Treatment Of Condylar Fractures Research Articles

A New Method in Dealing With Children's Condylar Fracture by Botulinum Toxin A Injection in Lateral Pterygoid Muscle.

Condylar is one of the most vulnerable sites to be traumatized in pediatric mandible fracture, while temporomandibular joint ankylosis might be the most severe complication of condylar fracture in children. There exists a long-time controversy on the treatment of condylar fractures in children. Considering the risk of facial nerve injury and a certain probability of absorption or even ankylosis after open reduction and internal fixation (ORIF) of condylar fractures, a series of nonsurgical approaches are preferred in cases without severe malocclusion or shortening of the ramus. Our treatment plan was carried out through combining procedures of Botulinum toxin A injection in lateral pterygoid muscle with ORIF of para symphyseal fracture; subsequently, a conservative way of the occlusal splint with elastic traction was performed. Three patients of bilateral or unilateral condylar fractures, aged between 2y and 6y, were involved in this treatment. After more than 1 year's follow-up, the occlusion was satisfactory in all patients. Condylar remodeling was approximately complete in 3 months, and no unwanted complications were observed. We may expect this method to offer a new idea when dealing with children's condylar fracture.

Influence of Method of Treatment of Mandibular Condylar Fractures on Range of Articular Path Measured by Cadiax Device.

Background/Objectives: The aim of this study was to evaluate the function of the treated temporomandibular joint based on the analysis of the image of the articular path using the Cadiax device depending on the choice of treatment method for unilateral condylar fracture of the mandible. Methods: Sixty patients who were treated for condylar fractures of the mandible at the Maxil-lofacial Surgery Department in Katowice were qualified for the analysis of the range of movements of the mandibular heads using the Cadiax device. From the group of patients who suffered fractures of the mandible, including condylar processes, patients were finally qualified for the measurement of the articular path of the injured and healthy joint according to strict criteria. Results: The condylar examination was performed in 20 patients who had conservative condylar fracture treatment and 40 patients who underwent various surgeries in the course of a single condylar fracture. The control group consisted of 20 patients whose mean values for the articular pathway measured for both sides were 12.73 and 12.69 and fell within the standard developed for healthy joints tested with the Cadiax device. Conclusions: We have achieved an almost ideal treatment for condylar fractures. We are also beginning to notice the need for rehabilitation of patients after this type of surgery.

Effect of Different Treatment Modalities for Condylar Fractures in Childhood on Mandibular Symmetry and Temporomandibular Joint Function: A Retrospective Study.

In a retrospective study of the effects of different treatment modalities of condylar fractures in childhood on mandibular symmetry and temporomandibular function, the cases selected for this article were adult patients who had sustained a condylar fracture in childhood. The aim was to investigate the effects of condylar fractures in children on the development and function of the mandible and their specific manifestations after the completion of mandibular development. According to the different treatment modalities, the patients were divided into the conservative treatment group and the open surgical treatment group, and the effects of the 2 treatment modalities on the patients' condylar healing, the difference in growth ability, and the symmetry of the jaws were evaluated. The effects of different treatment modalities of children's condylar fracture on the growth, development, and function of the mandible were investigated using the Ai and Di, the grading of the imaging results, and the 3-dimensional CT fixation measurements from the aspects of both clinical examination and imaging examination. The 2 groups had condylar malalignment and condylar morphology abnormality, and there was one case of joint ankylosis in the surgical treatment group. There was a statistical difference in the evaluation of condylar reconstruction between the 2 groups, and the condylar reconstruction in the surgical treatment group was better than that in the conservative treatment, and there was a statistical difference between the condylar length, condylar width, condylar height, and depth of TMJ fossa between the healthy side and the affected side in the closed treatment group. There was a statistical difference in the height of the mandibular ascending branch between the healthy side and the affected side, and the unilateral condylar fracture was treated conservatively; the difference in the bony chin point deviation between the 2 groups was not statistically significant. In children, after conservative treatment of condylar fracture, the growth of condylar process is poor, and the condylar shape and position are not as good as surgical repositioning, but through the proliferation of temporomandibular joint fossa, it can make up for the insufficient height of condylar process, which has no effect on the symmetry of the mandible, and the surgical treatment can achieve good anatomical repositioning, which has a greater effect on the symmetry of the mandible than the conservative treatment.

