Condylar fractures: Surgical management

Abstract

Considering the relatively benign, possibly adverse, consequences of condylar fractures (eg, jaw dysfunction, temporomandibular joint (TMJ)/muscle pain, and malocclusion), and the relatively difficult procedures required for open reduction (compared with reduction of a mandibular angle or symphysis fracture), there will always be a difference of opinion among surgeons concerning the merits of open versus closed reduction. A very good recent article in this Journal by Hayward and Scott reviewed the views and treatment approaches concerning fractures of the mandibular condylar process during 1943 through 1993.’ Readers are encouraged to review this article. The incidence of condylar process fractures among all mandibular fractures is high, most likely in the range of 25% to 50%.2 Thus, it is commonly treated by oral and maxillofacial surgeons. At least 48% of condylar process fractures are associated with other mandibular fractures, with half of these being in the symphysis and parasymphysis regions. A recent evaluation of 382 patients with condylar process fractures by Silvennoinen et al2 found that 1) 84% were unilateral/l6% bilateral; 2) 14% were intracapsular; 3) 24% were condylar neck; 4) 62% were subcondylar (low neck/ramus); and 5) 16% were categorized as having severe displacement (MacLennan’s classification). When analyzed by age group, 41% of the fractures in children 10 years or younger were judged to be intracapsular, whereas 70% were subcondylar in the 20to 29-year age group, and 66% were subcondylar in the 30to 39-year age group. Sixty percent of the fractures occurred in the 20to 39-year age range. There is much concern about ankylosis following condylar process fractures, but the actual incidence