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Mandibular condylar fractures: a 5-year retrospective analysis comparing open versus closed reduction
David Thean1, Frank Chang1,2,3
1Department of Maxillofacial Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.
ANZ Journal of Surgery
|September 25, 2023
Summary
Management of mandibular condylar fractures using open reduction and internal fixation (ORIF) or closed techniques shows similar rates of facial nerve injury and malocclusion. Fragment shortening significantly impacts facial nerve outcomes in these complex fractures.
Area of Science:
- Oral and Maxillofacial Surgery
- Trauma Surgery
- Reconstructive Surgery
Background:
- Mandibular fractures, particularly condylar fractures, present complex management challenges with ongoing debate regarding optimal treatment.
- Contemporary approaches include open reduction and internal fixation (ORIF) and closed management techniques.
Purpose of the Study:
- To compare outcomes of mandibular condylar fractures managed with open versus closed techniques.
- To evaluate post-operative facial nerve function, occlusion, and maximal mouth opening.
Main Methods:
- Retrospective multicentre cohort study of 246 patients with mandibular condyle fractures.
- Data collected from clinical records across three hospitals in Perth, Western Australia.
- Primary outcome: changes in post-operative facial nerve function.
Main Results:
- 132 patients underwent ORIF, 114 had closed management.
- Temporary facial nerve injury rate: 3.28% (ORIF); permanent rate: 0.82% (ORIF).
- Sialocoele occurred in 2.46% of ORIF patients; 6.14% had persistent malocclusion.
- Significant association between fragment shortening (≥5mm) and facial nerve injury (P=0.0063).
Conclusions:
- Debate continues regarding the optimal management of mandibular condylar injuries.
- Study shows comparable rates of temporary/permanent facial nerve injury and sialocoele to previous literature.
- Further prospective studies are needed to guide decision-making for mandibular condylar fractures.
