Exclusive Functional Treatment for Mandibular Condylar Fractures

Abstract

Despite the frequency of condylar fractures, no consensus has been reached regarding treatment alternatives (ie, operative vs nonoperative). The purpose of the present study was to describe functional treatment without intermaxillary fixation of condylar fractures and summarize the treatment outcomes. We designed a retrospective case series and enrolled patients with condylar fractures with malocclusion. The primary outcome was treatment success, assessed at the end of 6weeks. We recorded 5 parameters to assess treatment success, including a stable return to the initial occlusion, lateral excursion of more than 7mm, centered protrusion of more than 4mm, centered mouth opening of more than 35mm, and painless mandibular mobilization. If all 5 parameters were met, treatment was deemed a success. Treatment failure was defined as meeting less than all 5 parameters. We used numbers and percentages for these nominal qualitative variables (healing criterion absent or present). Two prognostic variables (ie, fracture type and age range), stratified by treatment success, were compared using the Fisher exact test for patients presenting with all healing criteria. We included 30 patients with a median age of 33years. Of the 30 patients (34 fractures), 15 had low subcondylar fractures (44.1%), 12 had high subcondylar fractures (35.3%), and 7 had head condylar fractures (20.5%). At the last consultation, 21 patients (70%) had exhibited all the criteria defining treatment success. A significant difference was found in the success rate when stratified by age (P=.002) in favor of the younger patients. Also, high subcondylar and head fractures were associated with a better success rate. Exclusive functional treatment showed promising results and should be considered for cooperative patients, avoiding the risks of surgery and the discomfort with intermaxillary fixation.