Evaluation of the Efficacy of Three Times Titanium Plate Gradual Fixation Method in the Treatment of Extracapsular Condylar Fractures.

OBJECTIVE: An improved method of treating inwardly dislocated mandibular extracapsular condylar fracture-three times titanium plate gradual fixation method was introduced, and the clinical efficacy of this method was evaluated. METHODS: Twenty patients with extracapsular condylar fractures who underwent surgical treatment using the three times titanium plate gradual restoration and fixation method in the Department of Oral Craniomaxillofacial Surgery of the Ninth People's Hospital of Shanghai from November 2020 to June 2023 were selected as the study subjects. RESULTS: After condylar restoration 22 sides reached healing and 1 side was basically healed; in 3 months after the operation, the degree of opening the mouth and the type of the opening of the mouth reached normal, and 1 case had mildly poor occlusion, which required to be further adjusted through orthodontics, and there was no temporomandibular function disorder or facial nerve function damage. CONCLUSION: Three times of gradual fixation with a titanium plate can make the condylar process achieve precise and stable repositioning, and make the surgical process orderly, and it is a kind of reliable fixation method for extracapsular condylar fractures.

Serious Condylar Head Absorption in Children With Intracapsular Condylar Fractures Treated Operatively With Long Screws.

OBJECTIVE: This study was performed to explore bone remodelling in children with intracapsular condylar fractures after the condylar fracture fragments were fixed using long screws and to offer possible explanations about the underlying mechanism. PATIENT AND METHODS: Records of children (less than 12 y old) who sustained intracapsular condylar fractures and fixed with long screws from May 2012 to January 2015 were retrieved. Age, gender, dates of injury, admission, and discharge, mechanism of trauma, location and pattern of fracture, other mandibular fractures, treatment methods, and time of review were recorded and analyzed. Image dates of pretreatments and posttreatments, including the date of review, were also recorded. RESULTS: A total of 8 patients completed their follow-up, and all patients (n=5) who were followed up after more than 3 months showed serious resorption of the condylar head. The condylar head resorbed until the height (or articular surface) dropped and aligned with the surface of the screw. The shortest time of absorption, as shown by the computed tomography scan was 106 days, and the longest time was 171 days (average time of 141.8 d). CONCLUSIONS: Intracapsular condyle fractures in children should be managed conservatively as much as possible. However, if the height of the fracture fragments drops remarkably, open reduction and rigid internal fixation become possible choices.

Control of Mandibular Width With 3D Printed Occlusal Splint in Children With Multiple Mandibular Fractures.

BACKGROUND: The fracture of mandibular symphysis combined with bilateral condylar fractures often leads to changes in the width of the mandible, which significantly widens the face of the child. Therefore, it is necessary to reposition the mandible through accurate adduction. METHODS: To ensure that the mandible can be accurately repositioned, a 3D printed occlusal splint was used. Bilateral maxillomandibular fixation screws were implanted. The 3D printed occlusal splint was located on the maxillary dentition and fixed to the maxillomandibular fixation screws with wire loops. The reference basis for adduction is to make the mandibular dentition located in the occlusal splint. The absorbable plate was contoured according to the restored model and fixed at the fracture site. The 3D printed occlusal splint was retained in the maxillary dentition for two months. RESULTS AND DISCUSSION: Postoperative computed tomography showed that the mandible had been adducted according to the preoperative design. Two months of follow-up showed that the child's facial development, mouth opening type, occlusion, and range of motion were good. It is especially suitable for children with mandibular symphyseal fractures accompanied by bilateral condylar fractures.

Does Open Reduction and Internal Fixation Yield Better Outcomes Over Closed Reduction of Mandibular Condylar Fractures?

