Open reduction without fixation of dislocated condylar process fractures: long-term clinical and radiologic analysis

Is the retromandibular approach a suitable approach to anatomical reduction of unilateral subcondylar fracture? A non-randomized clinical trial

The aim of this study was to evaluate the efficacy of the retromandibular approach (RMA) to produce three-dimensional (3-D) reduction of the unilateral subcondylar fracture and Temporomandibular Joint (TMJ) functional implication.

METHODS

 A prospective cohort study was designed. Twenty-nine patients with unilateral subcondylar fracture underwent consecutively Open Reduction, and Internal Fixation. The cohorts were divided into two groups; RMA group (n = 16, 55.17%) and submandibular approach SMA group (n = 13, 44.82%). The primary outcome was the anatomical 3-D reduction of the condyle. The secondary outcome was to compare the condyle position and inclination finding with TMJ outcomes. Helkimo Index score was used to evaluate the TMJ outcome at six months postoperatively.

RESULT

 There was a significant difference between the mediolateral condylar inclination, condylar medial and vertical positions when RMA compared with SMA groups (P < 0.05). The medial joint space was correlated with the medial condylar position in both groups (P < 0.05). The Helkimo Ai and Di was associated with mediolateral condylar inclination in SMG; however, Helkimo Ai was found to be correlated with the RMA group.

CONCLUSION

 The current study demonstrates that the RMA could re-establish the anatomical position of the unilateral subcondylar fracture in patients undergoing ORIF. The clinical outcome of the TMJ with RMA was better than SMA.

Three-dimensional assessment of accuracy for open reduction and internal fixation of the subcondylar fracture and its implications on the TMJ function

This study used three-dimensional cone beam computed tomography (CBCT) to assist the accuracy of open reduction and internal fixation (ORIF) for the unilateral subcondylar fracture and the long-term temporomandibular joint (TMJ) function impairment. Bilateral TMJs were analyzed postoperatively on CBCT images, involving the following three-dimensional (3D) parameters: condylar position and inclination; circumferential joint space, ramus, and mandible length; and the volumetric joint space. The inclusion criteria for adult patients included having a displaced fracture >5°, a shortening in ramus length >2 mm, and mouth opening limitation. The non-fracture side was used as the comparison group. The Helkimo index was employed for the clinical assessment of the outcomes, while the paired student t-test and Pearson coefficient test were used to compare both sides. The study included 60 joints in 30 consecutive patients. The condylar inclination to the horizontal plane on the fracture and non-fracture sides was 9.29 ± 3.9°, 12.46 ± 4.2°, (p < 0.001) and was positively related to the subjective (Helkimo Hi) and objective (Helkimo Di) clinical outcomes. In contrast, the condylar position to the midsagittal plane in the fracture and non-fracture sides was 51.95 ± 3.5 mm, 50.17 ± 3.6 mm (P = 0.038), and was positively related to the objective outcomes. Additionally, the objective outcome was negatively related to the change of the posterior joint space. CONCLUSION: The three-dimensional assessments seem to demonstrate that the ORIF is an accurate approach for obtaining a three-dimensional reduction to the displaced subcondylar fracture.

Changing trends in the management of condylar fractures

Our aim was to evaluate the functional outcomes and complications of mandibular condylar fractures managed surgically and non-surgically. Patients were identified retrospectively from audit data and clinical records from 2005-2018, and functional outcomes were evaluated based on the development of complications at clinical follow up. Patients were categorised into three treatment groups: conservative (management with soft diet, analgesia, and monitoring), closed (management with intermaxillary fixation), and open reduction and internal fixation (ORIF). A total of 358 patients were included with a median age of 33 years (mean 38), and a male:female ratio of 2.7:1. A total of 72 patients (20%) were treated conservatively, 177 (49%) were treated with closed management, and 109 (31%) with ORIF. The ORIF group demonstrated better outcomes than the closed group in terms of reduced protrusive and lateral excursive movements, and temporomandibular joint (TMJ) pain; and in terms of occlusal derangement when compared with the conservative group. The ORIF group had poorer outcomes than both the closed and conservative groups in terms of maximum mouth opening, and temporary facial nerve injury occurred in 5/109 (5%) and condylar resorption in 2/109 (2%) of patients in the ORIF group. There was no incidence of permanent facial nerve injury, Frey syndrome, or paraesthesia of the auricular nerve. The trend that favours ORIF can be justified, as it offers improved functional outcomes in severe or displaced condylar fractures. However, this must be evaluated against the risk of potential surgical complications. Careful case selection is therefore necessary to optimise management of these injuries.

