• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.48 no.5
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• pp.267-276
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• 2022

Objectives: 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. Materials and Methods: Six cases of condylar fractures treated with modified HSMA technique were reviewed. Results: 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. Conclusion: 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.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.5
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• pp.488-492
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• 2010

This review evaluates the literature on the relationship between mandibular condylar process fracture and temporomadibular joint (TMJ). The topic of condylar fracture generated more discussion and controversy than any other field of maxillofacial trauma associated with TMJ. Disturbance of occlusal function, devia-tion of mandible, internal derangements of TMJ, and ankylosis of the joint with resultant inability to move the jaw are sequelae of condylar process fracture. Thus it is necessary to understand how the masticatory system adapts to the structural alterations that accompany fractures of the mandibular condyle. Treatment of condylar process fracture include two methods ; closed treatment and open treatment. If one chooses totreat closed, one must understand that adaptations in the musculature, skeleton, and dentition will be necessary. Open treatment of condylar process fractures probably requires fewer adaptations within the masticatory system to provide a favorable functional outcome. However, one must weigh the risk of open surgery against the possible improvement in outcome. The risks are not just surgical risk, but biological risk as well, such as disruption of the blood supply to the condyle. This review presents relevant aspects of change of TMJ associated with condylar process fracture.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.31 no.1
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• pp.82-88
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• 2005

Treatment methods of mandibular condylar fracture were conservative and surgical method. Surgical method of mandibular high condylar fracture was very difficult because approach and internal fixation of small size fracture fragment were difficult. So there is a tendency to select conservative method over surgical method for guiding a stable occlusion and avoiding TMJ disorder and growth disturbance, minimizing pain and deviation during function. But, in case of mandibular high condylar fracture patient who has no biting teeth on posterior teeth area, guiding a stable occlusion and conservative functional treatment were very difficult. In this case, patient was 62years old male. He had fracture of mandibular symphysis, right mandibular body, left mandibular high condyle. We treated the patient for mandibular symphysis and right mandibular body fracture area with surgical method. But left mandibular high condylar fracture area was difficult to treat with surgical method. So we selected a conservative functional method on left mandibular high condylar fracture area. We intended recovery of vertical dimension and stable occlusion with implantation of immediate provisional implant on maxillar and mandibular posterior teeth area, and temporary crown. And then patient did mandibular functional movement and his mandibular function was recoverd.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.43 no.5
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• pp.343-350
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• 2017

The aim of this study is to introduce a surgical technique that can maintain blood supply to prevent condylar resorption in the extracorporeal reduction of condylar fracture. Neither the medial pterygoid muscle on the ramal bone nor the lateral pterygoid muscle on the condylar fragment was detached after vertical ramal osteotomy. Thus, reduction was performed in the intracorporeal state. Therefore, blood supply was expected to be maintained to the fragments of both the condylar and ramal bones. On postoperative radiographs, the anatomical outline of the fractured condyle was well restored, and the occlusion was stable. In the unilateral case, there were no signs of mandibular condylar resorption until postoperative 3 weeks. In the 2 bilateral cases, condylar displacements with plate fractures and screw loosening were observed at postoperative 1 month or 5 months, but radiodensity at the displaced fracture site increased during the follow-up period. Finally, complete remodeling of the condylar fragments with restored anatomic appearance was observed on 8-month or 2-year follow-up radiographs. All cases exhibited good healing aspects with no signs or symptoms of mandibular condylar dysfunction during the postoperative remodeling period after intracorporeal reduction of condylar fracture.

• Archives of Craniofacial Surgery
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• v.10 no.2
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• pp.131-134
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• 2009

Purpose: Mandible fractures are common in maxillofacial trauma and the incidence of condylar fracture is high. The management of mandibular condylar fracture continues to be controversial. Conservative treatment of it may lead to complications such as asymmetry, malocclusion, temporomandibular joint dysfunction. Moreover, open reduction can cause facial nerve injury, parotid gland injury, scarring and hematoma formation. We present a case of mandibular condylar fracture that was treated by manual reduction without incision under C-arm fluoroscopy. Methods: A 76-year-old female was admitted due to left side mandibular condylar fracture that required surgical intervention. Because of her age, history of diabetes mellitus, hypertension, she underwent closed manual reduction under general anesthesia. We adopted C-arm fluoroscopy as a method of identifying the fracture site and a evaluation of reduction state. C-arm fluoroscopy was set up like modified Towne's view. Results: The reduction was successful and didn't result in any complications that could occur in open reduction-facial nerve injury, infection, parotid gland injury, hematoma, avascular necrosis. The mandibular-maxillary fixations were removed after 4 weeks and patients were could open 3.5 cm after 6 weeks with physical therapy. Conclusion: We tried closed manual reduction of mandibular condylar fracture due to high risk of complication using C-arm fluoroscopy and did achieve anatomic reduction with avoiding open incision. This is simple, effective, reversible, time saving and fairly attemptable method in condylar fracture cases before open reduction.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.37 no.6
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• pp.448-456
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• 2011

