument 18g x 2.5” which was inserted into the superior chamber for lavage using about 50 cc sterile normal saline solution.
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Clinical and radiographic follow up
Clinical postoperative follow up was carried out at the intervals of one, two, four, six and twelve weeks postoperatively to evaluate pain, edema, maximum mouth opening, lateral excursive and protrusive movements in addition to the bite force. In cases of ORIF wound healing and sensory nerve function were also evaluated.
Radiographical follow up was done to evaluate the adequacy of reduction of the fractured segments and the fracture healing progression.
Clinical and radiographic results
Clinical results revealed significant decrease in pain intensity across all follow up periods in both groups with significant difference between the two groups especially after the application of arthrocentesis in the study group.
The results also showed significant increase in mouth opening, lateral excursive and protrusive movements in addition to the bite force through-out all follow up periods in both groups with significant difference between the two groups especially after the application of arthrocentesis in the study group.
Neither disturbed occlusion nor infections were reported in our study.
Radiographic follow up showed proper alignment and healing of the fractured segments.