Condyle Fractures: Impact of Surgical and Conservative Approaches on Oral Health

The aim of this study is to assess the impact of oral health on the quality of life of patients who underwent conservative or surgical treatment for mandibular condylar fracture. A retrospective study was conducted, and 24 patients with condylar fracture were selected and underwent surgical or conservative treatment. Oral Health Impact Profile-14 (OHIP-14) was utilized to evaluate the patients. The angles of condylar fracture were measured in panoramic and Towne radiographs using the ImageJ software, and the results were compared to the results of the OHIP-14 questionnaire. Condylar fractures had a negative impact on the patients' quality of life in pretreatment assessment. After conservative and surgical treatments, the condylar fracture had a low impact on the patients' quality of life. Greater fracture alignment was obtained in patients treated by open reduction. A low level of correlation was observed between fracture alignment and changes in OHIP-14 of the patients studied. In conclusion, the study showed a significant improvement in the quality of life in the post-treatment period of the sample assessed. However, in patients selected for this study, no difference was found in the quality of life between the surgically and conservatively treated groups.

Resorption behaviour of the articular surface dome and functional outcome after open reduction and internal fixation of mandibular condylar head fractures using small-fragment positional screws

PURPOSE

The aim of the study was to evaluate the resorption of the mandibular condylar head after open reduction and internal fixation of fractures with small-fragment screws and to evaluate the functional outcome.

PATIENTS AND METHOD

Forty-eight patients (55 condylar head fractures) underwent surgical treatment. All kinds of complications were recorded. In a subgroup of 20 patients, the average loss of bone height of the condylar head joint surface was gauged by measuring the vertical distances from 3 selected reference points of the fixation hardware to the vertex of the condyle in views of multiplanar radiographs after 6 months. Functional outcome was analysed by Helkimo index score.

RESULTS

Complication rates were low. Osteosynthesis loosening occurred in 4 cases. The mean bone resorption along the condylar head joint surface in the subgroup of 20 patients (with 23 joints) was 0.7 mm. Functional outcome was rated as follows: 8 patients - good, 11 patients - slightly impaired, 1 patient - moderately impaired.

CONCLUSION

Open reduction and internal fixation of condylar head fractures with small-fragment screws leads to reliable results in terms of joint surfaces relatively resistant to resorption and function. Low bone resorption on the joint surface of the condylar head can be expected.

Outcomes of open versus closed treatment in the management of mandibular subcondylar fractures

Objectives

To compare the clinical and radiological outcomes after closed reduction (CR) and open reduction and internal fixation (ORIF) in the management of subcondylar fractures.

Materials and Methods

Forty-eight patients presenting with subcondylar fracture between January 2010 and March 2013 were evaluated retrospectively. Fifteen patients were treated with CR and 33 patients with ORIF. The clinical and radiologic parameters were evaluated during follow-up (mean, 7.06 months; range, 3 to 36 months).

Results

In the CR group, no patients had any problems with regard to the clinical parameters. The average period of maxillomandibular fixation (MMF) was 5.47 days. The preoperative average tangential angulation of the fractured fragment was 3.67°, and loss of ramus height was 2.44 mm. In the ORIF group, no clinical problems were observed, and the average period of MMF was 6.33 days. The preoperative average tangential angulation of the subcondylar fragment was 8.66°, and loss of ramus height was 3.61 mm.

Conclusion

CR provided satisfactory clinical results, though ORIF provided more accurate reduction of the fractured fragment. So there is no distinct displacement of fractured fragment, CR should be selected than ORIF because of no need for surgery.

Open reduction and internal fixation of extracapsular mandibular condyle fractures: a long-term clinical and radiological follow-up of 25 patients

Background

During the last 2 decades, many studies on the treatment of mandibular condyle fracture have been published. The incidence of mandibular condyle fractures is variable, ranging from 17.5% to 52% of all mandibular fractures. This retrospective study evaluated the long-term clinical and radiological outcomes after surgical treatment of 25 patients with a total of 26 extracapsular condyle fractures.

