Rigid Versus Semirigid Fixation for Condylar Fracture: Experience With the External Fixation System

Cascone, Piero; Spallaccia, Fabrizio; Fatone, Flavia Maria Graziana; Rivaroli, Andrea; Saltarel, Andrea; Iannetti, Giorgio

doi:10.1016/j.joms.2007.06.621

« Previous Next »Journal of Oral and Maxillofacial Surgery
Volume 66, Issue 2 , Pages 265-271, February 2008

Rigid Versus Semirigid Fixation for Condylar Fracture: Experience With the External Fixation System

Piero Cascone, MD, PhD
- Associate Professor, Department of Craniomaxillofacial Surgery, La Sapienza University, Rome, Italy.
Fabrizio Spallaccia, MD
- Assistant, Department of Craniomaxillofacial Surgery, La Sapienza University, Rome, Italy.
Flavia Maria Graziana Fatone, MD, PhD
- Senior Resident, Department of Craniomaxillofacial Surgery, La Sapienza University, Rome, Italy.
- Address correspondence and reprint requests to Dr Fatone: Via Piave, 7-00187 Rome, Italy
Andrea Rivaroli, MD
- Assistant, Department of Craniomaxillofacial Surgery, La Sapienza University, Rome, Italy.
Andrea Saltarel, MD
- Assistant, Department of Craniomaxillofacial Surgery, La Sapienza University, Rome, Italy.
Giorgio Iannetti, MD, PhD
- Professor and Director, Department of Craniomaxillofacial Surgery, La Sapienza University, Rome, Italy.

Purpose

Although mandibular condylar fractures are very common, the treatment remains controversial. Many techniques of reduction and many devices have been suggested. The purpose of this study was to evaluate the advantages and drawbacks of semirigid fixation compared with rigid fixation using an external fixation system.

Patients and Methods

Between 1990 and 2005, 137 patients (83 males, 54 females; median age, 24.2 years; 116 with monocondylar fracture and 21 with bicondylar fracture) were treated with an external fixation system (Mand-X-Fix, Leibinger, Germany). In these cases, the distal fragment was dislocated medially and out of the glenoid cavity (stadium IV of MacLennan).

Results

At the 12-month follow-up, 91% of treated patients regained their pretrauma occlusion with good functional results (maximum mouth opening: 100% >30 mm, 81% >35 mm, 59% >40 mm; articular pain: <2%; clicking: <7%) and morphostructural results (fragment overlap significant in 2% of cases, light in 53% of cases, and absent in 45% of cases) and a very low rate of complications in the immediate postsurgical period (temporary paresis of the facial nerve: <7%; infection of the surgical wound: <2%). No long-term facial palsy was noted.

Conclusion

Our findings indicate that a semirigid fixation technique, represented by the external fixation system, seems to be a better approach to treating condylar fractures with luxation out of the glenoid fossa.