Open management of condylar head fractures. The first 50 cases: What have we learnt and where are we going?

Abstract

This study evaluates a single surgeon’s experience in the development of a practice in open treatment of intracapsular condylar fractures over three years at a tertiary maxillofacial trauma centre. An enhanced dynamic, peer-reviewed, longitudinal audit in keeping with the adoption of elements of new clinical practice was instituted. This aimed to record and analyse clinical and functional outcomes at both the surgeon and patient level. A retrospective review of patients treated for AO craniomaxillofacial (AOCMF)-classified intracapsular fractures was conducted, utilising an extended preauricular approach and positional screw fixation with an emphasis on early joint mobilisation and physiotherapy. The cohort consisted of 45 patients with 50 fractures, exhibiting a mean postoperative mouth opening of 32 mm, which increased over time and was noted to be statistically significant. Patient satisfaction was high, and the majority of radiological outcomes were deemed anatomical. No patients had permanent facial nerve injuries. Other postoperative complications were minimal, including one case of Frey syndrome and a 16% re-intervention rate, primarily for hardware removal. The findings suggest that open treatment can achieve satisfactory early function as part of the implementation of an in-part novel procedure. This paper provides insight into the establishment of a new technique in both experiential and governance domains, and looks at the lessons learned. The high levels of patient and surgeon satisfaction confirm increasing levels of evidence supporting open reduction and fixation in these challenging injuries, but the study’s limitations include the absence of a control group and potential non- generalisability due to the single-surgeon perspective. The study highlights the need to support colleagues providing this treatment and establish a national mentoring programme to achieve it. At this point, long-term studies and a multicentre trial are suggested for a comprehensive understanding of the treatment’s efficacy and the formal development of management protocols.