Trends of Surgical Approaches for Open Reduction and Internal Fixation of Mandibular Condyle Fracture

The 3rd Takao Forum of Oral and Maxillofacial Surgery

Prof. Takahiro Kanno, DDS, FIBCSOMS, FIBCSOMS-ONC/RECON, PhD

Department of Oral and Maxillofacial Surgery, Shimane University Faculty of

Medicine & Maxillofacial Trauma Center, Shimane University Hospital,

Izumo, Shimane, Japan

Title of Lecture②:

Trends of Surgical Approaches for Open Reduction and Internal Fixation of Mandibular Condyle Fracture

Abstract

Our maxillofacial injuries are commonly encountered in the daily practice and of

emergency medicine. Nearly 50% of such patients with these facial injuries have

multisystemic trauma that requires coordinated management between emergency

physicians and surgical specialists.

Of these, the mandibular condylar process is one of the most frequent sites of

mandibular fracture. Mandibular condylar fractures account for 18% - 52% of all

mandibular fractures as the most common fracture site of the mandible. Although

absolute and relative indications for surgical treatment of open reduction and

internal fixation (ORIF) have been proposed, and treatment choices in such patients

tend to be based on the surgeon’s experience and preferences. When mandibular

condylar fractures cause oromandibular dysfunction, surgical treatment of ORIF

may be needed for better occlusion and temporomandibular joint function because

accurate reduction and rigid fixation allow good anatomical repositioning and

immediate functional recovery. Recently, surgical treatment for condylar fractures

has become more and more the standard treatment option because of advancements

in technology, development of indigenous osteosynthesis devices, and

enhancement of surgical techniques and various feasible surgical approaches

introduced owing to a better understanding of surgical anatomy and

accumulated data may support these so far.

Several surgical approaches of intraoral (with or without endoscopic assistance)

and extraoral (Preauricular approach, Retromandibular approach, Submandibular

approach, High-submandibular approach) applicable for open treatment of ORIF of

mandibular condyle fractures, and have been used to expose, reduce, and stabilize

the fracture site, each with its own set of advantages and disadvantages. The

application of these various surgical approaches has been, however, all still

remaining controversial based on the surgeon’s experience and preferences.