Surgical management of extracapsular condylar fracture of the mandible: Our method

Abstract

Introduction: In face trauma, mandibular fractures are frequently seen, and 20%–60% are associated with condylar fracture. Conservative treatment has its limitations, whereas surgical treatment helps to achieve exact fragment positioning and hence mandibular ramus height and better radiologic result concerning resorption and pathologic changes to the condyle. This article describes our approach with modified Risdon incision. Materials and Methods: Patients admitted to our department with condylar fracture over a period of 4 years underwent clinical examination and radiological investigation. Out of the total 25 patients with condylar fractures, there were 20 extracapsular fractures involving the neck and subcondylar regions. The subcondylar fracture patients were treated with extended submandibular approach. Results: Out of twenty patients, two patients had isolated condyle fractures. The bilateral condylar fracture was found in two patients. Thirteen patients had fractures at the lower neck level and the remaining seven patients had a fracture at the subcondylar level. The undisplaced fracture was found in three patients, and a displaced fracture fragment was found in 12 patients, of which 4 patients had a medial override and 8 had a lateral override. The remaining five patients had a deviation of the proximal fracture fragment. Conclusion: Most of the low-neck and subcondylar fractures can be assessed using a posterior extension of submandibular incision and these fractures should be managed with open reduction and internal fixation (ORIF) to avoid complications associated with conservative management. ORIF can be managed with the use of proper retraction techniques such as reverse L retractor and the use of traction wire using simple stainless steel wires and appropriate mini-plates.