Open reduction and internal fixation of extracapsular mandibular condyle fractures: a long-term clinical and radiological follow-up of 25 patients

Abstract

Background: During the last 2 decades, many studies on the treatment of mandibular condyle fracture have been published. The incidence of mandibular condyle fractures is variable, ranging from 17.5% to 52% of all mandibular fractures. This retrospective study evaluated the long-term clinical and radiological outcomes after surgical treatment of 25 patients with a total of 26 extracapsular condyle fractures.

Methods: We used 2 types of surgical approaches, the retromandibular retroparotid or preauricular approach. Three kinds of rigid internal fixation plates were used-single plate, double plate, and trapezoidal plate. The following post-operative clinical parameters were evaluated: dental occlusion, facial nerve functionality, skin scarring, and temporomandibular joint functionality. All patients underwent post-operative orthopanoramic radiography and computed tomography. The patients were also monitored for complications such as Frey's syndrome, infection, salivary fistula, plate fracture, and permanent paralysis of the facial nerve; the patient's satisfaction was also recorded.

Results: Of the 25 patients, 80% showed occlusion recovery, 88% had no facial nerve injury, and 88% presented good surgical skin scarring. The patients showed early complete recovery of temporomandibular joint functionality and 72% of them were found to be asymptomatic. The postoperative radiographs of all patients indicated good recovery of the anatomical condylar region, and 80% of them had no postoperative complications. The average degree of patient satisfaction was 8.32 out of 10. Our results confirm that the technique of open reduction and internal fixation in association with postoperative functional rehabilitation therapy should be considered for treating patients with extracapsular condylar fractures.

Conclusion: The topic of condylar injury has generated more discussion and controversy than any other topic in the field of maxillofacial trauma. We confirm that open reduction and internal fixation is the treatment of choice for patients with neck and sub-condylar mandibular fractures.

Figure 1

Mandibular sub-condylar bilateral fracture: a) anterior open-bite with a posterior precontact; b) left preauricolar approach; c) right preauricolar approach; d) post-surgey occlusal plane; e)post-surgery orthopantomography.

Figure 2

Right mandibular sub-condylar fracture: a) pre-surgery CT (coronal view); b) ORIF with a TCP plate; c) mouth opening; d) right lateral movements; e) left lateral movements; f) post-surgey occlusal plane.

Figure 3

Right mandibular sub-condylar fracture: a) retromandibular approach; b) ORIF with a single plate; c,d,e) facial nerve functionality.

Figure 4

Left mandibular sub-condylar fracture: a) pretrauma mouth opening; b) post-surgery orthopantomography; c) ORIF with a TCP plate; d) scare result.