Methods

We used 2 types of surgical approaches, the retromandibular retroparotid or preauricular approach. Three kinds of rigid internal fixation plates were used—single plate, double plate, and trapezoidal plate. The following post-operative clinical parameters were evaluated: dental occlusion, facial nerve functionality, skin scarring, and temporomandibular joint functionality. All patients underwent post-operative orthopanoramic radiography and computed tomography. The patients were also monitored for complications such as Frey’s syndrome, infection, salivary fistula, plate fracture, and permanent paralysis of the facial nerve; the patient’s satisfaction was also recorded.

Results

Of the 25 patients, 80% showed occlusion recovery, 88% had no facial nerve injury, and 88% presented good surgical skin scarring. The patients showed early complete recovery of temporomandibular joint functionality and 72% of them were found to be asymptomatic. The postoperative radiographs of all patients indicated good recovery of the anatomical condylar region, and 80% of them had no postoperative complications. The average degree of patient satisfaction was 8.32 out of 10. Our results confirm that the technique of open reduction and internal fixation in association with postoperative functional rehabilitation therapy should be considered for treating patients with extracapsular condylar fractures.

Conclusion

The topic of condylar injury has generated more discussion and controversy than any other topic in the field of maxillofacial trauma. We confirm that open reduction and internal fixation is the treatment of choice for patients with neck and sub-condylar mandibular fractures.

Setbacks of bio-resorbable plates and screws in the management of condylar fractures: our experience

PURPOSE

Fractures of the condyle can be managed by open or by closed reduction. This study was designed to mention the complications of the bio-resorbable material we had experienced while using them in the management of condylar fractures.

METHODS

Fifteen (11 men and four women) patients with subcondylar fractures were included in the study. Resorbable poly-l-lactide plates and screws were used for the fracture fixation. Patients were followed up clinically and radiographically for a period of 2 years.

RESULTS

Seven patients had a satisfactory reduction following the placement of bio-resorbable plates. Three patients had developed a swelling in the pre-auricular region, extending till the angle. Two patients had a screw breakage whereby leading to malunion and three other patients had bone resorption, at the fractured site that was appreciated radiographically.

CONCLUSION

Inspite of the advantages of these materials, certain complications has been experienced in our study with regard to the resorption and degradation of the material which has been mentioned and explained in our article.

Effects of internal rigid fixation on mandibular development in growing rabbits with mandibular fractures

PURPOSE

The aim of this research was to determine whether rigid internal fixation interferes with mandibular growth and development in growing New Zealand white rabbits with induced mandibular fractures.

MATERIALS AND METHODS

Ten 3-month-old New Zealand white rabbits were included in the study. Surgical fractures were performed in the right mandibular bodies of the 10 rabbits. These fractures were reduced with internal rigid fixation by use of a 1.0-mm titanium system, taking the contralateral left mandibular bodies as the control group. We obtained radiographs preoperatively and at 1, 2, and 3 months postoperatively. Predetermined cephalometric points were used to measure and compare jaw growth. The protocol was approved by the Bioethics Committee of Universidad El Bosque, Bogotá, Colombia.

RESULTS

There were no statistically significant differences between the experimental and control groups (P = .95). Mandibular growth in the studied rabbits was not affected by the use of internal rigid fixation.

CONCLUSIONS

The use of internal rigid fixation for the treatment of induced mandibular fractures in growing rabbits did not alter the normal process of growth and development. The findings of this study should lead to investigations using larger samples and to long-term prospective follow-up studies of children who have undergone open reduction and internal rigid fixation.

Closed reduction of mandibular condyle fractures using C-arm fluoroscopy: a technical note

We describe a C-arm technique for mandibular condylar fractures in an anatomic study using a model skull and show its feasibility in a clinical case. The C-arm allowed posterior-anterior visualization of the condylar process. The X-ray axis was canted ∼15 degrees cranially to the Frankfort horizontal line. The skull's sagittal plane was rotated ∼15 degrees ipsilaterally to the X-ray axis. This technique facilitates clear visualization of the condylar neck with easy, flexible, and timely adjustments. In selected cases, this method would convert the clinical settings of the condylar fracture pattern to that which would not be amenable to an open approach, making possible minimally invasive surgical procedures.

Outcomes of open versus closed treatment of mandibular subcondylar fractures: a prospective randomized study

PURPOSE

To compare open reduction and internal fixation with closed treatment and maxillomandibular fixation for the management of subcondylar fractures of the mandible.

