Unusual Sequelae of Subcondylar Fracture: Non-Union and Fusion with Zygomatic Arch

Abstract

We present an unusual case of post-traumatic sequelae of subcondylar fracture where resorption and non-union occurred between the ramus and the condylar segment and the condylar component got fused with the zygomatic arch. A 40 years old male patient came to the maxillofacial out patient department in the hospital with the chief complain of restricted mouth opening. He gave a history of trauma one year back due to road traffic accident and was treated conservatively for lower jaw fracture in a peripheral general hospital. On examination the mouth opening was 2 cm. An orthopantamogram showed resorption and non-union between the condylar and the ramal end and the condylar segment was fused with the zygomatic arch. The coronoid process of the ipsilateral side was also elongated (Fig. 1). The radiograph also showed a healing fracture line in the left para-symphysis of the mandible. Fig. 1 Orthopantamogram showing non-union and fusion of the condylar segment with the zygomatic arch The patient was operated under general anesthesia and with a pre-auricular incision the condylar portion was removed. Simultaneously an ipsilateral coronoidectomy was performed with the same incision. The mouth opening increased to 4 cm intra-operatively. In the post-operative phase, the patient was encouraged for aggressing jaw physiotherapy and in the regular follow-ups he maintained a normal inter-incisal opening. Condylar non-union is a virtual unreality [1] and rarely one would encounter such situation after closed reduction. Our aim to report this case was to raise a possibility of this uncommon late complication which should be kept in mind while opting for closed reduction.