J Korean Assoc Oral Maxillofac Surg.  2017 Oct;43(5):343-350. 10.5125/jkaoms.2017.43.5.343.

Intracorporeal reduction of condylar fracture using both pedicled condylar and seperated ramal fragments after vertical ramal osteotomy

• Kim IK
• Jang JM
• Cho HY
• Seo JH
• Lee DH

• KMID: 2393601
• DOI: http://doi.org/10.5125/jkaoms.2017.43.5.343

Abstract

The aim of this study is to introduce a surgical technique that can maintain blood supply to prevent condylar resorption in the extracorporeal reduction of condylar fracture. Neither the medial pterygoid muscle on the ramal bone nor the lateral pterygoid muscle on the condylar fragment was detached after vertical ramal osteotomy. Thus, reduction was performed in the intracorporeal state. Therefore, blood supply was expected to be maintained to the fragments of both the condylar and ramal bones. On postoperative radiographs, the anatomical outline of the fractured condyle was well restored, and the occlusion was stable. In the unilateral case, there were no signs of mandibular condylar resorption until postoperative 3 weeks. In the 2 bilateral cases, condylar displacements with plate fractures and screw loosening were observed at postoperative 1 month or 5 months, but radiodensity at the displaced fracture site increased during the follow-up period. Finally, complete remodeling of the condylar fragments with restored anatomic appearance was observed on 8-month or 2-year follow-up radiographs. All cases exhibited good healing aspects with no signs or symptoms of mandibular condylar dysfunction during the postoperative remodeling period after intracorporeal reduction of condylar fracture.

Keyword

Mandibular fractures; Condylar fracture; Extracorporeal reduction; Intracorporeal reduction; Condylar resorption

MeSH Terms

Follow-Up Studies
Mandibular Fractures
Osteotomy*
Pterygoid Muscles

Figure

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  Fig. 1 Intraoperative photographs. Medial pterygoid muscle on ramal bone was not detached for blood supply (arrows).

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  Fig. 2 Postperative photographs and radiographs. Reduced condylar and osteotomized ramal fragments were repositioned to its original ramal body and fixed with two preadapted miniplates. A. Intraoperative photograph. B. Panoramic view. C. Three-dimensional computed tomography.

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  Fig. 3 Case 1. Preoperative radiographs. Left condylar fragment was dislocated to the antero-medial position (arrow).

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  Fig. 4 Case 1. Postoperative radiographs. A. Good anatomical reduction of the condylar fragment in glenoid fossa at postoperative 1 day. B. No signs of mandibular condylar resorption until postoperative 3 weeks.

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  Fig. 5 Case 1. Postoperative single photon emission computed tomography. Hot spot on left condylar and osteotomized ramal fragments. A. Coronal view. B. Axial view.

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  Fig. 6 Case 2. Preoperative radiographs. Both condylar fragments were displaced to the medio-inferior position and overlapped with ramus. A, B. Panoramic view (arrows). C, D. Axial view of computed tomography.

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  Fig. 7 Case 2. Postoperative radiographs. Good anatomical reduction of both condylar fragments in glenoid fossa on postoperative radiographs. A. Panoramic view. B. Three-dimensional computed tomography. C. Displacement of both condylar fragments with right plate fracture and left screw loosening at postoperative 1 month (arrows). D. Complete remodeling of condylar fragments with restored anatomic appearance at postoperative 2 years (arrows).

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  Fig. 8 Case 3. Preoperative radiographs. Both condylar fragments were dislocated to the antero-medial position and overlapped with ramus. A, B. Panoramic view. C, D. Axial view.

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  Fig. 9 Case 3. Postoperative radiographs. Good anatomical reduction of both condylar fragments in glenoid fossa on postoperative radiographs. A. Panoramic view. B. Three-dimensional computed tomography. C. Displacement and rotation of right condylar fragment with plates fractures and screw loosening at postoperative 5 months (arrows). D. Complete remodeling of both condylar fragment was observed at postoperative 8 months (arrows).

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