• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.48 no.5
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• pp.303-308
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• 2022

Objectives: Selection of treatment methods for mandibular condylar fractures remains controversial. In this study, we investigated treatment methods for condylar fractures to determine the indications for open or closed reduction. Patients and Methods: Patients >12 years of age treated for mandibular condylar fractures with a follow-up period of ≥3 months were included in this study. The medical records of enrolled patients were reviewed for sex, age, fracture site, treatment method (open or closed reconstruction), postoperative intermaxillary fixation period, operation time, and complications. Radiological analysis of fracture fragment displacement and changes in ramal height difference was performed using computed tomography and panoramic radiography. Results: A total of 198 patients was investigated, 48.0% (n=95) of whom underwent closed reduction and 52.0% (n=103) underwent open reduction. There was no significant correlation between reduction method and patient sex, age, or follow-up period. No statistically significant difference between the incidence of complications and treatment method was observed. None of the patients underwent open reduction of condylar head fracture. Binary logistic regression analysis showed that open reduction was significantly more frequent in patients with subcondylar fracture compared to in those with a fracture in the condylar head area. There was no statistically significant correlation between the groups and fracture fragment displacement. However, there was a significant difference between the treatment groups in amount of change in ramal height difference between the fractured and the non-fractured sides during treatment. Conclusion: No significant clinical differences were found between the open and closed reduction methods in patients with mandibular condylar fractures. According to fracture site, closed reduction was preferred for condyle head fractures. There was no significant relationship between fracture fragment displacement and treatment method.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.27 no.2
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• pp.164-170
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• 2005

The purpose of this study was to compare a sample of patients who had condylar fractures treated with open reduction using different plating techniques, to evaluate which plating technique is useful for stable fixation for fractures of the mandibular condyle and to evaluate effectiveness of resorbable miniplate. There were 60 patients (41 males, 19 females) whose condylar fractures were treated with open reduction. Rigid fixation was performed with a single miniplate, double miniplate ot one miniplate & one microplate and single resorbable plate. All patients remained intermaxillary fixation for 1 week postoperatively. Active physiotherapy was started after 2 weeks postoperatively. Radiographic evaluation (plate fracture, plate bending, screw loosening, displacement of condyle etc.) was performed at pre-operative, immediate, 2 weeks, 1 month, 3 months, 6 months after surgery. Clinical evaluation included degree of mouth opening, occlusion, mandibular lateral excursion, infection and facial nerve paralysis. In radiographic evaluation, displacement of fractured condylar segment associated with plate bending or screw loosening were showed 6 cases and 3 cases for single miniplate system and resorbable miniplate system. There was no patients who have this problem on double miniplate system. The results revealed that the application of two miniplates were more recommendable than single miniplates. When we select resorbable miniplate system, we should consider the type of fractures, post-operative treatment protocol and surgical technique.

• Journal of Dental Rehabilitation and Applied Science
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• v.30 no.2
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• pp.159-169
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• 2014

Panfacial fractures require complex multidisciplinary approaches for treatment. Functional stability of bilateral condylar-disc complex should be the goal of the treatment. A patient with complex clinical panfacial fractures, including a bilateral condylar fractures visited our clinic. Facial asymmetry, insufficient vertical space and multiple missing teeth of the patient were major problems. Closed reduction and splint treatment were tried for stable condylar position. A functional and esthetic rehabilitation was accomplished by using implants and full mouth rehabilitaion. Potential possibilities of unstable occlusion should be prevented with night guard and periodic occlusal adjustment.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.41 no.3
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• pp.149-155
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• 2015

Surgical approaches to the condylar fracture include intraoral, preauricular, submandibular, and retromandibular approaches. Each approach has its own advantages and disadvantages. When a patient needs esthetic results and an intraoral approach is not feasible, the transmasseteric antero-parotid facelift approach is considered. This approach permits direct exposure and allow the surgeon to fixate the fractured unit tangentially. Tangential fixation is critical to osteosynthesis. Disadvantages of the transmasseteric antero-parotid facelift approach include damage to the facial nerve and a longer operation time. However, after the initial learning curve, facial nerve damage can be avoided and operation time may decrease. We report three cases of subcondylar fractures that were treated with a transmasseteric antero-parotid facelift approach. Among these, two cases had trivial complications that were easily overcome. Instead of dissecting through the parotid gland parenchyma, the transmasseteric antero-parotid facelift approach uses transmasseteric dissection and reduces facial nerve damage more than the retromandibular transparotid approach. The esthetic result is superior to that of other approaches.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.11 no.1
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• pp.93-100
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• 1989

This is a report of comparison of condyle fracture treatment by functional treatment and surgical treatment. In cases of functional therapy, mode of action of Activator that we used; By fulcrum of posterior teeth, the mandibular elevators of the opposite side cause the gap in the dental arches to be reduced, while the mandible performs a rotational movement about the fulcrum during which the fracture surface of the large fragment moves downward. Condylar fractures are often seen in association with fractures of other regions of the mandible. In our department, such cases were treated by miniplate and intramaxillary fixation. Surgical treatment of fractures of the mandible condylar were treated by intraoral approach. The result were drawn as follows : 1. Lateral displacement of condyle ; functional therapy with activator. 2. Compound fracture ; miniplate osteosynthesis and physiotherapy. 3. Anteriormedially displacement ; surgical treatment.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.17 no.4
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• pp.429-437
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• 1995