PURPOSE: Despite decades of study, a consensus on therapeutic approaches to condylar fractures remains elusive, and the vexing question of invasive or noninvasive therapy remains to be definitively answered. This randomized clinical study aimed to compare the outcomes of mandibular condylar fractures (MCFs) treated by closed reduction (CR) with those treated by open reduction and internal fixation (ORIF). METHODS: The investigators designed and implemented a randomized controlled trial composed of patients with unilateral or bilateral MCFs. Patients were randomly allocated into the ORIF and CR groups. The primary predictor variable was treatment, either CR or ORIF. The primary outcome variable was temporomandibular joint function (pain and range of motion) assessed at 1 and 6 weeks and at 3, 6, and 12 months. The secondary outcomes included occlusion and complications (deviation, facial nerve injury, and scarring). Perioperative covariates included fracture displacement, ramus height loss, and associated mandibular fractures. The effect of treatment group on each of the 12-month outcomes was assessed using the χ2 test or the independent samples t test. A 5% significance level was used. RESULTS: A total of 116 patients with MCFs were included in the study. Sixty-eight (59%) and 48 (41%) patients were treated by CR and ORIF, respectively. No statistically significant differences were observed between the 2 groups for mouth opening (P = .073, protrusion (P = .71), laterotrusive movements toward fractured side (0.080), and nonfractured side (P = .28). The median pain scores decreased from 4 (interquartile range [IQR] 3 to 4) at 6 weeks to 0 (IQR 0 to 0) at 52 weeks and 6 (IQR 5 to 6) at 6 weeks to 0 (IQR 0 to 0) at 52 weeks in the CR and ORIF groups, respectively. Statistically significant differences between the groups were observed for the outcome of malocclusion (P = .040) and deviation (P < .0001). Ramal height loss (P = .013) and angle of displacement (P = .0084) were significantly associated with the presence of complications in the CR group. CONCLUSIONS: The results of the present study have shown that both treatment options for MCFs yield acceptable results. However, CR yielded more complications, especially in patients with bilateral MCFs, ramus height loss greater than 5 mm, and angle of displacement greater than 15°.

New Minimally Invasive Intraoral Procedure for Condylar Fractures: Clinical Presentation and Considerations on Current Techniques.

ABSTRACT: Mandibular fractures are the third most prevalent maxillofacial traumatic events. Surgical approaches to the condyle are a debated topic. This study describes a mini-invasive technique for condylar fracture reduction. The patient of this study suffered multiple traumatic injuries including a carotid artery dissecting aneurysm, which contraindicated the standard open reduction and internal fixation technique. The novel minimally invasive technique involves intraoral access and fracture fragment realignment using a periosteal elevator, a molar occlusal splint, and intermaxillary fixation after intraoperative radiologic imaging confirmation of condyle reposition.The approach avoids skin incisions and tissue dissection, with good aesthetic outcomes and facial nerve preservation. This technique proved to be safe and simple to be less demanding for the patient, with a shorter recovery time than experienced with other techniques.The results suggest this technique is a good option for the surgical treatment of condylar neck fractures showing favorable rim morphology with primary stability after reduction.

Change of the Inclination Angle in a Pediatric Bilateral Condylar Fracture Treated With Intermaxillary Fixation and an Occlusal Stop.

ABSTRACT: This paper presents the outcomes of a pediatric bilateral condylar fracture treated with intermaxillary fixation (IMF) and an occlusal stop.A 6-year-old girl presented with the complaint of pain on her chin. She had fallen down, whereas riding a bicycle and her face hit the road. She had limited mouth-opening (10 mm). Panoramic radiography and computed tomography confirmed a bilateral con-dylar fracture. The inclination of the fractured condyle (IFC) was 39.2° and 42.4° on the left and right sides, respectively. On the third post-trauma day, arch bars were applied and IMF was performed with a prefabricated wafer (occlusal stop) and rubber bands. The rubber bands were changed to wires on post-IMF day (PMF) 4.Immediately after IMF, the IFCs increased (left: 50.1° and right: 68.1°). On PMF 1, the IFCs had improved (44.5° and 46.9°, respectively). On PMF 3, 12, 28, and 35, the left and right IFCs were 46.9° and 70.7°,38.9° and 72.0°,38.0° and 56.5°, and 36.4° and 44.6°, respectively. On PMF 42, the IFCs had changed to 34.5° and 36.1 °, and wires were changed to rubber bands. On PMF 49, the IFCs were 34.0° and 36.5°, and rubber bands were applied at night only. On PMF 56, the IFCs had improved to 35.0° and 34.8°, and the arch bars were removed. The changes of IFC were fitted to an exponential regression model (left: y = 44.134e 0.005x and right: y = 11.378e 0.043x ).This case shows that pediatric bilateral mandibular condyle fractures can be treated by vertical lengthening using an occlusal stop and IMF.

Condylar Fractures: Multistep Surgical Planning by Mini-Invasive Approach, Patient Series.

