The surgical sequencing and techniques in the management of multiple mandibular fractures involving the condyle: A review of 121 surgical cases

Abstract

Aims: Surgical management of patients presenting with multiple fractures of the mandible involving condylar segments can be a challenging proposition to the maxillofacial surgeon. These fractures can be double or triple mandibular fractures and may also be in association with panfacial fractures. Even though most authors suggest that the conventional approachof reduction and fixation of the mandibular symphysis/ parasymphysis fractures, prior to addressing the fractured condylar segment is appropriate, there exists another school of thought suggesting that the condylar segment must be reduced and fixed first. This article aims to review the outcomes of surgery when reduction and fixation of the fractured condyle is done prior to other associated mandibular fractures and looks into the various surgical approaches advocated for the same. Materials and Methods: 121 surgically treated patients with multiple (double/ triple) mandibular fractures including a condylar component were reviewed. The preauricular, periangular and the retromandibular (anterior parotid-transmasseteric) approaches were advocated to access the fractured condylar segments. Results: The fractured condyle was the first segment to be addressed during the sequencing of the surgical management, irrespective of the approach used. Good reduction and fixation with limited complications were achieved by addressing the condylar fracture first. Conclusion: Sequencing of multiple mandibular fractures, though the prerogative of the operating surgeon, addressing the condylar segment first, provides the operator with a viable alternative to the conventional technique.