Sunday, October 10, 2004 - 2:31 PM

Closed Reduction and Percutaneous Stabilization of Subcondylar Fractures of the Mandible

Sean Boutros, MD

Displaced subcondylar fractures of the mandible are difficult to treat. Open reduction has risks including devascularization of the condylar segment, facial nerve injury, scarring, and long term TMJ problems. Closed treatment with MMF alone accepts a maligned fracture and relies on joint remodeling. The resulting wear on both joints carries a significant risk of long term TMJ arthritis or discomfort. In no other area is non-anatomic fracture reduction accepted as standard care when there is a misaligned joint. The purpose of this study is to evaluate closed reduction and percutaneous stabilization of subcondylar fractures.

Anatomical Study. Fresh cadaver dissections were performed after fractures were created with blows to the chin. A K-wire was placed in the condylar segment as a “joystick” and the fractures were manipulated. Fluoroscopy and open dissection confirmed that the condylar segment was easily manipulated and reduced.

Clinical Cases. Six cases with subcondylar factures were treated with this method. K-wires were placed in the condylar segment and, along with jaw manipulations, were used to reduce the fractures. In all cases, manipulation of the condylar segment with the “joystick” was possible. Reductions were obtained and additional K-wires were used to stabilize the condyle with the fracture aligned, joint reduced, and mandibular height restored. Patients were left in MMF for 18 to 21 days.

In all cases, the condylar segment was easily manipulated. It was also easy to traverse the fracture with a K-wire. More anatomic reductions were obtained in each case. All patients had midline mandibular opening with no deviation and minimal need for elastic therapy. MMO was between 38 and 43 mm at eight weeks after release of MMF.

Closed reduction of subcondylar fractures with a K-wire “joystick” is possible. This method achieves anatomic reduction and restores mandibular height. There is minimal risk associated with the procedure and minimal extra operative time. The post operative care of the patients is facilitated as they require less intensive follow up. The advantages of a reduced subcondylar fracture are substantial and easily obtained with this technique.

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