Of all facial fractures in children, condylar fractures have the greatest propensity to produce a growth disturbance. This risk appears to be greatest when the injury is during the first 3 years of during adolescence. Yet, the ability of a child to undergo compensatory growth that decrease the effects of the injury is also the greatest. Fracture dislocation of the condyle in the preadolescent often results in excellent remodeling and function. Because of this factor and the higher risRs of avascular necrosis and ankylosis open reduction of a condylar fracture in a child is not widely recommended. This retrospective study analyzed mandibular condyle fractures in the children who admitted in dept. of Oral and Maxillofacial Surgery, Pusan paik hospital from 1984 to 1993 clinically and radiologically.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.27 no.4
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• pp.372-380
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• 2005

Condylar process of mandible, has the specialized anatomic structure compared with any other body structure, acts directly in connection with mastication and speech and so on. In general, mandibular condyle fractures have been managed by two methods as open and closed reduction. But, there are no reasonable consensus about the proper management of this injury. This study was designed for analysis of the prognosis of two methods of treatment, open and closed reduction, with positional change of fractured condyle and complications within 6 months post-intermaxillary fixation period. We conducted a retrospective analysis of 154 patients whose unilateral mandibular condyle fractures were treated by open or closed reduction in our department. The horizontal, sagittal, and coronal change of the condyle was examined using modified Towne's and panoramic radiographs before intermaxillary fixation(IMF), immediately after IMF, and at 6 months after IMF. Patients, whose mandibular condyle fractures were treated by closed reduction, had significantly shorter ramus height on the side of injury(P<0.05). But, fractured condylar fragments were displaced insignificantly with aspect to sagittal and coronal plane(P>0.05). The level of the fracture influenced the ramus length and the degree of coronal change in the closed reduction group(P<0.05). There was no significant correlation among the level of the fracture, treatment methods and complications(P>0.05). From the results obtained in this study, fractured mandibular condyles, were treated by closed reduction, had a tendency that continuous condylar displacement was occurred with aspect to horozontal and coronal plane in treatment period including intermaxillary fixation. And then there was a correlation between the level of the fracture and the position change in close reduction group statistically. These result suggested that care must be taken in basing treatment decisions on the degree of displacement of the condyle and in treating the mandibular condyle fractures for a long time.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.40 no.3
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• pp.135-139
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• 2014

This following case report describes the open reduction, internal fixation and the reconstruction of an extensive comminuted mandibular fracture with bilateral condylar fractures in a 19-year-old male patient with an intellectual disability and autistic disorder. He suffered fall trauma, resulting in shattered bony fragments of the alveolus and mandibular body between both mandibular rami, the fracture of both condyles and the avulsion or dislocation of every posterior tooth of the mandible. The patient underwent open reduction and internal fixation between both mandibular rami using a reconstruction plate, open reduction and internal fixation of the shattered fragments using miniplates and screws, and the closed reduction of the bilateral condylar fractures.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.30 no.2
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• pp.121-130
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• 2004

The purpose of this study was the long-term clinical and radiological evaluation of conservatively treated condylar fractures in children. This study was therefore undertaken to analyze the long-term effects of treating condylar fractures in children with conservative therapy in order to resolve the controversial question of whether complete remodeling occurs in this age or, if not, whether it is more likely to be associated with certain types of fracture or with other factors. This study was based on a series of 11 consecutive children and adolescents, aged between 3 and 15 years, with fractures of the condylar process who had been treated with conservative therapy at the Department of Oral & Maxillofacial surgery, Inha University Hospital, Inchon, Korea. All patients underwent a clinical investigation with special emphasis on Temporomandibular joint function and facial asymmetry. The patients also underwent a radiologic investigation, focusing on fracture remodeling and symmetry of mandible. It consists of panoramic radiograph, PA & lateral cephalogram and 3-D CT. No patient described impaired temporomandibular joint(TMJ) function or pain on the affected side. 2 of 8 (25%) unilateral and 1 bilateral fractures show slight facial asymmetry. Despite apparently excellent recovery of function, there were marked remodeling changes evident on the CT scan. Such changes are not usually evident on panoramic radiograph. Radiologic investigation showed incomplete remodelling(54.5%) and asymmetry of the mandible (27.3%) in some patients. Conservative treatment of condyle fracture in children results in satisfactory long-term outcome of jaw function despite a relative high frequency of radiologically noted aberrations.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.36 no.1
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• pp.30-36
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• 2014

There are many treatment options in management of mandibular condylar neck fractures. Closed reduction is the most conservative treatment; however, achievement of anatomic reduction is difficult, and there are some risks of mandibular functional impairment. Open anatomic reduction and internal fixation have some advantages; therefore, many oral and maxillofacial surgeons have attempted to achieve anatomic reduction through the open approach and extracorporeal reduction and fixation. However, when using this method, there is some risk of resorption of the fractured mandibular condylar head. Therefore, we designed a modified extracorporeal reduction technique, without detaching the lateral pterygoid muscle in order to maintain the blood supply to the fractured mandibular condylar head. We believe that this minor modification may minimize the risk of resorption of the fractured mandibular condylar head. In this article, we introduce this technique in detail, and report on two cases.