Mandibular Subcondylar Fracture: Improved Functional Outcomes in Selected Patients with Open Treatment

Area of Science:

• Oral and Maxillofacial Surgery
• Trauma Surgery

Background:

• Subcondylar fractures are common mandibular injuries with controversial treatment options.
• Closed treatment leverages condyle plasticity, while open treatment poses surgical risks like nerve injury.

Purpose of the Study:

• To compare perioperative, functional, and patient-reported outcomes of open versus closed treatment for subcondylar fractures.

Main Methods:

• A comparative study of 60 patients with displaced subcondylar fractures, divided into open reduction and internal fixation (ORIF) with maxillomandibular fixation (MMF) versus closed MMF.
• Data collected included demographics, perioperative details, complications, symptoms, chin deviation, malocclusion, mouth opening, functional scores, and patient satisfaction (FACE-Q).

Main Results:

• Both groups had similar demographics; the open group had longer operating room time (76.39 min vs. 56.15 min).
• Long-term follow-up showed open treatment resulted in fewer symptoms (9% vs. 67%), less chin deviation (0% vs. 40%), improved mouth opening (3mm vs. 5mm restriction), and better functional scores (1.92 vs. 0.861).
• Transient facial nerve weakness occurred in 6% of open treatment cases.

Conclusions:

• Open treatment, particularly with endoscopic assistance and specialized plates, yields superior long-term results for selected subcondylar fractures.
• Improved symptom management and functional parameters support open treatment over closed treatment in specific cases.