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Vertical Ramus Osteotomy With Free Condylar Replantation for Adult High Condylar Fractures: A Midterm Retrospective

Jue Wang¹, Baoguo Chen², Quanwen Gao²

¹Department of Medical Cosmetology, Beijing Jishuitan Hospital, Capital Medical University.

The Journal of Craniofacial Surgery

|May 14, 2026

Summary

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Fractures: Bone Repair

Fractures: Bone Repair

Treatment for a fracture is based on the type of break, the bone affected, and the patient's age.
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the procedure...

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Vertical ramus osteotomy (VRO) with free condylar replantation effectively treats high condylar fractures in adults, improving mouth opening and reducing pain. This surgical approach offers a safe and effective solution with high patient satisfaction.

Area of Science:

Oral and Maxillofacial Surgery
Orthognathic Surgery
Trauma Surgery

Background:

Surgical management of high-level condylar fractures presents challenges due to complex anatomy and limited operative fields.
Vertical ramus osteotomy (VRO) with free condylar replantation is a potential technique to improve surgical exposure and reduction accuracy.
Limited evidence exists on the long-term efficacy and safety of VRO with free condylar replantation for these fractures.

Purpose of the Study:

To evaluate the clinical outcomes and safety of VRO with free condylar replantation in adult patients with high condylar fractures.
To assess functional recovery, pain reduction, and patient satisfaction following the procedure.

Main Methods:

Retrospective case series of 25 adults (37 joints) with high condylar fractures treated with VRO and free condylar replantation.

Keywords:

Condylar fracture free replantation open reduction and internal fixation temporomandibular joint vertical ramus osteotomy (VRO)

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Follow-up duration ranged from 2 to 4 years.

Clinical assessments included maximal mouth opening (MMO), occlusal relationship, temporomandibular joint (TMJ) pain (VAS), patient satisfaction, and radiographic healing.

Main Results:

Postoperative malocclusion decreased from 100% to 12%.
Anatomic reduction was achieved in 86% of joints, with bony union in all cases.
Significant improvements were observed in mean TMJ pain (VAS score from 9 to 1) and MMO (from 19.24 mm to 38.44 mm).
One patient (4%) experienced temporary facial nerve weakness with full recovery.

Conclusions:

VRO with free condylar replantation is a safe and effective surgical option for displaced high condylar fractures in adults.
The technique provides adequate exposure for precise reduction, leading to favorable functional outcomes and high patient satisfaction.
Midterm evidence supports the clinical application of this surgical approach.