Transoral endoscopic-assisted VS external approach for performing ORIF in mandibular condyle fractures: A case-series study

ObjectiveThe treatment of condylar fractures can have significant morbidity. The purpose of this study is to suggest the safest approach by comparing endoscope-assisted and open surgery. MethodsA case-series study was conducted in the Maxillo-Facial Surgery Unit of the Federico II University of Naples from January 2016 to January 2022 on 34 patients who underwent surgery for condylar fracture. Thirty patients met the inclusion criteria. They were divided into two groups according to the surgical technique used: Group A, made up of 15 patients treated by endoscope-assisted surgery; Group B made up of 15 patients treated by traditional non-endoscope-assisted surgery. ResultsThe most common complication was transient facial nerve palsy, observed in group B in 4 patients (26%) and in only 2 patients in Group A (13%). Permanent facial nerve palsy occurred in 2 patients (13%) in Group B. No permanent facial nerve palsy was observed in Group A. No plates infection occurred in Group A, 1 case (7%) was recorded in Group B. ConclusionsFrom our experience we can consider endoscope-assisted surgery a favorable option for treating condyle fractures. Patients’ selection for transoral endoscope-assisted surgery is extremely important to ensure the best surgical results with the less complications score.

Three-Dimensional Navigation-Assisted Open Reduction and Internal Fixation of a Subcondylar and Ramus Fracture on a Maxillary Oligodontia Patient.

Treatment of condylar fractures in patients with edentulous mandibles or no-occlusion reference is particularly challenging due to the absence of important anatomical structures and landmark for occlusion analysis. In this case, a 69-year-old female maxillary oligodontia victim suffered from a traumatic accident with a right facial contusion, resulting in a right-side subcondylar and mandibular ramus fracture with right ramus height loss. In the preoperative planning, the 3-dimensionalimage of the left-side mandible was highlighted by the navigation software. A mirror image of the left-side mandible was made and superimposed on the right side of the face. Surgical intervention with an endoscope and 3-dimensional navigation-assisted open reduction and internal fixation of the right-side subcondylar and ramus fracture was performed. The patient recovered well with no restriction in mandibular movement, no limitation in mouth opening, and a satisfied esthetic outcome.

Modified Blair’s (Transparotid) Approach for Open Reduction of Condylar Fractures - Our Experience

The treatment of condylar fractures is complex and controversial.The aim of the present study is to evaluate the treatment outcomes of open reduction of condylar fractures using Modified Blair’s (Transparotid) approach. Materials and Methods: A prospective study was conducted March 2021 to April 2023. Patients reporting to the department with condylar neck/ subcondylar fractures with or without other facial bone fractures and requiring open reduction internal fixation were included in the study. Modified Blair’s (Transparotid) approach was used to expose the condylar fracture site. Intraoperative surgical time of exposure, post-operative variables like swelling, pain, status of occlusion, facial nerve dysfunction, salivary leakage (salivary fistula/sialocele), Frey’s syndrome, greater auricular nerve damage, subjective assessment of scar esthetics were recorded after immediate post-op day 1, after 1st post-op week, after 1st post-op month, after 3rd post-op month and after 6th post-operative month. Results: The study included 36 condylar fractures sites in 30 patients, 24 unilateral and 6 bilateral. The mean average time from incision to exposure of fracture site was 22.5 minutes. Mild occlusal discrepancy was recorded in 3 patients which was corrected with elastic traction in the post-operative period. Transient facial nerve dysfunction was recorded in 6 patients with spontaneous recovery of nerve function within 6 months. No other major complications were noted. Conclusion: The Modified Blairs (transparotid) approach provided sufficient exposure of the condylar fracture site to facilitate anatomical reduction. It is a good technique and provides stable results with low complication rates and acceptable scar.

