A modified step technique for lip reconstruction

Abstract

Purpose: This study evaluates the clinical and radiologic results after open reduction and lag-screw osteosynthesis of fractured mandibular condyles.Materials and Methods: Eleven adult patients underwent surgery for displaced or dislocated mandibular condyle fractures via a submandibular approach. The repositioned fragments were fixed using lag screws designed by Krenkel or Eckelt. Maxillomandibular fixation was used postoperatively for 2.6 weeks on average (range, 1 to 4 weeks) in nine patients.Results: Slight transient weakness of the mandibular branch of the facial nerve occurred in three cases. Occlusal adjustment was needed in another three cases. Radiologically, the fracture line disappeared at 22.5 weeks on average (range, 8 to 38 weeks). Three screws had to be removed because of loosening. There were signs that the screws had migrated caudally from their original position in seven cases. Twenty-one months on average after operation (range, 8 to 31 months), patients were satisfied with treatment. Clinically, all patients had a stable occlusion and symmetry of the face. All had greater than 5-mm symmetrical lateral jaw excursions. Ten patients had wide (>40 mm) painless mouth opening. Healing in malposition occurred in four cases and there was considerable shortening of the mandibular ramus in four cases.Conclusions: Despite good clinical results, lag screws do not meet the needs for rigid internal fixation in the treatment of mandibular condyle fractures.