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. 2020 Sep 24;8(9):e3145.
doi: 10.1097/GOX.0000000000003145. eCollection 2020 Sep.

Algorithm for Management of Mandibular Condylar Base Fractures

Erin C Peterson  1 , Dennis C Nguyen  1 , Ethan J Baughman  1 , Gary B Skolnick  1 , John J Chi  2 , Kamlesh B Patel  1
Affiliations

Algorithm for Management of Mandibular Condylar Base Fractures

Erin C Peterson et al. Plast Reconstr Surg Glob Open. .

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.

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Conflict of interest statement

Disclosure: Dr. Patel is a consultant for Stryker CMF; Drs. Chi and Patel are course faculty member for AOCMF. All the other authors have no financial interest to declare.

Figures

Fig. 1.
Fig. 1.
Algorithm for patients with condylar base fractures assessing occlusion, dislocation, and fracture displacement.
Fig. 2.
Fig. 2.
Preoperative (A) and postoperative (B) lateral view computed tomography images after open reduction and internal fixation using transoral approach and a 3D condylar plate. This patient had a displaced condylar base fracture without condylar dislocation in conjunction with a symphyseal fracture.
Fig. 3.
Fig. 3.
Graphs showing mean operative times for patients presenting with condylar base fractures.
Fig. 4.
Fig. 4.
Scatter plot showing change in operative times operative times over the time course of this study.
Fig. 5.
Fig. 5.
(A) Preoperative computed tomography image showing dislocated condylar fracture; (B) 4-weeks postoperative x-ray after open reduction and internal fixation.
Fig. 6.
Fig. 6.
Four weeks after fixation of a left dislocated condylar base fracture (A) in centric occlusion; (B) maximal incisal opening.
See this image and copyright information in PMC

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