Prospective closed treatment of nondisplaced and nondislocated condylar neck and head fractures versus open reposition internal fixation of displaced and dislocated fractures

• Published in: Oral and maxillofacial surgery 2008-07, Vol.12 (2), p.79-88
• Main Authors: Landes, Constantin A., Day, Kai, Lipphardt, Ruben, Sader, Robert
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Dentistry; Follow-Up Studies; Fracture Fixation - methods; Fracture Healing - physiology; Humans; Jaw Relation Record; Joint Dislocations - surgery; Magnetic Resonance Imaging; Mandibular Condyle - injuries; Mandibular Condyle - surgery; Mandibular Fractures - classification; Mandibular Fractures - diagnostic imaging; Mandibular Fractures - therapy; Medicine; Medicine & Public Health; Middle Aged; Oral and Maxillofacial Surgery; Original Article; Pain; Prospective Studies; Radiography; Recovery of Function; Treatment Outcome; Vertical Dimension
• ISSN: 1865-1550; 1865-1569
• DOI: 10.1007/s10006-008-0108-6

Objective assessment of open reduction internal fixation in displaced or dislocated fractures of the condylar neck and head assessed versus closed treatment of nondisplaced, nondislocated fractures. Materials and methods One hundred and twenty patients suffering from 158 fractures; classes II to V according to Spiessl and Schroll, e.g., displaced and dislocated fractures were operated on; classes I and VI nondisplaced, nondislocated fractures were treated conservatively. At 1year, facial symmetry, pain, facial nerve function, and scarring were assessed clinically; reossification and fragment angulation were assessed from radiographs; vertical position, incisal maximum movements, and condyle translation were judged by millimeters. Results and discussion Clinical courses were uncomplicated in classes I to IV and did reach horizontal and vertical fragment reposition with minor remodeling in follow-up. Single cases evinced persistent pain, dysocclusion, facial nerve palsy, and plate fractures. Results were less successful in classes V and VI: although open reposition internal fixation showed good repositioning in class V, marked vertical bone remodeling occurred; single cases suffered from pain, dysocclusion, and plate fracture. Class VI cases had the worst translation, likewise marked condyle remodeling, and frequent dysocclusion. Conclusion Classes V and VI remain challenging to treat, while the other classes can be treated reliably with this study’s rationale. Condyle remodeling in classes V and VI, translation in class VI may benefit prospectively from even more careful mobilization, improved osteofixation as minimalized operation trauma.