Let Bilateral Condylar Fracture Fixation Be the Norm and Not a Choice

Abstract

In lieu of a lack of consensus among the global community, it becomes imperative to address the pitfalls in the surgical management of bilateral mandibular condylar fractures with the contemporary technique of open reduction and internal fixation of only one side. This dictum inevitably leads to postoperative complications despite the best efforts of the surgical team to optimize care. We present a case series comprising residual deformities and complications arising out of the inadequate treatment of bilateral condylar fractures. We aim to highlight the significance of open reduction and internal fixation of bilateral mandibular condylar fractures and reiterate that conventional subcondylar osteotomy is an effective method for revision surgery.

Re-Treatment of Mismanaged Bilateral Condylar Fracture and Post-Surgical Complication

“…Other studies have stated that up to 10% of bilateral condylar fracture treated via closed reduction would need a secondary orthognathic surgery in long-term follow-up. 6 Literatures suggest that performing closed reduction in bilateral condylar fracture could induce condylar deformity, abnormal fibro-osseus changes, and maladaptive remodeling of the articulation structure, even in patients with seemingly normal occlusion and jaw motions. 6,7,10,22 The longer a condylar fracture is neglected, the more difficult it would be to manage due to the maladaptive changes of the bony fragments, neuromuscular function, as well as the development of pseudo-joint inside the articular fossae.…”

“…6 Literatures suggest that performing closed reduction in bilateral condylar fracture could induce condylar deformity, abnormal fibro-osseus changes, and maladaptive remodeling of the articulation structure, even in patients with seemingly normal occlusion and jaw motions. 6,7,10,22 The longer a condylar fracture is neglected, the more difficult it would be to manage due to the maladaptive changes of the bony fragments, neuromuscular function, as well as the development of pseudo-joint inside the articular fossae. 7,10 In this case, it is unfeasible to reposition the structure back into their original places due to the anatomical changes, thus condylectomy is performed.…”

“…[3][4][5] In the past, non-surgical approach (closed reduction) is the preferred treatment of choice for condylar fracture due to limited resources and experience. 3,6 However, it must be noted that performing closed reduction in cases indicated for an open reduction would lead to complications such as chronic pain, malocclusion, and malunion of bony fragments, which would need a more complicated secondary surgery to rehabilitate the symptoms. [7][8][9][10] When condylar fracture is mismanaged or chronically neglected, maladaptive fibro-osseus changes could occur, causing difficulties in reduction procedure.…”