Open treatment of condylar fractures with biphase technique

Most fractures of the condyle of the mandible are managed by closed reduction techniques. Commonly used methods include intermaxillary fixation with a natural dentition or with dentures or splints. Fixation for a variable period of time provides for union of the fragments. In patients in whom the condyle is badly displaced and/or the adjoining mandibular segment is unstable, open techniques are often applied. This article discusses the indications for surgery and presents a method of reducing and maintaining fixation with an external device. Although the approach requires a major surgical procedure and can potentially cause injury to the facial nerve, there is a decided advantage in the direct visualization of the reduction and immobilization of the fracture. Several cases are presented to demonstrate the method and result.