Outcomes of Open Reduction and Internal Fixation for Supracondylar Humeral Fractures in Children

Objectives: The aim of this study was to evaluate the results of open reduction and internal fixation of humeral supracondylar fractures in pediatric patients. Patients and methods: A retrospective descriptive study conducted from 2006 to 2016, including 24 patients who underwent open reduction and internal fixation for the treatment of condylar fractures, adjusted by the closed method. The patients were clinically and radiographically evaluated according to the Gartland’s classification. Data collection also included postoperative radiological assessment, range of motion, presence of postoperative complications, and satisfaction questionnaire with treatment received. Results: Patient’s age: Mean 9.46 ± 2.07; Males : 15 (62.5%), Femeals: 9 (37.5%); Injured elbow: Left 17 (70.8%), Right 07 (29,2%); Injury/Sugery Interval (days): 2.2 ± 0.78; Gartland’s classification: Type II: 6 (25%), Type III: 17 (70.8%), Type IV: 1 (4.2%); Foll-up Period (months): 44. 08 ± 5.78; Baumann angle: 16.12° ± 2.23°; Final loss of flexion: averaged 5.9°; loss of extension: 0.73°. The KW was removed was 4.2 months (range: 3 - months). Complications: KW Pierce through brachial artery (intra - Operatively) 1 (4.2%), Iatrogemic ulnar injury 1 (4.2%), Cubitus varus 1 (4.2%). Evaluation: Satisfactory 22 (91.7%), Unsatisfactory 02 (8.3%). Conclusions: Conservative treatment is recommended for Gartland type I and nondisplaced type II fractures. Open reduction with two or three pins is the preferred treatment option for most supracondylar fractures. The use of appropriate criteria is wise in managing these cracks; Prognosis in the event of complications or possible complications should be explained.

A Comparison of Clinical Outcomes in Patients of Mandibular Condyles Fractures Treated with Open Versus Close Reduction

Aim: The absence of a widely acknowledged and conclusive therapy for condylar fractures is a matter of contemporary debate and contention, with the issue of whether surgical or conservative approaches are better suitable for managing such fractures being unresolved. This study investigates several methodologies pertaining to the conservative, closed, and open surgical interventions for the treatment of condylar fractures. The standardization of fracture classification systems and treatment techniques is necessary to provide a clear and optimum strategy for individual individuals and their respective fractures. Objectives: The objectives of the study are to compare clinical outcomes in patients of mandibular condyles fractures treated with open versus close reduction. Method: A total of 84 individuals diagnosed with subcondylar fractures of the mandible were assessed. All fractures seen in the study exhibited displacement, with either angulation ranging from 10° to 35° or a reduction in length of the ascending ramus by more than 2 mm. A comprehensive assessment, including both clinical and radiographic examination, was conducted at the 6-month mark after the occurrence of the trauma. The clinical criteria assessed in this study included mouth opening, temporomandibular joint (TMJ) discomfort, mandibular deviation, malocclusion, facial damage, and scar formation. Results: The findings indicated a statistically significant difference between the two groups, with a p-value of less than 0.05. The findings suggest that open reduction was found to be more efficacious than closed reduction in enhancing mouth opening, mandibular deviation, TMJ discomfort, and malocclusion. Conversely, closed reduction was shown to be more beneficial than open reduction. Conclusion: The study findings indicate that the open treatment approach yields superior progress compared to closed techniques, and these differences are statistically significant. Patients who had open reduction demonstrated considerably superior results in all functional measures, with the exception of facial nerve damage and scar formation, when compared to those who underwent closed reduction. Keyword: Mandibular fracture, open reduction, closed reduction, clinical outcome

A Novel Approach to the Treatment of Comminuted Mandibular Condyle Fractures

Introduction: A suture enlocation (SE) approach is proposed to manage comminuted intra-articular mandibular condyle fractures not amenable to open reduction internal fixation approaches. The SE approach is an effective operative option for the treatment of condylar fractures with the combination of fracture dislocation, malocclusion, comminution, and inadequate surface area for open fixation techniques. This study describes the SE approach, outcomes, and complications. Methods: The SE technique is described, and the health records of patients treated with the SE approach are reviewed. Outcome data were collected for diet, interincisal opening, occlusion, pain, and complications. Results: Technique: The SE approach involves reducing the fractured condylar fragment using a hole drilled through the fragment to secure it to the periosteum with a polydioxanone suture. This allows the reduced fragment to be managed as a nondisplaced fracture with mandibulomaxillary fixation and class 2 elastics. Outcomes: A chart review involving 8 patients (11 condyles) illustrates the outcomes of the SE approach from 2006 to 2021. Age at the time of injury ranged from 12 to 51 years and the follow up ranged from 2 to 68 months. At final follow up, 7 patients were eating a regular diet, 7 had normal interincisal opening, 4 had normal occlusion, and 4 reported ongoing mandibular discomfort. Failure of fixation occurred in 1 case, which required further operative management. Conclusions: The SE technique shows promise as an effective way to reduce fracture components, manage occlusion, and facilitate secondary bone healing in comminuted and displaced mandibular condyle fractures.

