Open Reduction and Rigid Internal Fixation of Mandibular Condylar Fractures by an Intraoral Approach: A Long-Term Follow-Up Study of 15 Patients
Purpose
To evaluate the long-term results obtained with open reduction and rigid internal fixation of mandibular condylar fractures by an intraoral approach.
Patients and Methods
Fifteen patients with 24 mandibular condylar fractures were retrospectively examined with an average follow-up of 23 months (range, 6-63 months). Clinical and radiographic examination was conducted according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), including an evaluation of maximum voluntary bite force measurements and facial nerve function. Statistical analysis was performed on maximum voluntary bite force measurements and maximum pressure pain threshold.
Results
Two patients fulfilled the criteria for a RDC/TMD diagnosis. Myofacial pain (group I) and bilateral arthralgia (group III), combined with a moderate nonspecific physical symptom score, was diagnosed in 1 patient and 1 patient received a diagnosis of disc displacement with reduction (group II). Satisfying radiographic fracture healing was seen in 12 joints. However, miniplate fracture occurred in 3 patients and severe bone resorption of the condylar head was seen in one patient. Minor adjustment of the postoperative occlusion was necessary in 6 patients. No significant difference between maximum voluntary isometric bite force measurements or maximum pressure pain threshold was found between the fracture side and the opposite side in unilateral cases or between the operated and nonoperated side in bilateral cases. None of the patients showed facial nerve injury or visible facial scars.
Conclusion
Within the limitations of a retrospective study, the present study emphasized that optimal management of dislocated bilateral condylar injuries combined with other fractures of the facial skeleton constitute a challenging issue in maxillofacial trauma. Moreover, open reduction and rigid internal fixation of mandibular condylar fractures by an intraoral approach is a technically demanding surgical procedure associated with a high risk of postoperative complications in these injuries.
⁎Consultant, Department of Oral and Maxillofacial Surgery, Aalborg Hospital, Aarhus University Hospital, Denmark.
†Consultant and Head of Department, Department of Oral and Maxillofacial Surgery, Aalborg Hospital, Aarhus University Hospital, Denmark.
‡Consultant, Department of Oral and Maxillofacial Surgery, Aalborg Hospital, Aarhus University Hospital, Denmark.
§Consultant, Department of Oral and Maxillofacial Surgery, Aalborg Hospital, Aarhus University Hospital, Denmark.
∥Resident, Department of Oral and Maxillofacial Surgery, Aalborg Hospital, Aarhus University Hospital, Denmark.
¶Professor, Department of Oral and Maxillofacial Surgery, Aarhus University Hospital and Department of Clinical Oral Physiology, School of Dentistry, Faculty of Health Sciences, University of Aarhus, Aalborg Hospital, Aarhus University Hospital, Denmark.
Address correspondence and reprint requests to Dr Jensen: Department of Oral and Maxillofacial Surgery, Aalborg Hospital, Aarhus University Hospital, Hobrovej 18-22 DK-9000 Aalborg, Denmark
ABSTRACT