Poster 77: Treatment of Mandibular Subcondylar Fractures: A Retrospective Study

Abstract

The purpose of this study was to evaluate treatment outcomes following closed versus open repair of mandibular subcondylar fractures in terms of functional, radiographic, and esthetic parameters. A retrospective chart review of patients who presented with mandibular subcondylar fractures was conducted at Truman Medical Center, Kansas City, MO between January 2004 and August 2010. We reviewed patient demographics (gender, age, and pertinent co-morbidities), physical exam findings, imaging studies, intra-operative findings, and follow-up exam findings. Our dataset included 193 patients, with a mean age of 29 years. Most common etiology for subcondylar fracture was assault (n=117 [61%]). Majority (n=148 [77%]) of subjects were male. Half of all fractures (n=97 [50%]) occurred on the left and 71 (36.8%) on the right right side, with remaining 22 (11.4%) being bilateral subcondylar fractures. Only 65 (33.7%) of the fractures were isolated subcodylar fractures and the rest coexisted with concomitant fractures of other parts of mandible. Fracture dislocation was observed in 76 (39.3%) of all cases. Total of 51 (26.4%) of these fractures were treated via open reduction with internal fixation via retro mandibular approach, and 105 (54.4%) were reduced in a closed fashion via guiding elastics for a period of 4 to 6 weeks. The remaining 37 (19%) were not surgically treated due to excellent occlusion. Most common post-operative complication was patient's pain perception (n=17 [8.8%]), malocclusion (n=11 [5.7%]), deviation of mandible upon mandibular opening (n=9 [4.7%]), and temporomandibular joint noises (n=8 [4.1%]). Among cases treated with ORIF, 4 (7.8%) experienced transient neurosensory deficit, 2 (3.9%) had post-operative infection, and 1 (1.96%) developed condylar resorption. None of the patients experienced ankylosis of TMJ or nonunion of the fracture; however, 3 (5.9%) patients required revision surgery due to infection. Open reduction and rigid internal fixation when indicated appears to be the suitable treatment modality in successful treatment of mandibular subcondylar fractures with minimal morbidity leading to early functional recovery.