Assessment of Various Complains after Non-Surgical Treatment of Condylar Fracture

Objective: To assess various complains of patients after non-surgical treatment of condylar fracture. Methodology: A cross-sectional study was performed from October 2021 to October 2022 at the Department of Oral and Maxillofacial Surgery, Nishtar Institute of Dentistry, Multan. The sample size collected was 34 patients using a consecutive non-probability sampling. Using pertinent clinical examination, the patient was assessed for disturbed occlusion, limited mouth opening, deviation of the mouth, pain, and clicking sound. The mean follow-up period was six months. Results: The male-to-female ratio was 1.8: 1, with male predominance. The leading cause of fracture was attributed to incidents involving road traffic accidents (RTAs) (n—26, 76.5%).Twenty-three patients had a positive post-opt complaint after treatment, from which the most complaints presented were with unilateral condylar fracture n=15. The most common complaint presented was TMJ Pain with limited mouth opening n=8(23.5%). Conclusion: Conservative care for unilateral mandibular condyle fractures is a safe treatment approach. However, it can cause a few post-treatment functional complaints, the most frequent of which is TMJ pain. To further evaluate the improvement in function and discomfort, more research and consistent long-term follow-ups are required. Keyword: Temporomandibular joint movement (TMJ), TMJ Pain, Maxillomandibular Fixation (MMF)

Total temporomandibular mandibular joint alloplastic replacement as first line treatment for condylar fracture

The treatment of condylar fractures has been the subject of debate and controversy. Open reduction and internal fixation, along with closed reduction, are the 2 main treatment modalities when well indicated and performed. In specific situations, however, the success of both treatment modalities can be challenged by local or systemic conditions. Alloplastic total temporomandibular joint replacement (TMJR) with the current systems, Biomet and Stryker, has proven to be successful in the long-term. The authors present 2 cases and propose the consideration of TMJR as a first-line treatment for condylar fractures in the following situations: fractures older than 4 weeks; 2) elderly patients with severely dislocated or displaced condyles; 3) condylar dislocation into the cranial fossa; 4) maxillomandibular fixation is not a viable option.

Modification of retromandibular approach in open reduction of condylar/subcondylar fractures

Mandibular condylar fractures are common in traumatic mandible fractures. Up to date, several techniques ofopen reduction have been proposed for the treatment of condylar fractures. In this report, some modifications ofretromandibular approach will be discussed.

Quality of life related to both general and oral health two years after treatment for subcondylar fracture

The success of treatment for condylar fractures is usually assessed by functional outcomes, while studies on patient perceptions are scarce. A cross-sectional study was performed to assess the middle-term quality of life, related to both general health and oral health, of patients treated for subcondylar fracture, either by open reduction or by closed fixation, compared to healthy volunteers. In a single trauma centre, among 226 consecutive patients with subcondylar fractures that were treated in years 2018–2019 (two to three years prior to the survey), 148 fulfilled the selection criteria. They were classified as those with other facial fractures that were treated by open reduction (n = 79), and those without other fractures that were treated either by open reduction (n = 34) or by closed fixation (n = 35). An age matched group of healthy volunteers (n = 65) also participated in the study. All participants replied to the Short-Form-Health-Survey (SF-36) and the Oral-Health-Impact-Profile (OHIP-49), using the social messenger platform WhatsApp. The SF-36 showed that patients with closed-fixation reported better mental health than patients with open reduction, but worse than healthy volunteers. Contrariwise, on the OHIP-49, compared to patients with open reduction (with/without other facial fractures) and to healthy volunteers, patients with closed-fixation reported worse quality of life on physical pain, psychological discomfort, and physical disability. The influence of age was evident just on the OHIP-49, on the report of physical limitation and physical pain. Two to three years after the subcondylar fracture, patients treated either by open reduction or closed fixation might report decreased quality of life compared to healthy volunteers; patients treated by open reduction might report lesser mental health related quality of life (SF-36), but superior oral health related quality of life (OHIP-49) than patients treated by closed fixation.

Comparative evaluation of post treatment CT scan and clinical parameters in open reduction and closed reduction treatment of condylar fractures.

