Mandibular coronoid fractures: treatment options

Fractures of the coronoid process are uncommon and can easily be missed. The purpose of this study was to classify the fracture patterns and explore the treatment options. This retrospective study included 39 patients with fractures of the mandibular coronoid process. Treatment protocols were developed based on the time of fracture, degree of mouth opening, location of the coronoid fracture, types of fracture, and other concomitant fractures. All patients were followed up for 12-60 months. Sixteen patients underwent conservative management and four of these patients developed progressive trismus, which improved significantly after removal of the coronoid process. Twenty-three patients underwent open reduction and internal fixation (ORIF) via the modified retromandibular approach. Follow-up data showed significant improvement in maximum mouth opening and symptoms (diet and pain) compared to their preoperative status. In summary, conservative management is first recommended for fractures of the coronoid process with minimal displacement or restriction of mouth opening. For patients with significant fracture displacement and limited mouth opening, or with concomitant fractures of the zygoma, zygomatic arch, or mandibular ramus, ORIF via the modified retromandibular approach through the anterior border of the parotid gland is an alternative treatment method.