PATIENTS AND METHODS

Forty patients with subcondylar fractures of the mandible were evaluated. All fractures were displaced; either angulated between 10 degrees and 35 degrees or the ascending ramus was shortened by more than 2 mm. Clinical and radiographic evaluation was performed 6 months after the trauma. Clinical parameters included mouth opening, protrusion, laterotrusion, deviation on mouth opening, and occlusion. Radiographic parameters included level of the fracture, deviation of the fragment, and shortening of the ascending ramus. Subjective parameters included pain according to a visual analog scale. Nonparametric data were compared for statistical significance with a chi(2) analysis and parametric data with an independent samples t test (P < .05).

RESULTS

Correct anatomical position of the fragments was achieved significantly more accurately in the operative group in contrast to the closed treatment group. Regarding mouth opening/lateral excursion/protrusion, significant (P = .00) differences were observed between both groups (open 39.6/12.5/5.9 mm vs closed 33.5/9.8/4.1 mm). The visual analog scoring revealed significant (P = .00) difference with less pain in the operative treatment group (1.1 open vs 5.2 closed). No statistically significant difference was found between the 2 groups for occlusion (P = .86).

CONCLUSION

Both treatment options for condylar fractures of the mandible yielded acceptable results. However, operative treatment was superior in all objective and subjective functional parameters except occlusion.

Long-term clinical and radiological outcomes for the surgical treatment of mandibular condylar fractures

PURPOSE

This retrospective study evaluated the long-term results and complications of open reduction and internal fixation of displaced and dislocated fractures of the condylar process.

PATIENTS AND METHODS

Two hundred four patients were treated via various surgical approaches between 1991 and 2005. Fifty patients with a total of 57 treated condylar fractures who underwent complete clinical and radiological documentation were included in this study. Follow-up clinical and radiological evaluations were carried out after an average period of 88 months.

RESULTS

We found that 12% of our patients reported temporary weakness of the facial nerve and 4% had mild permanent facial nerve palsy. Clinical and radiological assessment showed satisfactory recovery of facial symmetry. Excellent recovery of function was observed, and very few patients complained of temporomandibular joint-related symptoms. Severe condylar remodeling was observed in 8% of the patients, 47% showed slight or moderate remodeling, and 45% showed no remodeling. A statistically significant association was observed between the presence of condylar remodeling and poor mouth opening at the follow-up examination.

CONCLUSIONS

Surgical treatment of condylar fractures, in association with postoperative functional therapy, promotes the recovery of function, occlusion, and facial symmetry with few complications. However, some difficulties remain related to the surgeon, the patient, and the objective complexity of this pathology.

Prospective closed treatment of nondisplaced and nondislocated condylar neck and head fractures versus open reposition internal fixation of displaced and dislocated fractures

OBJECTIVE

assessment of open reduction internal fixation in displaced or dislocated fractures of the condylar neck and head assessed versus closed treatment of nondisplaced, nondislocated fractures.

MATERIALS AND METHODS

One hundred and twenty patients suffering from 158 fractures; classes II to V according to Spiessl and Schroll, e.g., displaced and dislocated fractures were operated on; classes I and VI nondisplaced, nondislocated fractures were treated conservatively. At 1year, facial symmetry, pain, facial nerve function, and scarring were assessed clinically; reossification and fragment angulation were assessed from radiographs; vertical position, incisal maximum movements, and condyle translation were judged by millimeters.

RESULTS AND DISCUSSION

Clinical courses were uncomplicated in classes I to IV and did reach horizontal and vertical fragment reposition with minor remodeling in follow-up. Single cases evinced persistent pain, dysocclusion, facial nerve palsy, and plate fractures. Results were less successful in classes V and VI: although open reposition internal fixation showed good repositioning in class V, marked vertical bone remodeling occurred; single cases suffered from pain, dysocclusion, and plate fracture. Class VI cases had the worst translation, likewise marked condyle remodeling, and frequent dysocclusion.

CONCLUSION

Classes V and VI remain challenging to treat, while the other classes can be treated reliably with this study's rationale. Condyle remodeling in classes V and VI, translation in class VI may benefit prospectively from even more careful mobilization, improved osteofixation as minimalized operation trauma.

Biomechanical comparison of plating techniques for fractures of the mandibular condyle

We compared the biomechanical behaviour of various rigid internal fixation techniques for treatment of fractures of the mandibular condylar process. Fifteen sheep hemimandibles were used to evaluate three bicortical plating techniques. A custom-made 3-point biomechanical test model was used for the samples. Each group was tested with compression forces by an Instron Lloyd LRX machine. The resistance to forces (N) that caused displacements of 1.75 and 3.50mm were compared using the Instron software programme and displacement graphics. There were no significant differences among the three groups for displacements of 1.75 and 3.50mm. Our study showed that the titanium miniadaptation plates, minicompression plates, and the absorbable miniplates did not differ significantly in their biomechanical behaviour.

