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DOI: 10.5999/aps.2017.00962
Retromandibular reduction of medially dislocated condylar process fractures
This article was presented at the 2017 Korean Cleft Palate-Craniofacial Association Symposium on March 18–19, 2017, in Seoul, Korea.![](https://www.thieme-connect.de/media/10.1055-s-00051611/201801/lookinside/thumbnails/10_5999_aps_2017_00962_23-1.jpg)
Background Condylar process fractures account for one-third of all mandibular fractures, and the distal fragment is prone to dislocate to the medial side due to the pulling of the lateral pterygoid muscle. Retromandibular approaches are commonly used, but the intraoperative view becomes limited in medially dislocated fractures. This study summarized a series of cases of retromandibular reduction for medially dislocated condylar process fractures and described our supplementary procedure to realign the dislocated condylar process.
Methods Nine patients with medially dislocated condylar process fractures underwent surgical correction from January 2012 to December 2016. In 6 of them, it was possible to realign the fractures with a conventional retromandibular approach, but for 3 cases of severe dislocation to the middle cranial fossa, a supplementary transoral procedure was carried out. The angle difference between the ramus and condyle, ramus height, and maximal mouth opening (MMO) were evaluated.
Results All 9 cases were restored to the proper anatomical alignment without any major complications, and postoperative images revealed successful union. The angle difference was 8.94°±4.11° preoperatively, and 0.99±0.49° at the 6-month follow-up. The pretreatment ramus height difference was 6.12±6.09 mm, and the postoperative difference was 0.18±0.10 mm. These changes after surgery were statistically significant. The MMO before surgery was 11.44±3.0 mm, and the postoperative MMO was 37.2±2.9 mm, reflecting a significant increase after reduction.
Conclusions Retromandibular reduction is a useful method in medially dislocated condylar process fractures, and additional transoral assistance should be considered to realign condylar processes that severely dislocate to the middle cranial fossa.
Publication History
Received: 31 May 2017
Accepted: 24 October 2017
Article published online:
03 April 2022
© 2018. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)
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REFERENCES
- 1 Kang DH. Surgical management of a mandible subcondylar fracture. Arch Plast Surg 2012; 39: 284-90
- 2 Haug RH, Prather J, Indresano AT. An epidemiologic survey of facial fractures and concomitant injuries. J Oral Maxillofac Surg 1990; 48: 926-32
- 3 Bos RR, Ward Booth RP, de Bont LG. Mandibular condyle fractures: a consensus. Br J Oral Maxillofac Surg 1999; 37: 87-9
- 4 Zide MF, Kent JN. Indications for open reduction of mandibular condyle fractures. J Oral Maxillofac Surg 1983; 41: 89-98
- 5 Liu CK, Liu P, Meng FW. et al. The role of the lateral pterygoid muscle in the sagittal fracture of mandibular condyle (SFMC) healing process. Br J Oral Maxillofac Surg 2012; 50: 356-60
- 6 Handschel J, Ruggeberg T, Depprich R. et al. Comparison of various approaches for the treatment of fractures of the mandibular condylar process. J Craniomaxillofac Surg 2012; 40: e397-401
- 7 Villarreal PM, Monje F, Junquera LM. et al. Mandibular condyle fractures: determinants of treatment and outcome. J Oral Maxillofac Surg 2004; 62: 155-63
- 8 Kim HJ, Roh TS, Tark KC. et al. Outcome of surgical treatment for mandibular condyle fractures. J Korean Soc Plast Reconstr Surg 2004; 31: 632-6
- 9 Haug RH, Assael LA. Outcomes of open versus closed treatment of mandibular subcondylar fractures. J Oral Maxillofac Surg 2001; 59: 370-5
- 10 Hinds EC, Girotti WJ. Vertical subcondylar osteotomy: a reappraisal. Oral Surg Oral Med Oral Pathol 1967; 24: 164-70
- 11 Koberg WR, Momma WG. Treatment of fractures of the articular process by functional stable osteosynthesis using miniaturized dynamic compression plates. Int J Oral Surg 1978; 7: 256-62