Surgical Versus Non Surgical Treatment of Fractures of the Mandibular Condyle

الملخص

The mandible is frequently injured after facial trauma, and 25 to 40% of mandibular fractures involve
the condyle. Management of mandibular condylar fractures remains an ongoing matter of controversy
in maxillofacial surgery. The current study was designed to assess significant differences in clinical outcomes
between surgical and non surgical methods of treatment for mandibular condylar fractures.
The study consisted of 134 patients. 107 patients had non-isolated unilateral and 27 patients had bilateral condylar
fracture. Surgical method (open reduction) was conducted in 56 patients with unilateral condylar fractures and 15
patients with bilateral condylar fracture. Non surgical method, (closed reduction) was done in 51 cases of unilateral
and 12 cases of bilateral condylar fracture between 2005- 2015. In non surgical method 54 patients underwent
maxillomandibular fixation with arch bars and 9 patients underwent maxillomandibular fixation using Ivy eyelet
wiring under local anesthesia.
The maxillomandibular fixation was maintained for 2- 4 weeks. In surgical method, under general anesthesia;
approaches used were submandibular in 13 cases. mini-retromandibular incision was used in 58 patients. Fixation was
carried with 4 holes straight miniplate. Elastic maxillomandibular fixation was used for 5 to 7 days postoperatively
only for patients with bilateral condylar fracture.
134 patients with condylar fractures were included in this study. Out of 134 patients 108 were males and 26 females.
Road traffic accidents were the most common cause of trauma, 98 of 134 patients (73%), gunshot, 26 patients
(19.5%), work injury, 6 patients (4.5%), and sports injury 4 patients (4.5%). The age distribution showed a typical
peak between 20 and 40 years (70%). There were 103 subcondylar fractures (77%), 16 cases (12%) were condylar
head (intracapsular) fracture and 15 (11%) was condylar neck fracture. There were 15 associated other mandibular
fracture ( body, angle, parasymphysis (12%); and the rest were isolated condylar fractures (92 patients had unilateral
and 27 patients had bilateral condylar fracture).
Fracture without displacement of the mandibular condyle neck, traditionally been managed with non surgical
method (closed reduction technique) and the functional result of the non surgical method is dependent entirely on the
accidental position of the fragments.
Any of the following points was an indication for surgical method (open reduction);
- A unilateral fracture with considerable overriding of the fragments.
- A bilateral fracture with considerable overriding and resultant open bite.
- Gross malalignment of condylar fragment i.e. situated at an angle to the ramus and projecting over it.
- A position of the condyle that causes interference with the movement of the jaw or limits its opening