Open Reduction and Internal Fixation of Dislocated Condylar Fractures in Children

The purpose of this study was to investigate the long-term clinical and radiologic outcomes of treating dislocated condylar fractures sustained in childhood with open reduction and internal fixation (ORIF). Six children 14 years or younger with a condylar neck or subcondylar fracture with dislocation of the condyle from the glenoid fossa were treated with ORIF. Patients were followed for 27 to 92 months post-ORIF (mean: 67.6 months) with routine clinical and radiologic examinations. On the dislocated side, all patients radiographically showed signs of remodeling of the condylar process and shortening of the ramus. Subsequent to their fractures, 3 patients were classified with Angle class II malocclusion, retrognathism, and deviation of the mandibular symphysis. Four patients had objective and/or subjective signs of temporomandibular (TMJ) dysfunction. Until open surgery demonstrates a consistent functional advantage, nonsurgical management should be considered the first treatment option for the dislocated pediatric condylar fracture.

Fractures of the mandibular condyle: A review of 466 cases. Literature review, reflections on treatment and proposals

INTRODUCTION

The incidence of condylar fractures is high. Condylar fractures can be extracapsular (condylar neck or subcondylar) or intracapsular, undisplaced, deviated, displaced or dislocated. Treatment depends on the age of the patient, the co-existence of other mandibular or maxillary fractures, whether the condylar fracture is unilateral or bilateral, the level and displacement of the fracture, the state of dentition and the dental occlusion, and the surgeon's experience.

PURPOSE

This report presents the experience acquired in the treatment of 466 condylar fractures over 7 years, reviews the pertinent literature and proposes guidelines for treatment.

MATERIAL AND METHODS

The archives of KAT, General District Hospital between 1995 and 2002 were scrutinized and the condylar fractures were recorded. The aetiology, age, sex, level of fracture, degree of displacement, associated facial fractures, malocclusion, and type of treatment were noted.

RESULTS

Four hundred and sixty-six condylar fractures were admitted, the male:female ratio was 3.5:1. Road traffic accidents were the main cause and most fractures were unilateral, displaced, subcondylar, occurred on the left side and were treated conservatively.

CONCLUSIONS

Early mobilization is the key in treating condylar fractures. Whilst rigid internal fixation provides stabilization and allows early mobilization, conservative treatment is the treatment of choice for the majority of fractures. Children and intracapsular fractures are treated conservatively with or without maxillo-mandibular fixation. Open reduction is recommended in selected cases to restore the occlusion, in severely displaced and dislocated fractures, in cases of loss of ramus height, and in edentulous patients. It may be considered in those with 'medical problems' where intermaxillary fixation is not recommended.

A comparative study of unilateral dislocated mandibular condyle fractures in the rabbit

PURPOSE

The purpose of this study was to clarify the influence of patients age and the degree of dislocation on the healing of mandibular condyle fractures.

MATERIAL AND METHODS

Sixty-two Japanese white rabbits (30 adolescent and 30 adult ones) were used. They underwent unilateral condylar neck osteotomy. The proximal fragments were positioned differently. In group I animals, the fragments were reduced into the original position, in group II animals the small fragment was dislocated 55-90 degrees to the ramus. In group III animals the proximal fragment was dislocated 135 degrees to the ramus. Gross and microscopic assessment was performed 4, 6, 8, 12 and 24 weeks postoperatively.

RESULTS

In adolescent animals, complete healing of the fracture was observed, irrespective of the degree of dislocation. In the adult animals, there was complete healing of the fractures in groups I and II. In group III animals, there was a decrease of ramus height accompanied by some fibro-cartilaginous changes.

CONCLUSION

Even in rabbits condylar deformation has been found following heavily dislocated artificial condylar fractures in adult animals. This result will help to decide for or against surgical treatment of condylar fractures in humans.

