Abstract
ObjectiveThe current classification of mandibular condyle fractures as basal, low neck, and high neck as reported by Loukota et al. (Br J Oral Maxillofac Surg 43:72–73, 2005) and Neff et al. (Craniomaxillofac Trauma Reconstr 7:S44–S58, 2014) has a weakness. Nearly no high-neck fractures are reported (they are typically classified as type C head fractures) contrary to basal condylar fractures, which are overestimated (nearly all low-neck fractures are classified as basal). The aim of this study is to present a modified AO/SORG classification of mandibular condyle fractures.Material and methodsA new arrangement of the reference lines is proposed because the fracture lines are mainly oblique in this region. The proposed classification was validated using a series of 84 cases that were treated surgically.ResultsThe diagnoses using the proposed new classification system significantly differed from those based on the old system (p < 0.005). All basal fractures in the new classification system were also classified as basal in the old system. The same was true for type C head fractures. The differences were found for low-neck fractures (4 of 84 diagnoses differed between the old and new classifications, i.e., they were previously classified as basal fractures) and high-neck fractures (3 of 84 fractures were diagnosed as low-neck fractures or type C head fractures using the old classification).ConclusionThe epidemiology of the condyle injury should be based on a classification, which reveals types of fractures which are represented by factually and frequently observed cases. That is why a relatively common AO/SORG classification can be modified for the benefit of assessing incidences of high-neck and low-neck fractures.Clinical relevanceConsidering that the treatment of the high-neck fractures is much technically complicated than the low-neck ones, this will have an influence on the management of trauma to the area.
Highlights
For the last decade, the classification/nomenclature of fractures of the mandibular condyle region has been based on the Strasbourg Osteosynthesis Research Group [1] and Arbeitsgemeinschaft für Osteosynthesefragen (AO) systems [2]
According to the clinical perspective, a condylar process fracture is defined as any fracture that is situated over the foramen mandibulae and runs from within or above the angle of the mandible into the sigmoid notch or the condylar head
Numerous classifications exist [6,7,8]; this subclassification has always been confused by homonymic classifications that are restricted to the condylar neck region and the use of the homonymic classification terms for completely different fracture levels in papers worldwide
Summary
The classification/nomenclature of fractures of the mandibular condyle region has been based on the Strasbourg Osteosynthesis Research Group [1] and Arbeitsgemeinschaft für Osteosynthesefragen (AO) systems [2]. The accurate anatomical description of the classification allows for visualization by most clinicians without the need to memorize numerically ordered types of fractures. A new classification system was retrospectively analyzed in a cohort of patients with condylar fractures and found to be simple to use and helpful in the prediction of treatment needs and outcomes [4]. As this classification was implemented, it became obvious that most fractures were classified as condylar basal and head fractures. High-neck fracture disappeared as a classification result. The maintenance and utilization of this fracture classification is important due to the special techniques and fixation materials that are required to treat such high fractures that are still not classified as type C head fractures [5]
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