Extracorporeal Fixation and Re-Implantation for High Condylar Split Fractures: The Motamed Technique

Management of high sagittal split fractures of the mandibular condyle remains a formidable surgical challenge due to limited visualization, technical difficulties with direct in situ fixation, and the high risk of secondary avascular necrosis or temporomandibular joint (TMJ) ankylosis.

To evaluate the clinical outcomes and technical efficacy of the "Motamed Technique," a standardized protocol involving extracorporeal rigid internal fixation followed by anatomic re-implantation for complex high condylar split fractures.

A retrospective evaluation was conducted on a clinical series of 11 consecutive patients (9 males and 2 females) presenting with severe, displaced high sagittal split condylar fractures secondary to high-velocity trauma. In all cases, the fragmented condylar segments were completely retrieved, stabilized ex vivo on a back table using a titanium X-shaped 3D mini-plate system (1.5 mm), and meticulously reimplanted into the glenoid fossa. Total cold ischemia time was strictly maintained between 10 and 20 minutes. The postoperative longitudinal follow-up period ranged from 6 to 11 months (mean duration: 8.6 mo). Comprehensive postoperative tracking included clinical parameter checking, 3D Computed Tomography (3D-CT), and high-resolution dynamic Magnetic Resonance Imaging (MRI) to analyze bony union, vertical ramus height restoration, and articular disc kinetics.

All 11 patients achieved predictable and stable functional outcomes. At the definitive milestones, the mean maximum mouth opening (MMO) was 37.3 mm (range: 33-45 mm), demonstrating excellent vertical clearance and stable lateral/protrusive excursions. Pretraumatic stable centric occlusion was perfectly restored and maintained in 100% of cases (n=11), with zero incidence of postoperative open bite or crossbite. Facial nerve motor function was entirely preserved across the cohort (100% House-Brackmann grade I at final follow-up). Longitudinal 3D-CT scans confirmed complete osseous union and anatomic alignment in all cases by the fourth postoperative month, with no radiographic evidence of condylar head resorption or hardware failure. Follow-up MRI findings demonstrated preservation of TMJ dynamics, functional articular disc movement (with stable reduction in 3 cases), and the complete absence of avascular necrosis or intra-articular effusion. No cases of TMJ ankylosis were reported.

The Motamed Technique provides a reliable, reproducible, and biologically sound approach for managing intricate high condylar split fractures. By utilizing systematic extracorporeal mini-fixation, this protocol effectively overcomes intraoperative spatial limitations while ensuring excellent long-term anatomic stability, stable occlusion, and functional joint mobility without compromising facial nerve integrity.