Retromandibular Reduction of Medially Dislocated Condylar Process Fractures.

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Retromandibular Reduction of Medially Dislocated Condylar Process Fractures.

Arch Plast Surg. 2017 Oct 27;:

Authors: Lee GH, Kang DH, Oh SA

Abstract
Background: Condylar process fractures are accounting for one-third of all mandibular fractures and the distal fragment is prone to dislocate to the medial side due to the pulling of lateral pterygoid muscle. Retromandibular approaches are commonly used but the intraoperative view becomes limited in medially dislocated fracture. This study summarized the cases of retromandibular reduction for medially dislocated condylar process fractures and described our supplementary procedure to realign dislocated condylar process.
Methods: Nine patients with medially dislocated condylar process fractures underwent surgical correction from January 2012 to December 2016. In 6 of them, it was possible to realign the fractures with conventional retromandibular approach, but for the 3 cases of severe dislocation to the middle cranial fossa, a supplementary transoral procedure was carried out. Angle difference between ramus and condyle, ramus height and maximal mouth opening (MMO) were evaluated.
Results: All 9 cases were restored to the proper anatomical alignment without any major complications and postoperative images revealed successful union. The preoperative angle difference was 8.94 ± 4.11° and 0.99 ± 0.49° at the 6-month follow-up. The pretreatment ramus height difference was 6.12 ± 6.09 mm, and the postoperative difference was 0.18 ± 0.10 mm. These changes after surgery were statistically significant. The MMO before surgery was 11.44 ± 3.0 mm, and the postoperative MMO was 37.2 ± 2.9 mm, reflecting a significant increase after reduction.
Conclusions: Retromandibular reduction is a useful method in medially dislocated condylar process fractures and additional transoral assistance should be considered to realign the condylar process that severely dislocate to the middle cranial fossa.

PMID: 29076315 [PubMed - as supplied by publisher]