PURPOSE: Surgical treatment for condylar fractures is a challenging procedure most debated in scientific literature without a broad consensus on the selection of surgical techniques to be used and relative indications.The goal of this work is to propose a multistep surgical planning for condylar fractures based on an effective mini-invasive approach and safe procedure aimed to avoid as much as possible skin incision in the aesthetic areas of the face and neck, to decrease the risk of facial nerve injury. METHODS: Ten patients with dislocated condylar neck fractures and sub-condylar fractures were included in this study.All the patients were studied with radiological images, computed tomography scans with three-dimensional reconstructions preoperatively and immediate postoperatively.Patients were evaluated pre- and post-operatively for dental occlusion, bone fragment alignment after reduction and after fixation, facial nerve functionality, skin scarring, temporomandibular joint functionality, temporomandibular joint symptomatology, and patient satisfaction. RESULTS: Results were satisfactory for different parameters evaluated. No significant complications resulted in follow-up, particularly for facial nerve injury. By using this multistep procedure with each stage functional to the following one, the authors achieved satisfactory results following treatment of dislocated condylar fractures.

Comparative evaluation of bite force in patients treated for unilateral mandibular condylar fractures by open and closed methods.

BACKGROUND/AIM: Condylar fractures account for a large proportion (20% to 52%) of mandibular injuries. The goal of treating these fractures is to restore the occlusion, thereby re-establishing the masticatory function as close as possible to the patient's pre-trauma state. The aim of this study was to compare the bite forces following unilateral condylar fractures treated by open reduction and internal fixation (ORIF) with those managed by the closed method. METHOD: Patients with unilateral mandibular condylar fractures were divided into two groups (n = 20) using a simple randomization method. Patients in group I were treated by open reduction and internal fixation (ORIF) using titanium miniplates and screws. Patients in group II were treated by the closed method with inter-maxillary fixation. Patients in both groups were evaluated pre-operatively and then post-operatively at one week, one month and three months for maximum bite force achieved at the central incisor, premolar and molar regions. RESULTS: Pre-operative bite forces on the unaffected site were significantly higher than the affected site in both groups, whereas no significant difference was observed in bite forces between the unaffected and affected sites in both groups post-operatively. The bite forces achieved at both the unaffected and affected sites in the ORIF group were significantly higher than in the closed group. CONCLUSION: Maximum bite forces differed significantly when the treatment was done with the open method, and the patients treated with the open method needed less time to achieve the maximum bite forces, thereby making an earlier return to function.

Does Dynamic Intermaxillary Fixation With Elastics Improve Outcomes Following Unilateral Condylar Fracture?

PURPOSE: The use of rigid versus semi-rigid intermaxillary fixation (IMF) following subcondylar fractures is controversial. This study aims to investigate whether the "dynamic" elastic fixation technique improves the outcomes, compared to the rigid fixation technique for the treatment of displaced subcondylar fractures in adults. MATERIALS AND METHODS: This nonblinded randomized clinical trial was performed on adult patients with unilateral displaced mandibular subcondylar fractures. Patients were randomly allocated into two groups (n = 17). The primary predictor variable was wire versus elastic IMF. Changes in primary (mouth opening) and secondary (other clinical and radiological) outcomes were recorded. Data were analyzed with the t test and Mann-Whitney test with SPSS software version 20. P-value < .05 considered as significant. RESULTS: In this study 34 patients (with mean age of 33.03 ± 1.79, 23.5% females & 76.5% males) in two groups (Elastics & Wire) followed up to 6 months. The Elastics group showed significant improvement in mouth opening (primary outcome) after 1 month of follow-up, but the differences were not significant at the end of the study. In terms of secondary outcomes, the ramus height shortening compared to the opposite side revealed favorable improvement in the Elastics group in the period of study. The differences between the two groups in the lateral movement and protrusive movement were significant in favor of the Elastics group. The differences in pain, fracture displacement, and midline deviation between study groups were not significant at the end of the study. Just 1 case with malocclusion was observed in the Wire group. Patients were more satisfied with dynamic nonrigid IMF with elastics. CONCLUSIONS: The results of this study showed that using the dynamic IMF technique is more tolerable, and patients have better functional and clinical outcomes during and at the end treatment.

Restoration of Ramus Height in Child Patients With Extracapsular Condylar Fractures: Is This Mission Almost Impossible to Accomplish?