Introduction: Condylar fractures are common in the maxillofacial region, comprising 29-40 percent of all mandibular fractures, accounting for about 20-62 percent). Previous studies reported that pediatric condylar fractures can cause disorders in facial growth and function, and the treatment methods have been controversial. Recently, conservative treatment has shown good results in skeletal growth and functional recovery but the conservative treatment of pediatric condylar fractures has shown unpredictable and undesirable results in some cases, such as facial asymmetry and temporomandibular joint disorder. This study examined the specific age groups and specific mandibular condylar fracture type in growing children treated conservatively in the past. Materials and Methods: Eighteen patients (10 men and 8 women) who received conservative treatment for unilateral condylar fractures in Dankook University Dental Hospital between 2000 to 2007 were followed up for a mean period of 7.2 years. Results: In the survey of 18 pediatric patients who received conservative treatment for condylar fractures, the incidence of temporomandibular dysfunction and growth disturbance was 45% and 35%, respectively. Conclusion: In all complications, the symptoms observed most frequently was mouth opening displacement of the mandible exceeding 2 mm. The other complications of functional and growth disturbance included facial asymmetry concentrated along specific condylar types. Complications including facial asymmetry and functional and growth disturbances showed an increasing tendency according to the specific fracture types. Functional and growth disturbances in the undisplaced condylar fracture type showed a lower incidence(P <0.05). Functional and growth disturbances differed according to the fracture type, which has poor relationship with articular fossa and condyle(P <0.05). Functional and growth disturbance in the cases of the high-level condylar fracture type showed a higher incidence(P <0.05). The functional and growth disturbances of the fracture types were similar in the fragment-contact and non-contact groups(P >0.05).

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.6
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• pp.521-528
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• 2010

Purpose: Anatomical reduction of the fractured condylar process is an important prerequisite for re-establishing function. The authors reported about effectiveness of transoral approach for mandibular subcondyle fracture using trochar device in cases that the fracture line is below the reference line, the perpendicular line of the longitudinal axis of condylar process passing the lowest point of sigmoid notch. As a serial study, we report the open reduction via preauricular approach for mandibular condyle fracture, in cases that the fracture line is above the reference line. Patients and Methods: Sixteen condylar fractures of 15 adult patients were divided two groups and treated by open reduction via preauricular approach (8 cases) or by closed reduction (8 cases). The degree of maximal mouth opening, occlusion, anatomical reduction, condylar resorption and complications were assessed and evaluated for the two groups. Results: The open reduction of condyle via preauricular approach leads to good results without permanent complications. Anatomical reduction of open reduction group and maximal mouth opening range of the closed reduction group is significantly better than the other group. No significant differences were found in the condylar resorption and the occlusion. Conclusion: The preauricular approach was useful to reduce and fix the condylar fragment, in cases that the fracture line is above the reference line.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.25 no.2
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• pp.447-457
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• 1995

The subjects of this study consisted of 75 patients with 83 condylar fractures, who were admitted to Chonbuk National University Hospital from Jan. 1988 to Oct. 1995. The purpose of this study was to compare the imagings of conventional radiograms with those of computed tomograms and to aid in the diagnosis of condylar fractures. Also the author evaluated the usefulness of 3-dimensional reconstructive imaging in condylar fractures. The obtained results were as follows: 1. The condylar fractures were observed mainly between 2nd and 4th decades, but there was no significant difference of incidence between decades. The incidence of condyalr fractures by fracture site was subcondyalr(44.6％), condylar head(36.1％), condylar neck(19.3％) in orders. 12 of 30 condylar head fractures were sagittal splitting fractures. 2. According to the relationship of condylar head to articular fossa, the incidence of condylar fractures was higher in Type II and Type m. And the incidence of subcondylar fractures was higher in Type I classified by Mclennan. But there was no significant difference of incidence between Types. 3. The more the fracture fragments were displaced, the easier the fracture patterns were detected in conventional radiograms. The computed tomograms were also useful in the diagnosis of sagittal splitting fractures which were displaced mesially. 4. The 3-dimensional reconstructive imaging were useful in the evaluation of the fracture patterns, but they were not useful when the size of fragment and the degree of displacement were small.

• Journal of Yeungnam Medical Science
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• v.19 no.2
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• pp.144-150
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• 2002

Mandibular condylar fracture is common in mandibular fractures. Unlike other facial, skeletal fractures, most of mandibular condylar neck or head fractures are treated with closed reduction and subsequent functional therapy is essential for preventing complications including ankylosis, arthrosis and growth disturbance. From January, 2000 to September, 2002, we have treated 15 cases of mandibular condylar fractures with closed reduction by using functional appliance with bite block. Among these cases, we report a case of 14-year-old female with mandibular condylar neck fracture, resulted in good clinical and radiographic progress.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.34 no.3
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• pp.388-397
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• 2008

The present study was performed to evaluate the function of the mandible according to the pattern of fracture and treatment methods of condylar fractures of the mandible and help operators in making a treatment plan. Sixty patients (average follow-up period was $7.8{\pm}9.4$ months) who were treated for condylar fracture from June, 2002 to May, 2006 at the Department of Oral and Maxillofacial surgery, Chonnam National University Hospital were reviewed. The common causes of the condylar fracture were traffic accident and fall-down (35.0%). In concomitant injuries, laceration was 46.7% and the fracture of the mandibular symphysis was highest incidence (60.0%). The common site of the fracture was the condylar head (47.8%), followed by subcondyle (36.2%) and condylar neck (15.9%). Under 15 years old patients, the closed reduction was performed in 87.5% out of the patients. All of the condylar fragments were fixed to the mandible with titanium miniplates in cases of open reduction. The mean period of intermaxillary fixation (IMF) was $14.2{\pm}6.5$ days in closed reduction and $10.0{\pm}4.2$ days in open reduction. The old patient with bilateral condylar head fractures, who were treated by closed reduction with IMF for 3 weeks, showed the limitation of mandibular movements. But, there was no significant different results between open reduction and closed reduction with the respect of the Helkimo's mandibular mobility index and clinical dysfunction index (DI). Complications, such as fibrous ankylosis and resorption of the mandibular condyle, were not observed in all patients. These results suggest that the good results can be obtained by closed reduction with proper IMF periods and functional exercise in most condylar fractures of the mandible except severely displaced extracapsular fractures.