Episode Details

Quick Review #272 - #surgery #surgeon #doctorgallagher #oralsurgery #oralsurgeon #omfs #dentist #dentistry #dental

- 3.19.25

The primary treatment options for reducing a subcondylar neck/ramus fracture include both open and closed techniques, with the choice depending on factors such as displacement, occlusion, functional needs, and associated injuries.

1. Open Reduction and Internal Fixation (ORIF)

• Indication: ORIF is recommended for significantly displaced fractures, functional deviation, occlusal discrepancies, or bilateral condylar fractures with a risk of open bite.

• Technique: A preauricular, retromandibular, or transoral approach is commonly used to expose the fracture, followed by fixation using mini-plates or lag screws.

Advantages:

• Direct visualization of the fracture

• Anatomical reduction and rigid fixation

• Immediate function restoration

Disadvantages:

• Surgical risks: facial nerve injury, scarring, and infection

• Longer operative time

2. Closed Reduction with Maxillomandibular Fixation (MMF)

• Indication: Non-displaced or minimally displaced fractures, patients with contraindications for surgery, or pediatric cases.

• Technique: Application of arch bars, intermaxillary elastics, or Erich arch bars to maintain occlusion for 2–4 weeks.

Advantages:

• Minimally invasive, avoiding surgical risks

• Effective in stable fractures

Disadvantages:

• Prolonged immobilization can lead to TMJ dysfunction or ankylosis

• Patient discomfort, requiring dietary modification

3. Functional Treatment (Early Mobilization with Guiding Elastics)

• Indication: Minimally displaced fractures, particularly in children or cooperative adults.

• Technique: Uses guiding elastics or occlusal splints to assist in functional adaptation while allowing controlled motion.

Advantages:

• Avoids rigid immobilization

• Reduces risk of TMJ stiffness or ankylosis

Disadvantages:

• Requires patient compliance

• Not suitable for significantly displaced fractures

References:

1. Foster, C. M. B., & Chew, F. S. (2016). Fractures and dislocations of the face. In Broken Bones: The Radiologic Atlas of Fractures and Dislocations (pp. 318–339). Cambridge University Press.

2. Bayat, M., Parvin, M., & Meybodi, A. A. (2016). Mandibular subcondylar fractures: A review on treatment strategies. Electronic Physician, 8(10), 3144–3149

3. Oyer, S. L., & Boochoon, K. S. (2023). Treatment of subcondylar fractures of the mandible: A shifting paradigm. AAO-HNS Bulletin

4. Kuang, S.-J., He, Y.-Q., Zheng, Y.-H., & Zhang, Z.-G. (2019). Open reduction and internal fixation of mandibular condylar fractures: A national inpatient sample analysis, 2005–2014. Medicine, 98(37), e16814

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