OBJECTIVE: This study aimed to assess whether ramus height is restored in children with extracapsular condylar fractures treated by conservative or surgery procedures. METHODS: The sample consisted of 35 children (collected consecutively) less than 12 years old who presented with extracapsular condylar fractures and treated within an 8-year period (June 2011 to April 2019). Data on the age, gender, date of injury, mechanism of trauma, location and pattern of mandibular condylar fracture, associated injuries and treatment methods were recorded and analyzed. Ramus height restoration is the main evaluation indicator during the follow-up period. RESULTS: Within the 8-year record retrieval, the 35 children sustained 41 extracapsular condylar fractures. For the sample size, 10 (24.4%) and 31 (75.6%) had condylar neck and base fractures, respectively. Deviation and green-stick fracture were the predominant types in condylar neck and base fractures, accounting for more than 3 quarters (31, 75.6%). The majority (33, 80.5%) of patients were treated with nonsurgical treatment, and 8 (19.5%) were treated by open reduction and internal fixation (ORIF). During the follow-up period (1-1419 days, average time of 110.6 days), only 1 patient (with bilateral extracapsular condylar fractures) had their ramus height restored (follow-up period, 256 days). Most members of the ORIF group (5 of 8, 62.5%) postoperatively showed bended ramus (deviated angularly/fragment angulation). CONCLUSION: Conservative treatment could hardly restore the ramus height of children with extracapsular condylar fractures. Anatomically or totally restoring the ramus height is difficult even with the surgical treatment of ORIF; however, surgical treatment of ORIF can substantially restore the ramus height for dislocated fractures or seriously displaced fractures.

Management of Medially Displaced Sub-Condylar Mandibular Fractures in Pediatric Population Using Novel Atraumatic Approach.

ABSTRACT: The appropriate treatment of pediatric mandibular condyle fractures is subject to much debate and concern among surgeons, with improper treatment potentially resulting in a number of adverse outcomes. Such outcomes include the disruption of mandible growth, decreased posterior facial height, facial asymmetry, and temporomandibular joint ankylosis. Several surgical and nonsurgical approaches to these fractures have been described in the literature; however, each one carries its own risk of various complications. In this study, the authors illustrate a new atraumatic approach for mild to moderately displaced subcondylar fractures, with least possible complications and unexpected outcomes. In this study, 6 patients (2 female and 4 male) with unilateral medially displaced condylar base and neck fractures, angulated between 30 and 45 degrees, were treated using a novel intraoral approach. The follow-up period varied from 12 to 18 months. All patients achieved normal occlusion and had painless functioning of the temporomandibular joint with proper mouth opening (>35 mm) without any recurrence at long term follow up. This minimally invasive approach could eliminate the possibility of major complications and be considered a safe and feasible surgical technique for certain cases of pediatric mandibular condyle fracture.

Assessment of complications of the open treatment of mandibular condylar fractures

The objective of our study was to analyze the complications of open treatment of mandibular condylar fractures operated via various surgical approaches. Thirtyeight patients with 42 fracture sides having moderate to severely displaced condylar fractures were studied. Open treatment was performed, and patients were assessed for complications of open treatment in terms of facial nerve paresis, unaesthetic scar, salivary fistula/sialocele. Facial nerve paresis was noted in 13 (31%) cases, mostly transient in nature (n=9, 69.2%), that recovered within 8 weeks. Furthermore, 5 (11.9%) patients had unaesthetic scar formation, while just 1 (2.4%) case of salivary fistula was observed. Facial nerve paresis was the most common complication of open treatment of mandibular condylar fractures and most of them were observed in cases operated by preauricular approach.

Will Closed Treatment Provide Better Mandibular Motion Than Open Reduction and Internal Fixation in Cases of Unilateral Displaced Subcondylar Fracture? A Systematic Review and Meta-Analysis.

PURPOSE: The aim of the present systematic review was to determine whether closed treatment (CLT) with intermaxillary fixation (IMF) is superior or equivalent to open reduction and internal fixation (ORIF) in the management of unilateral displaced subcondylar fractures regarding the range of mandibular motion. MATERIALS AND METHODS: To address our question, we conducted a systematic review and meta-analysis of the reported data after a comprehensive manual and electronic database search of studies reported up to 2017 in the English language that had compared CLT and ORIF of mandibular condyle fractures in adults. The following outcomes were recorded: maximum interincisal opening (MIO), protrusive movement (PM), lateral excursion toward the fractured side (LEFS), and lateral excursion toward the nonfractured side (LENFS). RESULTS: The search resulted in 8 studies, 4 of which were included in the meta-analysis. The MIO and PM showed no statistically significant differences, with an effect size of -0.823 (P = .112) and -0.633 (P = .079), respectively. However, the LEFS and LENFS were superior after CLT, with an effect size of -0.710 (P = .031) and -0.682 (P = .017), respectively. CONCLUSIONS: The findings from the present review suggest that both ORIF and CLT can provide comparable MIO and PM in subjects with unilateral displaced subcondylar fractures. However, CLT was superior to ORIF for both LEFS and LENFS.