Mandibular fracture is the second most common fracture of facial bone, next to nasal bone. Twenty-five to forty percent of mandibular fractures involve the condyle. In the literature, there exists no consensus "gold standard" treatment for mandibular condylar fractures, and there is a continuing debate on whether condylar fractures should undergo closed or open reduction. Twenty patients who had undergone open reduction and closed reduction treatment were included in the study. Clinically maximal interincisal opening, laterotrusive and protrusive movements, pain on mouth opening, malocclusion, chin deviation on mouth opening, facial nerve palsy, hematoma, infected implant, and bite force were evaluated after a minimum of 3 months postoperatively. Also, a postoperative CT is done to evaluate the anatomical position of fragment. On evaluation of clinical parameters, both groups had comparable results. However, none of the patients in open reduction group had deviation of mandible from midline on mouth opening. Also, better anatomical repositioning is obtained in open reduction group. The results of this study suggest that the open reduction method is a better alternative to closed reduction in treatment of mandibular condylar fractures.

Modified high-submandibular appraoch for open reduction and internal fixation of condylar fracture: case series report.

Recently a modified high-submandibular approach (HSMA) has been introduced for treatment of condylar fracture. This approach involves an incision line close to the mandibular angle and transmasseteric transection, leading to a low incidence of facial palsy and allowing good visualization of the condyle area, especially the condylar neck and subcondyle positions. This study reports several cases managed with this modified HSMA technique for treating condylar fractures. Six cases of condylar fractures treated with modified HSMA technique were reviewed. Three unilateral subcondylar fracture, 1 bilateral subcondylar fracture, 1 unilateral condylar neck fracture, 1 unlateral simultaneous condylar neck and subcondylar fracture cases were reviewed. All the cases were successfully treated without any major complication. Reduction, fixation, and osteosynthesis of condylar fractures via the modified HSMA technique enabled effective and stable treatment outcomes. Therefore, the described approach can be used especially for subcondylar and condylar neck fractures with minimal complications.

Post Operative Outcomes of Single Versus Two Miniplates for Management of Condylar Fractures

Objective: To compare the outcomes in patients with single versus two miniplates for condylar fracture. Study Design: Cross-Sectional Study Place and Duration of Study: The study took place in Department of Oral & Maxillofacial Surgery, Institute of Dentistry LUMHS, Jamshoro. The duration of study was 6 months after the approval of the synopsis. Methodology: 40 people in all were included in the trial. A single miniplate was used for Group A's treatment, whereas two miniplates were used for Group B's treatment. Clinical assessment, orthopantomogram (OPG), a P.A. image of the face, and, if necessary, a 3D CT scan will be used to make the diagnosis of condylar fracture.The data was analysed by SPSS version 21 Results: Results of this investigation indicated that the preoperative evaluation of the variables including malocclusion, mouth opening, protrusive movement, and lateral movement revealed greater values, but much less means were found in postoperative examination. ANOVA is done one method to compare the means between preoperative and postoperative malocclusion. The statistical comparison is significant at less than 5%. The examination of platform fracture or bending occurs after the operation, which demonstrates that 92.5% of the population without platform fracture, while 7.5% exhibit platform fracture after surgery. Conclusion: In conclusion, it is indicated that two miniplates with less complicated fixing are superior to a single miniplate. Keywords: condylar fracture, single miniplates, double miniplate, treatment of condylar fracture, post-operative outcomes of condylar fracture.

Minimally Invasive Reduction and Stabilization of Fractures of the Humeral Condyle by Skeletal Traction in Dogs: 18 Cases

AbstractClosed reduction or limited open reduction in conjunction with internal or external fixation has been recommended as the preferred treatment for many types of fractures, but this technique has rarely been recommended for articular fractures because of the need for anatomic alignment of articular surfaces. However, the proposed benefits of closed reduction should be applicable to articular fractures if appropriate reduction and implant placement can be achieved. The aim of this study was to retrospectively evaluate a surgical technique for minimally invasive reduction and stabilization of fractures of the humeral condyle by means of intraoperative traction applied to the ulna under fluoroscopic guidance. Nineteen fractures of the humeral condyle in eighteen dogs were reduced by intraoperative osteotaxis applied by traction of the ulna, minimally invasive approach to the epicondyle and fracture stabilization under fluoroscopic guidance. Postoperative reduction was considered good or excellent in most fractures. This technique can be considered as a potential option for the treatment of condylar fractures, allowing for minimally invasive reduction and stabilization, thus avoiding the need for surgical exposure of the elbow joint.

