Changing trends in the management of condylar fractures

Our aim was to evaluate the functional outcomes and complications of mandibular condylar fractures managed surgically and non-surgically. Patients were identified retrospectively from audit data and clinical records from 2005-2018, and functional outcomes were evaluated based on the development of complications at clinical follow up. Patients were categorised into three treatment groups: conservative (management with soft diet, analgesia, and monitoring), closed (management with intermaxillary fixation), and open reduction and internal fixation (ORIF). A total of 358 patients were included with a median age of 33 years (mean 38), and a male:female ratio of 2.7:1. A total of 72 patients (20%) were treated conservatively, 177 (49%) were treated with closed management, and 109 (31%) with ORIF. The ORIF group demonstrated better outcomes than the closed group in terms of reduced protrusive and lateral excursive movements, and temporomandibular joint (TMJ) pain; and in terms of occlusal derangement when compared with the conservative group. The ORIF group had poorer outcomes than both the closed and conservative groups in terms of maximum mouth opening, and temporary facial nerve injury occurred in 5/109 (5%) and condylar resorption in 2/109 (2%) of patients in the ORIF group. There was no incidence of permanent facial nerve injury, Frey syndrome, or paraesthesia of the auricular nerve. The trend that favours ORIF can be justified, as it offers improved functional outcomes in severe or displaced condylar fractures. However, this must be evaluated against the risk of potential surgical complications. Careful case selection is therefore necessary to optimise management of these injuries.