Treatment of mandibular condylar process fractures: Biological considerations

The topic of condylar injury in adults has generated more discussion and controversy than any other in the field of maxillofacial trauma. It is an important subject because such injuries are common and complications of trauma to the temporomandibular joint (TMJ) are far-reaching in their effects. Why are there so many different methods to treat this injury? How can seemingly disparate treatment options all produce satisfactory outcomes in the majority of patients? The reason lies with the biological adaptations that occur within the masticatory system that are poorly understood, not readily quantifiable, and variable from one person to the next. This discussion presents our current understanding of the adaptations that must occur to provide the patient with a satisfactory outcome. The adaptations for patients treated open are different than for those treated closed. However, it is when these adaptations fail to occur that unsatisfactory outcomes occur, regardless of how they were treated.

Resorbable poly-l-lactide plates and screws for the treatment of mandibular condylar process fractures: a clinical and radiologic follow-up study

PURPOSE

The purpose of this study was to determine whether a resorbable poly-l-lactide (PLLA) miniplate system could be used to treat mandibular condylar process fracture.

PATIENTS AND METHODS

Fourteen patients (12 males, 2 females, aged 23.1 +/- 5.7 years) who had mandibular condylar process fractures treated with PLLA implants were recalled for follow-up clinical and radiologic examinations at 3 years.

RESULTS

Mouth opening recovered to more than 35 mm and occlusion was stable in all patients. There was no facial asymmetry 3 months postoperatively. Two patients had mild chronic postoperative tenderness at the implantation site; however, there was no wound infection. All fractured mandibular condyles showed anatomic good reduction and long-term stability with the use of resorbable miniplates and screws. Bone healing was satisfactory in all patients, and there was no evidence of abnormal resorption of the condylar process. The screw holes remained evident after 3 years. Screw holes in 2 patients showed enlargement on radiographic examination.

CONCLUSION

The PLLA miniplate system provides reliable stability when used for the fixation of mandibular condylar process fractures.

A comparative evaluation of osteosynthesis with lag screws, miniplates, or Kirschner wires for mandibular condylar process fractures

PURPOSE

This study compared the clinical and radiologic outcomes of open treatment of mandibular condylar process fractures using lag screws, miniplates, or Kirschner wires.

PATIENTS AND METHODS

Open reduction and internal fixation was performed for severely displaced or dislocated mandibular condylar process fractures in 23 patients (26 fractures) using Eckelt lag screws, in 10 patients (10 fractures) using Kirschner wires, and in 21 patients (22 fractures) using miniplates. Clinical and radiologic evaluations were made 6 months postoperatively and at final follow-up (mean, 18.4 months; range, 7 to 106 months). Radiologic evaluation included accuracy of reduction of the fractured condylar processes and changes in ramus height.

RESULTS

Most fractured condylar processes (approximately 90%) were repositioned precisely in all groups. A shortening of the ramus of more than 5 mm was observed significantly more frequently (P <.05) in the miniplate group than in the lag screw group at 6 months. The condyles were severely resorbed in 2 or 3 patients in each group. All of these patients were associated with malunion, and partial bone resorption of the condyles was seen during the first 6 months. The relation between reduction or screw position and bone healing in patients treated with lag screws indicated that correct reduction and screw insertion allowed normal bone healing. The patients in all groups showed satisfactory clinical results. No significant intergroup differences were noted in maximum mouth opening and laterotrusion. However, deviation during mouth opening was significantly greater (P <.05) in cases treated with miniplates than with lag screws.

CONCLUSION

Lag screw osteosynthesis may be more advantageous for restoration of ramus height than miniplates or Kirschner wires.

Open treatment of condylar process fractures: assessment of adequacy of repositioning and maintenance of stability

PURPOSE

This study was designed to determine how well fractured condylar processes were reduced and the stability of the internal fixation in a group of patients whose fractures were treated by open reduction.

PATIENTS AND METHODS

Sixty-one patients treated by open reduction and internal fixation for unilateral condylar process fractures were studied prospectively using Towne's and panoramic radiographs. The radiographs were made before surgery, and immediately, 6 weeks, and 6 months postoperatively. The images were traced and digitized, and the position of the fractured condylar process was statistically compared with the position of the nonfractured condylar process in both the coronal and sagittal planes. Additionally, 2 observers examined the images and assessed these same 2 factors.

RESULTS

After surgery, the difference in position between the fractured and nonfractured sides averaged less than 2 degrees (not significantly different), indicating good reduction of the fractures. However, subsequently, between 10% and 20% of condylar processes had postsurgical changes in position of more than 10 degrees.

CONCLUSIONS

This study showed that it is possible to anatomically reduce the fractured condylar process, but changes in position of the condylar fragment may then result from a loss of fixation.