Epidemiology and treatment outcome of surgically treated mandibular condyle fractures. A five years retrospective study

https://doi.org/10.1016/j.jcms.2014.01.002Get rights and content

Abstract

Surgical management of mandibular condyle fractures is still controversial. Although it provides better outcome than closed treatment questions still remain about the surgical approach and the osteosynthesis devices to be used.

Between 2005 and 2010, we managed 168 mandibular condyle fractures with open treatment. Two surgical approaches were used in this study, a pre-auricular and a high submandibular approach (one or the other or as a combined approach). Internal fixation was performed using TCP® plates (Medartis, Basel, Switzerland) or with two lag screws (15 and 17 mm). Delta plates were used in 15 cases (8.9%).

We report the epidemiology of these fractures and the outcomes of the surgical treatment. We assessed the complications related to the surgical procedure and those related to the osteosynthesis material.

The facial nerve related complication rate was very low and the osteosynthesis materials used proved to be strong enough to realize a stable fixation.

The two approaches used in this study appeared to be safe with good aesthetic results.

Most of the surgical procedure failures occurred in high subcondylar fractures especially when bilateral.

Introduction

Management of mandibular condyle fractures, one of the most frequent fractures that a maxillofacial surgeon has to handle (Bormann et al., 2009, Chrcanovic et al., 2012, Zachariades et al., 2006, Zhou et al., 2013), remains controversial. The closed reduction has been used for a long time regardless of the type of fracture and displacement. Since then, open reduction internal fixation (ORIF) has become widely used.

Surgical management is the only way to achieve the proper reduction of a displaced fracture and should avoid intermaxillary fixation. Despite these advantages, this treatment has a bad reputation due to the possible complications, the main one being damage to the facial nerve with resulting facial palsy. In addition, there are questions remaining about the best osteosynthesis material (OSM) and the surgical approach that should be used.

Studies on condylar fracture are often conducted on small samples of patients and/or a wide range of different OSMs.

We reviewed the condylar fractures managed with ORIF in our department over 5 years. We mainly used 2 types of OSMs, one for subcondylar fractures and one for diacapitular fractures. We used cutaneous approaches only.

We studied: the epidemiology of condylar fractures, the surgical treatment outcomes, types and rates of complications after surgical treatment. The goal of this study is to assess whether or not the surgical treatment of condyle fractures is safe and reliable using specific OSM when possible.

This series of patients is different from the one presented by Meyer et al., in 2008 as no patient of this previous study were included in this paper (Meyer et al., 2008).

Section snippets

Material and methods

141 patients underwent surgical treatment for mandibular condyle fracture between 2005 and 2010 in the maxillofacial surgery department of the university hospital of Strasbourg (Strasbourg, France). 114 patients (80.9%) had unilateral mandibular condyle fracture and 27 (19.1%) had bilateral fractures for a total of 168 mandibular condyle fractures.

Surgical treatment with open reduction internal fixation (ORIF) was chosen in patients who presented clinically with either a dysocclusion or and

Results

On the 141 patients, 105 (75%) were males and 36 (25%) were females (sex ratio 3:1). Age of the patients ranged from 8 years to 84 years with a mean of 35 years (SD ± 17.15).

The distribution of each type of fracture is summarized in Table 1, Table 2. The LSCFs stand for almost two thirds (64.8%) of mandibular condyle fractures.

Falls were found to be the main aetiology for condylar fractures in this study (30%). Two other frequent aetiologies were assaults (25 %) and road traffic accidents (RTA)

Discussion

Our study shows very good results of ORIF in condylar fractures regardless of the level of fracture. It has been proved that ORIF provides the best results with more comfort for the patients (Schneider et al., 2008). Ellis stated that the open treatment was associated with faster recovery of mandibular movements (Throckmorton and Ellis, 2000).

Reduction should be particularly good in patients with HSCFs and/or bicondylar fractures, partially edentulous mandible. If the reduction is approximate,

Conclusion

Open reduction internal fixation of condylar fractures is safe and reliable if used within good indications. Anatomical reduction and fixation stability are keys to good healing of the fracture.

For best results, it has to be associated with post-operative physiotherapy.

HSMA and pre-auricular approaches provide good access to the fracture which allows more precise reduction and fixation.

Our study shows good results for the use of specific osteosynthesis materials. These devices allow a stable

Conflict of interest statement

The senior author was involved in the development of TCP plates in cooperation with Medartis®. Nevertheless, the authors received no grants for this study.

Grants

No grants were received by the authors.

References (36)

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