Extracorporealization of the Mandibular Condyle: Effects on Viability and Function.

For certain condylar fractures, extracorporealization of the condylar segment may be performed via extra-oral vertical ramus osteotomy (EVRO) to facilitate reduction and fixation. This approach can similarly be used for condyle-sparing resection of osteochondromas of the condyle. Due to controversy regarding long-term health of the condyle after extracorporealization, we conducted a retrospective analysis of surgical outcomes. For certain condylar fractures, extracorporealization of the condylar segment may be performed via extra-oral vertical ramus osteotomy (EVRO) to facilitate reduction and fixation. This approach can similarly be used for condyle-sparing resection of osteochondromas of the condyle. Due to controversy regarding long-term health of the condyle after extracorporealization, we investigated the viability of this technique through a retrospective analysis of outcomes. Twenty-six patients were treated using EVRO with extracorporealization of the condyle for both condylar fractures (18 patients) and osteochondroma (8 patients). Of the 18 trauma patients, 4 were excluded due to limited follow-up. Clinical outcomes were measured, including occlusion, maximum interincisal opening (MIO), facial asymmetry, incidence of infection, and temporomandibular joint (TMJ) pain. Radiographic signs of condylar resorption were investigated, quantified, and categorized using panoramic imaging. Average follow-up was 15.9months. Average maximum interincisal opening was 36.8mm. Four patients demonstrated mild resorption and one patient demonstrated moderate resorption. Two cases of malocclusion were attributed to failed repairs of other concurrent facial fractures. Three patients reported TMJ pain. Extracorporealization of the condylar segment with EVRO to facilitate open treatment of condylar fractures is a viable treatment option when more conventional approaches prove unsuccessful.

Stability of single 3-D trapezoidal plate in condylar fracture in comparison to 2 Miniplates

Background: Condylar fractures account for one third of all mandibular fractures being in the range of 17.5–52%1, 2 of all mandibular fractures. The main goal in the treatment of condylar fractures is to predictably restore pre-injury anatomical form, with associated aesthetics and function. Aim: The aim of this study is to assess the efficacy and stability of single 3-D trapezoidal condylar plate and compare it with 2.0mm conventional miniplates in the Open Reduction and Internal Fixation of mandibular sub-condylar fractures. Methods: This study was conducted on 20 patients with subcondylar fracture.10 patients were allotted by random sampling in each Group. 3-D trapezoidal condylar plates were used in Group A and 2.0mm conventional minplates were used in Group B. The mini retromandibular surgical approach was common to both the groups. Function and stability was assessed post operatively at 1st, 3rd and 6th month respectively. Results: Intergroup analysis showed no statistically significant difference in results with respect to function and the stability of the fractured fragments. Conclusion: 3D trapezoidal condylar plates are more stable and structurally more efficient in reducing the torque forces leading to better osteosynthesis.

A comparative evaluation of retromandibular versus Modified Risdon approach in surgical treatment of condylar fracture

The purpose of this study was aimed to compare the efficiency and safety of retromandibular versus modified Risdon approach using periangular incision for open reduction and internal fixation of low subcondylar mandibular fracture. Open reduction and internal fixation with different plating systems were utilized via retromandibular approach (group I) and via modified Risdon approach with periangular incision (group II).Twenty four (n= 24) condylar fractures in 21 adult patients were divided randomly into two equal groups (12 each) according to the cutaneous incision (approach) utilized. The evaluation score for scarring in group I it was excellent in 9 patients, good in 2 patients and acceptable in only one patient (Mean 2.4 ± SD 3.38). While in group II was excellent in 10 patients and good in 2 patients (Mean 2.4 ± SD 3.87) and the p value was 0.591. Symptoms of transient facial nerve weakness were noted in only 3 patients in group I with slight to moderate dysfunction (Mean 2 ± SD 3.21), while only one patient had facial nerve weakness in group II with House - Brackman score of 2 immediate postoperatively and this got resolved in 6 weeks (Mean 2 ± SD 4.04) and the p value was 0.00022.Within the limitations of the study it seems that a modified Risdon approach using periangular incision for reduction and fixation of low subcondylar fracture should be preferred whenever possible because it yields better outcomes.