Reappraisal of the surgical strategy in treatment of mandibular condylar fractures.

Abstract

Over the past few decades, there has been a trend toward open reduction and internal fixation of mandibular condylar fractures. However, not all patients have fared well following the open surgical approach. A number of clinical parameters have been observed to be related to suboptimal treatment results on a long-term basis. A comprehensive investigation of the role of those risk factors is a worthwhile pursuit. A total of 23 surgically treated patients were enrolled in the study during an 11-year period. A retrospective chart review was conducted to collect clinical and radiographic information both before and after surgery. Statistical analyses were used to determine the relationship of presurgical clinical variables to the postsurgical complications. Fractures of the condylar neck and head were associated with a high incidence of postoperative morbidity; all cases (seven of seven) suffered from some form of image or clinical disorder. In contrast, the subcondylar fracture fared well following surgery, with maintenance of function, cosmesis, and skeletal integrity in the majority (14 of 16) over long-term follow-up (p < 0.000). Comminution and obliquity of the fracture line were also correlated with the occurrence of postoperative morbidities. Results of the present study suggest that patients with subcondylar fracture fare better with open reduction in comparison with those suffering condylar neck or head fractures. Delayed-onset deformation tends to occur in patients with a short proximal segment, comminuted head, and obliquity of the fracture line. A renewed algorithm is thus provided to address the high condylar fracture problems.