Management of Nonunion and Malunion After Primary Mandibular Condylar Fracture Treatment: A Review and Recommendations.

PURPOSE: After primary treatment of mandibular condylar fractures, nonunion and malunion can result in considerable malocclusion and temporomandibular joint dysfunction owing to the integral role the condylar head plays in the temporomandibular joint. At present, the choice and timing of treatment are highly heterogeneous. The purpose of this study was to evaluate the current literature to identify possible pitfalls, discuss available treatment options, and make recommendations. METHODS: The electronic databases PubMed, MEDLINE, PROSPERO, CENTRAL (Cochrane Central Register of Controlled Trials), and Embase were searched for content matching mandibular condylar fracture "revision surgery," "secondary surgery," "refracture," "malunion," and "malunion osteotomy." Articles in English, limited to human adults, published in the past 10 years, with abstracts and full text available and appropriate study designs, were included. RESULTS: A total of 101 articles were retrieved for analysis, and 4 articles were included. Because of heterogeneity in these studies, a pooled analysis could not be performed. CONCLUSIONS: Surgery can be considered as primary treatment of condylar fractures, and early detection of complications allows for early intervention, leading to better outcomes. Treatment of temporomandibular joint dysfunction is highly heterogeneous and ranges from nonsurgical measures to joint reconstruction. Unilateral malocclusion can often be corrected with unilateral surgery, but bilateral surgery may be indicated in select cases. Bilateral deformities often require bilateral mandibular surgery, but in cases with preserved symmetry, maxillary surgery can be performed.

Open Surgery Versus Closed Treatment of Unilateral Mandibular Condyle Fractures.

PURPOSE: The aim of this meta-analysis was to evaluate the efficacy of open surgery and closed treatment for unilateral moderately displaced mandibular condyle fractures. METHODS: PubMed, Embase, and Cochrane Library databases were searched according to PRISMA guidelines from inception to October, 2018. Inclusion criteria were based on humans randomized controlled trials in the English literature. Pertinent data were collected and the incidence of the complications was calculated. RESULTS: A total of 6 studies with 227 patients were included in the meta-analysis. The results showed that there were no significant differences in incidence of malocclusion (odds ratio [OR], 0.33; 95% confidence interval [CI]: 0.07-1.46; P = 0.14). However, open surgery group had a better maximal mouth opening (WMD = 3.82, 95% CI: 1.93-5.71, P < 0.01), protrusion (WMD = 1.16, 95% CI: 0.42-1.89, P < 0.01) and sum of both laterotrusions (WMD: 2.50, 95% CI: 1.77-3.22, P < 0.01). And the incidence of temporomandibular joint pain was lower than closed treatment group (OR: 0.15, 95% CI: 0.06-0.37, P < 0.01). CONCLUSIONS: Compared with closed treatment, open surgery has significant advantages in improving mouth opening and mandibular movement, and reducing the incidence of temporomandibular joint pain, provided that open surgery was a promising application in treatment of unilateral moderately displaced mandibular condyle fractures.

Endoscopically Assisted Open Reduction and Internal Fixation of Sub-Condylar Fractures: Debunking Some of the Myths.

Endoscopically assisted open reduction and internal fixation has cumulate advantages over both open and closed techniques. Even though, this approach had not become popular. The study intended to summarize the outcomes and complications from the first 12 consecutive cases of sub condylar fractures that treated by endoscope and trans-buccal trocar. All patients experienced improvement in mouth opening. No postoperative malocclusion was noticed. The learning curve was assessed subjectively regarding the use of the endoscope and objectively by operating time reduction. The significant decrease in operating time and the ease of handling the endoscope were already noticed after the 5th operation. The mean time for endoscopically assisted open reduction and internal fixation in our study was 180 minutes, which was the same as for external approaches open reduction and internal fixation for sub-condylar fracture cases. No special designed instruments except an endoscope and a trans-buccal trocar were used. We can conclude that the learning curve for this technique is not as steep as it was thought to be, and it can be mastered after a relatively small number of operations. There is no difference in mean operation time comparing to external approaches. No need for special designed instruments.

A comparative study of intraoral versus retromandibular approach in the management of subcondylar fracture.

