Algorithm for Management of Mandibular Condylar Base Fractures

Abstract

Background: Increasing evidence suggests that open reduction and internal fixation of condylar base fractures in adults results in improved outcomes in regard to interincisal opening, jaw movement, pain, and malocclusion. However, most of the condylar fractures are managed by maxillomandibular fixation alone due to the need for specialized training and equipment. Our aim was to present an algorithm for condylar base fractures to simplify surgical management. Methods: A retrospective review was performed of patients (n = 22) with condylar base fractures treated from 2016 to 2020. Patients who presented with operative fractures that require open treatment underwent 1 of 2 different techniques depending on the fracture type: a preauricular approach with a transoral approach if the condyle was dislocated (n = 2) or a transoral only approach (n = 20) in nondislocated cases. Operative time, occlusion, range of motion, and postoperative complications were assessed. Results: Condylar base fractures were combined with other mandibular fractures in 16 of 22 patients. Patients with condylar dislocation were managed with a preauricular approach with a secondary transoral incision (n = 2, median 147 minutes). Those without dislocation were treated with a transoral approach (n = 20, median 159 minutes). Most patients were restored to their preoperative occlusion without long-term complications. Conclusions: We present a simplified algorithm for treating condylar base fractures. Our case series suggests that reduction in operative time and clinical success can be achieved with open reduction and internal fixation using a transoral approach alone or in combination with a preauricular approach for dislocated fractures.

New protocol for simplified reduction and fixation of subcondylar fractures of the mandible: a technical note

“…Reduction and fixation of medially displaced subcondylar fractures have always posed a challenge to a young surgeon. Peterson et al 5 described the use of a maxillo-mandibular fixation screw on the proximal segment to aid in its reduction, and also mentioned the use of temporary suture or wire around the condylar head as alternatives. However, there is no stepwise go-to guide mentioned in the literature to help surgeons in the decision making process after surgically identifying the proximal and distal segments.…”

Comparison of Preauricular Approach Versus Retromandibular Approach in Management of Condylar Fractures

“…Previously, closed condylar fracture reduction was the most preferred technique in patients undergoing maxillo-mandibular fixation for varying periods [1][2] . Many surgeons prefer open fractured condyle surgery due to the possibility of a wide variety of complications that can result from closed reduction, such as facial asymmetry and stiffness [3][4] . A large number of reported condyle fractures are due to indirect trauma, where an external force applied to a specific position of the mandible will cause a fracture elsewhere.…”