The indications for condylar process fracture treatment are controversial, even among expert surgeons. At this point in time, consensus has not been reached. The surgeon must take into account the following considerations:
- Location of the fracture
- Amount of vertical reduction in height of the ramus
- Degree of angulation
- Degree of luxation of the condylar head out of the glenoid fossa
- Fragmentation pattern (simple versus complex)
- Association with other mandibular injuries
- Dental occlusion/status of dentition
- Association with other facial bone injuries
- Association with systemic injuries
- Association with the condition of the patient (comorbidity factors)
- Foreign body in temporomandibular joint (TMJ)
|Non- or minimally displaced fractures in compliant patient.|
- Minimally or nondisplaced fracture
- Dentate patients should have a stable occlusion over time
- Acceptable level of pain
- Patient compliance
Patient must be advised that additional treatment may be required if complications arise during the observation period.
|Standard method of treatment for non-dislocated or minimally displaced fractures in compliant patients with good dentition and amenable for MMF.|
Closed reduction is a misnomer. Often there is no anatomic reduction of the fracture. Closed treatment results in a functional adaptation by the patient to achieve a repeatable occlusion.
- Minimally invasive technique
- Can be performed under local anesthesia at the surgeon’s practice.
- Many patients favor nonoperative techniques for management of their fractures where possible.
|ORIF, one/two plate(s) - extraoral approach|
|Displaced fractures resulting in shortening of the ramus height or when the fracture segment interferes with normal mandibular function.|
The main advantage of an extraoral approach is the direct access and improved visualization of the fracture for reduction and fixation.
|ORIF, one/two plate(s) - intraoral approach|
|Low condylar process fractures.|
- Avoidance of injury to the facial nerve
- No need for cutaneous access with the consequent scar.
It is more difficult to treat higher condylar process fractures using this surgical approach.
Note: intraoral approaches require formal specialist training and specialized equipment.
|ORIF, one/two plate(s) - endoscopically assisted|
|Higher condylar process fractures amenable to an intraoral approach with endoscopic assistance.|
Note: intraoral approaches and endoscopic assistance require formal training of the surgical team and specialized equipment. Endoscopic equipment can be very expensive and difficult to maintain.
Be prepared for a back-up strategy.
|Basic surgical experience, no specialized skills|
|Some specialized surgical experience|
|Highly experienced and skilled surgeon|
|Basic equipment only|
|Simple surgical and imaging resources|
|Full specialized surgical and imaging resources|