BACKGROUND: The purpose of this study was to compare the outcomes and effectiveness between intraoral approach and retromandibular approach for treatment of subcondylar fracture of mandible. METHODS: Between March 2011 and October 2013, 24 patients with subcondylar fractures of the mandible were treated by a single surgeon with an intraoral approach using an angulated screwdriver (n = 14) or by another surgeon using a retromandibular approach (n = 10). The interincisal distance was measured 1 week (T0), 6 weeks (T1), 3 months (T2), and 6 months (T3) postoperatively. We also compare the average operation time and the cost of operation between the two groups. RESULTS: At 6 months postoperatively, all 24 patients achieved satisfactory ranges of temporomandibular joint movement, with an interincisal distance > 40 mm without deviation and with stable centric occlusion. The intraoral group had the median interincisal distance of 14 mm at T0, 38 mm at T1, 42.5 mm at T2, and 43 mm at T3, while the retromandibular group had that of 15, 29, 35, and 42.5 mm respectively. There was no statistically significant difference between the intraoral and the retromandibular group at T0 and T4. However, significant differences were noted T1 and T2 (p < 0.01). The differences of average operation time between the intraoral (81 min) and retromandibular group (45 min) were statistically significant (p < 0.01). The cost of an operation was 369.96 ± 8.14 (United States dollar [USD]) in intraoral group and was 345.48 ± 0.0 (USD) in retromandibular group. The differences between the two groups were statistically significant (p < 0.01). CONCLUSION: In open reduction of a subcondylar fracture of the mandible, a intraoral approach using an angulated screwdriver is superior to the retromandibular approach in terms of interincisal distance, although the operation time is longer.

Progressive idiopathic condylar resorption: Three case reports.

Progressive condylar resorption, also known as idiopathic condylar resorption, is an uncommon, aggressive, degenerative disease of the temporomandibular joint (TMJ) seen mostly in adolescent girls and young women. This condition leads to loss of condylar bone mass, decrease of mandibular ramal height, steep mandibular and occlusal plane angles, and an anterior open bite. In 3 case reports, we review the pathogenesis of TMJ degenerative disease and the clinical management of TMJ arthrosis. We emphasize that TMJ arthritic disease should be discussed in dental circles as a pathologic entity in the same way that orthodontists discuss arthritic disease in orthopedic circles. Regarding the degenerative pathology of the TMJ, treatment goals include restored function and pain reduction. The treatment methods used to achieve these goals can range from noninvasive therapy to minimally invasive and invasive surgery. Most patients can be treated noninvasively, and the importance of disease prevention and conservative management in the overall treatment of TMJ disease must be acknowledged. The decision to manage TMJ osteoarthrosis surgically must be based on evaluation of the patient's response to noninvasive treatments, mandibular form and function, and effect of the condition on his or her quality of life.

A Modified Peri-Angular Approach for Exposure of Condylar Fractures.

PURPOSE: To describe a modified peri-angular approach to address subcondylar and condylar neck fractures. MATERIALS AND METHODS: A modified peri-angular incision is used to approach a fractured condyle through the anteroparotid transmasseteric approach. RESULTS: In the authors' experience, this method provides quick and clean exposure to the fractured condylar base and neck fractures for open reduction and internal fixation. CONCLUSION: Although the peri-angular approach has been discussed in the literature, the authors' modification lessens the chance of complications, such as marginal nerve injury and parotid fistula formation, because the nerve is visualized and kept isolated throughout.

Open Reduction and Internal Fixation of Mandibular Condylar Base and Neck Fractures Using Strut Plates.

PURPOSE: To evaluate clinical, radiologic, and functional outcomes of patients with condylar neck or base fractures treated with open reduction and internal fixation using strut plates. PATIENTS AND METHODS: Thirty patients with 34 condylar neck and base fractures were included in the study. Transoral endoscopically assisted, submandibular, or transparotid approaches were performed. Clinical and radiologic outcomes were evaluated. Functional outcomes were assessed with the Helkimo index in a subgroup of 15 patients. RESULTS: Strut plates were successfully placed in all surgical approaches used in this study. Fracture healing occurred without complications in 33 condylar processes. One plate fracture occurred. In the subgroup, 7 patients had a good functional outcome, 7 had a slightly impaired functional outcome, and 1 patient had a moderately impaired functional outcome. CONCLUSION: Strut plates are appropriate for retromandibular transparotid, endoscopically assisted transoral, or submandibular approaches in the management of condylar neck or base fractures. Intraoperative handling and fitting accuracy of the strut plates are good. Good to slightly impaired functional outcome was observed in a subgroup of patients.