[Clinical study on mandibular condylar fracture. 2. Long-term follow-up study in 48 patients with 66 joints]

Sixty-six joints in 49 patients with mandibular condylar fracture were investigated by means of long-term follow-up observation. The group of patients consisted of 39 males and 10 females with ages from 15 to 75 years. The classification of the fractures was follows: MacLennan type 1; four, type 2; four, type 3; 39, and type 4; 39 joints respectively. Treatment was as follows: 25 joints were by conservative therapy, 31 joints were by surgical fixation, and 10 joints condylectomy. The follow-up period of observation ranged from 18 months to 10 years and one month an average of five years and seven months. Clinical assessment was based upon Nakatomi's dysfunction index on mandibular condylar fracture, of which the criteria are as follows; Excellent (No clinical dysfunction sign on the TMJ), Fair (Slight pain, noise, and limited range of motion of the mandible, but clinically no affected mastication), Poor (Moderate dysfunctioned jaw), and Failure (Severe dysfunctioned jaw). 23 joints in 18 patients were ranked as having excellent results. 31 joints in 22 patients were assessed as fair. Ten joints in seven patients were defined as poor, and the remaining two joints in two patients were failures. The overall success rate was 81.7%. There are no statistical differences between patient's groups based on age, sex, uni/bilateral modality, with/without other concomitant fracture, surgical/conservative procedure, location and form of fractures, and duration of period from injury. These results indicated that the conservative procedure would be the first choice as a reasonable and less invasive procedure for functional repair of mandibular condylar fracture. On the other hand, as most patients had some dysfunction sign on the TMJ after mandibular condylar fracture, a more appropriate treatment, surgical or otherwise, should be found.